Characteristics that Predict Physician Participation in a Web-Based CME Activity: The MI-Plus Study

ERIC Educational Resources Information Center

Schoen, Michael J.; Tipton, Edmond F.; Houston, Thomas K.; Funkhouser, Ellen; Levine, Deborah A.; Estrada, Carlos A.; Allison, Jeroan J.; Williams, O. Dale; Kiefe, Catarina I.

2009-01-01

Introduction: Physician use of the Internet for practice improvement has increased dramatically over the last decade, but research shows that many physicians choose not to participate. The current study investigated the association of specific physician characteristics with enrollment rates and intensity of participation in a specific…

Online nutrition and T2DM continuing medical education course launched on state-level medical association.

PubMed

Hicks, Kristen K; Murano, Peter S

2017-01-01

The purpose of this research study was to determine whether a 1-hour online continuing medical education (CME) course focused on nutrition for type 2 diabetes would result in a gain in nutrition knowledge by practicing physicians. A practicing physician and dietitian collaborated to develop an online CME course (both webinar and self-study versions) on type 2 diabetes. This 1-hour accredited course was launched through the state-level medical association's education library, available to all physicians. Physicians (n=43) registered for the course, and of those, 31 completed the course in its entirety. A gain in knowledge was found when comparing pre- versus post-test scores related to the online nutrition CME ( P <0.0001). Online CME courses launched via state-level medical associations offer convenient continuing education to assist practicing physicians in addressing patient nutrition and lifestyle concerns related to chronic disease. The present diabetes CME one-credit course allowed physicians to develop basic nutrition care concepts on this topic to assist patients in a better way.

CME, Physicians, and Pavlov: Can We Change What Happens When Industry Rings the Bell?

PubMed Central

Lichter, Paul R.

2008-01-01

Purpose To show how physicians’ conditioned response to “keeping up” has helped industry’s opportunistic funding of continuing medical education (CME) and to propose ways to counter the conditioned response to the benefit of patients and the public. Methods Review of the literature and commentary on it. Results The pharmaceutical and device industries (hereafter referred to as industry) have a long history of bribing physicians to prescribe and use their products. Increasing pressure from Congress and the public has been brought to bear on industry gifting. This pressure, coinciding with increasing financial problems for the providers of CME, provided industry with reason and opportunity to expand its role in the financing of CME. Industry’s incentive to make its CME funding appear to be an arm’s-length transaction has spawned medical education service supplier (MESS) companies. Industry makes “unrestricted grants” to the MESS, and the MESS puts on the CME program. Helped by these CME programs, industry is able to subtly “buy” physicians one at a time, so that under the cover of “education” they and their academic institutions and medical organizations lose sight of being CME pawns in industry’s sole objective: profit. Conclusions Despite a vast literature showing how physician integrity is easy prey to industry, the medical profession continues to allow industry to have a detrimental influence on the practice of medicine and on physician respectability. It will take resolute action to change the medical profession’s conditioned response to industry’s CME bell and its negative effect on patients and the public. PMID:19277219

German Ambulatory Care Physicians' Perspectives on Continuing Medical Education--A National Survey

ERIC Educational Resources Information Center

Kempkens, Daniela; Dieterle, Wilfried E.; Butzlaff, Martin; Wilson, Andrew; Bocken, Jan; Rieger, Monika A.; Wilm, Stefan; Vollmar, Horst C.

2009-01-01

Introduction: This survey aimed to investigate German ambulatory physicians' opinions about mandatory continuing medical education (CME) and CME resources shortly before the introduction of mandatory CME in 2004. Methods: A structured national telephone survey of general practitioners and specialists was conducted. Main outcome measures were…

Assessing the Impact of Continuing Medical Education through Structured Physician Dialogue.

ERIC Educational Resources Information Center

Wergin, Jon F.; And Others

A method for evaluating physicians' practice behavior after undertaking continuing medical education (CME) conducted by the American College of Cardiology (ACC) was developed and tested during 1983-1985. The literature on CME effectiveness and physician behavior change was reviewed. Physicians who were trained interviewers conducted telephone…

Using speed dating sessions to foster collaboration in continuing interdisciplinary education.

PubMed

Laprise, Réjean; Thivierge, Robert L

2012-01-01

There are numerous examples of care gaps that could be reduced through enhanced knowledge exchange and practice collaboration between medical specialist physicians. In this paper, we report preliminary results on using speed-dating sessions (SDSs) to stimulate the development of continuing interdisciplinary education (CIDE) activities. In 2007, a 35-minute SDS was carried out during a 2-hour faculty development workshop to provide continuing medical education (CME) directors of Quebec's 35 medical specialist associations with a formal opportunity to quickly share clinical issues and goals. A post-workshop survey was used to assess participants' satisfaction and whether they had met new colleagues, learned about interdisciplinary issues, and discovered opportunities for collaboration. CME accreditation files were audited to assess the occurrence of CIDE activities in the year prior and the 2 years that followed the workshop. CME directors were called to assess whether the development of these activities was directly attributable to their participation in the SDS. CME directors of 26 specialist physician associations attended the faculty development workshop. The vast majority of survey respondents (n = 18/20) were satisfied with the SDS and believed that this method was a stimulating and efficient way to meet new colleagues, quickly share clinical issues and goals, learn about unexpected but important interdisciplinary issues, and identify opportunities for CIDE collaboration. Sixty percent (12/20) reported having identified at least 1 opportunity for collaboration that was worth pursuing in the near future, and 19% of attending CME directors (5/26) developed a CIDE activity within 2 years, as compared with none in the previous year and for the 9 nonparticipating associations. Results suggest that SDSs enhanced networking, knowledge exchange, and collaboration in continuing education among CME providers who participated in a faculty development activity on CIDE. Copyright © 2012 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

SKOLAR MD: A Model for Self-Directed, In-Context Continuing Medical Education

PubMed Central

Strasberg, Howard R.; Rindfleisch, Thomas C.; Hardy, Steven

2003-01-01

INTRODUCTION SKOLAR has implemented a web-based CME program with which physicians can earn AMA Category 1 credit for self-directed learning. METHODS Physicians researched their questions in SKOLAR and applied for CME. Physician auditors reviewed all requests across two phases of the project. A selection rule set was derived from phase one and used in phase two to flag a subset of requests for detailed review. The selection rule set is described. RESULTS In phase one, SKOLAR received 1039 CME applications. Applicants frequently found their answer (94%) and would apply it clinically (93%). A linear regression analysis comparing time awarded to time requested (capped at actual time spent) had R2=0.79. DISCUSSION We believe that hat this self-directed approach to CME is effective and an important complement to traditional CME programs. However, selective audit of self-directed CME requests is necessary to ensure validity of credits awarded. PMID:14728250

Attitudes and Preferences of Pennsylvania Primary Care Physicians Regarding Continuing Medical Education.

ERIC Educational Resources Information Center

Mansfield, Phyllis; And Others

Primary care physicians in Pennsylvania were asked to give their attitudes and preferences regarding continuing medical education (CME) in an effort to expand and develop physician-oriented CME programs for the Hershey Continuing Education department at Penn State. A 32-item questionnaire was mailed to 952 primary care physicians practicing in…

Effect of CME on Primary Care and OB/GYN Treatment of Breast Masses

ERIC Educational Resources Information Center

Price, David W.; Xu, Stanley; McClure, David

2005-01-01

Introduction: CME program planners are being asked to move beyond assessments of knowledge to assessing the impact of CME on practice and patient outcomes. Methods: We conducted a pre-post analysis of administrative data from 107 physicians, nurse practitioners (NPs), or physician's assistants (PAs) who attended one or two continuing medical…

Promoting Free Online CME for Intimate Partner Violence: What Works at What Cost?

ERIC Educational Resources Information Center

Harris, John M., Jr.; Novalis-Marine, Cheryl; Amend, Robert W.; Surprenant, Zita J.

2009-01-01

Introduction: There is a need to provide practicing physicians with training on the recognition and management of intimate partner violence (IPV). Online continuing medical education (CME) could help meet this need, but there is little information on the costs and effectiveness of promoting online CME to physicians. This lack of information may…

Promoting Physician Preventive Practices: Needs Assessment for CME in Breast Cancer Detection.

ERIC Educational Resources Information Center

Lane, Dorothy S.; Burg, Mary Ann

1989-01-01

Needs assessment for a continuing medical education (CME) intervention directed at increasing breast cancer screening of women over 50 included a survey of target primary care physicians (n=323) to explore areas of interest for CME in breast care detection and to establish baseline screening practices. A survey of 1,440 women in the target age…

Performance improvement CME for quality: challenges inherent to the process.

PubMed

Vakani, Farhan Saeed; O'Beirne, Ronan

2015-01-01

The purpose of this paper is to discuss the perspective debates upon the real-time challenges for a three-staged Performance Improvement Continuing Medical Education (PI-CME) model, an innovative and potential approach for future CME, to inform providers to think, prepare and to act proactively. In this discussion, the challenges associated for adopting the American Medical Association's three-staged PI-CME model are reported. Not many institutions in USA are using a three-staged performance improvement model and then customizing it to their own healthcare context for the specific targeted audience. They integrate traditional CME methods with performance and quality initiatives, and linking with CME credits. Overall the US health system is interested in a structured PI-CME model with the potential to improve physicians practicing behaviors. Knowing the dearth of evidence for applying this structured performance improvement methodology into the design of CME activities, and the lack of clarity on challenges inherent to the process that learners and providers encounter. This paper establishes all-important first step to render the set of challenges for a three-staged PI-CME model.

A Correlational Study of Self-Directed Learning Readiness and Learning Activity Preference for Continuing Medical Education among Family Physicians

ERIC Educational Resources Information Center

Barrett, Theresa J.

2014-01-01

This quantitative, nonexperimental, correlational study sought to determine whether a relationship exists between family physicians' levels of self-directed learning readiness (SDLR) and their preferences for continuing medical education (CME) activities. The study also sought to determine whether years in clinical practice or size of clinical…

Physician preferences for accredited online continuing medical education.

PubMed

Young, Kevin J; Kim, Julie J; Yeung, George; Sit, Christina; Tobe, Sheldon W

2011-01-01

The need for up-to-date and high-quality continuing medical education (CME) is growing while the financial investment in CME is shrinking. Despite online technology's potential to efficiently deliver electronic CME (eCME) to large numbers of users, it has not yet displaced traditional CME. The purpose of this study was to explore what health care providers want in eCME and how they want to use it. This was a qualitative study. Two 3-hour focus groups were held with physicians in both academic and community practices as well as trainees knowledgeable in the hypertension clinical practice guidelines with a willingness to discuss eCME. Content/thematic analysis was used to examine the data. Three main themes emerged: credibility, content/context, and control. Credibility was the most consistent and dominant theme. Affiliations with medical organizations and accreditation were suggested as methods by which eCME can gain credibility. The content and need for discussion of the content emerged as a key pivot point between eCME and traditional CME: a greater need for discussion was linked to a preference for traditional face-to-face CME. Control over the content and how it was accessed was an emergent theme, giving learners the ability to control the depth of learning and the time spent. They valued the ability to quickly find information that was in a format (podcast, video, mobile device) that best suited their learning needs or preferences at the time. This study provides insight into physician preferences for eCME and hypotheses that can be used to guide further research. Copyright © 2011 The Alliance for Continuing Medical Education, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

An Analysis of 2.3 Million Participations in the Continuing Medical Education Program of a General Medical Journal: Suitability, User Characteristics, and Evaluation by Readers.

PubMed

Christ, Hildegard; Franklin, Jeremy; Griebenow, Reinhard; Baethge, Christopher

2017-04-03

Physicians frequently use continuing medical education (CME) in journals. However, little is known of the evaluation of journal CME by readers and also user and participation characteristics. Deutsches Ärzteblatt, the journal of the German Medical Association, is distributed to every physician in Germany and regularly offers its readers CME articles. Therefore, it provides a unique opportunity to analyze a journal CME program directed at an entire population of physicians. The aim is to show key sociodemographic characteristics of participants, frequency and temporal distributions of participations, and to analyze whether the articles are suitable for a general medical audience, how physicians rate the CME articles, how successful they were in answering simple multiple-choice questions, and to detect distinct clusters of participants. Using obligatory online evaluation forms and multiple-choice questions, we analyzed all participations of the entire 142 CME articles published between September 2004 and February 2014. We compared demographic characteristics of participants with official figures on those characteristics as provided by the German Medical Association. A total of 128,398 physicians and therapists (male: 54.64%, 70,155/128,393; median age class 40 to 49 years) participated 2,339,802 times (mean 16,478, SD 6436 participations/article). Depending on the year, between 12.33% (44,064/357,252) and 16.15% (50,259/311,230) of all physicians in the country participated at least once. The CME program was disproportionally popular with physicians in private practice, and many participations took place in the early mornings and evenings (4544.53%, 1,041,931/2,339,802) as well as over the weekend (28.70%, 671,563/2,339,802). Participation by specialty (ranked in descending order) was internal medicine (18.25%, 23,434/128,392), general medicine (16.38%, 21,033/128,392), anesthesiology (10.00%, 12,840/128,392), and surgery (7.06%, 9059/128,392). Participants rated the CME articles as intelligible to a wider medical audience and filling clinically relevant knowledge gaps; 78.57% (1,838,358/2,339,781) of the sample gave the CME articles very good or good marks. Cluster analysis revealed three groups, one comprised of only women, with two-thirds working in private practice. The CME article series of Deutsches Ärzteblatt is used on a regular basis by a considerable proportion of all physicians in Germany; its multidisciplinary articles are suitable to a broad spectrum of medical specialties. The program seems to be particularly attractive for physicians in private practice and those who want to participate from their homes and on weekends. Although many physicians emphasize that the articles address gaps in knowledge, it remains to be investigated how this impacts professional performance and patient outcomes. ©Hildegard Christ, Jeremy Franklin, Reinhard Griebenow, Christopher Baethge. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 03.04.2017.

Physician Preferences for Accredited Online Continuing Medical Education

ERIC Educational Resources Information Center

Young, Kevin J.; Kim, Julie J.; Yeung, George; Sit, Christina; Tobe, Sheldon W.

2011-01-01

Introduction: The need for up-to-date and high-quality continuing medical education (CME) is growing while the financial investment in CME is shrinking. Despite online technology's potential to efficiently deliver electronic CME (eCME) to large numbers of users, it has not yet displaced traditional CME. The purpose of this study was to explore…

Characteristics That Predict Physician Participation in a Web-Based CME Activity: The MI-Plus Study

PubMed Central

Schoen, Michael J.; Tipton, Edmond F.; Houston, Thomas K.; Funkhouser, Ellen; Levine, Deborah A.; Estrada, Carlos A.; Allison, Jeroan J.; Williams, O. Dale; Kiefe, Catarina I.

2011-01-01

Introduction Physician use of the Internet for practice improvement has increased dramatically over the last decade, but research shows that many physicians choose not to participate. The current study investigated the association of specific physician characteristics with enrollment rates and intensity of participation in a specific Internet-delivered educational intervention to improve care to post–myocardial infarction (MI) patients. Methods Primary-care physicians were recruited for participation in a randomized controlled trial designed to compare effectiveness of an intervention Web site versus a control Web site in the management of adult chronic disease. Physicians were informed that the intervention focused on ambulatory post–myocardial infarction patients. Physician characteristics were obtained from a commercial vendor with data merged from the American Medical Association and Alabama State Licensing Board. Enrollment and Web use were tracked electronically. Results Out of a sample of 1337 eligible physicians, 177 (13.2%) enrolled in the study. Enrollment was higher for physicians with more post-MI patients (≥20 vs < 20 patients, 15.3% vs 9.3%, P = .002) and for those practicing in rural compared to urban areas (16.3% vs 12.1%, P = .046). Intensity of use of the Internet courses after initial enrollment was not predicted by physician characteristics in the current sample. Discussion Physicians with more post-MI patients and rural practice location were found to predict enrollment in an Internet-delivered continuing medical education (CME) intervention designed to improve care for post-MI patients. These factors predicted program interest but not program use. More research is needed to replicate these findings to investigate variables that determine physician engagement in Internet CME. PMID:19998447

Evaluating online continuing medical education seminars: evidence for improving clinical practices.

PubMed

Weston, Christine M; Sciamanna, Christopher N; Nash, David B

2008-01-01

The purpose of this study was to evaluate the potential for online continuing medical education (CME) seminars to improve quality of care. Primary care physicians (113) participated in a randomized controlled trial to evaluate an online CME series. Physicians were randomized to view either a seminar about type 2 diabetes or a seminar about systolic heart failure. Following the seminar, physicians were presented with 4 clinical vignettes and asked to describe what tests, treatments, counseling, or referrals they would recommend. Physicians who viewed the seminars were significantly more likely to recommend guideline-consistent care to patients in the vignettes. For example, physicians who viewed the diabetes seminar were significantly more likely to order an eye exam for diabetes patients (63%) compared with physicians in the control group (27%). For some guidelines there were no group differences. These results provide early evidence of the effectiveness of online CME programs to improve physician clinical practice.

An internet based approach to improve general practitioners' knowledge and practices: the development and pilot testing of the "ABC's of vitamin D" program.

PubMed

Bonevski, B; Magin, P; Horton, G; Bryant, J; Randell, M; Kimlin, M G

2015-06-01

Online continuing medical education (CME) offers a number of advantages for physicians including flexibility with regards to location and timing of use. In order to effect physician practices and improve patient outcomes, it is important that the development of online CME is theory and evidence-based. This paper aims to describe the development of an online CME program for practising general practitioners (GPs) on vitamin D and sun health called "The ABC's of Vitamin D for GPs" using elements of design principles for physician-education web sites as a framework. The paper will also report the program's usability and acceptability pilot test results. The ABC's of Vitamin D program was developed following nine principles: needs assessment; evidence-based content development; multimodal program and modularisation; clinical cases; tailoring and interactivity; audit and feedback; credibility of the web site host; patient education materials; ease of use and navigation. Among the 20 GPs invited, acceptability and useability was tested with 12 GPs (60%) who agreed to participate and were interviewed following use of the program. The study was conducted between 2011 and 2013. An online CME program consisting of eight modules was constructed. Of the 12 participating GPs, most (n=11) reported that the program was clear and easy to understand, logical, easy to navigate, and took a reasonable amount of time (estimated between 1 and 3h) to complete. Eleven of 12 participants said they would use the program as an accredited CME activity and all participants indicated that the program was 'very or somewhat' likely to lead to changes in the advice patients are given. This study found that a theory and evidence based approach for the development of an online CME program for GPs was acceptable to users. Further research is needed to examine whether the online CME program is effective at changing GP practices and improving patient outcomes. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Ethics and Continuing Medical Education.

ERIC Educational Resources Information Center

Felch, William C.

1986-01-01

Aspects of ethics and continuing medical education (CME) are discussed in terms of CME consumers (physicians), providers, and others; vacation CME and "brownie points"; marketing and cosponsorship; financial support from industry; and entrepreneurialism. (CT)

Assessing the impact of a medical librarian on identification of valid and actionable practice gaps for a continuing medical education committee.

PubMed

Bartkowiak, Barbara A; Safford, Lindsey A; Stratman, Erik J

2014-01-01

Identifying educational needs related to professional practice gaps can be a complex process for continuing medical education (CME) committees and for physicians who submit activity applications. Medical librarians possess unique skills that may be useful for identifying practice gaps relevant to CME committees. We assessed this assumption by assessing a medical librarian's contributions to practice gap identification for the Marshfield Clinic's CME Committee. We reviewed all locally relevant, locally actionable practice gaps identified annually by various stakeholders and presented to our CME Committee from 2010 to 2013. Total numbers of practice gaps identified, total categorized as actionable, and numbers of subsequent activities resulting from these gaps were calculated for each year. Medical librarian totals were compared to those of other CME committee stakeholders to determine the relative contribution. The medical librarian identified unique, actionable published practice gaps that directly contributed to CME activity planning. For each study year, contributions by the medical librarian grew, from 0 of 27 actionable gaps validated by CME Committee in 2010 to 49 of 108 (45.4%) in 2013. With the librarian's assistance, the number of valid practice gaps submitted between 2010 and 2013 by stakeholders climbed from 23 for 155 activities (14.8%) to 133 for 157 activities (84.7%). Medical librarians can provide a valuable service to CME committees by identifying valid professional practice gaps that inform decisions about educational activities aimed at improving clinical practice. Medical librarians bring into deliberations unique information, including national health policy priorities, practice gaps found in the literature, and point-of-care search engine statistics. © 2014 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education.

Interactions between physicians and the pharmaceutical industry: what does the literature say?

PubMed Central

Lexchin, J

1993-01-01

OBJECTIVE: To determine the effect of three types of interaction between physicians and the pharmaceutical industry--company-funded clinical trials, company-sponsored continuing medical education (CME) and information for physicians supplied by pharmaceutical detailers--on orientation and quality of clinical trials, content of CME courses and physicians' prescribing behaviour. DATA SOURCES: MEDLINE and HEALTH searches for English-language articles published from 1978 to 1993, supplemented by material from the author's personal collection. STUDY SELECTION: A total of 227 papers from the MEDLINE and HEALTH searches and about 2000 items from the author's library were initially reviewed. The following selection criteria were used: studies conducted in Australia, Canada, New Zealand, Britain and the United States; studies conducted after 1977; quantitative surveys containing details of the survey methods; studies on the orientation and quality of company-funded clinical trials and on the content of CME courses giving explicit criteria used in the evaluation; and reports on the outcome of interactions stating how the outcomes were assessed. Thirty-six studies met these criteria. DATA EXTRACTION: Information was extracted on five topics: physicians' attitudes toward drug industry interactions, frequency with which physicians participate in the interactions, orientation and quality of company-funded clinical trials, content of company-sponsored CME courses and changes in physicians' prescribing behaviour as a result of an interaction. DATA SYNTHESIS: Although most physicians participate only occasionally in company-sponsored clinical trials, most see detailers and attend company-sponsored CME courses. However, physicians do not have a very high opinion of the information from detailers or of company-sponsored CME events. Many doctors regard pharmaceutical companies as an important source of funding for clinical trials, but they also have concerns about accepting money from this source. Company funding of clinical trials may affect the quality of the trials and the types of research that physicians undertake. Company-sponsored CME courses may have a commercial bias even if conducted under guidelines designed to ensure the independence of the event. All three types of interactions affect physicians' prescribing behaviour and, in the case of obtaining information from detailers, physicians' prescribing practices are less appropriate as a result of the interaction. CONCLUSIONS: Physicians are affected by their interactions with the pharmaceutical industry. Further research needs to be done in most cases to determine whether such interactions lead to more or less appropriate prescribing practices. The CMA's guidelines on this topic should be evaluated to see whether they are effective in controlling physician-industry interactions. Further measures may be necessary if the guidelines fail to prevent negative effects on prescribing practices. PMID:8221424

Japanese practicing physicians' relationships with pharmaceutical representatives: a national survey.

PubMed

Saito, Sayaka; Mukohara, Kei; Bito, Seiji

2010-08-13

Previous surveys on the relationship between physicians and pharmaceutical representatives (PRs) have been of limited quality. The purpose of our survey of practicing physicians in Japan was to assess the extent of their involvement in pharmaceutical promotional activities, physician characteristics that predict such involvement, attitudes toward relationships with PRs, correlations between the extent of involvement and attitudes, and differences in the extent of involvement according to self-reported prescribing behaviors. From January to March 2008, we conducted a national survey of 2621 practicing physicians in seven specialties: internal medicine, general surgery, orthopedic surgery, pediatrics, obstetrics-gynecology, psychiatry, and ophthalmology. The response rate was 54%. Most physicians met with PRs (98%), received drug samples (85%) and stationery (96%), and participated in industry-sponsored continuing medical education (CME) events at the workplace (80%) and outside the workplace (93%). Half accepted meals outside the workplace (49%) and financial subsidies to attend CME events (49%). Rules at the workplace banning both meetings with PRs and gifts predicted less involvement of physicians in promotional activities. Physicians valued information from PRs. They believed that they were unlikely to be influenced by promotional activities, but that their colleagues were more susceptible to such influence than themselves. They were divided about the appropriateness of low-value gifts. The extent of physician involvement in promotional activities was positively correlated with the attitudes that PRs are a valuable source of information and that gifts are appropriate. The extent of such involvement was higher among physicians who prefer to ask PRs for information when a new medication becomes available, physicians who are not satisfied with patient encounters ending only with advice, and physicians who prefer to prescribe brand-name medications. Involvement in pharmaceutical promotional activities is widespread among practicing physicians in Japan. The extent of such involvement varies according to certain physician characteristics. As a group, they are at risk for influence by promotional activities.

Continuing educational needs in computers and informatics. McGill survey of family physicians.

PubMed Central

McClaran, J.; Snell, L.; Duarte-Franco, E.

2000-01-01

OBJECTIVE: To describe family physicians' perceived educational needs in computers and informatics. DESIGN: Mailed survey. SETTING: General or family practices in Canada. PARTICIPANTS: Physicians (489 responded to a mailing sent to 2,500 physicians) who might attend sessions at the McGill Centre for CME. Two duplicate questionnaires were excluded from the analysis. METHOD: Four domains were addressed: practice profile, clinical CME needs, professional CME needs, and preferred learning formats. Data were entered on dBASE IV; analyses were performed on SPSS. MAIN FINDINGS: In the 487 questionnaires retained for analysis, "informatics and computers" was mentioned more than any other clinical diagnostic area, any other professional area, and all but three patient groups and service areas as a topic where improvement in knowledge and skills was needed in the coming year. Most physicians had no access to computer support for practice (62.6%); physicians caring for neonates, toddlers, or hospital inpatients were more likely to report some type of computer support. CONCLUSIONS: Family physicians selected knowledge and skills for computers and informatics as an area for improvement in the coming year more frequently than they selected most traditional clinical CME topics. This educational need is particularly great in small towns and in settings where some computerized hospital data are already available. PMID:10790816

The Growth, Characteristics, and Future of Online CME

ERIC Educational Resources Information Center

Harris, John M., Jr.; Sklar, Bernard M.; Amend, Robert W.; Novalis-Marine, Cheryl

2010-01-01

Introduction: Physician use of online continuing medical education (CME) is growing, but there are conflicting data on the uptake of online CME and few details on this market. Methods: Analyses of 11 years of data from the Accreditation Council for Continuing Medical Education (ACCME) and a survey of 272 publicly available CME Web sites. …

Obstetrician/Gynecologists and Postpartum Mental Health: Differences between CME Course Takers and Nontakers

ERIC Educational Resources Information Center

Leddy, Meaghan A.; Farrow, Victoria A.; Joseph, Gerald F., Jr.; Schulkin, Jay

2012-01-01

Introduction: Continuing medical education (CME) courses are an essential component of professional development. Research indicates a continued need for understanding how and why physicians select certain CME courses, as well as the differences between CME course takers and nontakers. Purpose: Obstetrician-gynecologists (OB-GYNs) are health care…

Who is driving continuing medical education for family medicine?

PubMed

Klein, Douglas; Allan, G Michael; Manca, Donna; Sargeant, Joan; Barnett, Carly

2009-01-01

Considerable time and money are invested in continuing medical education (CME) for family physicians (FPs) but the effectiveness is uncertain. The participation of FPs as coordinators and teachers is not well known. The goal of this project was to describe the role of FPs in organizing and teaching CME events that are accredited for FPs. Information about accredited CME events occurring in Alberta and Nova Scotia was requested from universities, provincial chapters of the College of Family Physicians of Canada, and pharmaceutical companies. Location, coordinating site, organizing committee members, teaching faculty, and format were recorded from each event. The number and proportion of FPs involved in both organizing and teaching CME events accredited for FPs were calculated and compared. A total of 314 CME events were collected, comprising a total of 1,472 hours of CME. From the CME events collected, there were 1,730 organizing committee members and 1,647 teachers. FPs constitute 59% of the organizing committees and 17% of the teachers. Significant differences in the numbers of FP planners and teachers were related to organizing group, format, location, and expected audience composition. The accreditation requirement for FPs on organizing committees likely helps preserve a reasonable proportion of FP organizers but not teachers in FP CME. The proportions of true FP planners and teachers may actually be lower than planning documents indicate. Low level of family physician teachers in CME may be due to FPs' not selecting FP teachers, the FP teaching pool's being inadequate, or the organizing committee's being unaware of FPs who are knowledgeable in particular areas.

Didactic CME and Practice Change: Don't Throw that Baby out Quite yet

ERIC Educational Resources Information Center

Olson, Curtis A.; Tooman, Tricia R.

2012-01-01

Skepticism exists regarding the role of continuing medical education (CME) in improving physician performance. The harshest criticism has been reserved for didactic CME. Reviews of the scientific literature on the effectiveness of CME conclude that formal or didactic modes of education have little or no impact on clinical practice. This has led…

Evaluation of an online bioterrorism continuing medical education course.

PubMed

Casebeer, Linda; Andolsek, Kathryn; Abdolrasulnia, Maziar; Green, Joseph; Weissman, Norman; Pryor, Erica; Zheng, Shimin; Terndrup, Thomas

2006-01-01

Much of the international community has an increased awareness of potential biologic, chemical, and nuclear threats and the need for physicians to rapidly acquire new knowledge and skills in order to protect the public's health. The present study evaluated the educational effectiveness of an online bioterrorism continuing medical education (CME) activity designed to address clinical issues involving suspected bioterrorism and reporting procedures in the United States. This was a retrospective survey of physicians who had completed an online CME activity on bioterrorism compared with a nonparticipant group who had completed at least 1 unrelated online CME course from the same medical school Web site and were matched on similar characteristics. An online survey instrument was developed to assess clinical and systems knowledge and confidence in recognition of illnesses associated with a potential bioterrorism attack. A power calculation indicated that a sample size of 100 (50 in each group) would achieve 90% power to detect a 10% to 15% difference in test scores between the two groups. Compared with nonparticipant physicians, participants correctly diagnosed anthrax (p = .01) and viral exanthem (p = .01), but not smallpox, more frequently than nonparticipants. Participants knew more frequently than nonparticipants who to contact regarding a potential bioterrorism event (p = .03) Participants were more confident than nonparticipants about finding information to guide diagnoses of patients with biologic exposure (p = .01), chemical exposure (p = .02), and radiation exposure (p = .04). An online bioterrorism course shows promise as an educational intervention in preparing physicians to better diagnose emerging rare infections, including those that may be associated with a bioterrorist event, in increasing confidence in diagnosing these infections, and in reporting of such infections for practicing physicians.

Systems-Based Framework for Continuing Medical Education and Improvements in Translating New Knowledge into Physicians' Practices

ERIC Educational Resources Information Center

Van Harrison, R.

2004-01-01

Concerns about health care costs and quality are focusing increasing attention on physicians and their continuing medical education (CME). These concerns have produced several calls for "a new definition," "a new vision," "repositioning," "reinventing," and "transforming" CME. However, differences in conceptualizations and vocabularies have…

Computer use and needs of internists: a survey of members of the American College of Physicians-American Society of Internal Medicine.

PubMed Central

Lacher, D.; Nelson, E.; Bylsma, W.; Spena, R.

2000-01-01

The American College of Physicians-American Society of Internal Medicine conducted a membership survey in late 1998 to assess their activities, needs, and attitudes. A total of 9,466 members (20.9% response rate) reported on 198 items related to computer use and needs of internists. Eighty-two percent of the respondents reported that they use computers for personal or professional reasons. Physicians younger than 50 years old who had full- or part-time academic affiliation reported using computers more frequently for medical applications. About two thirds of respondents who had access to computers connected to the Internet at least weekly, with most using the Internet from home for e-mail and nonmedical uses. Physicians expressed concerns about Internet security, confidentiality, and accuracy, and the lack of time to browse the Internet. In practice settings, internists used computers for administrative and financial functions. Less than 19% of respondents had partial or complete electronic clinical functions in their offices. Less than 7% of respondents exchanged e-mail with their patients on a weekly or daily basis. Also, less than 15% of respondents used computers for continuing medical education (CME). Respondents reported they wanted to increase their general computer skills and enhance their knowledge of computer-based information sources for patient care, electronic medical record systems, computer-based CME, and telemedicine While most respondents used computers and connected to the Internet, few physicians utilized computers for clinical management. Medical organizations face the challenge of increasing physician use of clinical systems and electronic CME. PMID:11079924

Computer use and needs of internists: a survey of members of the American College of Physicians-American Society of Internal Medicine.

PubMed

Lacher, D; Nelson, E; Bylsma, W; Spena, R

2000-01-01

The American College of Physicians-American Society of Internal Medicine conducted a membership survey in late 1998 to assess their activities, needs, and attitudes. A total of 9,466 members (20.9% response rate) reported on 198 items related to computer use and needs of internists. Eighty-two percent of the respondents reported that they use computers for personal or professional reasons. Physicians younger than 50 years old who had full- or part-time academic affiliation reported using computers more frequently for medical applications. About two thirds of respondents who had access to computers connected to the Internet at least weekly, with most using the Internet from home for e-mail and nonmedical uses. Physicians expressed concerns about Internet security, confidentiality, and accuracy, and the lack of time to browse the Internet. In practice settings, internists used computers for administrative and financial functions. Less than 19% of respondents had partial or complete electronic clinical functions in their offices. Less than 7% of respondents exchanged e-mail with their patients on a weekly or daily basis. Also, less than 15% of respondents used computers for continuing medical education (CME). Respondents reported they wanted to increase their general computer skills and enhance their knowledge of computer-based information sources for patient care, electronic medical record systems, computer-based CME, and telemedicine While most respondents used computers and connected to the Internet, few physicians utilized computers for clinical management. Medical organizations face the challenge of increasing physician use of clinical systems and electronic CME.

Are online learning modules an effective way to deliver hand trauma management continuing medical education to emergency physicians?

PubMed

Williams, Jason G

2014-01-01

The enormity of modern medical knowledge and the rapidity of change have created increased need for ongoing or continuing medical education (CME) for physicians. Online CME is attractive for its availability at any time and any place, low cost and potentially increased effectiveness compared with traditional face-to-face delivery. To determine whether online CME modules are an effective method for delivering plastic surgery CME to primary care physicians. A needs assessment survey was conducted among all emergency and family physicians in Nova Scotia. Results indicated that this type of program was appealing, and that hand trauma related topics were most desired for CME. 7 Lesson Builder (SoftChalk LLC, www.softchalk.com) was used to construct a multimedia e-learning module that was distributed along with a pretest, post-test and feedback questionnaire. Quantitative (pre- and post-test scores) and qualitative (feedback responses) data were analyzed. The 32 participants who completed the study indicated that it was a positive and enjoyable experience, and that there was a need for more resources like this. Compared with pretest scores, there was a significant gain in knowledge following completion of the module (P=0.001). The present study demonstrated that an e-learning format is attractive for this population and effective in increasing knowledge. This positive outcome will lead to development of additional modules.

General Practitioners' preferences and use of educational media: a German perspective

PubMed Central

Vollmar, Horst Christian; Rieger, Monika A; Butzlaff, Martin E; Ostermann, Thomas

2009-01-01

Background Several studies suggest that General Practitioners (GPs) prefer "traditional" media such as journals or quality circles when they are seeking out different options to meet their continuing medical education (CME) requirements. A survey was designed in order to gain a better understanding of German General Practitioners' preferences for different forms of educational media that will meet their CME needs. Methods Four hundred and forty nine (N = 449) German physicians were contacted to take part in this study on the occasion of one of their quality circle meetings. The participating physicians received a standardized 26-item-questionnaire that surveyed their preferences for different forms of educational media. A factor analysis was performed in order to determine whether the observed variables can be explained largely or entirely in terms of the underlying patterns. Results Two hundred and sixty-four physicians with an average age of 51.1 years participated (28.5% female, 71.5% male). We found that GPs favor learning environments such as: journals, colleagues, and quality circles. New media like the internet was used less often for their learning activities, even though the usage of the internet in general was quite high. The most important requirements for media in medical education as perceived by the participants were its relevancy for daily practice and dependability. Conclusion Despite a growing use of the Internet it seems that German GPs favor "classical/traditional" settings for their learning activities. These results should be taken into consideration when planning CME or CPD programs or other learning activities. Trial registration Current Controlled Trials ISRCTN36550981. PMID:19220905

Effectiveness of continuing medical education.

PubMed

Marinopoulos, Spyridon S; Dorman, Todd; Ratanawongsa, Neda; Wilson, Lisa M; Ashar, Bimal H; Magaziner, Jeffrey L; Miller, Redonda G; Thomas, Patricia A; Prokopowicz, Gregory P; Qayyum, Rehan; Bass, Eric B

2007-01-01

Despite the broad range of continuing medical education (CME) offerings aimed at educating practicing physicians through the provision of up-to-date clinical information, physicians commonly overuse, under-use, and misuse therapeutic and diagnostic interventions. It has been suggested that the ineffective nature of CME either accounts for the discrepancy between evidence and practice or at a minimum contributes to this gap. Understanding what CME tools and techniques are most effective in disseminating and retaining medical knowledge is critical to improving CME and thus diminishing the gap between evidence and practice. The purpose of this review was to comprehensively and systematically synthesize evidence regarding the effectiveness of CME and differing instructional designs in terms of knowledge, attitudes, skills, practice behavior, and clinical practice outcomes. We formulated specific questions with input from external experts and representatives of the Agency for Healthcare Research and Quality (AHRQ) and the American College of Chest Physicians (ACCP) which nominated this topic. We systematically searched the literature using specific eligibility criteria, hand searching of selected journals, and electronic databases including: MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, The Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Database of Abstracts of Reviews of Effects (DARE), PsycINFO, and the Educational Resource Information Center (ERIC). Two independent reviewers conducted title scans, abstract reviews, and then full article reviews to identify eligible articles. Each eligible article underwent double review for data abstraction and assessment of study quality. Of the 68,000 citations identified by literature searching, 136 articles and 9 systematic reviews ultimately met our eligibility criteria. The overall quality of the literature was low and consequently firm conclusions were not possible. Despite this, the literature overall supported the concept that CME was effective, at least to some degree, in achieving and maintaining the objectives studied, including knowledge (22 of 28 studies), attitudes (22 of 26), skills (12 of 15), practice behavior (61 of 105), and clinical practice outcomes (14 of 33). Common themes included that live media was more effective than print, multimedia was more effective than single media interventions, and multiple exposures were more effective than a single exposure. The number of articles that addressed internal and/or external characteristics of CME activities was too small and the studies too heterogeneous to determine if any of these are crucial for CME success. Evidence was limited on the reliability and validity of the tools that have been used to assess CME effectiveness. Based on previous reviews, the evidence indicates that simulation methods in medical education are effective in the dissemination of psychomotor and procedural skills. Despite the low quality of the evidence, CME appears to be effective at the acquisition and retention of knowledge, attitudes, skills, behaviors and clinical outcomes. More research is needed to determine with any degree of certainty which types of media, techniques, and exposure volumes as well as what internal and external audience characteristics are associated with improvements in outcomes.

Didactic CME and practice change: don't throw that baby out quite yet.

PubMed

Olson, Curtis A; Tooman, Tricia R

2012-08-01

Skepticism exists regarding the role of continuing medical education (CME) in improving physician performance. The harshest criticism has been reserved for didactic CME. Reviews of the scientific literature on the effectiveness of CME conclude that formal or didactic modes of education have little or no impact on clinical practice. This has led some to argue that didactic CME is a highly questionable use of organizational and financial resources, and a cause of lost opportunities for physicians to engage in meaningful learning. The authors' current program of research has forced them to reconsider the received wisdom regarding the relationship between didactic modes of education and learning, and the role frank dissemination can play in bringing about practice change. The authors argued that the practice of assessing and valuing educational methods based only on their capacity to directly influence practice reflects an impoverished understanding of how change in clinical practice actually occurs. Drawing on case studies research, examples were given of the functions didactic CME served in the interest of improved practice. Reasons were then explored as to why the contribution of didactic CME is often missed or dismissed. The goal was not to advocate for a return to the status quo ante where lecture-based education is the dominant modality, but rather to acknowledge both the limits and potential of this longstanding approach to delivering continuing education.

Increasing faculty participation in resident education and providing cost-effective self-assessment module credit to faculty through resident-generated didactics.

PubMed

Kim, Hyun; Malatesta, Theresa M; Anné, Pramila R; McAna, John; Bar-Ad, Voichita; Dicker, Adam P; Den, Robert B

Board certified radiation oncologists and medical physicists are required to earn self-assessment module (SAM) continuing medical education (CME) credit, which may require travel costs or usage fees. Data indicate that faculty participation in resident teaching activities is beneficial to resident education. Our hypothesis was that providing the opportunity to earn SAM credit in resident didactics would increase faculty participation in and improve resident education. SAM applications, comprising CME certified category 1 resident didactic lectures and faculty-generated questions with respective answers, rationales, and references, were submitted to the American Board of Radiology for formal review. Surveys were distributed to assess main academic campus physician, affiliate campus physician, physicist, and radiation oncology resident impressions regarding the quality of the lectures. Survey responses were designed in Likert-scale format. Sign-test was performed with P < .05 considered statistically different from neutral. First submission SAM approval was obtained for 9 of 9 lectures to date. A total of 52 SAM credits have been awarded to 4 physicists and 7 attending physicians. Main academic campus physician and affiliate campus physician attendance increased from 20% and 0%, respectively, over the 12 months preceding CME/SAM lectures, to 55.6% and 20%, respectively. Survey results indicated that the change to SAM lectures increased the quality of resident lectures (P = .001), attending physician participation in resident education (P < .0001), physicist involvement in medical resident education (P = .0006), and faculty motivation to attend resident didactics (P = .004). Residents reported an increased amount of time required to prepare lectures (P = .008). We are the first department, to our knowledge, to offer SAM credit to clinical faculty for participation in resident-generated didactics. Offering SAM credit at resident lectures is a cost-effective alternative to purchasing SAM resources, increases faculty attendance, and may improve the quality of radiation oncology resident education. Copyright © 2016 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

Interrater reliability to assure valid content in peer review of CME-accredited presentations.

PubMed

Quigg, Mark; Lado, Fred A

2009-01-01

The Accreditation Council for Continuing Medical Education (ACCME) provides guidelines for continuing medical education (CME) materials to mitigate problems in the independence or validity of content in certified activities; however, the process of peer review of materials appears largely unstudied and the reproducibility of peer-review audits for ACCME accreditation and designation of American Medical Association Category 1 Credit(TM) is unknown. Categories of presentation defects were constructed from discussions of the CME committee of the American Epilepsy Society: (1) insufficient citation, (2) poor formatting, (3) nonacknowledgment of non-FDA-approved use, (4) misapplied data, (5) 1-sided data, (6) self- or institutional promotion, (7) conflict of interest/commercial bias, (8) other, or (9) no defect. A PowerPoint lecture (n = 29 slides) suitable for presentation to general neurologists was purposefully created with the above defects. A multirater, multilevel kappa statistic was determined from the number and category of defects. Of 14 reviewers, 12 returned completed surveys (86%) identifying a mean +/- standard deviation 1.6 +/- 1.1 defects/slide. The interrater kappa equaled 0.115 (poor reliability) for number of defects/slides. No individual categories achieved kappa > 0.38. Interrater reliability on the rating of durable materials used in subspecialty CME was poor. Guidelines for CME appropriate content are too subjective to be applied reliably by raters knowledgeable in their specialty field but relatively untrained in the specifics of CME requirements. The process of peer review of CME materials would be aided by education of physicians on validation of materials appropriate for CME.

Implementation of a Flipped Classroom for Nuclear Medicine Physician CME.

PubMed

Komarraju, Aparna; Bartel, Twyla B; Dickinson, Lisa A; Grant, Frederick D; Yarbrough, Tracy L

2018-06-21

Increasingly, emerging technologies are expanding instructional possibilities, with new methods being adopted to improve knowledge acquisition and retention. Within medical education, many new techniques have been employed in the undergraduate setting, with less utilization thus far in the continuing medical education (CME) sphere. This paper discusses the use of a new method for CME-the "flipped classroom," widely used in undergraduate medical education. This method engages learners by providing content before the live ("in class") session that aids in preparation and fosters in-class engagement. A flipped classroom method was employed using an online image-rich case-based module and quiz prior to a live CME session at a national nuclear medicine meeting. The preparatory material provided a springboard for in-depth discussion at the live session-a case-based activity utilizing audience response technology. Study participants completed a survey regarding their initial experience with this new instructional method. In addition, focus group interviews were conducted with session attendees who had or had not completed the presession material; transcripts were qualitatively analyzed. Quantitative survey data (completed by two-thirds of the session attendees) suggested that the flipped method was highly valuable and met attendee educational objectives. Analysis of focus group data yielded six themes broadly related to two categories-benefits of the flipped method for CME and programmatic considerations for successfully implementing the flipped method in CME. Data from this study have proven encouraging and support further investigations around the incorporation of this innovative teaching method into CME for nuclear imaging specialists.

An online spaced-education game for global continuing medical education: a randomized trial.

PubMed

Kerfoot, B Price; Baker, Harley

2012-07-01

To assess the efficacy of a "spaced-education" game as a method of continuing medical education (CME) among physicians across the globe. The efficacy of educational games for the CME has yet to be established. We created a novel online educational game by incorporating game mechanics into "spaced education" (SE), an evidence-based method of online CME. This 34-week randomized trial enrolled practicing urologists across the globe. The SE game consisted of 40 validated multiple-choice questions and explanations on urology clinical guidelines. Enrollees were randomized to 2 cohorts: cohort A physicians were sent 2 questions via an automated e-mail system every 2 days, and cohort B physicians were sent 4 questions every 4 days. Adaptive game mechanics re-sent the questions in 12 or 24 days if answered incorrectly and correctly, respectively. Questions expired if not answered on time (appointment dynamic). Physicians retired questions by answering each correctly twice-in-a-row (progression dynamic). Competition was fostered by posting relative performance among physicians. Main outcome measures were baseline scores (percentage of questions answered correctly upon initial presentation) and completion scores (percentage of questions retired). A total of 1470 physicians from 63 countries enrolled. Median baseline score was 48% (interquartile range [IQR] 17) and, in multivariate analyses, was found to vary significantly by region (Cohen dmax = 0.31, P = 0.001) and age (dmax = 0.41, P < 0.001). Median completion score was 98% (IQR 25) and varied significantly by age (dmax = 0.21, P < 0.001) and American Board of Urology certification (d = 0.10, P = 0.033) but not by region (multivariate analyses). Question clustering reduced physicians' performance (d = 0.43, P < 0.001). Seventy-six percent of enrollees (1111/1470) requested to participate in future SE games. An online SE game can substantially improve guidelines knowledge and is a well-accepted method of global CME delivery.

A Standardized Approach to Assessing Physician Expectations and Perceptions of Continuing Medical Education

ERIC Educational Resources Information Center

Shewchuk, Richard M.; Schmidt, Hilary J.; Benarous, Alexandra; Bennett, Nancy L.; Abdolrasulnia, Maziar; Casebeer, Linda L.

2007-01-01

Introduction: Rapidly expanding science and mandates for maintaining credentials place increasing demands on continuing medical education (CME) activities to provide information that is current and relevant to patient care. Quality may be seen as the perceived level of service measured against consumer expectations. Standard tools have not been…

Preventing and treating nicotine addiction: a review with emphasis on adolescent health.

PubMed

Alouf, Benjamin; Feinson, Judith A; Chidekel, Aaron S

2006-07-01

This article is the fourth in a series of four providing current, state-of-the-art information about the tobacco problem and how physicians can effectively intervene. The articles review the health effects of second-hand smoke, current treatment strategies for nicotine addiction and the implementation of best practices, such as the "5 As," to effectively intervene with families with smokers. Three of the articles are accredited for free continuing medical education (CME) credit for physicians. To obtain AMA PRA Category 1 Credit(s)TM for this article, please go online to www.PedsEducation.org, your source for free continuing medical education from Nemours. Choose "Online Education" and the article, and complete the post-test as directed. CME accreditation for this educational presentation is provided at no cost as a service of Nemours, one of the nation's largest children's health systems. Nemours is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Nemours designates this educational activity for a maximum of .5 AMA PRA Category 1 Credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity. This article will focus on the prevention of adolescent smoking and discuss a global approach to the tobacco problem among youth. It also reviews the rationale for and pharmacology of treating nicotine addiction to empower physicians to assist smokers with quitting. By reading the article and completing the post-test, it is anticipated that the following learning objectives will be met: Physicians will become familiar with: 1) Options for treating nicotine addiction, 2) The unique aspects of the tobacco problem in adolescence, 3) The risk factors for teen smoking initiation.

Is Physician Engagement With Web-Based CME Associated With Patients’ Baseline Hemoglobin A1c Levels? The Rural Diabetes Online Care Study

PubMed Central

Crenshaw, Katie; Curry, William; Salanitro, Amanda H.; Safford, Monika M.; Houston, Thomas K.; Allison, Jeroan J.; Estrada, Carlos A.

2011-01-01

Purpose To investigate the association between physician participants’ levels of engagement in a Web-based educational intervention and their patients’ baseline diabetes measures. Method The authors conducted a randomized trial of online CME activities designed to improve diabetes care provided by family, general, and internal medicine physicians in rural areas of 11 southeastern states between September 2006 and July 2008. Using incidence rate ratios derived from negative binomial models, the relationship between physicians’ engagement with the study Web site and baseline proportion of their patients having controlled diabetes (hemoglobin A1c ≤7%) was explored. Results One hundred thirty-three participants (intervention = 64; control = 69) provided information for 1,637 patients with diabetes. In the intervention group, physicians in practices in the worst quartiles of A1c control were least engaged with the study Web site in nearly all dimensions. Total number of pages viewed decreased as quartile of A1c control worsened (137, 73, 68, 57; P = .007); similarly, for a given 10% increase in proportion of patients with controlled A1c, participants viewed 1.13 times more pages (95% CI: 1.02–1.26, P = .02). In the control group, engagement was neither correlated with A1c control nor different across quartiles of A1c control. Conclusions Engagement in Web-based interventions is measurable and has important implications for research and education. Because physicians of patients with the greatest need for improvement in A1c control may not use online educational resources as intensely as others, other strategies may be necessary to engage these physicians in professional development activities. PMID:20736679

How do medical doctors in the European Union demonstrate that they continue to meet criteria for registration and licencing?

PubMed

Solé, Meritxell; Panteli, Dimitra; Risso-Gill, Isabelle; Döring, Nora; Busse, Reinhard; McKee, Martin; Legido-Quigley, Helena

2014-12-01

This paper reviews procedures for ensuring that physicians in the European Union (EU) continue to meet criteria for registration and the implications of these procedures for cross-border movement of health professionals following implementation of the 2005/36/EC Directive on professional qualifications. A questionnaire was completed by key informants in 10 EU member states, supplemented by a review of peer-reviewed and grey literature and a review conducted by key experts in each country. The questionnaire covered three aspects: actors involved in processes for ensuring continued adherence to standards for registration and/or licencing (such as revalidation), including their roles and functions; the processes involved, including continuing professional development (CPD) and/or continuing medical education (CME); and contextual factors, particularly those impacting professional mobility. All countries included in the study view CPD/CME as one mechanism to demonstrate that doctors continue to meet key standards. Although regulatory bodies in a few countries have established explicit systems of ensuring continued competence, at least for some doctors (in Belgium, Germany, Hungary, the Netherlands, Slovenia and the UK), self-regulation is considered sufficient to ensure that physicians are up to date and fit to practice in others (Austria, Finland, Estonia and Spain). Formal systems vary greatly in their rationale, structure, and coverage. Whereas in Germany, Hungary and Slovenia, systems are exclusively focused on CPD/CME, the Netherlands also includes peer review and minimum activity thresholds. Belgium and the UK have developed more complex mechanisms, comprising a review of complaints or compliments on performance and (in the UK) colleague and patient questionnaires. Systems for ensuring that doctors continue to meet criteria for registration and licencing across the EU are complex and inconsistent. Participation in CPD/CME is only one aspect of maintaining professional competence but it is the only one common to all countries. Thus, there is a need to bring clarity to this confused landscape. © 2014 Royal College of Physicians.

Advantages and disadvantages of educational email alerts for family physicians: viewpoint.

PubMed

Badran, Hani; Pluye, Pierre; Grad, Roland

2015-02-27

Electronic knowledge resources constitute an important channel for accredited Continuing Medical Education (CME) activities. However, email usage for educational purposes is controversial. On the one hand, family physicians become aware of new information, confirm what they already know, and obtain reassurance by reading educational email alerts. Email alerts can also encourage physicians to search Web-based resources. On the other hand, technical difficulties and privacy issues are common obstacles. The purpose of this discussion paper, informed by a literature review and a small qualitative study, was to understand family physicians' knowledge, attitudes, and behavior in regard to email in general and educational emails in particular, and to explore the advantages and disadvantages of educational email alerts. In addition, we documented participants' suggestions to improve email alert services for CME. We conducted a qualitative descriptive study using the "Knowledge, Attitude, Behavior" model. We conducted semi-structured face-to-face interviews with 15 family physicians. We analyzed the collected data using inductive-deductive thematic qualitative data analysis. All 15 participants scanned and prioritized their email, and 13 of them checked their email daily. Participants mentioned (1) advantages of educational email alerts such as saving time, convenience and valid information, and (2) disadvantages such as an overwhelming number of emails and irrelevance. They offered suggestions to improve educational email. The advantages of email alerts seem to compensate for their disadvantages. Suggestions proposed by family physicians can help to improve educational email alerts.

Team- and Case-Based Learning to Activate Participants and Enhance Knowledge: An Evaluation of Seminars in Germany

ERIC Educational Resources Information Center

Kuhne-Eversmann, Lisa; Eversmann, Thomas; Fischer, Martin R.

2008-01-01

Introduction: There is a strong need for high-quality continuing medical education (CME) in Germany. To maintain a medical license, physicians are required to participate in regular training. Although evidence suggests that compared to lectures interactive methods can impart sustainable knowledge and a high degree of satisfaction, few interactive…

Internet Point of Care Learning at a Community Hospital

ERIC Educational Resources Information Center

Sinusas, Keith

2009-01-01

Introduction: Internet point of care (PoC) learning is a relatively new method for obtaining continuing medical education credits. Few data are available to describe physician utilization of this CME activity. Methods: We describe the Internet point of care system we developed at a medium-sized community hospital and report on its first year of…

Knowledge gaps in the diagnosis and management of patients with tropical diseases presenting to Canadian emergency departments: are the gaps being met?

PubMed

Meshkat, Nazanin; Misra, Shikha; Hunchak, Cheryl; Cleiman, Paula; Khan, Yasmin; Puchalski Ritchie, Lisa M

2014-11-01

We conducted a needs assessment to identify knowledge gaps in the management of tropical diseases by Canadian emergency physicians and identify available, related continuing medical education (CME) resources. A literature review was conducted to summarize challenges in the management of commonly encountered tropical diseases. An anonymous online survey was administered to Canadian emergency physicians using the Canadian Association of Emergency Physicians survey deployment service in July and August 2012. The survey identified self-reported gaps in knowledge and assessed knowledge using case-based vignettes. A list of CME resources was generated from a review of major academic emergency medicine journals, online cases, and conference topics from emergency medicine associations during 2010-2011. Two independent reviewers assessed the relevance of the resources; differences were resolved by consensus. From 635 citations, 47 articles were selected for full review; the majority (66%) were retrospective chart reviews, few (10.6%) had an emergency medicine focus, and fewer still were Canadian (8.5%). In total, 1,128 surveys were distributed, and 296 (27%) participants were included in the study. Most respondents reported "no" (52.4%) or "some" (45.9%) training in tropical medicine. Most (69.9%) rated their comfort in managing patients with tropical diseases as "low." Few (11.1%) respondents reported a tropical disease being misdiagnosed or mismanaged; 44.1% indicated malaria. The perceived need for further training was high (76.7%). Conference workshops were the most highly requested CME modality, followed by case studies and podcasts. Correct answers to case vignettes ranged from 30.7 to 58.4%. Although 2,038 CME titles were extracted from extensive searches, only 6 were deemed relevant. Most Canadian emergency physicians have had minimal training in tropical diseases, reported a low comfort level in their management, and identified a high need for CME opportunities, which are lacking.

The influence of double-credit evidence-based continuing medical education on presenters and learners.

PubMed

Lawrence, Steven L; Morzinski, Jeffrey A; Radjenovich, Mary Ellen

2008-07-01

Medical specialties are adopting methods to improve continuing medical education (CME). A "double credit" option, sponsored by the American Academy of Family Physicians, is now available for presentations submitted and approved as evidence based (EB). To compare usual and double-credit CME presentations to determine differences in preparation resources and time, and to compare conference attendees' satisfaction. Those not submitting double-credit applications were asked about perceived barriers. Three pretested, written surveys were administered at a 2.5 day CME conference held annually in Southeastern Wisconsin. Subjects were 38 presenters and 172 attendees, mostly primary care physicians. Twelve presentations were approved for double-credit; these presenters used a greater percentage of on-line EB resources to prepare their talks (64% versus 23%), and preparation required an additional 4.75 hours on average. Over 90% of attendees perceived greater conference quality due to the EB emphasis. Top barriers to double-credit EB applications were time limits and perceptions that topics were inappropriate. Double-credit presenters use a greater percentage of EB resources, while their counterparts used more professional experience to prepare CME presentations. Attendees reported improved quality and value with increased EB CME. Time is a perceived and real factor in preparing double-credit applications.

PUB1/359: The Use of the Internet for CME Purposes in Turkey

PubMed Central

Yaman, H; Kut, A

1999-01-01

While continuing medical education (CME) is receiving increasing attention from medical educators and health administrators world-wide, many efforts need to be made to improve its performance and overall effectiveness. CME has depended primarily on periodic courses and conferences. High costs and distant location make CME journals an alternative to these events. The Turkish Medical Association is publishing a journal for CME purposes called STED. By this way, every month, 9000 exemplars of each edition are distributed mainly to primary care physicians in the whole of Turkey. To make the journal also accessible to non-subscribers and professionals, who live outside Turkey, English abstracts of articles published in STED are going to be prepared and published soon by Internet services (www.ato.org.tr). By increasing the use of computer-assisted teaching and modern telecommunications, in the near future, the costs of CME can be reduced and its effectiveness improved.

Problem-Based Learning in Canadian Undergraduate and Continuing Medical Education

ERIC Educational Resources Information Center

Jubien, Peggy

2008-01-01

This article provides an overview of problem-based learning (PBL) in Canadian undergraduate medical education and continuing medical education (CME) programs. The CME field in Canada is described, and the major professional associations that require physicians to take annual courses and programs are noted. A brief history of PBL in undergraduate…

Improving CME: Using Participant Satisfaction Measures to Specify Educational Methods

ERIC Educational Resources Information Center

Olivieri, Jason J.; Regala, Roderick P.

2013-01-01

Imagine having developed a continuing medical education (CME) initiative to educate physicians on updated guidelines regarding high cholesterol in adults. This initiative consisted of didactic presentations and case-based discussions offered in 5 major US cities, followed by a Web-based enduring component to distill key points of the live…

[Conflict of interest in continuing medical education - Studies on certified CME courses].

PubMed

Lenzen, Laura Marianne; Weidringer, Johann Wilhelm; Ollenschläger, Günter

2016-01-01

Although the problem of conflict of interest in medical education is discussed intensively, few valid data have been published on how to deal with the form, content, funding, sponsorship, and the influence of economic interests in continuing medical education (CME). Against this background, we carried out an analysis of data which had been documented for the purpose of certification by a German Medical Association. A central aim of the study was to obtain evidence of possible influences of economic interests on continuing medical education. Furthermore, strategies for quality assurance of CME contents and their implementation were to be examined. We analyzed all registration data for courses certified in the category D ("structured interactive CME via print media, online media and audiovisual media") by the Bavarian Chamber of Physicians in 2012. To measure the effects of conflict of interest, relationships between topics of training and variables relating to the alleged self-interest of the organizer/sponsor (for example, drug sales in a group of physicians) were statistically verified. These data were taken from the Bavarian Medical Statistics 2012 and the GKV-Arzneimittelschnellinformation. In 2012, a total of 734 CME course offerings have been submitted for 51 medical specialties by 30 course suppliers in the Bavarian Medical Association. To ensure the neutrality of interests of the CME courses the course suppliers signed a cooperation treaty ensuring their compliance with defined behavior towards the Bavarian Medical Association concerning sponsorship. The correlation between course topics and drug data suggests that course suppliers tend to submit topics that are economically attractive to them. There was a significant correlation between the number of CME courses in a specific field and the sales from drug prescriptions issued by physicians in the respective field. The results show that neutrality of interests regarding continuing medical education is difficult to achieve under the current framework for the organization, certification, and especially the funding of CME events in Germany. The cooperation agreement between the Bavarian Medical Association and training applicants is taken as an example of how legal certainty can be ensured. Based on the findings described below, suggestions and strategies to strengthen assessment expertise of course participants have been developed and elaborated. Copyright © 2016. Published by Elsevier GmbH.

Current practices in cancer pain management in Asia: a survey of patients and physicians across 10 countries.

PubMed

Kim, Yong-Chul; Ahn, Jin Seok; Calimag, Maria Minerva P; Chao, Ta Chung; Ho, Kok Yuen; Tho, Lye Mun; Xia, Zhong-Jun; Ward, Lois; Moon, Hanlim; Bhagat, Abhishek

2015-08-01

In order to implement more effective policies for cancer pain management, a better understanding of current practices is needed. Physicians managing cancer pain and patients experiencing cancer pain were randomly surveyed across 10 Asian countries to assess attitudes and perceptions toward cancer pain management. A total of 463 physicians (77.3% oncologists) with a median experience of 13 years were included. Medical school training on opioid use was considered inadequate by 30.5% of physicians and 55.9% indicated ≤ 10 h of continuing medical education (CME). Of the 1190 patients included, 1026 reported moderate-to-severe pain (median duration, 12 months). Discordance was observed between physician and patient outcomes on pain assessment with 88.3% of physicians reporting pain quantification, while 49.5% of patients claimed that no scale was used. Inadequate assessment of pain was recognized as a barrier to therapy optimization by 49.7% of physicians. Additional barriers identified were patients' reluctance owing to fear of addiction (67.2%) and adverse events (65.0%), patients' reluctance to report pain (52.5%), excessive regulations (48.0%) and reluctance to prescribe opioids (42.8%). Opioid use was confirmed only in 53.2% (286/538) of patients remembering their medication. Pain affected the activities of daily living for 81.3% of patients. These findings highlight the need for better training and CME opportunities for cancer pain management in Asia. Collaborative efforts between physicians, patients, policy makers, and related parties may assist in overcoming the barriers identified. Addressing the opioid stigma and enhancing awareness is vital to improving current standards of patient care. © 2015 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Current practices in cancer pain management in Asia: a survey of patients and physicians across 10 countries

PubMed Central

Kim, Yong-Chul; Ahn, Jin Seok; Calimag, Maria Minerva P; Chao, Ta Chung; Ho, Kok Yuen; Tho, Lye Mun; Xia, Zhong-Jun; Ward, Lois; Moon, Hanlim; Bhagat, Abhishek

2015-01-01

In order to implement more effective policies for cancer pain management, a better understanding of current practices is needed. Physicians managing cancer pain and patients experiencing cancer pain were randomly surveyed across 10 Asian countries to assess attitudes and perceptions toward cancer pain management. A total of 463 physicians (77.3% oncologists) with a median experience of 13 years were included. Medical school training on opioid use was considered inadequate by 30.5% of physicians and 55.9% indicated ≤10 h of continuing medical education (CME). Of the 1190 patients included, 1026 reported moderate-to-severe pain (median duration, 12 months). Discordance was observed between physician and patient outcomes on pain assessment with 88.3% of physicians reporting pain quantification, while 49.5% of patients claimed that no scale was used. Inadequate assessment of pain was recognized as a barrier to therapy optimization by 49.7% of physicians. Additional barriers identified were patients’ reluctance owing to fear of addiction (67.2%) and adverse events (65.0%), patients’ reluctance to report pain (52.5%), excessive regulations (48.0%) and reluctance to prescribe opioids (42.8%). Opioid use was confirmed only in 53.2% (286/538) of patients remembering their medication. Pain affected the activities of daily living for 81.3% of patients. These findings highlight the need for better training and CME opportunities for cancer pain management in Asia. Collaborative efforts between physicians, patients, policy makers, and related parties may assist in overcoming the barriers identified. Addressing the opioid stigma and enhancing awareness is vital to improving current standards of patient care. PMID:25914253

Can outcome-based continuing medical education improve performance of immigrant physicians?

PubMed

Castel, Orit Cohen; Ezra, Vered; Alperin, Mordechai; Nave, Rachel; Porat, Tamar; Golan, Avivit Cohen; Vinker, Shlomo; Karkabi, Khaled

2011-01-01

Immigrant physicians are a valued resource for physician workforces in many countries. Few studies have explored the education and training needs of immigrant physicians and ways to facilitate their integration into the health care system in which they work. Using an educational program developed for immigrant civilian physicians working in military primary care clinics at the Israel Defence Force, we illustrate how an outcome-based CME program can address practicing physicians' needs for military-specific primary care education and improve patient care. Following an extensive needs assessment, a 3-year curriculum was developed. The curriculum was delivered by a multidisciplinary educational team. Pre/post multiple-choice examinations, objective structured clinical examinations (OSCE), and end-of-program evaluations were administered for curriculum evaluation. To evaluate change in learners' performance, data from the 2003 (before-program) and 2006 (after-program) work-based assessments were retrieved retrospectively. Change in the performance of program participants was compared with that of immigrant physicians who did not participate in the program. Out of 28 learners, 23 (82%) completed the program. Learners did significantly better in the annual post-tests compared with the pretests (p <.01) and improved their OSCE scores (p <.001). Most program graduates (90%) rated overall satisfaction as very good or excellent. In comparison with nonparticipants, program graduates performed better on work-based assessments (Cohen's d =.63). Our intensive, outcome-based, longitudinal CME program has yielded encouraging results. Other medical educators, facing the challenge of integrating immigrant physicians to fit their health care system, may consider adapting our approach. Copyright © 2011 The Alliance for Continuing Medical Education, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

The mCME Project: A Randomized Controlled Trial of an SMS-Based Continuing Medical Education Intervention for Improving Medical Knowledge among Vietnamese Community Based Physicians' Assistants.

PubMed

Gill, Christopher J; Le Ngoc, Bao; Halim, Nafisa; Nguyen Viet, Ha; Larson Williams, Anna; Nguyen Van, Tan; McNabb, Marion; Tran Thi Ngoc, Lien; Falconer, Ariel; An Phan Ha, Hai; Rohr, Julia; Hoang, Hai; Michiel, James; Nguyen Thi Thanh, Tam; Bird, Liat; Pham Vu, Hoang; Yeshitla, Mahlet; Ha Van, Nhu; Sabin, Lora

2016-01-01

Community health workers (CHWs) provide critical services to underserved populations in low and middle-income countries, but maintaining CHW's clinical knowledge through formal continuing medical education (CME) activities is challenging and rarely occurs. We tested whether a Short Message Service (SMS)-based mobile CME (mCME) intervention could improve medical knowledge among a cadre of Vietnamese CHWs (Community Based Physician's Assistants-CBPAs) who are the leading providers of primary medical care for rural underserved populations. The mCME Project was a three arm randomized controlled trial. Group 1 served as controls while Groups 2 and 3 experienced two models of the mCME intervention. Group 2 (passive model) participants received a daily SMS bullet point, and were required to reply to the text to acknowledge receipt; Group 3 (interactive model) participants received an SMS in multiple choice question format addressing the same thematic area as Group 2, entering an answer (A, B, C or D) in their response. The server provided feedback immediately informing the participant whether the answer was correct. Effectiveness was based on standardized examination scores measured at baseline and endline (six months later). Secondary outcomes included job satisfaction and self-efficacy. 638 CBPAs were enrolled, randomized, and tested at baseline, with 592 returning at endline (93.7%). Baseline scores were similar across all three groups. Over the next six months, participation of Groups 2 and 3 remained high; they responded to >75% of messages. Group 3 participants answered 43% of the daily SMS questions correctly, but their performance did not improve over time. At endline, the CBPAs reported high satisfaction with the mCME intervention, and deemed the SMS messages highly relevant. However, endline exam scores did not increase over baseline, and did not differ between the three groups. Job satisfaction and self-efficacy scores also did not improve. Average times spent on self-study per week did not increase, and the kinds of knowledge resources used by the CBPAs did not differ between the three groups; textbooks, while widely available, were seldom used. The SMS-based mCME intervention, while feasible and acceptable, did not result in increased medical knowledge. We hypothesize that this was because the intervention failed to stimulate lateral learning. For an intervention of this kind to be effective, it will be essential to find more effective ways to couple SMS as a stimulus to promote increased self-study behaviors. ClinicalTrials.gov NCT02381743.

Who Is Driving Continuing Medical Education for Family Medicine?

ERIC Educational Resources Information Center

Klein, Douglas; Allan, G. Michael; Manca, Donna; Sargeant, Joan; Barnett, Carly

2009-01-01

Introduction: Considerable time and money are invested in continuing medical education (CME) for family physicians (FPs) but the effectiveness is uncertain. The participation of FPs as coordinators and teachers is not well known. The goal of this project was to describe the role of FPs in organizing and teaching CME events that are accredited for…

Can Rational Prescribing Be Improved by an Outcome-Based Educational Approach? A Randomized Trial Completed in Iran

ERIC Educational Resources Information Center

Esmaily, Hamideh M.; Silver, Ivan; Shiva, Shadi; Gargani, Alireza; Maleki-Dizaji, Nasrin; Al-Maniri, Abdullah; Wahlstrom, Rolf

2010-01-01

Introduction: An outcome-based education approach has been proposed to develop more effective continuing medical education (CME) programs. We have used this approach in developing an outcome-based educational intervention for general physicians working in primary care (GPs) and evaluated its effectiveness compared with a concurrent CME program in…

Advantages and Disadvantages of Educational Email Alerts for Family Physicians: Viewpoint

PubMed Central

Badran, Hani; Grad, Roland

2015-01-01

Background Electronic knowledge resources constitute an important channel for accredited Continuing Medical Education (CME) activities. However, email usage for educational purposes is controversial. On the one hand, family physicians become aware of new information, confirm what they already know, and obtain reassurance by reading educational email alerts. Email alerts can also encourage physicians to search Web-based resources. On the other hand, technical difficulties and privacy issues are common obstacles. Objective The purpose of this discussion paper, informed by a literature review and a small qualitative study, was to understand family physicians’ knowledge, attitudes, and behavior in regard to email in general and educational emails in particular, and to explore the advantages and disadvantages of educational email alerts. In addition, we documented participants’ suggestions to improve email alert services for CME. Methods We conducted a qualitative descriptive study using the “Knowledge, Attitude, Behavior” model. We conducted semi-structured face-to-face interviews with 15 family physicians. We analyzed the collected data using inductive-deductive thematic qualitative data analysis. Results All 15 participants scanned and prioritized their email, and 13 of them checked their email daily. Participants mentioned (1) advantages of educational email alerts such as saving time, convenience and valid information, and (2) disadvantages such as an overwhelming number of emails and irrelevance. They offered suggestions to improve educational email. Conclusions The advantages of email alerts seem to compensate for their disadvantages. Suggestions proposed by family physicians can help to improve educational email alerts. PMID:25803184

Continuing Dermatology Education for Rural Physician Assistants in Ghana: An Assessment of Needs and Effectiveness.

PubMed

Truong, Amanda; Cobb, Nadia M; Hawkes, Jason E; Adjase, Emmanuel T; Goldgar, David E; Powell, Douglas L; Lewis, Bethany K H

2018-03-01

To assess the effectiveness of lectures for continuing medical education (CME) in dermatology in a global health setting and to determine provider and patient demographics of physician assistants (PAs) practicing in rural Ghana. Physician assistants from Ghana who attended dermatology lectures at the International Seminar for Physician Assistants in 2011 or 2014 were included in this study. Surveys were administered to participants to determine dermatology resource availability, commonly encountered skin diseases, and management practices. Quizzes were administered before and after CME dermatology lectures to assess short-term retention of lecture material. In all, 353 PAs participated in this study. Physician assistants reported seeing an average of 55 patients per day. The most commonly seen skin diseases were infections, with antifungals and antibiotics being the most commonly prescribed medications. Dermatology-related complaints represented 9.5% of total clinic visits. Among practicing PAs, 23.2% reported having internet access. A total of 332 PAs completed the quizzes, and a statistically significant increase in test scores was noted in postlecture quizzes. This study reinforces the importance of dermatology education for PAs practicing in rural areas of Ghana and lends insight to critical topics for dermatology curriculum development. In addition, the increase in test scores after CME sessions suggests that lectures are an effective tool for short-term retention of dermatology-related topics. Our study indicates that as the need for health workers increases globally and a paradigm shift away from the traditional physician model of care occurs, dermatology training of PAs is not only important but also achievable.

Learning in a Virtual World: Experience With Using Second Life for Medical Education

PubMed Central

Heyden, Robin; Sternthal, Elliot; Merialdi, Mario

2010-01-01

Background Virtual worlds are rapidly becoming part of the educational technology landscape. Second Life (SL) is one of the best known of these environments. Although the potential of SL has been noted for health professions education, a search of the world’s literature and of the World Wide Web revealed a limited number of formal applications of SL for this purpose and minimal evaluation of educational outcomes. Similarly, the use of virtual worlds for continuing health professional development appears to be largely unreported. Methods We designed and delivered a pilot postgraduate medical education program in the virtual world, Second Life. Our objectives were to: (1) explore the potential of a virtual world for delivering continuing medical education (CME) designed for physicians; (2) determine possible instructional designs using SL for CME; (3) understand the limitations of SL for CME; (4) understand the barriers, solutions, and costs associated with using SL, including required training; and (5) measure participant learning outcomes and feedback. We trained and enrolled 14 primary care physicians in an hour-long, highly interactive event in SL on the topic of type 2 diabetes. Participants completed surveys to measure change in confidence and performance on test cases to assess learning. The post survey also assessed participants’ attitudes toward the virtual learning environment. Results Of the 14 participant physicians, 12 rated the course experience, 10 completed the pre and post confidence surveys, and 10 completed both the pre and post case studies. On a seven-point Likert scale (1, strongly disagree to 7, strongly agree), participants’ mean reported confidence increased from pre to post SL event with respect to: selecting insulin for patients with type 2 diabetes (pre = 4.9 to post = 6.5, P= .002); initiating insulin (pre = 5.0 to post = 6.2, P= .02); and adjusting insulin dosing (pre = 5.2 to post = 6.2, P= .02). On test cases, the percent of participants providing a correct insulin initiation plan increased from 60% (6 of 10) pre to 90% (9 of 10) post (P= .2), and the percent of participants providing correct initiation of mealtime insulin increased from 40% (4 of 10) pre to 80% (8 of 10) post (P= .09). All participants (12 of 12) agreed that this experience in SL was an effective method of medical education, that the virtual world approach to CME was superior to other methods of online CME, that they would enroll in another such event in SL, and that they would recommend that their colleagues participate in an SL CME course. Only 17% (2 of 12) disagreed with the statement that this potential Second Life method of CME is superior to face-to-face CME. Conclusions The results of this pilot suggest that virtual worlds offer the potential of a new medical education pedagogy to enhance learning outcomes beyond that provided by more traditional online or face-to-face postgraduate professional development activities. Obvious potential exists for application of these methods at the medical school and residency levels as well. PMID:20097652

Learning in a virtual world: experience with using second life for medical education.

PubMed

Wiecha, John; Heyden, Robin; Sternthal, Elliot; Merialdi, Mario

2010-01-23

Virtual worlds are rapidly becoming part of the educational technology landscape. Second Life (SL) is one of the best known of these environments. Although the potential of SL has been noted for health professions education, a search of the world's literature and of the World Wide Web revealed a limited number of formal applications of SL for this purpose and minimal evaluation of educational outcomes. Similarly, the use of virtual worlds for continuing health professional development appears to be largely unreported. We designed and delivered a pilot postgraduate medical education program in the virtual world, Second Life. Our objectives were to: (1) explore the potential of a virtual world for delivering continuing medical education (CME) designed for physicians; (2) determine possible instructional designs using SL for CME; (3) understand the limitations of SL for CME; (4) understand the barriers, solutions, and costs associated with using SL, including required training; and (5) measure participant learning outcomes and feedback. We trained and enrolled 14 primary care physicians in an hour-long, highly interactive event in SL on the topic of type 2 diabetes. Participants completed surveys to measure change in confidence and performance on test cases to assess learning. The post survey also assessed participants' attitudes toward the virtual learning environment. Of the 14 participant physicians, 12 rated the course experience, 10 completed the pre and post confidence surveys, and 10 completed both the pre and post case studies. On a seven-point Likert scale (1, strongly disagree to 7, strongly agree), participants' mean reported confidence increased from pre to post SL event with respect to: selecting insulin for patients with type 2 diabetes (pre = 4.9 to post = 6.5, P= .002); initiating insulin (pre = 5.0 to post = 6.2, P= .02); and adjusting insulin dosing (pre = 5.2 to post = 6.2, P= .02). On test cases, the percent of participants providing a correct insulin initiation plan increased from 60% (6 of 10) pre to 90% (9 of 10) post (P= .2), and the percent of participants providing correct initiation of mealtime insulin increased from 40% (4 of 10) pre to 80% (8 of 10) post (P= .09). All participants (12 of 12) agreed that this experience in SL was an effective method of medical education, that the virtual world approach to CME was superior to other methods of online CME, that they would enroll in another such event in SL, and that they would recommend that their colleagues participate in an SL CME course. Only 17% (2 of 12) disagreed with the statement that this potential Second Life method of CME is superior to face-to-face CME. The results of this pilot suggest that virtual worlds offer the potential of a new medical education pedagogy to enhance learning outcomes beyond that provided by more traditional online or face-to-face postgraduate professional development activities. Obvious potential exists for application of these methods at the medical school and residency levels as well.

Continuing medical education for general practitioners: a practice format

PubMed Central

VanNieuwenborg, Lena; Goossens, Martine; De Lepeleire, Jan; Schoenmakers, Birgitte

2016-01-01

Introduction Our current knowledge-based society and the many actualisations within the medical profession require a great responsibility of physicians to continuously develop and refine their skills. In this article, we reflect on some recent findings in the field of continuing education for professional doctors (continuing medical education, CME). Second, we describe the development of a CME from the Academic Center for General Practice (ACHG) of the KU Leuven. Methods First, we performed a literature study and we used unpublished data of a need assessment performed (2013) in a selected group of general practitioners. Second, we describe the development of a proposal to establish a CME programme for general practitioners. Results CME should go beyond the sheer acquisition of knowledge, and also seek changes in practice, attitudes and behaviours of physicians. The continuing education offerings are subject to the goals of the organising institution, but even more to the needs and desires of the end user. Conclusions Integrated education is crucial to meet the conditions for efficient and effective continuing education. The ACHG KU Leuven decided to offer a postgraduate programme consisting of a combination of teaching methods: online courses (self-study), contact courses (traditional method) and a materials database. PMID:26850504

Report on Proceedings of the Tenth Annual European CME Forum, Dublin, Ireland, November 2017

PubMed Central

Murray, Ron

2018-01-01

ABSTRACT The august setting of the Royal College of Physicians of Ireland saw participants from 17 different countries assemble for the Tenth European CME Forum between 8th and 10th November 2017. The main themes of the meeting were classified under the headings Inward (Educational design), Outward (Listening to others) and Onward (Collaborations and partnerships) addressed via a combination of presentations, interactive workshops, posters, and panel discussions. Topics explored included team engagement, the voice of the patient, harmonisation in European accreditation, competencies for CME professionals, and publishing in CME. Discussion evoked both consensus and contention and provided participants with excellent networking opportunities moving forward to the next decade of Forum meetings. PMID:29644142

Case Method in COPD education for primary care physicians: study protocol for a cluster randomised controlled trial.

PubMed

Sandelowsky, Hanna; Krakau, Ingvar; Modin, Sonja; Ställberg, Björn; Nager, Anna

2017-04-27

Chronic obstructive pulmonary disease (COPD) is a common cause of morbidity and mortality worldwide. It is often undiagnosed and insufficiently managed. Effective forms of continuing medical education (CME) for primary care physicians (PCPs) are necessary to ensure the implementation of guidelines in clinical practice and, thus, improve patients' health. In this study, we will measure the effects of CME by Case Method and compare them against those of traditional lectures and no CME at all through an unblinded, cluster randomised controlled trial (CRCT). Thirty-three primary health care centres (PHCCs) in Stockholm, Sweden, with a total of 180 PCPs will be involved. Twenty-two primary PHCCs, will be cluster-randomised into: an intervention group who will receive CME by Case Method (n = 11) and a control group who will receive traditional lectures (n = 11). The remaining PHCCs (n = 11) will be a reference group and will receive no CME. From the intervention and control groups, 460 randomly selected patients with COPD in GOLD stages 2 and 3 will participate, while no patients will be recruited from the reference group. For the patients, smoking status, actual treatment and urgent visits to a health provider due to airway problems will be registered. For the PCPs, professional competence (i.e. knowledge and management skills) in COPD, will be measured using a questionnaire based on current guidelines and guideline implementation problems in clinical practice which has previously been described by the authors. Data will be collected at baseline and at follow-up, which will be after 1.5 years for the patients, and 1 year for the PCPs. Statistical methods for individual-level and cluster-level analyses will be used. COPD is considered a particularly complex clinical challenge involving managing multimorbidity, symptom adaptation, and lifestyle problematisation. Case Method in CME for PCPs may contribute to a better understanding of the impact of COPD on patients' lives and, thus, improve their management of it. The present study is expected to contribute scientific knowledge about indicators for an effective CME in COPD that is tailor-made to primary care physicians. ClinicalTrials.gov, identifier: NCT02213809 . Registered on 10 August 2014. Protocol version: Issue date: May 2014.

Educating doctors on evaluation of fitness to drive: impact of a case-based workshop.

PubMed

Dow, Jamie; Jacques, André

2012-01-01

In 2004, faced with demographic data predicting large increases in the number of older drivers within a relatively short period combined with the realization that screening for driver fitness was largely dependent on health professionals, principally physicians, the Société de l'assurance automobile du Québec (SAAQ) initiated measures to achieve better cooperation with the health professionals performing the screening. A continuing medical education (CME) program was initiated to improve the health professionals' understanding of road safety considerations. This article describes the program and its impact. A 90-minute workshop combining presentation and discussion methods and centering on five case studies was developed and delivered to 824 participants. Outcomes were evaluated at the levels of satisfaction and performance. Participants reported a high level of satisfaction with the workshop. Data suggest that there was an increase in the number of reports submitted by physicians. The quality of physician reports also improved. SAAQ statistics show the benefit of its CME program. Informed physicians appear more willing to report drivers with medical problems affecting driver fitness, especially when they are asked to provide functional evaluations and not make decisions about fitness to drive. We believe that the success of this program was due to several factors: (1) its clinical rather than administrative orientation, (2) the use of physicians to deliver the workshop, and (3) formal recognition of the program by the authority responsible for licensing physicians. Copyright © 2012 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

Effectiveness of e-learning in continuing medical education for occupational physicians.

PubMed

Hugenholtz, Nathalie I R; de Croon, Einar M; Smits, Paul B; van Dijk, Frank J H; Nieuwenhuijsen, Karen

2008-08-01

Within a clinical context e-learning is comparable to traditional approaches of continuing medical education (CME). However, the occupational health context differs and until now the effect of postgraduate e-learning among occupational physicians (OPs) has not been evaluated. To evaluate the effect of e-learning on knowledge on mental health issues as compared to lecture-based learning in a CME programme for OPs. Within the context of a postgraduate meeting for 74 OPs, a randomized controlled trial was conducted. Test assessments of knowledge were made before and immediately after an educational session with either e-learning or lecture-based learning. In both groups, a significant gain in knowledge on mental health care was found (P < 0.05). However, there was no significant difference between the two educational approaches. The effect of e-learning on OPs' mental health care knowledge is comparable to a lecture-based approach. Therefore, e-learning can be beneficial for the CME of OPs.

Feasibility of a knowledge translation CME program: Courriels Cochrane.

PubMed

Pluye, Pierre; Grad, Roland; Granikov, Vera; Theriault, Guyléne; Frémont, Pierre; Burnand, Bernard; Mercer, Jay; Marlow, Bernard; Arroll, Bruce; Luconi, Francesca; Légaré, France; Labrecque, Michel; Ladouceur, Roger; Bouthillier, France; Sridhar, Soumya Bindiganavile; Moscovici, Jonathan

2012-01-01

Systematic literature reviews provide best evidence, but are underused by clinicians. Thus, integrating Cochrane reviews into continuing medical education (CME) is challenging. We designed a pilot CME program where summaries of Cochrane reviews (Courriels Cochrane) were disseminated by e-mail. Program participants automatically received CME credit for each Courriel Cochrane they rated. The feasibility of this program is reported (delivery, participation, and participant evaluation). We recruited French-speaking physicians through the Canadian Medical Association. Program delivery and participation were documented. Participants rated the informational value of Courriels Cochrane using the Information Assessment Method (IAM), which documented their reflective learning (relevance, cognitive impact, use for a patient, expected health benefits). IAM responses were aggregated and analyzed. The program was delivered as planned. Thirty Courriels Cochrane were delivered to 985 physicians, and 127 (12.9%) completed at least one IAM questionnaire. Out of 1109 Courriels Cochrane ratings, 973 (87.7%) conta-ined 1 or more types of positive cognitive impact, while 835 (75.3%) were clinically relevant. Participants reported the use of information for a patient and expected health benefits in 595 (53.7%) and 569 (51.3%) ratings, respectively. Program delivery required partnering with 5 organizations. Participants valued Courriels Cochrane. IAM ratings documented their reflective learning. The aggregation of IAM ratings documented 3 levels of CME outcomes: participation, learning, and performance. This evaluation study demonstrates the feasibility of the Courriels Cochrane as an approach to further disseminate Cochrane systematic literature reviews to clinicians and document self-reported knowledge translation associated with Cochrane reviews. Copyright © 2012 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

eLearning: a review of Internet-based continuing medical education.

PubMed

Wutoh, Rita; Boren, Suzanne Austin; Balas, E Andrew

2004-01-01

The objective was to review the effect of Internet-based continuing medical education (CME) interventions on physician performance and health care outcomes. Data sources included searches of MEDLINE (1966 to January 2004), CINAHL (1982 to December 2003), ACP Journal Club (1991 to July/August 2003), and the Cochrane Database of Systematic Reviews (third quarter, 2003). Studies were included in the analyses if they were randomized controlled trials of Internet-based education in which participants were practicing health care professionals or health professionals in training. CME interventions were categorized according to the nature of the intervention, sample size, and other information about educational content and format. Sixteen studies met the eligibility criteria. Six studies generated positive changes in participant knowledge over traditional formats; only three studies showed a positive change in practices. The remainder of the studies showed no difference in knowledge levels between Internet-based interventions and traditional formats for CME. The results demonstrate that Internet-based CME programs are just as effective in imparting knowledge as traditional formats of CME. Little is known as to whether these positive changes in knowledge are translated into changes in practice. Subjective reports of change in physician behavior should be confirmed through chart review or other objective measures. Additional studies need to be performed to assess how long these new learned behaviors could be sustained. eLearning will continue to evolve as new innovations and more interactive modes are incorporated into learning.

Teleconferenced Educational Detailing: Diabetes Education for Primary Care Physicians

ERIC Educational Resources Information Center

Harris, Stewart B.; Leiter, Lawrence A.; Webster-Bogaert, Susan; Van, Daphne M.; O'Neill, Colleen

2005-01-01

Introduction: Formal didactic continuing medical education (CME) is relatively ineffective for changing physician behavior. Diabetes mellitus is an increasingly prevalent disease, and interventions to improve adherence to clinical practice guidelines (CPGs) are needed. Methods: A stratified, cluster-randomized, controlled trial design was used to…

Does an outcome-based approach to continuing medical education improve physicians' competences in rational prescribing?

PubMed

Esmaily, Hamideh M; Savage, Carl; Vahidi, Rezagoli; Amini, Abolghasem; Dastgiri, Saeed; Hult, Hakan; Dahlgren, Lars Owe; Wahlstrom, Rolf

2009-11-01

Continuing medical education (CME) is compulsory in Iran, and traditionally it is lecture-based, which is mostly not successful. Outcome-based education has been proposed for CME programs. To evaluate the effectiveness of an outcome-based educational intervention with a new approach based on outcomes and aligned teaching methods, on knowledge and skills of general physicians (GPs) working in primary care compared with a concurrent CME program in the field of "Rational prescribing". The method used was cluster randomized controlled design. All GPs working in six cities in one province in Iran were invited to participate. The cities were matched and randomly divided into an intervention arm for education on rational prescribing with an outcome-based approach, and a control arm for a traditional program on the same topic. Knowledge and skills were assessed using a pre- and post-test, including case scenarios. In total, 112 GPs participated. There were significant improvements in knowledge and prescribing skills after the training in the intervention arm as well as in comparison with the changes in the control arm. The overall intervention effect was 26 percentage units. The introduction of an outcome-based approach in CME appears to be effective when creating programs to improve GPs' knowledge and skills.

The Haiti Medical Education Project: development and analysis of a competency based continuing medical education course in Haiti through distance learning.

PubMed

Battat, Robert; Jhonson, Marc; Wiseblatt, Lorne; Renard, Cruff; Habib, Laura; Normil, Manouchka; Remillard, Brian; Brewer, Timothy F; Sacajiu, Galit

2016-10-19

Recent calls for reform in healthcare training emphasize using competency-based curricula and information technology-empowered learning. Continuing Medical Education programs are essential in maintaining physician accreditation. Haitian physicians have expressed a lack access to these activities. The Haiti Medical Education Project works in alliance with Haitian medical leadership, faculty and students to support the Country's medical education system. We present the creation, delivery and evaluation of a competency-based continuing medical education curriculum for physicians in rural Haiti. Real time lectures from local and international institutions were teleconferenced to physicians in remote Haitian sites using VidyoConferencing™ technology. With American Academy of Family Physicians (AAFP) and College of Family Physicians Canada (CFPC) guidelines as references, a competency-derived syllabus was created for a Haitian continuing medical education program. The resulting educational goals were reviewed by a committee of Haitian and North American physician/medical education practitioners to reflect local needs. All authors reviewed lectures and then conferred to establish agreement on competencies presented for each lecture. Sixty-seven lectures were delivered. Human immunodeficiency virus/Acquired Immunodeficiency Syndrome, ophthalmologic, infectious diseases, renal and endocrine competencies were well-represented, with more than 50 % of the joint AAFP and CFPC recommended competencies outlined. Areas under-represented included allergy and immunology, cardiology, surgery, pain management, gastroenterology, neurology, pulmonology, men's health and rheumatology; these topics accounted for less than 25 % of AAFP/CFPC recommended competencies. Areas not covered included geriatrics, nutrition, occupational health and women's health. Within practice-based lectures, only disaster medicine, health promotion and information management were included, but only partially covered. We identified teaching goals covered and competencies that were missing from a CME program for rural Haitian physicians. We aim to use this analysis to provide a competency-based CME lecture series that proportionally meets local needs while following recommendations of recognized national family medicine organizations.

Effects of a CME Program on Physicians' Transfusion Practices.

ERIC Educational Resources Information Center

Hull, Alan L.; And Others

1989-01-01

The hospital charts of 44 patients who were autologous blood donors undergoing elective orthopedic surgery and a matched group of 44 patients who were not autologous blood donors were analyzed to determine their physicians' transfusion practices. A continuing medical education program was developed. (Author/MLW)

Family physicians' information seeking behaviors: a survey comparison with other specialties.

PubMed

Bennett, Nancy L; Casebeer, Linda L; Kristofco, Robert; Collins, Blanche C

2005-03-22

Using technology to access clinical information has become a critical skill for family physicians. The aims of this study were to assess the way family physicians use the Internet to look for clinical information and how their patterns vary from those of specialists. Further, we sought a better understanding of how family physicians used just-in-time information in clinical practice. A fax survey was provided with 17 items. The survey instrument, adapted from two previous studies, was sent to community-based physicians. The questions measured frequency of use and importance of the Internet, palm computers, Internet CME, and email for information seeking and CME. Barriers to use were explored. Demographic data was gathered concerning gender, years since medical school graduation, practice location, practice type, and practice specialty. Family physicians found the Internet to be useful and important as an information source. They were more likely to search for patient oriented material than were specialists who more often searched literature, journals and corresponded with colleagues. Hand held computers were used by almost half of family physicians. Family physicians consider the Internet important to the practice of medicine, and the majority use it regularly. Their searches differ from colleagues in other specialties with a focus on direct patient care questions. Almost half of family physicians use hand held computers, most often for drug reference.

[An online emergency physician survey - demography, education and experience of German emergency physicians].

PubMed

Ilper, H; Kunz, T; Walcher, F; Zacharowski, K; Byhahn, C

2013-04-01

German emergency patients are treated by (emergency) physicians (EP). The entry level to emergency medicine differs. Manual skills experience (e. g. tracheal intubation) and knowledge of guidelines are minimum requirements. It is currently unclear who works as an EP and what medical experience he or she has. The anonymous survey was online from 10/15/2010 to 11/16/2011 and distribution was supported by leading physicians informing society members. Online networks informed independent physicians. 2091 EP took part, 1991 datasets were evaluated, 100 datasets were excluded. All results are shown as mean ± standard deviation and range (minimum - maximum). Mean age of the EP was 42 ± 8 years (26-71 years), 80 % (n = 1604) were male, 20 % (n = 387) were female. Participants finished medical school in 1997 ± 8 years (1964-2010). Base specialty during rotation was anesthesiology 59 %, internal medicine 32 %, surgery 26 %, trauma surgery/orthopedics 21 %, others 16 %. Consultants were 75 %. Main income source was answered as "hospital physician" by 77 %, "resident doctor" by 15 %, "professional emergency physician" by 7 %. The participants use a widespread chance for CME (Continuing Medical Education). The participants appear experienced in medicine and emergency medicine. They use a widespread chance for CME. Most of the participants work in anaesthesiology. © Georg Thieme Verlag KG Stuttgart · New York.

Morphea

MedlinePlus

... Spring Meeting Meeting Feedback CME CME Attestation CME Disclosure CME Objectives CME Requirements OCC GME Training ACGME ... 2017 Foundation for Osteopathic Dermatology 7/6/2016 Disclosure to members regarding CME activities 4/3/2014 ...

Atypical Moles

MedlinePlus

... Spring Meeting Meeting Feedback CME CME Attestation CME Disclosure CME Objectives CME Requirements OCC GME Training ACGME ... 2017 Foundation for Osteopathic Dermatology 7/6/2016 Disclosure to members regarding CME activities 4/3/2014 ...

Lichen Striatus

MedlinePlus

... Spring Meeting Meeting Feedback CME CME Attestation CME Disclosure CME Objectives CME Requirements OCC GME Training ACGME ... 2017 Foundation for Osteopathic Dermatology 7/6/2016 Disclosure to members regarding CME activities 4/3/2014 ...

Does familiarity with CDC guidelines, continuing education, and provider characteristics influence adherence to chronic pain management practices and opioid prescribing?

PubMed

McCalmont, Jean C; Jones, Kim D; Bennett, Robert M; Friend, Ronald

(1) To assess providers' experience and knowledge of chronic noncancer pain (CNCP) management. (2) To assess providers' utilization of the Centers for Disease Control and Prevention (CDC) 2016 Guideline for Prescribing Opioids for Chronic Pain. (3) To assess the influence of the 2016 CDC guideline on provider confidence in managing CNCP and adherence to the CDC recommendations. A cross-sectional, web-based survey conducted with 417 Oregon prescribing providers, divided into three continuing medical education (CME) groups composed of minimal (0-3), moderate (4-10), and high (≥11) hours of training. The three CME groups were associated with increased use of CDC opioid recommended practices (29.4, 34.2, 38.8; p = 0.001; scale 0-50), opioid conversion confidence (5.5, 6.5, 7.4; p < 0.001; scale 0-9), and confidence in pain management (5.5, 5.9, 6.9; p < 0.001, scale 0-9). Slightly more providers utilized CDC recommended practices than did not (57 vs 43 percent). However, CME groups differed substantially in utilization of CDC practices (42 vs 57 vs 72 percent; p < 0.001). Neither providers' profession (physician vs nurse practitioner [NP]) nor geographic setting (urban vs rural) showed differences in use of recommended practices or general confident in pain management (all p > 0.05); however, physicians were slightly more confident in opioid dose conversion than NPs (6.9 vs 5.9; p < 0. 001, scale 0-9). Higher hours of recent CME positively benefit provider confidence in pain management and utilization of CDC recommended practices. NPs and rural providers were equivalent to their physician and urban counterparts on confidence and adherence to CDC practices, with minor exceptions.

Cutaneous Larva Migrans

MedlinePlus

... Spring Meeting Meeting Feedback CME CME Attestation CME Disclosure CME Objectives CME Requirements OCC GME Training ACGME ... 2017 Foundation for Osteopathic Dermatology 7/6/2016 Disclosure to members regarding CME activities 4/3/2014 ...

Telogen Effluvium Hair Loss

MedlinePlus

... Spring Meeting Meeting Feedback CME CME Attestation CME Disclosure CME Objectives CME Requirements OCC GME Training ACGME ... 2017 Foundation for Osteopathic Dermatology 7/6/2016 Disclosure to members regarding CME activities 4/3/2014 ...

[Online continuing medical education based on national disease management guidelines. The e-learning platform leitlinien-wissen.de].

PubMed

Vollmar, H C; Schürer-Maly, C-C; Lelgemann, M; Koneczny, N; Koch, M; Butzlaff, M

2006-05-01

Effective translation of relevant knowledge into clinical practice is essential for modern health care systems. National Disease Management Guidelines (NDMG) are considered relevant instruments to support this transfer. To implement NDMG Internet-based continuing medical education (CME), modules and online case-based learning objects were designed and published. To ensure high quality the contents are based on NDMG and subjected to multi-step review processes. Presentation on the web was realized through a modified content management system. To obtain a CME certificate, completing an online questionnaire using a four-point Likert scale was mandatory. Between June 2003 and April 2005, 3,105 physicians were registered and used the platform: 95% of the physicians expressed positive feedback in the evaluation questionnaire, and 35% actually used the corresponding NDMG in practice. This prompted the development of interactive medical case-based learning objects as a second learning pathway. An Internet platform for CME including case-based learning objects can be a helpful tool to assure the provision of scientific knowledge for patient care.

[Evidence based medicine. A new paradigm for medical practice].

PubMed

Carneiro, A V

1998-01-01

Modern medical practice is an ever-changing process, and the doctor's need for information has been partially met by continuous medical education (CME) activities. It has been shown that CME activities have not prevented clinical knowledge, as well as medical practice, from deteriorating with time. When faced with the need to get the most recent and relevant information possible, the busy clinician has two major problems: most of the published medical literature is either irrelevant or not useful; and there is little time to read it. Evidence-based medicine constitutes a new paradigm for medical practice in the sense that it tries to transform clinical problems into well formulated clinical questions, selecting and critically appraising scientific evidence with predefined and rigorous rules. It combines the expertise of the individual clinician with the best external evidence from clinical research for rational, ethical and efficacious practice. Evidence-based medicine can be taught and practiced by physicians with different degrees of autonomy, with several subspecialties, working in the hospital or in outpatient clinics, alone or in groups.

Ex vivo and in vivo studies of CME-1, a novel polysaccharide purified from the mycelia of Cordyceps sinensis that inhibits human platelet activation by activating adenylate cyclase/cyclic AMP.

PubMed

Lu, Wan-Jung; Chang, Nen-Chung; Jayakumar, Thanasekaran; Liao, Jiun-Cheng; Lin, Mei-Jiun; Wang, Shwu-Huey; Chou, Duen-Suey; Thomas, Philip Aloysius; Sheu, Joen-Rong

2014-12-01

CME-1, a novel water-soluble polysaccharide, was purified from the mycelia of Cordyceps sinensis, and its chemical structure was characterized to contain mannose and galactose in a ratio of 4:6 (27.6 kDa). CME-1 was originally observed to exert a potent inhibitory effect on tumor migration and a cytoprotective effect against oxidative stress. Activation of platelets caused by arterial thrombosis is relevant to various cardiovascular diseases (CVDs). However, no data are available concerning the effects of CME-1 on platelet activation. Hence, the purpose of this study was to examine the ex vivo and in vivo antithrombotic effects of CME-1 and its possible mechanisms in platelet activation. The aggregometry, immunoblotting, flow cytometric analysis and platelet functional analysis were used in this study. CME-1 (2.3-7.6 μM) exhibited highly potent activity in inhibiting human platelet aggregation when stimulated by collagen, thrombin, and arachidonic acid but not by U46619. CME-1 inhibited platelet activation accompanied by inhibiting Akt, mitogen-activated protein kinases (MAPKs), thromboxane B2 (TxB2) and hydroxyl radical (OH(●)) formation. However, CME-1 interrupted neither FITC-triflavin nor FITC-collagen binding to platelets. CME-1 markedly increased cyclic AMP levels, but not cyclic GMP levels, and stimulated vasodilator-stimulated phosphoprotein (VASP) phosphorylation. SQ22536, an inhibitor of adenylate cyclase, but not ODQ, an inhibitor of guanylate cyclase, obviously reversed the CME-1-mediated effects on platelet aggregation and vasodilator-stimulated phosphoprotein (VASP), Akt, p38 MAPK phosphorylation, and TxB2 formation. CME-1 substantially prolonged the closure time of whole blood and the occlusion time of platelet plug formation. This study demonstrates for the first time that CME-1 exhibits highly potent antiplatelet activity that may initially activate adenylate cyclase/cyclic AMP and, subsequently, inhibit intracellular signals (such as Akt and MAPKs), ultimately inhibiting platelet activation. This novel role of CME-1 indicates that CME-1 exhibits high potential for application in treating and preventing CVDs. Copyright © 2014 Elsevier Ltd. All rights reserved.

Lexical analysis of the Code of Medical Ethics of the Federal Council of Medicine.

PubMed

Andrade, Edson de Oliveira; Andrade, Edson de Oliveira

2016-04-01

The Code of Medical Ethics (CME) of the Federal Council of Medicine is the legal document that exposes the moral discourse of Brazilian physicians to society and the profession. It is a set of propositions based on which doctors say they are committed to values of conduct aimed at fair and proper professional practice. To verify through lexical analysis of the CME corpus if the goals presented in the arguments of the resolution that established the code are properly addressed in these regulations. This is a quantitative and qualitative study of descriptive nature, aiming at a lexical analysis of the CME. The lexical analysis was performed using a method of Top-Down Hierarchical Classification of vocabulary, as described by Reinert in 1987, assuming that words used in similar contexts are associated with a single lexical world. In addition to the analysis of results, an improved representation of the charts related with Factorial and Similitude Analyses was made. Six clusters were extracted, leading to the identification of three major branches: health care, professional practice and research. These branches revolve around the figures of physician and patient. The similitude analysis revealed a complementarity status between these two figures. The lexical analysis showed that the purposes contained in the resolution that established the CME were adequately represented in the document body.

Postgraduate Educational Program for Primary Care Physicians in Remote Areas in Lebanon

ERIC Educational Resources Information Center

Saab, Bassem Roberto; Kanaan, Nabil; Hamadeh, Ghassan; Usta, Jinan

2003-01-01

Introduction: Continuing medical education (CME) is a requirement in many developed countries. Lebanon lacks such a rule; hence, the dictum "once a doctor always a doctor" holds. This article describes a pioneering postgraduate educational program for primary care physicians in remote areas of Lebanon. Method: The Lebanese Society of…

Continuing Medical Education: What Delivery Format Do Physicians Prefer?

ERIC Educational Resources Information Center

Stancic, Nancy; Mullen, Patricia Dolan; Prokhorov, Alexander V.; Frankowski, Ralph F.; McAlister, Alfred L.

2003-01-01

Background: Although physicians are in a unique position to prevent life-threatening outcomes by counseling patients to stop smoking, many of them miss the opportunity to intervene in their patients' use of tobacco. Nicotine Dependence Across the Lifespan was developed as a continuing medical education (CME) program to teach and encourage…

Point of care information services: a platform for self-directed continuing medical education for front line decision makers

PubMed Central

Moja, Lorenzo; Kwag, Koren Hyogene

2015-01-01

The structure and aim of continuing medical education (CME) is shifting from the passive transmission of knowledge to a competency-based model focused on professional development. Self-directed learning is emerging as the foremost educational method for advancing competency-based CME. In a field marked by the constant expansion of knowledge, self-directed learning allows physicians to tailor their learning strategy to meet the information needs of practice. Point of care information services are innovative tools that provide health professionals with digested evidence at the front line to guide decision making. By mobilising self-directing learning to meet the information needs of clinicians at the bedside, point of care information services represent a promising platform for competency-based CME. Several points, however, must be considered to enhance the accessibility and development of these tools to improve competency-based CME and the quality of care. PMID:25655251

Using developmental research to design innovative knowledge translation technology for spinal cord injury in primary care: Actionable Nuggets™ on SkillScribe™.

PubMed

Smith, Karen M; Naumann, Danielle N; McDiarmid Antony, Laura; McColl, Mary Ann; Aiken, Alice

2014-09-01

Actionable Nuggets™ for spinal cord injury (SCI) are a knowledge translation tool facilitating evidence-based primary care practice, originally developed in 2010 and refined in 2013. Evaluation results from these two phases of development have informed the design of SkillScribe™, an innovative electronic platform intended to offer reflective continuing medical education (CME) programming through mobile devices in order to support the key features of the Actionable Nuggets™ approach. This brief article describes the ongoing development of Actionable Nuggets™ for SCI on SkillScribe™ by: (1) summarizing the work to date on Actionable Nuggets™; (2) describing evaluation results of Actionable Nuggets™; (3) placing SkillScribe™ in the context of adult education. Developmental Research Design. Canadian primary care. Primary care physicians; specialist physicians. Twenty educational modules on SCI. Pre- and post-test knowledge survey, feedback and use statistics, impact assessment survey, qualitative analysis of evaluation data. In both hard copy and electronic form, physicians report that Actionable Nuggets™ are an acceptable and useful approach to providing CME for low-prevalence, high-impact conditions like SCI. The key elements of this tool are that they: offer evidence-based information in small, focused "nuggets"; position information where physicians most frequently seek it; offer information in a format that permits direct translation into action in primary care; allow time for reflection; attach practice tools; and offer CME credit. Actionable Nuggets™ for SCI, delivered using a convenient and portable electronic medium, with time-released content and interactive testing has the potential to improve the primary care of patients with SCI.

Solar and interplanetary activities of isolated and non-isolated coronal mass ejections

NASA Astrophysics Data System (ADS)

Bendict Lawrance, M.; Shanmugaraju, A.; Moon, Y.-J.; Umapathy, S.

2017-07-01

We report our results on comparison of two halo Coronal Mass Ejections (CME) associated with X-class flares of similar strength (X1.4) but quite different in CME speed and acceleration, similar geo-effectiveness but quite different in Solar Energetic Particle (SEP) intensity. CME1 (non-isolated) was associated with a double event in X-ray flare and it was preceded by another fast halo CME of speed = 2684 km/s (pre-CME) associated with X-ray flare class X5.4 by 1 h from the same location. Since this pre-CME was more eastern, interaction with CME1 and hitting the earth were not possible. This event (CME1) has not suffered the cannibalism since pre-CME has faster speed than post-CME. Pre-CME plays a very important role in increasing the intensity of SEP and Forbush Decrease (FD) by providing energetic seed particles. So, the seed population is the major difference between these two selected events. CME2 (isolated) was a single event. We would like to address on the kinds of physical conditions related to such CMEs and their associated activities. Their associated activities such as, type II bursts, SEP, geomagnetic storm and FD are compared. The following results are obtained from the analysis. (1) The CME leading edge height at the start of metric/DH type II bursts are 2 R⊙/ 4 R⊙ for CME1, but 2 R⊙/ 2.75 R⊙ for CME2. (2) Peak intensity of SEP event associated with the two CMEs are quite different: 6530 pfu for CME1, but 96 pfu for CME2. (3) The Forbush decrease occurred with a minimum decrease of 9.98% in magnitude for CME1, but 6.90% for CME2. (4) These two events produced similar intense geomagnetic storms of intensity of Dst index -130 nT. (5) The maximum southward magnetic fields corresponding to Interplanetary CME (ICME) of these two events are nearly the same, but there is difference in Sheath Bz maximum (-14.2, -6.9 nT). (6) The time-line chart of the associated activities of two CMEs show some difference in the time delay between the onsets of activities with respect to the onset of flare/CME.

E-learning for occupational physicians' CME: a study case.

PubMed

Mazzoleni, M Cristina; Rognoni, Carla; Finozzi, Enrico; Gri, Tommaso; Pagani, Marco; Imbriani, Marcello

2011-01-01

The present study reports the results of the evaluation of an e-learning CME course in the field of Occupational Medicine. In particular the following aspects have been investigated: If and how the course contents have met the educational users' needs; The effectiveness of the course in terms of knowledge improvement; Users' behaviour. Attendance data and results of a sample of 1128 attendees have been analyzed via ad hoc developed tools for direct inspection of Moodle CMS database. The results document the effectiveness of the e-learning course, as regards meeting the educational needs of physicians and also the improvement in terms of knowledge and problem solving skill acquisition. Users' behaviour has revealed a certain tendency for passing the tests, more than for pursuing the best possible result. Interaction with the tutor is low.

Zika Virus and Pregnancy

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Continuing medical education-driven skills acquisition and impact on improved patient outcomes in family practice setting.

PubMed

Bellamy, N; Goldstein, L D; Tekanoff, R A

2000-01-01

An abundance of educational theory, design, and delivery of continuing medical education (CME) learning interventions, including their impact on learners, are described in the health and social sciences literature. However, establishing a direct correlation between the acquisition of new skills by learners and patient outcomes as a result of a planned CME learning intervention has been difficult to demonstrate. The learning intervention described here tested the impact of an injection skills-acquisition program for family physicians treating osteoarthritis of the knee by measuring patient outcomes using the pain and function subscales of the Western Ontario and McMaster (WOMAC) 3.0 osteoarthritis index, a standardized and fully validated patient-centered outcome measurement. It was hypothesized that patients of family physicians who participated in this skills-acquisition CME program would benefit from treatment administered by their physician during the time between injection skills acquisition to 6 weeks post-injection. Inclusion of a validated health status measure administered pre- and post-injection in addition to more traditional faculty and participant program evaluations was deemed necessary to test this hypothesis. Rheumatology, orthopedic surgery, and family medicine specialists from across Canada were invited to contribute to the planning, curriculum elaboration, and delivery of the viscosupplement injector preceptorship (VIP) program. Thirty-nine orthopedic and rheumatology specialists agreed to serve as expert faculty and participated in training 474 Canadian family and general practitioners over 8 months. The learning intervention involved a review of pertinent literature by a local preceptor and a summary of recommendations of the planning committee, followed by demonstration of injector skills and then supervised practice with patients, who received hylan G-F 20 (Synvisc, Ridgefield, NJ) usually in the offices of the family physicians. The pain and function subscales of the WOMAC 3.0 questionnaire were self-administered to each patient in their physician's office, prior to receiving their joint injection and again at or near 6-weeks post-injection. Data were analyzed in the Department of Epidemiology and Biostatistics at The University of Western Ontario, London, ON. Clinically important statistically significant improvements in pain and physical function were noted in patients who received viscosupplementation treatment from family physicians who had recently acquired the necessary injection skills. Approximately three-quarters of the patients experienced a reduction in pain and an improvement in physical function of at least 20%. These results suggest a positive relationship between acquisition of a new skill by learners and improved patient outcomes as a result of this planned CME learning intervention.

Comparison of the Effectiveness of Interactive Didactic Lecture Versus Online Simulation-Based CME Programs Directed at Improving the Diagnostic Capabilities of Primary Care Practitioners.

PubMed

McFadden, Pam; Crim, Andrew

2016-01-01

Diagnostic errors in primary care contribute to increased morbidity and mortality, and billions in costs each year. Improvements in the way practicing physicians are taught so as to optimally perform differential diagnosis can increase patient safety and lower the costs of care. This study represents a comparison of the effectiveness of two approaches to CME training directed at improving the primary care practitioner's diagnostic capabilities against seven common and important causes of joint pain. Using a convenience sampling methodology, one group of primary care practitioners was trained by a traditional live, expert-led, multimedia-based training activity supplemented with interactive practice opportunities and feedback (control group). The second group was trained online with a multimedia-based training activity supplemented with interactive practice opportunities and feedback delivered by an artificial intelligence-driven simulation/tutor (treatment group). Before their respective instructional intervention, there were no significant differences in the diagnostic performance of the two groups against a battery of case vignettes presenting with joint pain. Using the same battery of case vignettes to assess postintervention diagnostic performance, there was a slight but not statistically significant improvement in the control group's diagnostic accuracy (P = .13). The treatment group, however, demonstrated a significant improvement in accuracy (P < .02; Cohen d, effect size = 0.79). These data indicate that within the context of a CME activity, a significant improvement in diagnostic accuracy can be achieved by the use of a web-delivered, multimedia-based instructional activity supplemented by practice opportunities and feedback delivered by an artificial intelligence-driven simulation/tutor.

The continuing medical education activities and attitudes of Australian doctors working in different clinical specialties and practice locations.

PubMed

Stewart, Grant D; Khadra, Mohamed H

2009-02-01

Currently, it is not clear which continuing medical education (CME) methods are being used by senior doctors and what their attitudes towards them are. The aims of this study were to investigate which modes of CME delivery senior Australian doctors utilise, to assess doctors' attitudes towards CME and to determine any differences in modes used and attitudes between clinical specialties and practice locations. A 52-statement questionnaire enquiring about doctors' current CME activities and their attitudes towards CME was distributed to 1336 senior Australian doctors. 494 doctors responded to the questionnaire. Traditional forms of CME (eg, meetings, conferences, journals and lectures) were most commonly used. Doctors thought CME involving face-to-face interaction was superior to electronic forms of CME. All doctors, especially those in hospital practice, had a positive attitude towards CME but found lack of time a barrier to learning. Rural doctors found CME sessions more difficult to attend than did their metropolitan colleagues. Traditional forms of CME were more popular than modern CME approaches, such as e-learning. Australian doctors had a positive attitude towards undertaking CME despite struggling to find time to perform CME. The differences in attitudes towards CME demonstrated between specialties and different practice location will aid future CME planning.

InsuOnline, an Electronic Game for Medical Education on Insulin Therapy: A Randomized Controlled Trial With Primary Care Physicians.

PubMed

Diehl, Leandro Arthur; Souza, Rodrigo Martins; Gordan, Pedro Alejandro; Esteves, Roberto Zonato; Coelho, Izabel Cristina Meister

2017-03-09

Most patients with diabetes mellitus (DM) are followed by primary care physicians, who often lack knowledge or confidence to prescribe insulin properly. This contributes to clinical inertia and poor glycemic control. Effectiveness of traditional continuing medical education (CME) to solve that is limited, so new approaches are required. Electronic games are a good option, as they can be very effective and easily disseminated. The objective of our study was to assess applicability, user acceptance, and educational effectiveness of InsuOnline, an electronic serious game for medical education on insulin therapy for DM, compared with a traditional CME activity. Primary care physicians (PCPs) from South of Brazil were invited by phone or email to participate in an unblinded randomized controlled trial and randomly allocated to play the game InsuOnline, installed as an app in their own computers, at the time of their choice, with minimal or no external guidance, or to participate in a traditional CME session, composed by onsite lectures and cases discussion. Both interventions had the same content and duration (~4 h). Applicability was assessed by the number of subjects who completed the assigned intervention in each group. Insulin-prescribing competence (factual knowledge, problem-solving skills, and attitudes) was self-assessed through a questionnaire applied before, immediately after, and 3 months after the interventions. Acceptance of the intervention (satisfaction and perceived importance for clinical practice) was also assessed immediately after and 3 months after the interventions, respectively. Subjects' characteristics were similar between groups (mean age 38, 51.4% [69/134] male). In the game group, 69 of 88 (78%) completed the intervention, compared with 65 of 73 (89%) in the control group, with no difference in applicability. Percentage of right answers in the competence subscale, which was 52% at the baseline in both groups, significantly improved immediately after both interventions to 92% in the game group and to 85% in control (P<.001). After 3 months, it remained significantly higher than that at the baseline in both groups (80% in game, and 76% in control; P<.001). Absolute increase in competence score was better with the game (40%) than with traditional CME (34%; P=.01). Insulin-related attitudes were improved both after the game (significant improvement in 4 of 9 items) and after control activity (3 of 9). Both interventions were very well accepted, with most subjects rating them as "fun or pleasant," "useful," and "practice-changing." The game InsuOnline was applicable, very well accepted, and highly effective for medical education on insulin therapy. In view of its flexibility and easy dissemination, it is a valid option for large-scale CME, potentially helping to reduce clinical inertia and to improve quality of care for DM patients. Clinicaltrials.gov NCT001759953; https://clinicaltrials.gov/ct2/show/NCT01759953 (Archived by WebCite at http://www.webcitation.org/6oeHoTrBf). ©Leandro Arthur Diehl, Rodrigo Martins Souza, Pedro Alejandro Gordan, Roberto Zonato Esteves, Izabel Cristina Meister Coelho. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 09.03.2017.

InsuOnline, an Electronic Game for Medical Education on Insulin Therapy: A Randomized Controlled Trial With Primary Care Physicians

PubMed Central

2017-01-01

Background Most patients with diabetes mellitus (DM) are followed by primary care physicians, who often lack knowledge or confidence to prescribe insulin properly. This contributes to clinical inertia and poor glycemic control. Effectiveness of traditional continuing medical education (CME) to solve that is limited, so new approaches are required. Electronic games are a good option, as they can be very effective and easily disseminated. Objective The objective of our study was to assess applicability, user acceptance, and educational effectiveness of InsuOnline, an electronic serious game for medical education on insulin therapy for DM, compared with a traditional CME activity. Methods Primary care physicians (PCPs) from South of Brazil were invited by phone or email to participate in an unblinded randomized controlled trial and randomly allocated to play the game InsuOnline, installed as an app in their own computers, at the time of their choice, with minimal or no external guidance, or to participate in a traditional CME session, composed by onsite lectures and cases discussion. Both interventions had the same content and duration (~4 h). Applicability was assessed by the number of subjects who completed the assigned intervention in each group. Insulin-prescribing competence (factual knowledge, problem-solving skills, and attitudes) was self-assessed through a questionnaire applied before, immediately after, and 3 months after the interventions. Acceptance of the intervention (satisfaction and perceived importance for clinical practice) was also assessed immediately after and 3 months after the interventions, respectively. Results Subjects’ characteristics were similar between groups (mean age 38, 51.4% [69/134] male). In the game group, 69 of 88 (78%) completed the intervention, compared with 65 of 73 (89%) in the control group, with no difference in applicability. Percentage of right answers in the competence subscale, which was 52% at the baseline in both groups, significantly improved immediately after both interventions to 92% in the game group and to 85% in control (P<.001). After 3 months, it remained significantly higher than that at the baseline in both groups (80% in game, and 76% in control; P<.001). Absolute increase in competence score was better with the game (40%) than with traditional CME (34%; P=.01). Insulin-related attitudes were improved both after the game (significant improvement in 4 of 9 items) and after control activity (3 of 9). Both interventions were very well accepted, with most subjects rating them as “fun or pleasant,” “useful,” and “practice-changing.” Conclusions The game InsuOnline was applicable, very well accepted, and highly effective for medical education on insulin therapy. In view of its flexibility and easy dissemination, it is a valid option for large-scale CME, potentially helping to reduce clinical inertia and to improve quality of care for DM patients. Trial Registration Clinicaltrials.gov NCT001759953; https://clinicaltrials.gov/ct2/show/NCT01759953 (Archived by WebCite at http://www.webcitation.org/6oeHoTrBf) PMID:28279950

Using developmental research to design innovative knowledge translation technology for spinal cord injury in primary care: Actionable Nuggets™ on SkillScribe™

PubMed Central

Smith, Karen M.; Naumann, Danielle N.; McDiarmid Antony, Laura; McColl, Mary Ann; Aiken, Alice

2014-01-01

Context/Objective Actionable Nuggets™ for spinal cord injury (SCI) are a knowledge translation tool facilitating evidence-based primary care practice, originally developed in 2010 and refined in 2013. Evaluation results from these two phases of development have informed the design of SkillScribe™, an innovative electronic platform intended to offer reflective continuing medical education (CME) programming through mobile devices in order to support the key features of the Actionable Nuggets™ approach. This brief article describes the ongoing development of Actionable Nuggets™ for SCI on SkillScribe™ by: (1) summarizing the work to date on Actionable Nuggets™; (2) describing evaluation results of Actionable Nuggets™; (3) placing SkillScribe™ in the context of adult education. Design Developmental Research Design. Setting Canadian primary care. Participants Primary care physicians; specialist physicians. Interventions Twenty educational modules on SCI. Outcome measures Pre- and post-test knowledge survey, feedback and use statistics, impact assessment survey, qualitative analysis of evaluation data. Results In both hard copy and electronic form, physicians report that Actionable Nuggets™ are an acceptable and useful approach to providing CME for low-prevalence, high-impact conditions like SCI. The key elements of this tool are that they: offer evidence-based information in small, focused “nuggets”; position information where physicians most frequently seek it; offer information in a format that permits direct translation into action in primary care; allow time for reflection; attach practice tools; and offer CME credit. Conclusion Actionable Nuggets™ for SCI, delivered using a convenient and portable electronic medium, with time-released content and interactive testing has the potential to improve the primary care of patients with SCI. PMID:25229739

Brief Continuing Medical Education (CME) Module Raises Knowledge of Developing Country Physicians

ERIC Educational Resources Information Center

Soliman, Amr S.; Samadi, Shahed; Banerjee, Mousumi; Chamberlain, Robert M.; Aziz, Zeba

2006-01-01

Breast cancer incidence in Pakistan is the highest reported in any South-Central Asian country. It is the most frequent malignancy in women, where it accounts for 38.5% of all female cancers. About half (43.7%) of all breast cancers are locally advanced. We recruited 183 primary care physicians in Pakistan and invited them to attend educational…

Capacity building toward evidence-based medicine among healthcare professionals at the university of medicine and pharmacy, ho chi minh city, and its related institutes.

PubMed

Nga, LE Thi Quynh; Goto, Aya; Trung, Tran The; Vinh, Nguyen Quang; Khue, Nguyen Thy

2014-02-01

Research capacity development enhances a country's ownership of activities aimed at strengthening its health system. In Vietnam, continuing medical education (CME) is attracting increasing attention with the establishment of legal and policy frameworks. During 2010-2013, the Japan International Cooperation Agency funded a research capacity building project targeting physicians in Ho Chi Minh City. The project had been developed in four previous courses that were conducted in collaboration with Fukushima Medical University and Ho Chi Minh City University of Medicine and Pharmacy (UMP). The project succeeded in obtaining accreditation as the city's CME course. A total of 262 physicians attended three courses that have a divided set of research competencies. Following the Kirkpatrick Model for evaluating the effectiveness of training programs, we confirmed the participants' positive reaction to the courses (Level 1 evaluation), their perceived increase in knowledge and confidence in research skills (Level 2 evaluation), and application of learned knowledge in their practice (Level 3 evaluation). Presented here is a step-by-step scaling-up model of health research capacity building. Strategies for the further expansion include: further capacity building of instructors; responding to clinicians' specific needs; building a recruiting system with authorization; and improving the Level 3 training evaluation.

The CME Flare Arcade and the Width of the CME in the Outer Corona

NASA Technical Reports Server (NTRS)

Moore, Ron; Falconer, David; Sterling, Alphonse

2008-01-01

Moore, Sterling, & Suess (2007, ApJ, 668, 1221) present evidence that (1) a CME is typically a magnetic bubble, a low-beta gplasmoid with legs h having roughly the 3D shape of a light bulb, and (2) in the outer corona the CME plasmoid is in lateral pressure equilibrium with the ambient magnetic field. They present three CMEs observed by SOHO/LASCO, each from a very different source located near the limb. One of these CMEs came from a compact ejective eruption from a small part of a sunspot active region, another came from a large quiet-region filament eruption, and the third CME, an extremely large and fast one, was produced in tandem with an X20 flare arcade that was centered on a huge delta sunspot. Each of these CMEs had more or less the classic lightbulb silhouette and attained a constant heliocentric angular width in the outer corona. This indicates that the CME plasmoid attained lateral magnetic pressure balance with the ambient radial magnetic field in the outer corona. This lateral pressure balance, together with the standard scenario for CME production by the eruption of a sheared-core magnetic arcade, yields the following simple estimate of the strength B(sub Flare) of the magnetic field in the flare arcade produced together with the CME: B(sub Flare) 1.4(theta CME/theta Flare)sup 2 G, where theta (sub CME) is the heliocentric angular width of the CME plasmoid in the outer corona and theta (sub Flare) is the heliocentric angular width of the full-grown flare arcade. Conversely, theta (sub CME) approximately equal to (R(sub Sun)sup -1(phi(sub Flare)/1.4)sup 1/2 radians, where Flare is the magnetic flux covered by the full-grown flare arcade. In addition to presenting the three CMEs of Moore, Sterling, & Suess (2007) and their agreement with this relation between CME and Flare, we present a further empirical test of this relation. For CMEs that erupt from active regions, the co-produced flare arcade seldom if ever covers the entire active region: if AR is the total magnetic flux of the active region, Flare . AR, and we predict that CME. (R(sub Sun))sup -1(theta AR/1.4)sup 1/2 radians. For a random sample of 31 CMEs that erupted from active regions within 30 of the limb, for each CME we have measured CME from LASCO/C3 and have measured AR from a SOHO/MDI magnetogram of the source active region when it was within 30 of disk center. We find that each CME obeys the above predicted inequality, none having width greater than half of the upper bound given by theta(sub AR). Thus, an active region's magnetic flux content, together with its location on the solar disk, largely determines whether the active region can possibly produce a CME that is wide enough to intercept the Earth.

Inhibitory mechanisms of CME-1, a novel polysaccharide from the mycelia of Cordyceps sinensis, in platelet activation.

PubMed

Chang, Yi; Hsu, Wen-Hsien; Lu, Wan-Jung; Jayakumar, Thanasekaran; Liao, Jiun-Cheng; Lin, Mei-Jiun; Wang, Shwu-Huey; Geraldine, Pitchairaj; Lin, Kuan-Hung; Sheu, Joen-Rong

2015-01-01

CME-1 is a polysaccharide purified from the mycelia of medicinal mushroom Cordyceps sinensis, its molecular weight was determined to be 27.6 kDa by using nuclear magnetic resonance and gas chromatography-mass spectrometry. The initiation of arterial thromboses is relevant to various cardiovascular diseases (CVDs) and is believed to involve platelet activation. Our recent study exhibited that CME-1 has potent antiplatelet activity via the activation of adenylate cyclase/cyclic AMP ex vivo and in vivo. The aggregometry, and immunoblotting were used in this study. In this study, the mechanisms of CME-1 in platelet activation is further investigated and found that CME-1 inhibited platelet aggregation as well as the ATP-release reaction, relative intracellular [Ca(+2)] mobilization, and the phosphorylation of phospholipase C (PLC)γ2 and protein kinase C (PKC) stimulated by collagen. CME-1 has no effects on inhibiting either convulxin, an agonist of glycoprotein VI, or aggretin, an agonist of integrin α2β1 stimulated platelet aggregation. Moreover, this compound markedly diminished thrombin and arachidonic acid (AA) induced phosphorylation of p38 mitogen-activated protein kinase (MAPK), extracellular signal-regulated kinase 2, c-Jun N-terminal kinase 1, and Akt. Treatment with SQ22536, an inhibitor of adenylate cyclase, markedly diminished the CME-1-mediated increasing of cyclic AMP level and reversed prostaglandin E1- or CME-1-mediated inhibition of platelet aggregation and p38 MAPK and Akt phosphorylation stimulated by thrombin or AA. Furthermore, phosphodiesterase activity of human platelets was not altered by CME-1. The crucial finding of this study is that the antiplatelet activity of CME-1 may initially inhibit the PLCγ2-PKC-p47 cascade, and inhibit PI3-kinase/Akt and MAPK phosphorylation through adenylate cyclase/ cyclic AMP activation, then inhibit intracellular [Ca(+2)] mobilization, and, ultimately, inhibit platelet activation. The novel role of CME-1 in antiplatelet activity indicates that this compound exhibits high therapeutic potential for treating or preventing CVDs.

Using a quasi-experimental research design to assess knowledge in continuing medical education programs.

PubMed

Markert, Ronald J; O'Neill, Sally C; Bhatia, Subhash C

2003-01-01

The objectives of continuing medical education (CME) programs include knowledge acquisition, skill development, clinical reasoning and decision making, and health care outcomes. We conducted a year-long medical education research study in which knowledge acquisition in our CME programs was assessed. A randomized separate-sample pretest/past-test design, a quasi-experimental technique, was used. Nine CME programs with a sufficient number of participants were identified a priori. Knowledge acquisition was compared between the control group and the intervention group for the nine individual programs and for the combined programs. A total of 667 physicians, nurses, and other health professionals participated. Significant gain in knowledge was found for six programs: Perinatology, Pain Management, Fertility Care 2, Pediatrics, Colorectal Diseases, and Alzheimer's Disease (each p < .001). Also, the intervention group differed from the control group when the nine programs were combined (p < .001), with an effect size of .84. The use of sound quasi-experimental research methodology (separate-sample pretest/post-test design), the inclusion of a representative sample of CME programs, and the analysis of nearly 700 subjects led us to have confidence in concluding that our CME participants acquired a meaningful amount of new knowledge.

Trunk Exercises Improve Gait Symmetry in Parkinson Disease: A Blind Phase II Randomized Controlled Trial.

PubMed

Hubble, Ryan P; Naughton, Geraldine; Silburn, Peter A; Cole, Michael H

2018-03-01

Deficits in step-to-step symmetry and trunk muscle activations have been linked to falls in Parkinson disease. Given such symptoms are poorly managed with anti-parkinsonian medications, alternate therapies are needed. This blind phase II randomized controlled trial sought to establish whether exercise can improve step-to-step symmetry in Parkinson disease. Twenty-four Parkinson disease patients with a falls history completed baseline assessments of symptom severity, balance confidence, mobility, and quality of life. Step-to-step symmetry was assessed by deriving harmonic ratios from three-dimensional accelerations collected for the head and trunk. Patients were randomly assigned to either 12 wks of exercise and falls prevention education or falls prevention education only. Both groups repeated the baseline tests 12 and 24 wks after the initial assessment. The Australian and New Zealand Clinical Trials Registry number is ACTRN12613001175763. At 12 wks, the exercise group had statistically significant and clinically relevant improvements in anterior-posterior step-to-step trunk symmetry. In contrast, the education group recorded statistically significant and clinically meaningful reductions in medial-lateral and vertical step-to-step trunk symmetry at 12 wks. Given that step-to-step symmetry improved for the exercise group and declined for the education group after intervention, active interventions seem more suited to increasing independence and quality of life for people with Parkinson disease. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to do the following: (1) Describe the effect deficits in trunk muscle function have on gait in individuals with Parkinson disease; (2) Identify the benefits of targeted trunk exercises on step-to-step symmetry; and (3) Discuss the benefits of improving step-to-step symmetry in individuals with Parkinson disease. Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Active Longitude and Coronal Mass Ejection Occurrences

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gyenge, N.; Kiss, T. S.; Erdélyi, R.

The spatial inhomogeneity of the distribution of coronal mass ejection (CME) occurrences in the solar atmosphere could provide a tool to estimate the longitudinal position of the most probable CME-capable active regions in the Sun. The anomaly in the longitudinal distribution of active regions themselves is often referred to as active longitude (AL). In order to reveal the connection between the AL and CME spatial occurrences, here we investigate the morphological properties of active regions. The first morphological property studied is the separateness parameter, which is able to characterize the probability of the occurrence of an energetic event, such asmore » a solar flare or CME. The second morphological property is the sunspot tilt angle. The tilt angle of sunspot groups allows us to estimate the helicity of active regions. The increased helicity leads to a more complex buildup of the magnetic structure and also can cause CME eruption. We found that the most complex active regions appear near the AL and that the AL itself is associated with the most tilted active regions. Therefore, the number of CME occurrences is higher within the AL. The origin of the fast CMEs is also found to be associated with this region. We concluded that the source of the most probably CME-capable active regions is at the AL. By applying this method, we can potentially forecast a flare and/or CME source several Carrington rotations in advance. This finding also provides new information for solar dynamo modeling.« less

Active Longitude and Coronal Mass Ejection Occurrences

NASA Astrophysics Data System (ADS)

Gyenge, N.; Singh, T.; Kiss, T. S.; Srivastava, A. K.; Erdélyi, R.

2017-03-01

The spatial inhomogeneity of the distribution of coronal mass ejection (CME) occurrences in the solar atmosphere could provide a tool to estimate the longitudinal position of the most probable CME-capable active regions in the Sun. The anomaly in the longitudinal distribution of active regions themselves is often referred to as active longitude (AL). In order to reveal the connection between the AL and CME spatial occurrences, here we investigate the morphological properties of active regions. The first morphological property studied is the separateness parameter, which is able to characterize the probability of the occurrence of an energetic event, such as a solar flare or CME. The second morphological property is the sunspot tilt angle. The tilt angle of sunspot groups allows us to estimate the helicity of active regions. The increased helicity leads to a more complex buildup of the magnetic structure and also can cause CME eruption. We found that the most complex active regions appear near the AL and that the AL itself is associated with the most tilted active regions. Therefore, the number of CME occurrences is higher within the AL. The origin of the fast CMEs is also found to be associated with this region. We concluded that the source of the most probably CME-capable active regions is at the AL. By applying this method, we can potentially forecast a flare and/or CME source several Carrington rotations in advance. This finding also provides new information for solar dynamo modeling.

Cost-benefit analysis on the use of telemedicine program of Kosova for continuous medical education: a sustainable and efficient model to rebuild medical systems in developing countries.

PubMed

Latifi, Kalterina; Lecaj, Ismet; Bekteshi, Flamur; Dasho, Erion; Doarn, Charles R; Merrell, Ronald C; Latifi, Rifat

2011-12-01

The Ministry of Health of Kosova has recently announced the Telemedicine Program of Kosova (TMPK) as the official institution responsible for managing and coordinating the nation's Long-Distance Continuous Medical Education (CME) program. There are a lack of studies on cost-benefit analysis (CBA) and other economic evaluations of telemedicine programs (TMP), in particular the financial value of CME offered through such a service. In addition, there is lack of prospective studies on Monitoring & Evaluation (M&E) of TMP. The goal of this study was to conduct a retrospective CBA of prospective data collected at TMPK over a 5-year period (2005-2010) in order to determine the cost benefit as opposed to the alternative method of delivery of this model for developing countries whose healthcare systems are in disarray. We reviewed data on the number of participants in virtual lectures both at the Telemedicine Center of Kosova (TCK) as well as the number of participants at six Regional Telemedicine Centers throughout Kosova, the number of lectures broadcasted, the clinical cases reviewed and transmitted for international consultation, and other quantitative data. Only in 2009, approximately 2,000 CME certificates were awarded to physicians and nurses of Kosova, 18 international teleconsultations were conducted, 138 videoconferences, lectures, and seminars were held, and there were over 9,000 visitors at the TCK e-library. Data analysis shows that the TMPK has been an efficient mechanism for CME and sustainable model for rebuilding the medical system. TMPK has been successful in offering physicians, nurses, and other medical professions access to electronic information. TMP is an efficient mechanism to ensure CME and rebuilding medical systems in developing countries. There is a need for prospective CBA of any TMP and the establishment of M&E programs in any future telemedicine initiatives in developing countries.

Funding sources for continuing medical education: An observational study

PubMed Central

Venkataraman, Ramesh; Ranganathan, Lakshmi; Ponnish, Arun S.; Abraham, Babu K.; Ramakrishnan, Nagarajan

2014-01-01

Aims: Medical accreditation bodies and licensing authorities are increasingly mandating continuing medical education (CME) credits for maintenance of licensure of healthcare providers. However, the costs involved in participating in these CME activities are often substantial and may be a major deterrent in obtaining these mandatory credits. It is assumed that healthcare providers often obtain sponsorship from their institutions or third party payers (i.e. pharmaceutical-industry) to attend these educational activities. Data currently does not exist exploring the funding sources for CME activities in India. In this study, we examine the relative proportion of CME activities sponsored by self, institution and the pharmaceutical-industry. We also wanted to explore the characteristics of courses that have a high proportion of self-sponsorship. Materials and Methods: This is a retrospective audit of the data during the year 2009 conducted at an autonomous clinical training academy. The details of the sponsor of each CME activity were collected from an existing database. Participants were subsequently categorized as sponsored by self, sponsored by institution or sponsored by pharmaceutical-industry. Results: In the year 2009, a total of 2235 participants attended 40 different CME activities at the training academy. Of the total participants, 881 (39.4%) were sponsored by self, 898 (40.2%) were sponsored by institution and 456 (20.3%) by pharmaceutical-industry. About 47.8% participants attended courses that carried an international accreditation. For the courses that offer international accreditation, 63.3% were sponsored by self, 34.9% were sponsored by institution and 1.6% were sponsored by pharmaceutical-industry. There were 126 participants (5.6%) who returned to the academy for another CME activity during the study period. Self-sponsored (SS) candidates were more likely to sponsor themselves again for subsequent CME activity compared with the other two groups (P < 0.001). Conclusions: In our study, majority of healthcare professionals attending CME activities were either self or institution sponsored. There was a greater inclination for self-sponsoring for activities with international accreditation. SS candidates were more likely to sponsor themselves again for subsequent CME activities. PMID:25136190

A new vision for distance learning and continuing medical education.

PubMed

Harden, Ronald M

2005-01-01

Increasing demands on continuing medical education (CME) are taking place at a time of significant developments in educational thinking and new learning technologies. Such developments allow today's CME providers to better meet the CRISIS criteria for effective continuing education: convenience, relevance, individualization, self-assessment, independent learning, and a systematic approach. The International Virtual Medical School (IVIMEDS) provides a case study that illustrates how rapid growth of the Internet and e-learning can alter undergraduate education and has the potential to alter the nature of CME. Key components are a bank of reusable learning objects, a virtual practice with virtual patients, a learning-outcomes framework, and self-assessment instruments. Learning is facilitated by a curriculum map, guided-learning resources, "ask-the-expert" opportunities, and collaborative or peer-to-peer learning. The educational philosophy is "just-for-you" learning (learning customized to the content, educational strategy, and distribution needs of the individual physician) and "just-in-time" learning (learning resources available to physicians when they are required). Implications of the new learning technologies are profound. E-learning provides a bridge between the cutting edge of education and training and outdated procedures embedded in institutions and professional organizations. There are important implications, too, for globalization in medical education, for multiprofessional education, and for the continuum of education from undergraduate to postgraduate and continuing education.

Effects of the Integration of Dynamic Weight Shifting Training Into Treadmill Training on Walking Function of Children with Cerebral Palsy: A Randomized Controlled Study.

PubMed

Wu, Ming; Kim, Janis; Arora, Pooja; Gaebler-Spira, Deborah J; Zhang, Yunhui

2017-11-01

The aim of the study was to determine whether applying an assistance force to the pelvis and legs during treadmill training can improve walking function in children with cerebral palsy. Twenty-three children with cerebral palsy were randomly assigned to the robotic or treadmill only group. For participants who were assigned to the robotic group, a controlled force was applied to the pelvis and legs during treadmill walking. For participants who were assigned to the treadmill only group, manual assistance was provided as needed. Each participant trained 3 times/wk for 6 wks. Outcome measures included walking speed, 6-min walking distance, and clinical assessment of motor function, which were evaluated before, after training, and 8 wks after the end of training, and were compared between two groups. Significant increases in walking speed and 6-min walking distance were observed after robotic training (P = 0.03), but no significant change was observed after treadmill training only. A greater increase in 6-min walking distance was observed after robotic training than that after treadmill only training (P = 0.01). Applying a controlled force to the pelvis and legs, for facilitating weight-shift and leg swing, respectively, during treadmill training may improve walking speed and endurance in children with cerebral palsy. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) discuss the importance of physical activity at the participation level (sports programs) for children with cerebral palsy; (2) contrast the changes in walking ability and endurance for children in GMFCS level I, II and III following sports programs; and (3) identify the impact of higher frequency of sports program attendance over time on walking ability. Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Effects of Participation in Sports Programs on Walking Ability and Endurance Over Time in Children With Cerebral Palsy.

PubMed

Ross, Sandy A; Yount, Morgan; Ankarstad, Sara; Bock, Samantha; Orso, Britta; Perry, Kimberly; Miros, Jennifer; Brunstrom-Hernandez, Janice E

2017-12-01

Children with cerebral palsy may benefit from maintaining a high level of physical fitness similar to typically developing children especially in terms of long-term physical performance, although in practice this is often difficult. The purpose of this study was to determine the effect of participation in sports programs on walking ability and endurance over time. A retrospective cohort study included participants with cerebral palsy, aged 6 to 20 yrs, who attended a summer sports program from 2004 to 2012. There were 256 participant sessions with pre/post data recorded. The participants consisted of a total of 97 children (mean age [SD] = 11.4 [3.1] yrs), many of whom attended multiple programs throughout the years. Programs were held 6 hrs/d, 5 d/wk for up to 4 wks. Outcome measures included the Timed Up and Go, modified 6-min walk, and 25-ft walk/run. The results showed significant improvements in the Timed Up and Go, modified 6-min walk distance and 25-ft walk/run over time. Children in Gross Motor Classification System level III made the largest gains. Walking ability and endurance seem to improve after participation in an intensive summer sports programs. Higher frequency of program attendance resulted in significant improvements in the Timed Up and Go. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Discuss the importance of physical activity at the participation level (sports programs) for children with cerebral palsy; (2) Contrast the changes in walking ability and endurance for children in Gross Motor Function Classification System level I, II, and III after sports programs; and (3) Identify the impact of higher frequency of sports program attendance over time on walking ability. Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 0.75 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Educating clinicians about cultural competence and disparities in health and health care.

PubMed

Like, Robert C

2011-01-01

An extensive body of literature has documented significant racial and ethnic disparities in health and health care. Cultural competency interventions, including the training of physicians and other health care professionals, have been proposed as a key strategy for helping to reduce these disparities. The continuing medical education (CME) profession can play an important role in addressing this need by improving the quality and assessing the outcomes of multicultural education programs. This article provides an overview of health care policy, legislative, accreditation, and professional initiatives relating to these subjects. The status of CME offerings on cultural competence/disparities is reviewed, with examples provided of available curricular resources and online courses. Critiques of cultural competence training and selected studies of its effectiveness are discussed. The need for the CME profession to become more culturally competent in its development, implementation, and evaluation of education programs is examined. Future challenges and opportunities are described, and a call for leadership and action is issued. Copyright © 2010 The Alliance for Continuing Medical Education, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

Correlation of the Coronal Mass Ejection Productivity of Solar Active Regions with Measures of their Global Nonpotentiality from Vector Magnetograms: Baseline Results

NASA Technical Reports Server (NTRS)

Falconer, D. A.; Moore, R. L.; Gary, G. A.

2002-01-01

Conventional magnetograms and chromospheric and coronal images show qualitatively that the fastest coronal mass ejections (CMEs) are magnetic explosions from sunspot active regions where the magnetic field is globally strongly sheared and twisted from its minimum-energy potential configuration. We present measurements from active region vector magnetograms that start to quantify the dependence of an active region's CME productivity on the global nonpotentiality of its magnetic field. From each of 17 magnetograms of 12 bipolar active regions, we measured the size of the active region (the magnetic flux content, phi) and three separate measures of the global nonpotentiality (L(sub SS), the length of strong-shear, strong-field main neutral line: I(sub N), the net electric current connecting one polarity to the other; and alpha = (mu)I(sub N)/phi), a flux normalized measure of the field twist). From these measurements and the observed CME productivity of the active regions, we find that: (1) All three measures of global nonpotentiality are statistically correlated with the active region flux content and with each other; (2) All three measures of global nonpotentiality are significantly correlated with CME productivity. The flux content correlates with CME productivity, but at a lower statistically significant confidence level (less than 95%); (3) The net current is less closely correlated with CME productivity than alpha and the correlation of CME productivity with flux content is even weaker. If these differences in correlation strength, and a significant correlation of alpha with flux content, persist to larger active regions, this would imply that the size of active regions does not affect CME productivity except through global nonpotentiality; and (4) For each of the four global magnetic quantities, the correlation with CME productivity is stronger for a two-day time window for the CME production than for windows half as wide or twice as wide. This plausibly is a result of the most counterproductive active regions producing less than one CME per day, and from the active region's evolution often significantly changing the global nonpotentiality over the course of several days. These results establish that measures of active region global nonpotentiality from vector magnetograms (such as L(sub SS), I(sub N), and alpha) should be useful for prediction a active region CMEs.

Prediction of Active-Region CME Productivity from Magnetograms

NASA Technical Reports Server (NTRS)

Falconer, D. A.; Moore, R. L.; Gary, G. A.

2004-01-01

We report results of an expanded evaluation of whole-active-region magnetic measures as predictors of active-region coronal mass ejection (CME) productivity. Previously, in a sample of 17 vector magnetograms of 12 bipolar active regions observed by the Marshall Space Flight Center (MSFC) vector magnetograph, from each magnetogram we extracted a measure of the size of the active region (the active region s total magnetic flux a) and four measures of the nonpotentiality of the active region: the strong-shear length L(sub SS), the strong-gradient length L(sub SG), the net vertical electric current I(sub N), and the net-current magnetic twist parameter alpha (sub IN). This sample size allowed us to show that each of the four nonpotentiality measures was statistically significantly correlated with active-region CME productivity in time windows of a few days centered on the day of the magnetogram. We have now added a fifth measure of active-region nonpotentiality (the best-constant-alpha magnetic twist parameter (alpha sub BC)), and have expanded the sample to 36 MSFC vector magnetograms of 31 bipolar active regions. This larger sample allows us to demonstrate statistically significant correlations of each of the five nonpotentiality measures with future CME productivity, in time windows of a few days starting from the day of the magnetogram. The two magnetic twist parameters (alpha (sub 1N) and alpha (sub BC)) are normalized measures of an active region s nonpotentially in that they do not depend directly on the size of the active region, while the other three nonpotentiality measures (L(sub SS), L(sub SG), and I(sub N)) are non-normalized measures in that they do depend directly on active-region size. We find (1) Each of the five nonpotentiality measures is statistically significantly correlated (correlation confidence level greater than 95%) with future CME productivity and has a CME prediction success rate of approximately 80%. (2) None of the nonpotentiality measures is a significantly better CME predictor than the others. (3) The active-region phi shows some correlation with CME productivity, but well below a statistically significant level (correlation confidence level less than approximately 80%; CME prediction success rate less than approximately 65%). (4) In addition to depending on magnetic twist, CME productivity appears to have some direct dependence on active-region size (rather than only an indirect dependence through a correlation of magnetic twist with active-region size), but it will take a still larger sample of active regions (50 or more) to certify this. (5) Of the five nonpotentiality measures, L(sub SG) appears to be the best for operational CME forecasting because it is as good or better a CME predictor than the others and it alone does not require a vector magnetogram; L(sub SG) can be measured from a line-of-sight magnetogram such as from the Michelson Doppler Imager (MDI) on the Solar and Heliospheric Observatory (SOHO).

Efforts to improve aviation medical examiner performance through continuing medical education and annual performance reports.

DOT National Transportation Integrated Search

1984-01-01

Continuing medical education (CME) serves to maintain or increase the knowledge, interpretive proficiencies, and technical skills that a physician uses in his/her practice of medicine. Resulting improvement in professional performance is frequently d...

Observations on the Content of a Formal CME Course before and after Needs Assessment.

ERIC Educational Resources Information Center

Swanson, Richard W.; Jennett, Penny A.

1992-01-01

Data from 13 of 50 physicians participating in continuing medical education refresher courses on hypertension and analysis of questions asked of medical information service databank were used to alter the delivery of refresher sessions. (SK)

Prediction of Coronal Mass Ejections from Vector Magnetograms: Quantitative Measures as Predictors

NASA Astrophysics Data System (ADS)

Falconer, D. A.; Moore, R. L.; Gary, G. A.

2001-05-01

In a pilot study of 4 active regions (Falconer, D.A. 2001, JGR, in press), we derived two quantitative measures of an active region's global nonpotentiality from the region's vector magnetogram, 1) the net current (IN), and 2) the length of the strong-shear, strong-field main neutral line (LSS), and used these two measures of the CME productivity of the active regions. We compared the global nonpotentiality measures to the active regions' CME productivity determined from GOES and Yohkoh/SXT observations. We found that two of the active regions were highly globally nonpotential and were CME productive, while the other two active regions had little global nonpotentiality and produced no CMEs. At the Fall 2000 AGU (Falconer, Moore, & Gary, 2000, EOS 81, 48 F998), we reported on an expanded study (12 active regions and 17 magnetograms) in which we evaluated four quantitative global measures of an active region's magnetic field and compared these measures with the CME productivity. The four global measures (all derived from MSFC vector magnetograms) included our two previous measures (IN and LSS) as well as two new ones, the total magnetic flux (Φ ) (a measure of an active region's size), and the normalized twist (α =μ IN/Φ ). We found that the three measures of global nonpotentiality (IN, LSS, α ) were all well correlated (>99% confidence level) with an active region's CME productivity within (2 days of the day of the magnetogram. We will now report on our findings of how good our quantitative measures are as predictors of active-region CME productivity, using only CMEs that occurred after the magnetogram. We report the preliminary skill test of these quantitative measures as predictors. We compare the CME prediction success of our quantitative measures to the CME prediction success based on an active region's past CME productivity. We examine the cases of the handful of false positive and false negatives to look for improvements to our predictors. This work is funded by NSF through the Space Weather Program and by NASA through the Solar Physics Supporting Research and Technology Program.

Continuing Medical Education Improves Gastroenterologists' Compliance with Inflammatory Bowel Disease Quality Measures.

PubMed

Sapir, Tamar; Moreo, Kathleen; Carter, Jeffrey D; Greene, Laurence; Patel, Barry; Higgins, Peter D R

2016-07-01

Low rates of compliance with quality measures for inflammatory bowel disease (IBD) have been reported for US gastroenterologists. We assessed the influence of quality improvement (QI) education on compliance with physician quality reporting system (PQRS) measures for IBD and measures related to National Quality Strategy (NQS) priorities. Forty community-based gastroenterologists participated in the QI study; 20 were assigned to educational intervention and control groups, respectively. At baseline, randomly selected charts of patients with moderate-to-severe ulcerative colitis were retrospectively reviewed for the gastroenterologists' performance of 8 PQRS IBD measures and 4 NQS-related measures. The intervention group participated in a series of accredited continuing medical education (CME) activities focusing on QI. Follow-up chart reviews were conducted 6 months after the CME activities. Independent t tests were conducted to compare between-group differences in baseline-to-follow-up rates of documented compliance with each measure. The analysis included 299 baseline charts and 300 follow-up charts. The intervention group had significantly greater magnitudes of improvement than the control group for the following measures: assessment of IBD type, location, and activity (+14 %, p = 0.009); influenza vaccination (+13 %, p = 0.025); pneumococcal vaccination (+20 %, p = 0.003); testing for latent tuberculosis before anti-TNF-α therapy (+10 %, p = 0.028); assessment of hepatitis B virus status before anti-TNF-α therapy (+9 %, p = 0.010); assessment of side effects (+17 %, p = 0.048), and counseling patients about cancer risks (+13 %, p = 0.013). QI-focused CME improves community-based gastroenterologists' compliance with IBD quality measures and measures aligned with NQS priorities.

Assessment of Barriers to Changing Practice as CME Outcomes

ERIC Educational Resources Information Center

Price, David W.; Miller, Elaine K.; Rahm, Alanna Kulchak; Brace, Nancy E.; Larson, R. Sam

2010-01-01

Introduction: Continuing medical education (CME) is meant to drive and support improvements in practice. To achieve this goal, CME activities must move beyond simply purveying knowledge, instead helping attendees to contextualize information and to develop strategies for implementing new learning. CME attendees face different barriers to…

Prediction of Coronal Mass Ejections From Vector Magnetograms: Quantitative Measures as Predictors

NASA Technical Reports Server (NTRS)

Falconer, D. A.; Moore, R. L.; Gary, G. A.; Rose, M. Franklin (Technical Monitor)

2001-01-01

We derived two quantitative measures of an active region's global nonpotentiality from the region's vector magnetogram, 1) the net current (I(sub N)), and 2) the length of strong-shear, strong-field main neutral line (Lss), and used these two measures in a pilot study of the CME productivity of 4 active regions. We compared the global nonpotentiality measures to the active regions' CME productivity determined from GOES and Yohkoh/SXT observations. We found that two of the active regions were highly globally nonpotential and were CME productive, while the other two active regions had little global nonpotentiality and produced no CMEs. At the Fall 2000 AGU, we reported on an expanded study (12 active regions and 17 magnetograms) in which we evaluated four quantitative global measures of an active region's magnetic field and compared these measures with the CME productivity. The four global measures (all derived from MSFC vector magnetograms) included our two previous measures (I(sub N) and L(sub ss)) as well as two new ones, the total magnetic flux (PHI) (a measure of an active region's size), and the normalized twist (alpha (bar)= muIN/PHI). We found that the three quantitative measures of global nonpotentiality (I(sub N), L(sub ss), alpha (bar)) were all well correlated (greater than 99% confidence level) with an active region's CME productivity within plus or minus 2 days of the day of the magnetogram. We will now report on our findings of how good our quantitative measures are as predictors of active-region CME productivity, using only CMEs that occurred after the magnetogram. We report the preliminary skill test of these quantitative measures as predictors. We compare the CME prediction success of our quantitative measures to the CME prediction success based on an active region's past CME productivity. We examine the cases of the handful of false positive and false negatives to look for improvements to our predictors. This work is funded by NSF through the Space Weather Program and by NASA through the Solar Physics Supporting Research and Technology Program.

Professional Development Perceptions and Practices Among U.S. Physicians: A Cross-Specialty National Survey.

PubMed

Cook, David A; Blachman, Morris J; Price, David W; West, Colin P; Berger, Richard A; Wittich, Christopher M

2017-09-01

Professional development (PD)-both for-credit continuing medical education (CME) and informal self-directed or point-of-care learning-is vital to all physicians. The authors sought to understand physicians' PD perceptions and practices and how these vary by specialty and practice type. The authors administered an Internet and paper survey, from September 2015 to April 2016, to randomly sampled U.S. physicians. Survey items addressed perceived PD needs and barriers and how physicians identify knowledge/skills gaps. Of 4,648 invitees, 988 (21.6%) responded. Respondents believed that they already know what they need to learn (mean 5.8 [1 = strongly disagree; 7 = strongly agree]), can answer clinical questions using available resources (5.9), and want credit for learning during patient care (5.1). They did not strongly desire help identifying learning gaps (4.0) or indicate difficulty accumulating CME credits (3.1). Most PD was done during personal time (5.5). Competencies regarding medical knowledge/skills, wellness, informatics, and practice/systems improvement were rated the highest priority, while research, teaching, and professionalism were rated the lowest. The most important sources used to identify knowledge/skills gaps were immediate patient care needs (4.1 [1 = not important; 5 = extremely important]), personal awareness (3.8), and practice updates (3.7). The most important barriers were time (3.5) and cost (2.9). Differences by specialty and practice type were generally small and not statistically significant. Physicians feel confident in identifying their own learning needs, perceive medical knowledge/skills as their highest-priority need, and desire more credit for learning during patient care.

What Constitutes Commercial Bias Compared with the Personal Opinion of Experts?

ERIC Educational Resources Information Center

Cornish, Jean K.; Leist, James C.

2006-01-01

Introduction: The presence of commercial messages in continuing medical education (CME) is an ongoing cause of concern. This study identifies actions perceived by CME participants to convey commercial bias from CME faculty. Methods: A questionnaire listing actions associated with CME activities was distributed to 230 randomly selected participants…

Pumpkin (Cucurbita moschata) fruit extract improves physical fatigue and exercise performance in mice.

PubMed

Wang, Shih-Yi; Huang, Wen-Ching; Liu, Chieh-Chung; Wang, Ming-Fu; Ho, Chin-Shan; Huang, Wen-Pei; Hou, Chia-Chung; Chuang, Hsiao-Li; Huang, Chi-Chang

2012-10-09

Pumpkin (Cucurbita moschata) is a popular and nutritious vegetable consumed worldwide. The overall purpose of this study was to evaluate the effects of C. moschata fruit extract (CME) on anti-fatigue and ergogenic functions following physiological challenges. Male ICR mice from four groups designated vehicle, CME-50, CME-100 and CME-250, respectively (n = 8 per group in each test) were orally administered CME for 14 days at 0, 50, 100 and 250 mg/kg/day. The anti-fatigue activity and exercise performance were evaluated using exhaustive swimming time, forelimb grip strength, as well as levels of plasma lactate, ammonia, glucose, and creatine kinase after an acute swimming exercise. The resting muscular and hepatic glycogen was also analyzed after 14-day supplementation with CME. Trend analysis revealed that CME treatments increased grip strength. CME dose-dependently increased 5% body weight loaded swimming time, blood glucose, and muscular and hepatic glycogen levels. CME dose-dependently decreased plasma lactate and ammonia levels and creatine kinase activity after a 15-min swimming test. The mechanism was relevant to the increase in energy storage (as glycogen) and release (as blood glucose), and the decrease of plasma levels of lactate, ammonia, and creatine kinase. Therefore, CME may be potential for the pharmacological effect of anti-fatigue.

Limbic and Basal Ganglia Neuroanatomical Correlates of Gait and Executive Function: Older Adults With Mild Cognitive Impairment and Intact Cognition.

PubMed

McGough, Ellen L; Kelly, Valerie E; Weaver, Kurt E; Logsdon, Rebecca G; McCurry, Susan M; Pike, Kenneth C; Grabowski, Thomas J; Teri, Linda

2018-04-01

This study aimed to examine differences in spatiotemporal gait parameters between older adults with amnestic mild cognitive impairment and normal cognition and to examine limbic and basal ganglia neural correlates of gait and executive function in older adults without dementia. This was a cross-sectional study of 46 community-dwelling older adults, ages 70-95 yrs, with amnestic mild cognitive impairment (n = 23) and normal cognition (n = 23). Structural magnetic resonance imaging was used to attain volumetric measures of limbic and basal ganglia structures. Quantitative motion analysis was used to measure spatiotemporal parameters of gait. The Trail Making Test was used to assess executive function. During fast-paced walking, older adults with amnestic mild cognitive impairment demonstrated significantly slower gait speed and shorter stride length compared with older adults with normal cognition. Stride length was positively correlated with hippocampal, anterior cingulate, and nucleus accumbens volumes (P < 0.05). Executive function was positively correlated with hippocampal, anterior cingulate, and posterior cingulate volumes (P < 0.05). Compared with older adults with normal cognition, those with amnestic mild cognitive impairment demonstrated slower gait speed and shorter stride length, during fast-paced walking, and lower executive function. Hippocampal and anterior cingulate volumes demonstrated moderate positive correlation with both gait and executive function, after adjusting for age. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) discuss gait performance and cognitive function in older adults with amnestic mild cognitive impairment versus normal cognition, (2) discuss neurocorrelates of gait and executive function in older adults without dementia, and (3) recognize the importance of assessing gait speed and cognitive function in the clinical management of older adults at risk for dementia. Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Randomized Controlled Trial on Effectiveness of Intermittent Serial Casting on Spastic Equinus Foot in Children with Cerebral Palsy After Botulinum Toxin-A Treatment.

PubMed

Dursun, Nigar; Gokbel, Tugba; Akarsu, Melike; Dursun, Erbil

2017-04-01

Physical therapy (PT) and botulinum toxin-A (BTX-A) injections are widely used in the treatment of spastic equinus foot due to cerebral palsy. The aim of this study was to show effects of intermittent serial casting (SC) in addition to standard treatment on spasticity, passive range of motion (PROM), and gait. Fifty-one ambulatory patients, treated by BTX-A to plantar flexor muscles, were randomly assigned to casting or control groups in a 2:1 ratio. Both groups received PT for 3 weeks. Casting group additionally received intermittent SC during 3 consecutive weekends. Assessments included Modified Ashworth Scale (MAS), Tardieu Scale, Observational Gait Scale (OGS), and Physician Global Assessment at baseline and posttreatment weeks 4 and 12. Significant improvements in PROM, MAS, Tardieu Scale, and OGS were recorded in both groups (P < 0.001 for all). Average changes in MAS, PROM, angle of catch, spasticity angle, and OGS of the casting group were significantly higher than those of the controls at week 4 (P = 0.006, P = 0.002, P < 0.001, P = 0.005, P = 0.011), and 12 (P = 0.013, P < 0.001, P < 0.001, P = 0.011, P < 0.001). Follow-up Physician Global Assessment also favored casting group (P < 0.001 for both). Combining intermittent SC with BTX-A injections and PT might provide additional benefits for spastic equinus foot. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) identify treatment options for spastic equinus goot in children with cerebral palsy; (2) explain different approaches of serial casting with an additional model of intermittent casting; and (3) describe the potential benefits of combined treatment modalities, including intermittent serial casting, for spastic equinus foot in children with cerebral palsy. Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Eating disorders during pregnancy.

PubMed

Cardwell, Michael S

2013-04-01

Eating disorders during pregnancy, once thought to be rare, occur in a significant number of women. The incidences of the major eating disorders-anorexia nervosa and bulimia nervosa-are increasing because of cultural pressures on the drive for thinness. Because the age range for these major eating disorders overlaps with the age range for reproductive function, it is not unusual for a clinician to encounter a pregnant patient with a major eating disorder. Eating disorders attributable to the pregnant state include pregnancy sickness, pica, and ptyalism. The diagnostic criteria, etiology, nutritional behavioral influences, evolutionary psychological considerations where elucidated, and treatment of these disorders will be presented. Obstetricians and gynecologists, family physicians After completing this CME activity, physicians should be better able to review how the major eating disorders impact pregnancy, to diagnose eating disorders during pregnancy using the diagnostic criteria, and to treat eating disorders during pregnancy.

Treatment of Viscosity in the Shock Waves Observed After Two Consecutive Coronal Mass Ejection Activities CME08/03/2012 and CME15/03/2012

NASA Astrophysics Data System (ADS)

Cavus, Huseyin

2016-11-01

A coronal mass ejection (CME) is one of the most the powerful activities of the Sun. There is a possibility to produce shocks in the interplanetary medium after CMEs. Shock waves can be observed when the solar wind changes its velocity from being supersonic nature to being subsonic nature. The investigations of such activities have a central place in space weather purposes, since; the interaction of shocks with viscosity is one of the most important problems in the supersonic and compressible gas flow regime (Blazek in Computational fluid dynamics: principles and applications. Elsevier, Amsterdam 2001). The main aim of present work is to achieve a search for the viscosity effects in the shocks occurred after two consecutive coronal mass ejection activities in 2012 (i.e. CME08/03/2012 and CME15/03/2012).

Advanced Initiatives in Medical Simulation, 3rd Annual Conference to Create Awareness of Medical Simulation

DTIC Science & Technology

2006-06-30

Mexico suggested bringing together government agencies, academics, and industry representatives with an interest in medical simulation to identify ways...test, take online continuing medical education (CME) courses on electronic fetal monitoring and shoulder dystocia , and complete a physician

[Continuing Medical Education in Germany - mandatory and voluntary obligations].

PubMed

Böthin, Elke

2013-01-01

After 1945 the common medical training infrastructure was broken up into two different political systems. While in the Federal Republic of Germany the structure was based on physicians' self-governance, in the German Democratic Republic medical professional structures were organised by the government. After the unification of the two German states, which took place on October 3, 1990, the centralistic structure was replaced by the system of physician self-governance. Before January 1, 2004, continuing medical education (CME) in West Germany relied on a system of voluntary obligations. In East Germany, though, professional CMEs were compulsory; they were called "obligatorische periphere Fortbildung." Based on 15 expert interviews on the topic of "CME in Germany", the different circumstances and conditions were analysed taking account of the historical background. Only selected professionals with experience in both German states (one with a federal, the other with a centralistic system), were chosen for the survey. Copyright © 2013. Published by Elsevier GmbH.

Is There a CME Rate Floor? CME and Magnetic Flux Values for the Last Four Solar Cycle Minima

NASA Astrophysics Data System (ADS)

Webb, D. F.; Howard, R. A.; St. Cyr, O. C.; Vourlidas, A.

2017-12-01

The recent prolonged activity minimum has led to the question of whether there is a base level of the solar magnetic field evolution that yields a “floor” in activity levels and also in the solar wind magnetic field strength. Recently, a flux transport model coupled with magneto-frictional simulations has been used to simulate the continuous magnetic field evolution in the global solar corona for over 15 years, from 1996 to 2012. Flux rope eruptions in the simulations are estimated (Yeates), and the results are in remarkable agreement with the shape of the SOlar Heliospheric Observatory/Large Angle and Spectrometric Coronagraph Experiment coronal mass ejection (CME) rate distribution. The eruption rates at the two recent minima approximate the observed-corrected CME rates, supporting the idea of a base level of solar magnetic activity. In this paper, we address this issue by comparing annual averages of the CME occurrence rates during the last four solar cycle minima with several tracers of the global solar magnetic field. We conclude that CME activity never ceases during a cycle, but maintains a base level of 1 CME every 1.5 to ∼3 days during minima. We discuss the sources of these CMEs.

Paramedic Learning Style Preferences and Continuing Medical Education Activities: A Cross-Sectional Survey Study.

PubMed

Staple, Louis; Carter, Alix; Jensen, Jan L; Walker, Mark

2018-01-01

Paramedics participate in continuing medical education (CME) to maintain their skills and knowledge. An understanding of learning styles is important for education to be effective. This study examined the preferred learning styles of ground ambulance paramedics and describes how their preferred learning styles relate to the elective CME activities these paramedics attend. All paramedics (n=1,036) employed in a provincial ground ambulance service were invited to participate in a survey containing three parts: demographics, learning style assessed by the Kolb Learning Style Inventory (LSI), and elective CME activity. 260 paramedics (25%) participated in the survey. Preferred learning styles were: assimilator, 28%; diverger, 25%; converger, 24%; and accommodator, 23%. Advanced life support (ALS) providers had a higher proportion of assimilators (36%), and basic life support (BLS) providers had a higher proportion of divergers (30%). The learning style categories of CME activities attended by paramedics were: assimilators, 25%; divergers, 26%; convergers, 25%; and accommodators, 24%. These results suggest that paramedics are a diverse group of learners, and learning style differs within their demographics. Paramedics attend CME activities that complement all learning styles. Organizations providing education opportunities to paramedics should consider paramedics a diverse learning group when designing their CME programs.

Effect of cortex mori on pharmacokinetic profiles of main isoflavonoids from pueraria lobata in rat plasma.

PubMed

Xiao, Bingxin; Sun, Zengxian; Sun, Shu Yang; Dong, Jie; Li, Yanli; Gao, Shan; Pang, Jie; Chang, Qi

2017-09-14

Radix pueraria (the root of pueraria lobata (Wild.) Ohwi.), which contains a class of isoflavonoids as the main active components, as well as cortex mori (the root bark of Morus alba L), which contains abundant active alkaloids, have been employed for the treatment of diabetes in traditional Chinese medicine for centuries. In previous studies, pharmacodynamic synergistic reactions have been observed in compatible application of pueraria lobata isoflavonoids extracts (PLF) and cortex mori alkaloids extracts (CME) for inhibiting α-glycosidase activity. It has also been demonstrated that PLF can effectively slow down the absorption of active alkaloid from CME, so as to produce a higher effective concentration in small intestine for depressing the elevation of postprandial blood glucose through inhibiting α-glycosidase activity. In this study, the hypoglycemic effect of PLF, CME or CME-PLF mixture (the mixture of CME and PLF at a ratio of 1:6.3) was further evaluated through in vivo glucose tolerance studies. And the effect of CME on pharmacokinetic profiles of main isoflavonoids from PLF in rat plasma was investigated to further underlie compatibility mechanism of the two herbs. Four groups of rats received an oral dose of starch solution alone or simultaneously with drugs by gavage feeding. The blood samples were collected to determine glucose concentrations by glucose oxidase method. In addition, another two groups of rats were orally administered with PLF or CME-PLF. The plasma samples were collected and assayed using an LC/MS/MS method for comparatively pharmacokinetic studies of five main isoflavonoids. For starch loading, co-administration of CME-PLF resulted in more potent inhibition effects on glucose responses compared to those by CME or PLF in rat. The isoflavonoids from PLF were rapidly absorbed, presenting similarly low concentrations in plasma. When CME was added, the C max and AUC of all the five isoflavonoids were increased. A phenomenon of double peaks was found for all analysts. The elimination rates of all the detected isoflavonoids were also slowed down with extension of t 1/2. CONCLUSIONS: CME has been found to increase the absorption and delay the elimination of main isoflavonoids from PLF, which might result in higher concentrations of circulating active compounds for anti diabetes. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Automated LASCO CME Catalog for Solar Cycle 23: Are CMEs Scale Invariant?

NASA Astrophysics Data System (ADS)

Robbrecht, E.; Berghmans, D.; Van der Linden, R. A. M.

2009-02-01

In this paper, we present the first automatically constructed LASCO coronal mass ejection (CME) catalog, a result of the application of the Computer Aided CME Tracking software (CACTus) on the LASCO archive during the interval 1997 September-2007 January. We have studied the CME characteristics and have compared them with similar results obtained by manual detection (CDAW CME catalog). On average, CACTus detects less than two events per day during solar minimum, up to eight events during maximum, nearly half of them being narrow (<20°). Assuming a correction factor, we find that the CACTus CME rate is surprisingly consistent with CME rates found during the past 30 years. The CACTus statistics show that small-scale outflow is ubiquitously observed in the outer corona. The majority of CACTus-only events are narrow transients related to previous CME activity or to intensity variations in the slow solar wind, reflecting its turbulent nature. A significant fraction (about 15%) of CACTus-only events were identified as independent events, thus not related to other CME activity. The CACTus CME width distribution is essentially scale invariant in angular span over a range of scales from 20° to 120° while previous catalogs present a broad maximum around 30°. The possibility that the size of coronal mass outflows follow a power-law distribution could indicate that no typical CME size exists, i.e., that the narrow transients are not different from the larger well defined CMEs.

Factors Associated with Behavior Change in Family Physicians After CME Presentation.

ERIC Educational Resources Information Center

Ferguson, Kristi J.; And Others

1984-01-01

Registrants of a four-day family practice refresher course responded to a survey assessing their reaction to a brief presentation recommending the use of penile anesthesia in newborn circumcision. The results suggest that evaluation of behavior change should consider attitudinal variables. (Author/MLW)

TRAIL-death receptor endocytosis and apoptosis are selectively regulated by dynamin-1 activation.

PubMed

Reis, Carlos R; Chen, Ping-Hung; Bendris, Nawal; Schmid, Sandra L

2017-01-17

Clathrin-mediated endocytosis (CME) constitutes the major pathway for uptake of signaling receptors into eukaryotic cells. As such, CME regulates signaling from cell-surface receptors, but whether and how specific signaling receptors reciprocally regulate the CME machinery remains an open question. Although best studied for its role in membrane fission, the GTPase dynamin also regulates early stages of CME. We recently reported that dynamin-1 (Dyn1), previously assumed to be neuron-specific, can be selectively activated in cancer cells to alter endocytic trafficking. Here we report that dynamin isoforms differentially regulate the endocytosis and apoptotic signaling downstream of TNF-related apoptosis-inducing ligand-death receptor (TRAIL-DR) complexes in several cancer cells. Whereas the CME of constitutively internalized transferrin receptors is mainly dependent on the ubiquitously expressed Dyn2, TRAIL-induced DR endocytosis is selectively regulated by activation of Dyn1. We show that TRAIL stimulation activates ryanodine receptor-mediated calcium release from endoplasmic reticulum stores, leading to calcineurin-mediated dephosphorylation and activation of Dyn1, TRAIL-DR endocytosis, and increased resistance to TRAIL-induced apoptosis. TRAIL-DR-mediated ryanodine receptor activation and endocytosis is dependent on early caspase-8 activation. These findings delineate specific mechanisms for the reciprocal crosstalk between signaling and the regulation of CME, leading to autoregulation of endocytosis and signaling downstream of surface receptors.

TRAIL-death receptor endocytosis and apoptosis are selectively regulated by dynamin-1 activation

PubMed Central

Reis, Carlos R.; Chen, Ping-Hung; Bendris, Nawal; Schmid, Sandra L.

2017-01-01

Clathrin-mediated endocytosis (CME) constitutes the major pathway for uptake of signaling receptors into eukaryotic cells. As such, CME regulates signaling from cell-surface receptors, but whether and how specific signaling receptors reciprocally regulate the CME machinery remains an open question. Although best studied for its role in membrane fission, the GTPase dynamin also regulates early stages of CME. We recently reported that dynamin-1 (Dyn1), previously assumed to be neuron-specific, can be selectively activated in cancer cells to alter endocytic trafficking. Here we report that dynamin isoforms differentially regulate the endocytosis and apoptotic signaling downstream of TNF-related apoptosis-inducing ligand–death receptor (TRAIL–DR) complexes in several cancer cells. Whereas the CME of constitutively internalized transferrin receptors is mainly dependent on the ubiquitously expressed Dyn2, TRAIL-induced DR endocytosis is selectively regulated by activation of Dyn1. We show that TRAIL stimulation activates ryanodine receptor-mediated calcium release from endoplasmic reticulum stores, leading to calcineurin-mediated dephosphorylation and activation of Dyn1, TRAIL–DR endocytosis, and increased resistance to TRAIL-induced apoptosis. TRAIL–DR-mediated ryanodine receptor activation and endocytosis is dependent on early caspase-8 activation. These findings delineate specific mechanisms for the reciprocal crosstalk between signaling and the regulation of CME, leading to autoregulation of endocytosis and signaling downstream of surface receptors. PMID:28049841

The Great "Non-Event" of 7 January 2014: Challenges in CME Arrival Time and Geomagnetic Storm Strength Prediction

NASA Astrophysics Data System (ADS)

Mays, M. L.; Thompson, B. J.; Jian, L.; Evans, R. M.; Savani, N.; Odstrcil, D.; Nieves-Chinchilla, T.; Richardson, I. G.

2014-12-01

We present a case study of the 7 January 2014 event in order to highlight current challenges in space weather forecasting of CME arrival time and geomagnetic storm strength. On 7 January 2014 an X1.2 flare and CME with a radial speed ~2400 km/s was observed from active region 11943. The flaring region was only ten degrees southwest of disk center with extensive dimming south of the active region and preliminary analysis indicated a fairly rapid arrival at Earth (~36 hours). Of the eleven forecasting groups world-wide who participated in CCMC's Space Weather Scoreboard (http://kauai.ccmc.gsfc.nasa.gov/SWScoreBoard), nine predicted early arrivals and six predicted dramatic geomagnetic storm impacts (Kp predictions ranged from 6 to 9). However, the CME only had a glancing blow arrival at Earth - Kp did not rise above 3 and there was no geomagnetic storm. What happened? One idea is that the large coronal hole to the northeast of the active region could have deflected the CME. This coronal hole produced a high speed stream near Earth reaching an uncommon speed of 900 km/s four days after the observed CME arrival. However, no clear CME deflection was observed in the outer coronagraph fields of view (~5-20Rs) where CME measurements are derived to initiate models, therefore deflection seems unlikely. Another idea is the effect of the CME flux rope orientation with respect to Earth orbit. We show that using elliptical major and minor axis widths obtained by GCS fitting for the initial CME parameters in ENLIL would have improved the forecast to better reflect the observed glancing blow in-situ signature. We also explore the WSA-ENLIL+Cone simulations, the background solar wind solution, and compare with the observed CME arrival at Venus (from Venus Express) and Earth.

Managing Diabetes Mellitus: A Survey of Attitudes and Practices Among Family Physicians.

PubMed

Fogelman, Yacov; Goldfracht, Margalit; Karkabi, Khaled

2015-10-01

Due to the increasing prevalence of diabetes and the shortage of endocrinologists, family physicians have an important role in diabetes management. The purpose of this study was to examine the sources of knowledge, attitudes and practices of family physicians regarding the management of type 2 diabetes. Attendees at continuous medical education (CME) programs in Israel were requested to respond anonymously to written questions about their sources of knowledge about diabetes, the methods of diabetes management they advise their patients, their knowledge of diabetes medication treatments, and their attitudes toward people with type 2 diabetes. Questionnaires were completed by 362 family physicians (79% response rate). Of them, 329 (91%) reported that they usually manage their patients' diabetes care, including that of patients with concomitant risk factors. Their most common recommendations for diabetes control were: to increase physical activity, decrease total calorie intake, consult with a dietitian and undergo weight loss counseling. Almost all physicians (97%) reported providing lifestyle change counseling. Sixty percent reported lacking knowledge about nutritional issues. Only 58% answered correctly regarding the effect of the anti-diabetic drug, GLP1 analog. Board certified family physicians and their residents exhibited more knowledge about diabetes practice than did non-board certified family physicians. The great majority of family physicians surveyed usually manage their patients' diabetes themselves, and do not refer them to diabetes specialists. The implementation of strategies that will enhance the competencies and confidence of family physicians in diabetes management are important for achieving successful treatment.

Probing the Magnetic Causes of CMEs: Free Magnetic Energy More Important Than Either Size Or Twist

NASA Technical Reports Server (NTRS)

Falconer, D. A.; Moore, R. L.; Gary, G. A.

2006-01-01

To probe the magnetic causes of CMEs, we have examined three types of magnetic measures: size, twist and total nonpotentiality (or total free magnetic energy) of an active region. Total nonpotentiality is roughly the product of size times twist. For predominately bipolar active regions, we have found that total nonpotentiality measures have the strongest correlation with future CME productivity (approx. 75% prediction success rate), while size and twist measures each have a weaker correlation with future CME productivity (approx. 65% prediction success rate) (Falconer, Moore, & Gary, ApJ, 644, 2006). For multipolar active regions, we find that the CME-prediction success rates for total nonpotentiality and size are about the same as for bipolar active regions. We also find that the size measure correlation with CME productivity is nearly all due to the contribution of size to total nonpotentiality. We have a total nonpotentiality measure that can be obtained from a line-of-sight magnetogram of the active region and that is as strongly correlated with CME productivity as are any of our total-nonpotentiality measures from deprojected vector magnetograms. We plan to further expand our sample by using MDI magnetograms of each active region in our sample to determine its total nonpotentiality and size on each day that the active region was within 30 deg. of disk center. The resulting increase in sample size will improve our statistics and allow us to investigate whether the nonpotentiality threshold for CME production is nearly the same or significantly different for multipolar regions than for bipolar regions. In addition, we will investigate the time rates of change of size and total nonpotentiality as additional causes of CME productivity.

Antimicrobial and Antibiofilm Effects of Human Amniotic/Chorionic Membrane Extract on Streptococcus pneumoniae

PubMed Central

Yadav, Mukesh K.; Go, Yoon Y.; Kim, Shin Hye; Chae, Sung-Won; Song, Jae-Jun

2017-01-01

Background: Streptococcus pneumoniae colonize the human nasopharynx in the form of biofilms. The biofilms act as bacterial reservoirs and planktonic bacteria from these biofilms can migrate to other sterile anatomical sites to cause pneumonia, otitis media (OM), bacteremia and meningitis. Human amniotic membrane contains numerous growth factors and antimicrobial activity; however, these have not been studied in detail. In this study, we prepared amniotic membrane extract and chorionic membrane extract (AME/CME) and evaluated their antibacterial and antibiofilm activities against S. pneumoniae using an in vitro biofilm model and in vivo OM rat model. Materials and Methods: The AME/CME were prepared and protein was quantified using DCTM (detergent compatible) method. The minimum inhibitory concentrations were determined using broth dilution method, and the synergistic effect of AME/CME with Penicillin-streptomycin was detected checkerboard. The in vitro biofilm and in vivo colonization of S. pneumoniae were studied using microtiter plate assay and OM rat model, respectively. The AME/CME-treated biofilms were examined using scanning electron microscope and confocal microscopy. To examine the constituents of AME/CME, we determined the proteins and peptides of AME/CME using tandem mass tag-based quantitative mass spectrometry. Results: AME/CME treatment significantly (p < 0.05) inhibited S. pneumoniae growth in planktonic form and in biofilms. Combined application of AME/CME and Penicillin-streptomycin solution had a synergistic effect against S. pneumoniae. Biofilms grown with AME/CME were thin, scattered, and unorganized. AME/CME effectively eradicated pre-established pneumococci biofilms and has a bactericidal effect. AME treatment significantly (p < 0.05) reduced bacterial colonization in the rat middle ear. The proteomics analysis revealed that the AME/CME contains hydrolase, ribonuclease, protease, and other antimicrobial proteins and peptides. Conclusion: AME/CME inhibits S. pneumoniae growth in the planktonic and biofilm states via its antimicrobial proteins and peptides. AME/CME are non-cytotoxic, natural human product; therefore, they may be used alone or with antibiotics to treat S. pneumoniae infections. PMID:29089928

Anti-cancer effects of CME-1, a novel polysaccharide, purified from the mycelia of Cordyceps sinensis against B16-F10 melanoma cells.

PubMed

Jayakumar, Thanasekaran; Chiu, Chong-Chi; Wang, Shwu-Huey; Chou, Duen-Suey; Huang, Yung-Kai; Sheu, Joen-Rong

2014-01-01

Matrix metalloproteinases (MMPs) play important roles in the invasion and migration of cancer cells. In melanoma, several signaling pathways are constitutively activated. Among these, the mitogen-activated protein kinase (MAPKs) signaling pathways are activated through multiple signal transduction molecules and appear to play major roles in melanoma progression. Therefore, the inhibition of MAPK signaling might be a crucial role for the treatment of melanoma cancer. We examined the anticancer effect of CME-1, a novel water-soluble polysaccharide fraction, isolated from Cordyceps sinensis mycelia on B16-F10 melanoma cells. B16-F10 cells were exposed to different concentrations of CME-1 (250, 500 and 800 μg/ml) for 24 h in 5% CO² incubator at 37°C. Western blot analysis was performed to detect the expression of MMP-1, p-p38 MAPK, p-ERK1/2, and IkB-α in B16-F10 cells. Cell migration test was performed by wound healing migration assay. CME-1 suppresses cell migration in a concentration-dependent manner. Western blotting analysis revealed that CME-1 led to the reduction on the expression levels of MMP-1 and down regulated the expression of phosphorylated extracellular signal-regulated kinase (ERK1/2 and p38 mitogen-activated protein kinase (p38 MAPK). CME-1 restored the IkB-degradation in B16F10 cells. These results indicate that CME-1 inhibited MMP-1 expressions in B16F10 melanoma cells through either NF-kB or ERK/p38 MAPK down regulation thereby inhibiting B16F10 cell migration. Therefore, we proposed that CME-1 might be developed as a therapeutic potential candidate for the treatment of cancer metastasis.

Impact of Nuclear Laboratory Personnel Credentials & Continuing Education on Nuclear Cardiology Laboratory Quality Operations.

PubMed

Malhotra, Saurabh; Sobieraj, Diana M; Mann, April; Parker, Matthew W

2017-12-22

Background/Objectives: The specific credentials and continuing education (CME/CE) of nuclear cardiology laboratory medical and technical staff are important factors in the delivery of quality imaging services that have not been systematically evaluated. Methods: Nuclear cardiology accreditation application data from the Intersocietal Accreditation Commission (IAC) was used to characterize facilities performing myocardial perfusion imaging by setting, size, previous accreditation and credentials of the medical and technical staff. Credentials and CME/CE were compared against initial accreditation decisions (grant or delay) using multivariable logistic regression. Results: Complete data were available for 1913 nuclear cardiology laboratories from 2011-2014. Laboratories with initial positive accreditation decisions had a greater prevalence of Certification Board in Nuclear Cardiology (CBNC) certified medical directors and specialty credentialed technical directors. Certification and credentials of the medical and technical directors, respectively, staff CME/CE compliance, and assistance of a consultant with the application were positively associated with accreditation decisions. Conclusion: Nuclear cardiology laboratories directed by CBNC-certified physicians and NCT- or PET-credentialed technologists were less likely to receive delay decisions for MPI. CME/CE compliance of both the medical and technical directors was associated with accreditation decision. Medical and technical directors' years of experience were not associated with accreditation decision. Copyright © 2017 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

A Comparison of Internet-Based Learning and Traditional Classroom Lecture to Learn CPR for Continuing Medical Education

ERIC Educational Resources Information Center

Hemmati, Nima; Omrani, Soghra; Hemmati, Naser

2013-01-01

The purpose of this study was to compare the satisfaction and effectiveness of Internet-based learning (IBL) and traditional classroom lecture (TCL) for continuing medical education (CME) programs by comparing final resuscitation exam results of physicians who received the newest cardiopulmonary resuscitation (CPR) curriculum guidelines training…

Development of a Competency Framework for Quality Improvement in Family Medicine: A Qualitative Study

ERIC Educational Resources Information Center

Czabanowska, Katarzyna; Klemenc-Ketis, Zalika; Potter, Amanda; Rochfort, Andree; Tomasik, Tomasz; Csiszar, Judit; Van den Bussche, Piet

2012-01-01

Objective: The aim of this study was to develop a comprehensive framework of quality improvement competencies for use in continuing professional development (CPD) and continuing medical education (CME) for European general practice/family medicine physicians (GPs/FDs). Methods: The study was carried out in three phases: literature review,…

eLearning: A Review of Internet-Based Continuing Medical Education

ERIC Educational Resources Information Center

Wutoh, Rita; Boren, Suzanne Austin; Balas, E. Andrew

2004-01-01

Introduction: The objective was to review the effect of Internet-based continuing medical education (CME) interventions on physician performance and health care outcomes. Methods: Data sources included searches of MEDLINE (1966 to January 2004), CINAHL (1982 to December 2003), ACP Journal Club (1991 to July/August 2003), and the Cochrane Database…

Does Patient Partnership in Continuing Medical Education (CME) Improve the Outcome in Osteoporosis Management.

ERIC Educational Resources Information Center

Pazirandeh, Mahmood

2002-01-01

Patients (n=672) were screened and instructed about osteoporosis; 53 of their physicians attended lectures, a control group did not. A survey of 258 patients showed doctor-ordered screening tests increased regardless of lecture attendance. Increased patient-initiated discussions about osteoporosis suggest that patient education is effective.…

The Albany Two-Way Radio Conferences, 1955-1981: a retrospective look at a program providing interactive continuing medical education at a distance.

PubMed

Tulgan, Henry

2014-01-01

Despite early widespread recognition of the necessity of continuing medical education (CME) for practicing physicians and surgeons, medical schools and national medical organizations were slow to mobilize to address the need. One pioneering program, developed by the Albany Medical College in New York, not only provided CME, but did so in a live distance education format that allowed for interaction between the participants and the faculty presenters. The Albany Program commenced in 1955 using what was then state-of-the-art technology; it exemplified principles and practices that can be seen as the precursors for the distance education approaches used to reach physicians today. This short article describes the contributions of the Albany Two-Way Radio Conferences and places them in the context of developments in national organizations and policies in the 20th century. © 2014 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education.

A Ca2+ channel differentially regulates Clathrin-mediated and activity-dependent bulk endocytosis.

PubMed

Yao, Chi-Kuang; Liu, Yu-Tzu; Lee, I-Chi; Wang, You-Tung; Wu, Ping-Yen

2017-04-01

Clathrin-mediated endocytosis (CME) and activity-dependent bulk endocytosis (ADBE) are two predominant forms of synaptic vesicle (SV) endocytosis, elicited by moderate and strong stimuli, respectively. They are tightly coupled with exocytosis for sustained neurotransmission. However, the underlying mechanisms are ill defined. We previously reported that the Flower (Fwe) Ca2+ channel present in SVs is incorporated into the periactive zone upon SV fusion, where it triggers CME, thus coupling exocytosis to CME. Here, we show that Fwe also promotes ADBE. Intriguingly, the effects of Fwe on CME and ADBE depend on the strength of the stimulus. Upon mild stimulation, Fwe controls CME independently of Ca2+ channeling. However, upon strong stimulation, Fwe triggers a Ca2+ influx that initiates ADBE. Moreover, knockout of rodent fwe in cultured rat hippocampal neurons impairs but does not completely abolish CME, similar to the loss of Drosophila fwe at the neuromuscular junction, suggesting that Fwe plays a regulatory role in regulating CME across species. In addition, the function of Fwe in ADBE is conserved at mammalian central synapses. Hence, Fwe exerts different effects in response to different stimulus strengths to control two major modes of endocytosis.

A Ca2+ channel differentially regulates Clathrin-mediated and activity-dependent bulk endocytosis

PubMed Central

Liu, Yu-Tzu; Lee, I-Chi; Wang, You-Tung; Wu, Ping-Yen

2017-01-01

Clathrin-mediated endocytosis (CME) and activity-dependent bulk endocytosis (ADBE) are two predominant forms of synaptic vesicle (SV) endocytosis, elicited by moderate and strong stimuli, respectively. They are tightly coupled with exocytosis for sustained neurotransmission. However, the underlying mechanisms are ill defined. We previously reported that the Flower (Fwe) Ca2+ channel present in SVs is incorporated into the periactive zone upon SV fusion, where it triggers CME, thus coupling exocytosis to CME. Here, we show that Fwe also promotes ADBE. Intriguingly, the effects of Fwe on CME and ADBE depend on the strength of the stimulus. Upon mild stimulation, Fwe controls CME independently of Ca2+ channeling. However, upon strong stimulation, Fwe triggers a Ca2+ influx that initiates ADBE. Moreover, knockout of rodent fwe in cultured rat hippocampal neurons impairs but does not completely abolish CME, similar to the loss of Drosophila fwe at the neuromuscular junction, suggesting that Fwe plays a regulatory role in regulating CME across species. In addition, the function of Fwe in ADBE is conserved at mammalian central synapses. Hence, Fwe exerts different effects in response to different stimulus strengths to control two major modes of endocytosis. PMID:28414717

Adapting continuing medical education for post-conflict areas: assessment in Nagorno Karabagh - a qualitative study.

PubMed

Balalian, Arin A; Simonyan, Hambardzum; Hekimian, Kim; Crape, Byron

2014-08-06

One of the major challenges in the current century is the increasing number of post-conflict states where infrastructures are debilitated. The dysfunctional health care systems in post-conflict settings are putting the lives of the populations in these zones at increased risk. One of the approaches to improve such situations is to strengthen human resources by organizing training programmes to meet the special needs in post-conflict zones. Evaluations of these training programmes are essential to assure effectiveness and adaptation to the health service needs in these conditions. A specialized qualitative evaluation was conducted to assess and improve a post-conflict continuing medical education (CME) programme that was conducted in Nagorno Karabagh. Qualitative research guides were designed for this post-conflict zone that included focus group discussions with physician programme participants and semi-structured in-depth interviews with directors of hospitals and training supervisors. Saturation was achieved among the three participating groups in the themes of impact of participation in the CME and obstacles to application of obtained skills. All respondents indicated that the continuing medical education programme created important physician networks absent in this post-conflict zone, updated professional skills, and improved professional confidence among participants. However, all respondents indicated that some skills gained were inapplicable in Nagorno Karabagh hospitals and clinics due to lack of appropriate medical equipment, qualified supporting human resources and facilities. The qualitative research methods evaluation highlighted the fact that the health care human resources training should be closely linked to appropriate technologies, supplies, facilities and human resources available in post-conflict zones and identified the central importance of creating health professional networks and professional confidence among physicians in these zones. The qualitative research approach most effectively identifies these limitations and strengths and can directly inform the optimal adjustments for effective CME planning in these difficult areas of greatest need.

SPE in Solar Cycle 24 : Flare and CME characteristic

NASA Astrophysics Data System (ADS)

Neflia, Neflia

SPE is one of the most severe hazards in the space environment. Such events, tend to occur during periods of intense solar activity, and can lead to high radiation doses in short time intervals. The proton enhancements produced by these solar events may last several days and are very hard to predict in advance and they also can cause harm to both satellite and human in space. The most significant sources of proton in the interplanetary medium are both solar flares and interplanetary shocks driven by coronal mass ejections (CMEs). In this study, I try to find the characteristic of Flare and CME that can cause the proton events in interplanetary medium. For my preliminary study, I will search flare characteristic such as class and position as an SPE causes. I also did the research with CME characteristic such as Angular Width (AW) and linier velocity. During solar cycle 24, the solar activity remain very low with several large flare and Halo CME. This low activity also occur on solar proton events in interplanetary medium. From January 2009 to May 2013, there are 25 SPEs with flux range from 12 - 6530 sfu (10 MeV). The solar flare during these events varies from C to X- class flare. From 27 X-class flare that occur during 2009 - May 2013, only 7 flares cause the SPE. Most of active region location are at solar Western Hemisphere (16/25). only 24 from 139 halo CME (AW=360) cause SPE. Although the probability of SPE from all flare and CME during this range of time is small but they have 3 common characteristics, ie, most of the SPE have active region position at Solar Western Hemisphere, the CME have AW=360 and they have a high linier velocity.

A Series of Jets that Drove Streamer-Puff CMEs from Giant Active Region of 2014

NASA Technical Reports Server (NTRS)

Panesar, Navdeep K.; Sterling, Alphonse C.; Moore, Ronald L.

2016-01-01

We investigate characteristics of solar coronal jets that originated from active region NOAA 12192 and produced coronal mass ejections (CMEs). This active region produced many non­-jet major flare eruptions (X and M class) that made no CME. A multitude of jets occurred from the southeast edge of the active region, and in contrast to the major-­flare eruptions in the core, six of these jets resulted in CMEs. Our jet observations are from SDO/AIA EUV channels and from Hinode/XRT, and CME observations are from the SOHO/LASCO C2 coronograph. Each jet-­driven CME was relatively slow-­moving (approx. 200 - 300 km/s) compared to most CMEs; had angular width (20deg - 50deg) comparable to that of the streamer base; and was of the "streamer­-puff" variety, whereby a pre-existing streamer was transiently inflated but not removed (blown out) by the passage of the CME. Much of the chromospheric-­temperature plasma of the jets producing the CMEs escaped from the Sun, whereas relatively more of the chromospheric plasma in the non-CME-producing jets fell back to the solar surface. We also found that the CME-producing jets tended to be faster in speed and longer in duration than the non-CME-­producing jets. We expect that the jets result from eruptions of mini-filaments. We further propose that the CMEs are driven by magnetic twist injected into streamer-­base coronal loops when erupting twisted mini-filament field reconnects with the ambient field at the foot of those loops.

A Series of Jets that Drove Streamer-Puff CMEs from Giant Active Region of 2014

NASA Technical Reports Server (NTRS)

Panesar, Navdeep K.; Sterling, Alphonse C.; Moore, Ronald L.

2016-01-01

We investigate characteristics of solar coronal jets that originated from active region NOAA 12192 and produced coronal mass ejections (CMEs). This active region produced many non-jet major flare eruptions (X and M class) that made no CME. A multiitude of jets occurred from the southeast edge of the active region, and in contrast to the major-flare eruptions in the core, six of these jets resulted in CMEs. Our jet observations are from multiple SDO/AIA EUV channels, including 304, 171 and 193 Angstrom, and CME observations are taken from SOHO/LASCO C2 coronograph. Each jet-driven CME was relatively slow-moving (approximately 200 - 300 km s(sup-1) compared to most CMEs; had angular width (20deg - 50deg) comparable to that of the streamer base; and was of the "streamer-puff" variety, whereby a preexisting streamer was transiently inflated but not removed (blown out) by the passage of the CME. Much of the chromospheric-temperature plasma of the jets producing the CMEs escaped from the Sun, whereas relatively more of the chromospheric plasma in the non-CME-producing jets fell back to the solar surface. We also found that the CME-producing jets tended to be faster in speed and longer in duration than the non-CME-producing jets. We expect that the jets result from eruptions of mini-filaments. We further propose that the CMEs are driven by magnetic twist injected into streamer-base coronal loops when erupting twisted mini-filament field reconnects with the ambient field at the foot of those loops.

Lessons for continuing medical education from simulation research in undergraduate and graduate medical education: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines.

PubMed

McGaghie, William C; Siddall, Viva J; Mazmanian, Paul E; Myers, Janet

2009-03-01

Simulation technology is widely used in undergraduate and graduate medical education as well as for personnel training and evaluation in other healthcare professions. Simulation provides safe and effective opportunities for learners at all levels to practice and acquire clinical skills needed for patient care. A growing body of research evidence documents the utility of simulation technology for educating healthcare professionals. However, simulation has not been widely endorsed or used for continuing medical education (CME). This article reviews and evaluates evidence from studies on simulation technology in undergraduate and graduate medical education and addresses its implications for CME. The Agency for Healthcare Research and Quality Evidence Report suggests that simulation training is effective, especially for psychomotor and communication skills, but that the strength of the evidence is low. In another review, the Best Evidence Medical Education collaboration supported the use of simulation technology, focusing on high-fidelity medical simulations under specific conditions. Other studies enumerate best practices that include mastery learning, deliberate practice, and recognition and attention to cultural barriers within the medical profession that present obstacles to wider use of this technology. Simulation technology is a powerful tool for the education of physicians and other healthcare professionals at all levels. Its educational effectiveness depends on informed use for trainees, including providing feedback, engaging learners in deliberate practice, integrating simulation into an overall curriculum, as well as on the instruction and competence of faculty in its use. Medical simulation complements, but does not replace, educational activities based on real patient-care experiences.

Changing physician knowledge, attitudes, and beliefs about migraine: evaluation of a new educational intervention.

PubMed

Patwardhan, Meenal B; Samsa, Gregory P; Lipton, Richard B; Matchar, David B

2006-05-01

Use a presurvey of primary care providers (PCPs) enrolled in a continuing medical education (CME) program on headache management to ascertain their existing knowledge, attitudes, and beliefs regarding migraine and use a postsurvey to determine the extent to which the CME program has brought participant knowledge, attitudes, and skills closer to conformance with best evidence. Migraine is a common and debilitating condition, which PCPs may not always manage satisfactorily. In an effort to improve management, the American Headache Society has developed a CME program called BRAINSTORM that encourages PCPs to adopt the US Headache Consortium Guidelines for headache care. A 20-item questionnaire was developed that covered the essential elements of migraine care. The questionnaire was administered before and after a BRAINSTORM presentation to 254 consenting primary care clinicians attending a medical meeting at 1 of 6 sites. A control group of 112 comparable physicians who did not attend the presentation completed the same questionnaire. Prepresentation scores of attendees were compared to scores of nonattendees to assess the generalizability of results. Prepresentation scores on selected questions were used to assess participant baseline knowledge, attitudes, and beliefs. Pre- and postpresentation scores for attendees at all sites were compared using the Mantel-Haenszel statistic to assess the effectiveness of the BRAINSTORM CME. Pre- and postpresentation scores were compared by site using the Breslow-Day test to evaluate any differential impact based on CME location. Prepresentation scores of attendees and nonattendees were found to be similar. No significant difference in performance was noted across sites. A chi-square analysis revealed a statistically significant difference between pre- and postpresentation scores for 16 of the test's 20 questions. In the pretest, all participants scored <66% on 2 questions related to prevalence, impact, and pathophysiology of migraine, 2 questions pertaining to history taking/physical examination, and 3 migraine management questions. Attendee scores improved to >66% posttest on all except 2 questions related to prevalence, impact, and pathophysiology of migraine. Our results indicate that PCPs need to acquire greater understanding about the epidemiology and pathophysiology of migraine and may require guidance in history taking and physical examination of migraine patients. Improvement in scores posttest confirms that the BRAINSTORM program has a significant immediate impact on the knowledge, beliefs, and attitudes of participants. The program could be strengthened to improve emphasis in some areas where posttest scores showed no improvement.

Continuing Medical Education, Maintenance of Certification, and Physician Reentry

PubMed Central

Luchtefeld, Martin; Kerwel, Therese G.

2012-01-01

Continuing medical education serves a central role in the licensure and certification for practicing physicians. This chapter explores the different modalities that constitute CME along with their effectiveness, including simulation and best education practices. The evolution to maintenance of certification and the requirements for both the American Board of Surgery and the American Board of Colon and Rectal Surgery are delineated. Further progress in the education of practicing surgeons is evidenced through the introduction of laparoscopic colectomy and the improvements made from the introduction of laparoscopic cholecystectomy. Finally, reentry of physicians into practice following a voluntary leave of absence, a new and challenging issue for surgeons, is also discussed. PMID:23997673

Effectiveness of Extracorporeal Shock Wave Therapy Without Local Anesthesia in Patients With Recalcitrant Plantar Fasciitis: A Meta-Analysis of Randomized Controlled Trials.

PubMed

Lou, Jing; Wang, Shuai; Liu, Shuitao; Xing, Gengyan

2017-08-01

The objective of this meta-analysis was to investigate the efficacy of extracorporeal shock wave therapy in the treatment of recalcitrant plantar fasciitis without local anesthesia. The Cochrane Library, EMBASE, PubMed, and Web of Science databases were searched from inception to September 2015 for randomized controlled trials comparing ESWT without local anesthesia versus placebo for treatment of plantar fasciitis in adults. The primary outcome was the 12-week post-intervention success rate of reducing the visual analog scale score by 60% from baseline at the first step in the morning, reducing the VAS score by 60% from baseline during daily activities, reducing the Roles and Maudsley score, reducing overall heel pain, and reducing pain after applying a force meter. Nine studies were included in the meta-analysis. Compared with placebo, ESWT significantly improved the success rate of reducing overall heel pain, reducing the VAS score by 60% at the first step in the morning and during daily activities, improving the Roles and Maudsley score to excellent or good, and reducing heel pain after application of a pressure meter. ESWT seems to be particularly effective in relieving pain associated with RPF. ESWT should be considered when traditional treatments have failed. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to (1) understand the recovery rates for nonsurgical treatment of plantar fasciitis, (2) understand the role of extracorporeal shockwave therapy (ESWT) in the treatment of recalcitrant plantar fasciitis, and (3) understand the indications to incorporate ESWT in the treatment plan of recalcitrant plantar fasciitis. Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Diffusion of an e-Portfolio to Assist in the Self-Directed Learning of Physicians: An Exploratory Study

ERIC Educational Resources Information Center

Goliath, Cheryl Lynn

2009-01-01

Professional societies in the field of medicine have recommended that the traditional model for lifelong medical learning, which had previously focused on attendance at weeklong didactic continuing medical education (CME) courses, should be replaced by individualized study. Self-directed and practice-linked learning are well accepted in principle,…

The association of transequatorial loops in the solar corona with coronal mass ejection onset

NASA Astrophysics Data System (ADS)

Glover, A.; Harra, L. K.; Matthews, S. A.; Foley, C. A.

2003-03-01

It has been shown that transequatorial loops can disappear in association with the onset of a coronal mass ejection (CME) (Khan & Hudson \\cite{khan}). We extend this result by considering a larger sample of transequatorial loop systems (TLS) to investigate their associated flaring and CME activity. We find 10 of a total 18 TLS considered here to be associated with flaring and CME onset originating from a connected active region. A total 33 cases of flaring and associated CME onset are observed from these 10 systems during their lifetime. We observe the influence of this activity on the TLS in each case. In contrast to the Khan & Hudson result, we find evidence that transequatorial loop eruption leading to soft X-ray brightening equivalent in temperature to a B-class flare is equally as common as dimming in the corona. Consequently we conclude that the scenario observed by Khan & Hudson is not universal and that other types of CME-TLS association occur. It was found that for transequatorial loops that were associated with CMEs the asymmetry in longitude was larger than for those that were not associated to a CME by 10o. In addition, the extent in latitude (as a measure of the loop length) was nearly twice as large for those TLS associated with CMEs than those that were not. The asymmetry in latitude was actually on average larger for those TLS not associated with CMEs, than for those that were. This suggests that differential rotation is not a major contributor to the production of CMEs from transequatorial loops. Instead it is more likely for a CME to be produced if the loop is long, and if there is a large asymmetry in longitude. The implications of these results for CME onset prediction are discussed.

Increasing confidence and changing behaviors in primary care providers engaged in genetic counselling.

PubMed

Wilkes, Michael S; Day, Frank C; Fancher, Tonya L; McDermott, Haley; Lehman, Erik; Bell, Robert A; Green, Michael J

2017-09-13

Screening and counseling for genetic conditions is an increasingly important part of primary care practice, particularly given the paucity of genetic counselors in the United States. However, primary care physicians (PCPs) often have an inadequate understanding of evidence-based screening; communication approaches that encourage shared decision-making; ethical, legal, and social implication (ELSI) issues related to screening for genetic mutations; and the basics of clinical genetics. This study explored whether an interactive, web-based genetics curriculum directed at PCPs in non-academic primary care settings was superior at changing practice knowledge, attitudes, and behaviors when compared to a traditional educational approach, particularly when discussing common genetic conditions. One hundred twenty one PCPs in California and Pennsylvania physician practices were randomized to either an Intervention Group (IG) or Control Group (CG). IG physicians completed a 6 h interactive web-based curriculum covering communication skills, basics of genetic testing, risk assessment, ELSI issues and practice behaviors. CG physicians were provided with a traditional approach to Continuing Medical Education (CME) (clinical review articles) offering equivalent information. PCPs in the Intervention Group showed greater increases in knowledge compared to the Control Group. Intervention PCPs were also more satisfied with the educational materials, and more confident in their genetics knowledge and skills compared to those receiving traditional CME materials. Intervention PCPs felt that the web-based curriculum covered medical management, genetics, and ELSI issues significantly better than did the Control Group, and in comparison with traditional curricula. The Intervention Group felt the online tools offered several advantages, and engaged in better shared decision making with standardized patients, however, there was no difference in behavior change between groups with regard to increases in ELSI discussions between PCPs and patients. While our intervention was deemed more enjoyable, demonstrated significant factual learning and retention, and increased shared decision making practices, there were few differences in behavior changes around ELSI discussions. Unfortunately, barriers to implementing behavior change in clinical genetics is not unique to our intervention. Perhaps the missing element is that busy physicians need systems-level support to engage in meaningful discussions around genetics issues. The next step in promoting active engagement between doctors and patients may be to put into place the tools needed for PCPs to easily access the materials they need at the point-of-care to engage in joint discussions around clinical genetics.

A Small-Scale Flux Rope and its Associated CME and Shock.

NASA Astrophysics Data System (ADS)

Feng, L.; Ying, B.; Lu, L.; Zhang, J.

2016-12-01

A magnetic flux rope (MFR) is thought be a key ingredient of a coronal mass ejection (CME). It has been extensively explored after the Solar Dynamics Observatory (SDO) mission was launched. Previous studies are often concentrated on large-scale MFRs whose size are comparable to the active regions they reside. In this paper, we investigate the properties of a small-scale magnetic flux rope (SMFR) of a limb event observed by Atmospheric Imaging Assembly (AIA) . This SMFR originated from a very small and compact region at the edge of the active region and appeared mainly in the AIA 94 Å passband. It drove a coronal mass ejection (CME) and a type II burst was associated with the CME-driven shock. The type II burst started with a very high frequency. We obtain the compression ratio of the shock from the band splitting of the type II emissions and further derive the Alfvénic Mach number and the coronal magnetic field strength. On the other hand,we study the CME structure in LASCO coronagraph images and address its characteristics through measuring its mass and energy. Compared to the nature of the standard model of the CME, this CME triggered by the SMF are found to be different in some aspects.

Chikusetsusaponin IVa methyl ester induces cell cycle arrest by the inhibition of nuclear translocation of β-catenin in HCT116 cells

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lee, Kyung-Mi; Yun, Ji Ho; Lee, Dong Hwa

2015-04-17

We demonstrate that chikusetsusaponin IVa methyl ester (CME), a triterpenoid saponin from the root of Achyranthes japonica, has an anticancer activity. We investigate its molecular mechanism in depth in HCT116 cells. CME reduces the amount of β-catenin in nucleus and inhibits the binding of β-catenin to specific DNA sequences (TCF binding elements, TBE) in target gene promoters. Thus, CME appears to decrease the expression of cell cycle regulatory proteins such as Cyclin D1, as a representative target for β-catenin, as well as CDK2 and CDK4. As a result of the decrease of the cell cycle regulatory proteins, CME inhibits cellmore » proliferation by arresting the cell cycle at the G0/G1 phase. Therefore, we suggest that CME as a novel Wnt/β-catenin inhibitor can be a putative agent for the treatment of colorectal cancers. - Highlights: • CME inhibits cell proliferation in HCT116 cells. • CME increases cell cycle arrest at G0/G1 phase and apoptosis. • CME attenuates cyclin D1 and regulates cell cycle regulatory proteins. • CME inhibits β-catenin translocation to nucleus.« less

Selectivity of commonly used inhibitors of clathrin-mediated and caveolae-dependent endocytosis of G protein-coupled receptors.

PubMed

Guo, Shuohan; Zhang, Xiaohan; Zheng, Mei; Zhang, Xiaowei; Min, Chengchun; Wang, Zengtao; Cheon, Seung Hoon; Oak, Min-Ho; Nah, Seung-Yeol; Kim, Kyeong-Man

2015-10-01

Among the multiple G protein-coupled receptor (GPCR) endocytic pathways, clathrin-mediated endocytosis (CME) and caveolar endocytosis are more extensively characterized than other endocytic pathways. A number of endocytic inhibitors have been used to block CME; however, systemic studies to determine the selectivity of these inhibitors are needed. Clathrin heavy chain or caveolin1-knockdown cells have been employed to determine the specificity of various chemical and molecular biological tools for CME and caveolar endocytosis. Sucrose, concanavalin A, and dominant negative mutants of dynamin blocked other endocytic pathways, in addition to CME. In particular, concanavalin A nonspecifically interfered with the signaling of several GPCRs tested in the study. Decreased pH, monodansylcadaverine, and dominant negative mutants of epsin were more specific for CME than other treatments were. A recently introduced CME inhibitor, Pitstop2™, showed only marginal selectivity for CME and interfered with receptor expression on the cell surface. Blockade of receptor endocytosis by epsin mutants and knockdown of the clathrin heavy chain enhanced the β2AR-mediated ERK activation. Overall, our studies show that previous experimental results should be interpreted with discretion if they included the use of endocytic inhibitors that were previously thought to be CME-selective. In addition, our study shows that endocytosis of β2 adrenoceptor through clathrin-mediated pathway has negative effects on ERK activation. Copyright © 2015 Elsevier B.V. All rights reserved.

Controlling Quality in CME/CPD by Measuring and Illuminating Bias

ERIC Educational Resources Information Center

Dixon, David; Takhar, Jatinder; Macnab, Jennifer; Eadie, Jason; Lockyer, Jocelyn; Stenerson, Heather; Francois, Jose; Bell, Mary; Monette, Celine; Campbell, Craig; Marlow, Bernie

2011-01-01

Introduction: There has been a surge of interest in the area of bias in industry-supported continuing medical education/continuing professional development (CME/CPD) activities. In 2007, we published our first study on measuring bias in CME, demonstrating that our assessment tool was valid and reliable. In light of the increasing interest in this…

A randomized trial to improve patient-centered care and hypertension control in underserved primary care patients.

PubMed

Cooper, Lisa A; Roter, Debra L; Carson, Kathryn A; Bone, Lee R; Larson, Susan M; Miller, Edgar R; Barr, Michael S; Levine, David M

2011-11-01

African Americans and persons with low socioeconomic status (SES) are disproportionately affected by hypertension and receive less patient-centered care than less vulnerable patient populations. Moreover, continuing medical education (CME) and patient-activation interventions have infrequently been directed to improve the processes of care for these populations. To compare the effectiveness of patient-centered interventions targeting patients and physicians with the effectiveness of minimal interventions for underserved groups. Randomized controlled trial conducted from January 2002 through August 2005, with patient follow-up at 3 and 12 months, in 14 urban, community-based practices in Baltimore, Maryland. Forty-one primary care physicians and 279 hypertension patients. Physician communication skills training and patient coaching by community health workers. Physician communication behaviors; patient ratings of physicians' participatory decision-making (PDM), patient involvement in care (PIC), reported adherence to medications; systolic and diastolic blood pressure (BP) and BP control. Visits of trained versus control group physicians demonstrated more positive communication change scores from baseline (-0.52 vs. -0.82, p = 0.04). At 12 months, the patient+physician intensive group compared to the minimal intervention group showed significantly greater improvements in patient report of physicians' PDM (β = +6.20 vs. -5.24, p = 0.03) and PIC dimensions related to doctor facilitation (β = +0.22 vs. -0.17, p = 0.03) and information exchange (β = +0.32 vs. -0.22, p = 0.005). Improvements in patient adherence and BP control did not differ across groups for the overall patient sample. However, among patients with uncontrolled hypertension at baseline, non-significant reductions in systolic BP were observed among patients in all intervention groups-the patient+physician intensive (-13.2 mmHg), physician intensive/patient minimal (-10.6 mmHg), and the patient intensive/physician minimal (-16.8 mmHg), compared to the patient+physician minimal group (-2.0 mmHg). Interventions that enhance physicians' communication skills and activate patients to participate in their care positively affect patient-centered communication, patient perceptions of engagement in care, and may improve systolic BP among urban African-American and low SES patients with uncontrolled hypertension.

Kinematic and Energetic Properties of the 2012 March 12 Polar Coronal Mass Ejection

NASA Technical Reports Server (NTRS)

Gopalswamy, N.; Yashiro, Seiji; Akiyama, S.

2015-01-01

We report on the energetics of the 2012 March 12 polar coronal mass ejection (CME) originating from a southern latitude of approximately 60deg. The polar CME is similar to low-latitude (LL) CMEs in almost all respects: three-part morphology; post-eruption arcade (PEA), CME, and filament kinematics; CME mass and kinetic energy; and the relative thermal energy content of the PEA. From polarized brightness images, we estimate the CME mass, which is close to the average mass of LL CMEs. The CME kinetic energy (3.3 × 10(sup 30) erg) is also typical of the general population of CMEs. From photospheric magnetograms, we estimate the free energy (1.8 × 10(sup 31) erg) in the polar crown source region, which we find is sufficient to power the CME and the PEA. About 19% of the free energy went into the CME kinetic energy. We compute the thermal energy content of the PEA (2.3 × 10(sup 29) erg) and find it to be a small fraction (6.8%) of the CME kinetic energy. This fraction is remarkably similar to that in active region CMEs associated with major flares. We also show that the 2012 March 12 is one among scores of polar CMEs observed during the maximum phase of cycle 24. The cycle 24 polar crown prominence eruptions have the same rate of association with CMEs as those from LLs. This investigation supports the view that all CMEs are magnetically propelled from closed field regions, irrespective of their location on the Sun (polar crown filament regions, quiescent filament regions, or active regions).

KINEMATIC AND ENERGETIC PROPERTIES OF THE 2012 MARCH 12 POLAR CORONAL MASS EJECTION

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gopalswamy, N.; Yashiro, S.; Akiyama, S., E-mail: nat.gopalswamy@nasa.gov

2015-08-10

We report on the energetics of the 2012 March 12 polar coronal mass ejection (CME) originating from a southern latitude of ∼60°. The polar CME is similar to low-latitude (LL) CMEs in almost all respects: three-part morphology; post-eruption arcade (PEA), CME, and filament kinematics; CME mass and kinetic energy; and the relative thermal energy content of the PEA. From polarized brightness images, we estimate the CME mass, which is close to the average mass of LL CMEs. The CME kinetic energy (3.3 × 10{sup 30} erg) is also typical of the general population of CMEs. From photospheric magnetograms, we estimatemore » the free energy (1.8 × 10{sup 31} erg) in the polar crown source region, which we find is sufficient to power the CME and the PEA. About 19% of the free energy went into the CME kinetic energy. We compute the thermal energy content of the PEA (2.3 × 10{sup 29} erg) and find it to be a small fraction (6.8%) of the CME kinetic energy. This fraction is remarkably similar to that in active region CMEs associated with major flares. We also show that the 2012 March 12 is one among scores of polar CMEs observed during the maximum phase of cycle 24. The cycle 24 polar crown prominence eruptions have the same rate of association with CMEs as those from LLs. This investigation supports the view that all CMEs are magnetically propelled from closed field regions, irrespective of their location on the Sun (polar crown filament regions, quiescent filament regions, or active regions)« less

Effectiveness of Kinesiotaping and Subacromial Corticosteroid Injection in Shoulder Impingement Syndrome.

PubMed

Şahin Onat, Şule; Biçer, Seda; Şahin, Zehra; Küçükali Türkyilmaz, Ayşegül; Kara, Murat; Özbudak Demir, Sibel

2016-08-01

The aim of this study was to investigate whether kinesiotaping or subacromial corticosteroid injection provides additional benefit when used with nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with shoulder impingement syndrome. Patients with shoulder impingement syndrome were divided into 3 groups as follows: NSAID group (n = 33), kinesiotaping group (kinesiotaping + NSAID) (n = 33), and injection group (subacromial corticosteroid injection + NSAID) (n = 33). Outcome measures including visual analog scale, shoulder ranges of motion, Shoulder Disability Questionnaire, and University of California-Los Angeles (UCLA) scale were evaluated before and after the treatment (fourth week). A total of 99 patients (21 male and 78 female patients) were enrolled in this study. Demographic and baseline clinical characteristics of the groups (except for body mass index and visual analog scale at night, both P = 0.05) were similar between the groups (all P > 0.05). Clinical parameters were found to have improved in the 3 groups (all P < 0.001). While the kinesiotaping and injection groups showed similar improvements (all P > 0.05), each group had better outcome than did the NSAID group as regards pain (activity visual analog scale), ranges of motion, and Shoulder Disability Questionnaire and UCLA scale scores (all P < 0.05). Addition of kinesiotaping or subacromial corticosteroid injection to NSAID treatment seems to have better/similar effectiveness in patients with shoulder impingement syndrome. Therefore, kinesiotaping might serve as an alternative treatment in case (injection of) corticosteroids are contraindicated. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES:: Upon completion of this article, the reader should be able to: (1) Delineate appropriate treatment options for shoulder impingement syndrome; (2) Identify treatment benefits of kinesiotaping and corticosteroid injections in shoulder impingement syndrome; and (3) Incorporate kinesiotaping and corticosteroid injections into the treatment plan for patients with shoulder impingement syndrome. Advanced : The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this activity for amaximumof 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Hand Robotic Therapy in Children with Hemiparesis: A Pilot Study.

PubMed

Bishop, Lauri; Gordon, Andrew M; Kim, Heakyung

2017-01-01

The aim of this study was to understand the impact of training with a hand robotic device on hand paresis and function in a population of children with hemiparesis. Twelve children with hemiparesis (mean age, 9 [SD, 3.64] years) completed participation in this prospective, experimental, pilot study. Participants underwent clinical assessments at baseline and again 6 weeks later with instructions to not initiate new therapies. After these assessments, participants received 6 weeks of training with a hand robotic device, consisting of 1-hour sessions, 3 times weekly. Assessments were repeated on completion of training. Results showed significant improvements after training on the Assisting Hand Assessment (mean difference, 2.0 Assisting Hand Assessment units; P = 0.011) and on the upper-extremity component of the Fugl-Meyer scale (raw score mean difference, 4.334; P = 0.001). No significant improvements between pretest and posttest were noted on the Jebsen-Taylor Test of Hand Function, the Quality of Upper Extremity Skills Test, or the Pediatric Evaluation of Disability Inventory after intervention. Total active mobility of digits and grip strength also failed to demonstrate significant changes after training. Participants tolerated training with the hand robotic device, and significant improvements in bimanual hand use, as well as impairment-based scales, were noted. Improvements were carried over into bimanual skills during play. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Understand key components of neuroplasticity; (2) Discuss the benefits of robotic therapy in the recovery of hand function in pediatric patients with hemiplegia; and (3) Appropriately incorporate robotic therapy into the treatment plan of pediatric patients with hemiplegia. Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

The Rise of E-learning and Opportunities for Indian Family Physicians.

PubMed

Datta, Chayan

2012-01-01

The IT (information technology) revolution is sweeping across the globe. Distance, location and costs have become irrelevant. With availability of newer communication tools, medical education and practice are bound to be transformed. Rapid advancement of science requires medical professionals to update their knowledge constantly. Online interface for CME (Continued Medical Education) presents an exciting opportunity as an E learning tool.

Nanoscale manipulation of membrane curvature for probing endocytosis in live cells.

PubMed

Zhao, Wenting; Hanson, Lindsey; Lou, Hsin-Ya; Akamatsu, Matthew; Chowdary, Praveen D; Santoro, Francesca; Marks, Jessica R; Grassart, Alexandre; Drubin, David G; Cui, Yi; Cui, Bianxiao

2017-08-01

Clathrin-mediated endocytosis (CME) involves nanoscale bending and inward budding of the plasma membrane, by which cells regulate both the distribution of membrane proteins and the entry of extracellular species. Extensive studies have shown that CME proteins actively modulate the plasma membrane curvature. However, the reciprocal regulation of how the plasma membrane curvature affects the activities of endocytic proteins is much less explored, despite studies suggesting that membrane curvature itself can trigger biochemical reactions. This gap in our understanding is largely due to technical challenges in precisely controlling the membrane curvature in live cells. In this work, we use patterned nanostructures to generate well-defined membrane curvatures ranging from +50 nm to -500 nm radius of curvature. We find that the positively curved membranes are CME hotspots, and that key CME proteins, clathrin and dynamin, show a strong preference towards positive membrane curvatures with a radius <200 nm. Of ten CME-related proteins we examined, all show preferences for positively curved membrane. In contrast, other membrane-associated proteins and non-CME endocytic protein caveolin1 show no such curvature preference. Therefore, nanostructured substrates constitute a novel tool for investigating curvature-dependent processes in live cells.

Homologous Flare-CME Events and Their Metric Type II Radio Burst Association

NASA Technical Reports Server (NTRS)

Yashiro, S.; Gopalswamy, N.; Makela, P.; Akiyama, S.; Uddin, W.; Srivastava, A. K.; Joshi, N. C.; Chandra, R.; Manoharan, P. K.; Mahalakshmi, K.;

Do continuing medical education articles foster shared decision making?

PubMed

Labrecque, Michel; Lafortune, Valérie; Lajeunesse, Judith; Lambert-Perrault, Anne-Marie; Manrique, Hermes; Blais, Johanne; Légaré, France

2010-01-01

Defined as reviews of clinical aspects of a specific health problem published in peer-reviewed and non-peer-reviewed medical journals, offered without charge, continuing medical education (CME) articles form a key strategy for translating knowledge into practice. This study assessed CME articles for mention of evidence-based information on benefits and harms of available treatment and/or preventive options that are deemed essential for shared decision making (SDM) to occur in clinical practice. Articles were selected from 5 medical journals that publish CME articles and are provided free of charge to primary-care physicians of the Province of Quebec, Canada. Two individuals independently scored each article with the use of a 10-item checklist based on the International Patient Decision Aid Standards. In case of discrepancy, the item score was established by team consensus. Scores were added to produce a total article score ranging from 0 (no item present) to 10 (all items present). Thirty articles (6 articles per journal) were selected. Total article scores ranged from 1 to 9, with a mean (+/- SD) of 3.1 +/- 2.0 (95% confidence interval 2.8-4.3). Health conditions and treatment options were the items most frequently discussed in the articles; next came treatment benefits. Possible harms, the use of the same denominators for benefits and harms, and methods to facilitate the communication of benefits and harms to patients were almost never described. No significant differences between journals were observed. The CME articles evaluated did not include the evidence-based information necessary to foster SDM in clinical practice. Peer-reviewed and non-peer-reviewed medical journals should require CME articles to include this type of information.

Commercial influence and learner-perceived bias in continuing medical education.

PubMed

Steinman, Michael A; Boscardin, Christy K; Aguayo, Leslie; Baron, Robert B

2010-01-01

To directly examine the relationship between commercial support of continuing medical education (CME) and perceived bias in the content of these activities. Cross-sectional study of 213 accredited live educational programs organized by a university provider of CME from 2005 to 2007. A standard question from course evaluations was used to determine the degree to which attendees believed commercial bias was present. Binomial regression models were used to determine the association between course features that may introduce commercial bias and the extent of perceived bias at those CME activities. Mean response rate for attendee evaluations was 56% (SD 15%). Commercial support covered 20%-49% of costs for 45 (21%) educational activities, and > or = 50% of costs for 46 activities (22%). Few course participants perceived commercial bias, with a median of 97% (interquartile range 95%-99%) of respondents stating that the activity they attended was free of commercial bias. There was no association between extent of commercial support and the degree of perceived bias in CME activities. Similarly, perceived bias did not vary for 11 of 12 event characteristics evaluated as potential sources of commercial bias, or by score on a risk index designed to prospectively assess risk of commercial bias. Rates of perceived bias were low for the vast majority of CME activities in the sample and did not differ by the degree of industry support or other event characteristics. Further study is needed to determine whether commercial influence persisted in more subtle forms that were difficult for participants to detect.

Performance assessment through pre- and post-training evaluation of continuing medical education courses in prevention and management of cardio-vascular diseases in primary health care facilities of Armenia.

PubMed

Khachatryan, Lilit; Balalian, Arin

2013-12-01

To assess the difference of pre- and post-training performance evaluation of continuing medical education (CME) courses in cardio-vascular diseases (CVD) management among physicians at primary health care facilities of Armenian regions we conducted an evaluation survey. 212 medical records were surveyed on assessment of performance before and after the training courses through a self-employed structured questionnaire. Analysis of survey revealed statistically significant differences (p < 0.05) in a number of variables: threefold increased recording of lipids and body mass index (p = 0.001); moderate increased recording of comorbidities and aspirin prescription (p < 0.012); eightfold increased recording of dyslipidemia management plan, twofold increased recording for CVD management plan and fivefold increased recording for CVD absolute risk (p = 0.000). Missing records of electrocardiography and urine/creatinine analyses decreased statistically significantly (p < 0.05). Statistically significant decrease was observed in prescription of thiazides and angiotensin receptor blockers/angiotensin converting enzyme inhibitors (p < 0.005), while prescription of statins and statins with diet for dyslipidemia management showed increased recording (p < 0.05). Similarly, we observed increased records for counseling of rehabilitation physical activity (p = 0.006). In this survey most differences in pre- and post-evaluation of performance assessment may be explained by improved and interactive training modes, more advanced methods of demonstration of modeling. Current findings may serve a basis for future planning of CME courses for physicians of remote areas facing challenges in upgrading their knowledge, as well as expand the experience of performance assessment along with evaluation of knowledge scores.

The February 15 2011 CME-CME interaction and possibly associated radio emission

NASA Astrophysics Data System (ADS)

Magdalenic, Jasmina; Temmer, Manuela; Krupar, Vratislav; Marque, Christophe; Veronig, Astrid; Eastwood, Jonathan

2017-04-01

On February 15, 2011 a particular, continuum-like radio emission was observed by STEREO WAVES and WIND WAVES spacecraft. The radio event appeared to be associated with the complex interaction of two coronal mass ejections (CMEs) successively launched (February 14 and February 15) from the same active region. Although the CME-CME interaction was widely studied (e.g. Temmer et al., 2014, Maricic et al., 2014, Mishra & Srivastava, 2014) none of the analyses confirmed an association with the continuum-like radio emission. The usual method of establishing temporal coincidence of radio continuum and a CME-CME interaction is not applicable in this event due to a complex and long-lasting interaction of the CMEs. Therefore, we performed radio triangulation studies (see also Magdalenic et al., 2014) which provided us with the 3D source positions of the radio emission. Comparison of the positions of radio sources and the reconstructed positions of the interacting CMEs, shows that the source position of the continuum-like radio emission is about 0.5 AU away from the interacting CMEs. We can therefore concluded that, in this event, the continuum-like emission is not the radio signature of the CME-CME interaction.

What do primary care practitioners want to know? A content analysis of questions asked at the point of care.

PubMed

Bjerre, Lise M; Paterson, Nicholas R; McGowan, Jessie; Hogg, William; Campbell, Craig M; Viner, Gary; Archibald, Douglas

2013-01-01

Assessing physician needs to develop continuing medical education (CME) activities is an integral part of CME curriculum development. The purpose of the present study was to demonstrate the feasibility of identifying areas of perceived greatest needs for continuing medical education (CME) by using questions collected electronically at the point of care. This study is a secondary analysis of the "Just-in-Time" (JIT) information librarian consultation service database of questions using quantitative content analysis methods. The original JIT project demonstrated the feasibility of a real-time librarian service for answering questions asked by primary care clinicians at the point of care using a Web-based platform or handheld device. Data were collected from 88 primary care practitioners in Ontario, Canada, from October 2005 to April 2006. Questions were answered in less than 15 minutes, enabling clinicians to use the answer during patient encounters. Description of type and frequency of questions asked, including the organ system on which the questions focused, was produced using 2 classification systems, the "taxonomy of generic clinical questions" (TGCQ), and the International Classification for Primary Care version 2 (ICPC-2). Of the original 1889 questions, 1871 (99.0%) were suitable for analysis. A total of 970 (52%) of questions related to therapy; of these, 671 (69.2%) addressed questions about drug therapy, representing 36% of all questions. Questions related to diagnosis (24.8%) and epidemiology (13.5%) were also common. Organ systems questions concerning musculoskeletal, endocrine, skin, cardiac, and digestive systems were asked more than other categories. Questions collected at the point of care provide a valuable and unique source of information on the true learning needs of practicing clinicians. The TGCQ classification allowed us to show that a majority of questions had to do with treatment, particularly drug treatment, whereas the use of the ICPC-2 classification illustrated the great variety of questions asked about the diverse conditions encountered in primary care. It is feasible to use electronically collected questions asked by primary care clinicians in clinical practice to categorize self-identified knowledge and practice needs. This could be used to inform the development of future learning activities. Copyright © 2013 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

PROPAGATION OF THE 2014 JANUARY 7 CME AND RESULTING GEOMAGNETIC NON-EVENT

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mays, M. L.; Collinson, G.; Taktakishvili, A.

2015-10-20

On 2014 January 7 an X1.2 flare and coronal mass ejection (CME) with a radial speed ≈2500 km s{sup −1} was observed from near an active region close to disk center. This led many forecasters to estimate a rapid arrival at Earth (≈36 hr) and predict a strong geomagnetic storm. However, only a glancing CME arrival was observed at Earth with a transit time of ≈49 hr and a K{sub P} geomagnetic index of only 3−. We study the interplanetary propagation of this CME using the ensemble Wang-Sheeley-Arge (WSA)–ENLIL+Cone model, that allows a sampling of CME parameter uncertainties. We exploremore » a series of simulations to isolate the effects of the background solar wind solution, CME shape, tilt, location, size, and speed, and the results are compared with observed in situ arrivals at Venus, Earth, and Mars. Our results show that a tilted ellipsoid CME shape improves the initial real-time prediction to better reflect the observed in situ signatures and the geomagnetic storm strength. CME parameters from the Graduated Cylindrical Shell model used as input to WSA–ENLIL+Cone, along with a tilted ellipsoid cloud shape, improve the arrival-time error by 14.5, 18.7, 23.4 hr for Venus, Earth, and Mars respectively. These results highlight that CME orientation and directionality with respect to observatories play an important role in understanding the propagation of this CME, and for forecasting other glancing CME arrivals. This study also demonstrates the importance of three-dimensional CME fitting made possible by multiple viewpoint imaging.« less

The heart truth professional education campaign on women and heart disease: needs assessment and evaluation results.

PubMed

Pregler, Janet; Freund, Karen M; Kleinman, Mary; Phipps, Maureen G; Fife, Rose S; Gams, Becky; Núñez, Ana E; Seaver, Margaret R; Lazarus, Cathy J; Raymond, Nancy C; Briller, Joan; Uijtdehaage, Sebastian; Moskovic, Cindy S; Guiton, Gretchen; David, Michele; Gabeau, Geralde V; Geller, Stacie; Meekma, Kelli; Moore, Christopher; Robertson, Candace; Sarto, Gloria

2009-10-01

Heart disease is the leading cause of death for women in the United States. Research has identified that women are less likely than men to receive medical interventions for the prevention and treatment of heart disease. As part of a campaign to educate healthcare professionals, 1245 healthcare professionals in 11 states attended a structured 1-hour continuing medical education (CME) program based on the 2004 AHA Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women and completed a pretest and posttest evaluation. We identified significant knowledge deficits in the pretest: 45% of attendees would initially recommend lifestyle changes alone, rather than statin therapy, for women diagnosed with coronary artery disease (CAD); 38% identified statin therapy as less effective in women compared with men for preventing CAD events; 27% identified Asian American women at low risk (rather than high risk) for type 2 diabetes mellitus (DM); and 21% identified processed meat (rather than baked goods) as the principal dietary source of trans fatty acids. Overall, healthcare professionals answered 5.1 of 8 knowledge questions correctly in the pretest, improving to 6.8 questions in the posttest (p < 0.001). Family physicians, obstetrician/gynecologists, general internists, nurse practitioners/physician assistants, and registered nurses all statistically significantly improved knowledge and self-assessed skills and attitudes as measured by the posttest. Significant knowledge deficits are apparent in a cross-section of healthcare providers attending a CME lecture on women and heart disease. A 1-hour presentation was successful in improving knowledge and self-assessed skills and attitudes among primary care physicians, nurse practitioners, physician assistants, and registered nurses.

Individual risk factors for physician boundary violations: the role of attachment style, childhood trauma and maladaptive beliefs.

PubMed

MacDonald, Kai; Sciolla, Andrés F; Folsom, David; Bazzo, David; Searles, Chris; Moutier, Christine; Thomas, Michael L; Borton, Katherine; Norcross, Bill

2015-01-01

The assessment and remediation of boundary-challenged healthcare professionals is enhanced through examination of individual risk factors. We assessed three such factors--attachment style, childhood trauma and maladaptive beliefs--in 100 attendees (mostly physicians) of a CME professional boundaries course. We propose a theoretical model which draws a causal arc from childhood maltreatment through insecure attachment and maladaptive beliefs to elevated risk for boundary violations. We administered the Experiences in Close Relationship Questionnaire (ECR-R), Childhood Trauma Questionnaire (CTQ), and Young Schema Questionnaire (YSQ) to 100 healthcare professionals (mostly physicians) attending a CME course on professional boundaries. Experts rated participant autobiographies to determine attachment style and early adversities. Correlations and relationships among self- and expert ratings and between different risk factors were examined. Five percent of participants reported CTQ total scores in the moderate to severe range; eleven percent reported moderate to severe emotional neglect or emotional abuse. Average attachment anxiety and attachment avoidance were low, and more than half of participants were rated “secure” by experts. Childhood maltreatment was correlated with attachment anxiety and avoidance and predicted expert-rated insecure attachment and maladaptive beliefs. Our findings support a potential link between childhood adversity and boundary difficulties, partly mediated by insecure attachment and early maladaptive beliefs. Furthermore, these results suggest that boundary education programs and professional wellness programs may be enhanced with a focus on sequelae of childhood maltreatment, attachment and common maladaptive thinking patterns.

Practice-based learning and improvement.

PubMed

Moore, Donald E; Pennington, Floyd C

2003-01-01

Workplace learning is becoming increasingly important in all fields. While workplace learning in medicine, also called practice-based learning and improvement (PBLI) is not new, understanding how it works and how it fits with an individual physician's continuing professional development is new. In this article, we describe seven issues associated with PBLI and then pose questions for reflections, as continuing medical education (CME) planners consider working with PBLI.

Analysing spectroscopically the propagation of a CME from its source on the disk to its impact as it propagates outwards

NASA Astrophysics Data System (ADS)

Harra, Louise K.; Doschek, G. A.; Matthews, Sarah A.; De Pontieu, Bart; Long, David

We analyse a complex coronal mass ejection observed by Hinode, SDO and IRIS. SDO AIA shows that the eruption occurs between several active regions with flaring occurring in all of them. Hinode EIS observed one of the flaring active regions that shows a fast outwards propagation which is related to the CME lifting off. The eruption is then observed as it propagates away from the Sun, pushing the existing post-flare loops downwards as it goes. Spectroscopic observations are made during this time with IRIS measuring the impact that this CME front has as it pushes the loops downwards. Strong enhancements in the cool Mg II emission at these locations that show complex dynamics. We discuss these new observations in context of CME models.

Multi-spacecraft Observations of the Coronal and Interplanetary Evolution of a Solar Eruption Associated with Two Active Regions

NASA Astrophysics Data System (ADS)

Hu, H.; Liu, Y. D.; Wang, R.; Zhao, X.; Zhu, B.; Yang, Z.

2017-12-01

We investigate the coronal and interplanetary evolution of a coronal mass ejection (CME) launched on 2010 September 4 from a source region linking two active regions (ARs), 11101 and 11103, using extreme ultraviolet imaging, magnetogram, white-light, and in situ observations from SDO, STEREO, SOHO, VEX, and Wind. A potential-field source-surface model is employed to examine the configuration of the coronal magnetic field surrounding the source region. The graduated cylindrical shell model and a triangulation method are applied to determine the kinematics of the CME in the corona and interplanetary space. From the remote sensing and in situ observations, we obtain some key results: (1) the CME was deflected in both the eastward and southward directions in the low corona by the magnetic pressure from the two ARs, and possibly interacted with another ejection, which caused that the CME arrived at VEX that was longitudinally distant from the source region; (2) although VEX was closer to the Sun, the observed and derived CME arrival times at VEX are not earlier than those at Wind, which suggests the importance of determining both the frontal shape and propagation direction of the CME in interplanetary space; and (3) the ICME was compressed in the radial direction while the longitudinal transverse size was extended.

The three-dimensional angular widths of CMEs and their relations to the source regions

NASA Astrophysics Data System (ADS)

Zhao, X.; Feng, X. S.

2017-12-01

The angular width of a coronal mass ejection (CME) is an important factor to determine whether the corresponding interplanetary CME (ICME) and its preceding shock will reach our Earth. However, very few studies are involved to study the decisive factors of the CME's angular width. In this study, we use the three-dimensional (3D) angular width of CMEs obtained from the Graduated Cylindrical Shell (GCS) model based on observations of Solar Terrestrial Relations Observatory (STEREO) to study the relations between the CME's 3D width and characteristics of the CME's source region. We find that for the CMEs produced by active regions (ARs), the CME width has some correlations with the AR's area and flux, but these correlations are not strong. The magnetic flux contained in the CME seems to come from only part of the AR's total flux. For the CMEs produced by flare regions, the correlations between the CME angular width and the flare region's area and flux are strong. The magnetic flux within those CMEs seems to totally (even not enough) come from the flare region. Our findings prefer to support that the CME's 3D angular width can be generally estimated based on observations of Solar Dynamics Observatory (SDO) for its source region instead of the observations from coronagraphs onboard Solar and Heliospheric Observatory (SOHO) and STEREO.

Herbal Formulation C168 Attenuates Proliferation and Induces Apoptosis in HCT 116 Human Colorectal Carcinoma Cells: Role of Oxidative Stress and DNA Damage

PubMed Central

Leong, Lek Mun; Chan, Kok Meng; Hamid, Asmah; Latip, Jalifah; Rajab, Nor Fadilah

2016-01-01

The use of herbal formulations has gained scientific interest, particularly in cancer treatment. In this study, the herbal formulation of interest, denoted as C168, is a mixture of eight genera of plants. This study aims to investigate the antiproliferative effect of C168 methanol extract (CME) on various cancer cells and its underlying mechanism of action on the most responsive cell line, namely, HCT 116 cells. CME exerted antiproliferative activities on HCT 116 colorectal carcinoma cells and HepG2 hepatocellular carcinoma cells but not on CCD-841-CoN normal colon epithelial cells, Jurkat E6.1 lymphoblastic leukemic cells, and V79-4 Chinese hamster lung fibroblasts. Further investigation on HCT 116 cells showed that CME induced G2/M cell-cycle arrest and apoptosis. Treatment of CME induced oxidative stress in HCT 116 cells by increasing the superoxide anion level and decreasing the intracellular glutathione. CME also increased tail moment value and H2AX phosphorylation in HCT 116 cells, suggesting DNA damage as an early signal of CME induced apoptosis. Loss of mitochondrial membrane potential in CME-treated cells also indicated the involvement of mitochondria in CME induced apoptosis. This study indicated the selectivity of CME toward colon cancer cells with the involvement of oxidative damage as its possible mechanism of action. PMID:26884792

HOMOLOGOUS JET-DRIVEN CORONAL MASS EJECTIONS FROM SOLAR ACTIVE REGION 12192

DOE Office of Scientific and Technical Information (OSTI.GOV)

Panesar, Navdeep K.; Sterling, Alphonse C.; Moore, Ronald L., E-mail: navdeep.k.panesar@nasa.gov

We report observations of homologous coronal jets and their coronal mass ejections (CMEs) observed by instruments onboard the Solar Dynamics Observatory (SDO) and the Solar and Heliospheric Observatory (SOHO) spacecraft. The homologous jets originated from a location with emerging and canceling magnetic field at the southeastern edge of the giant active region (AR) of 2014 October, NOAA 12192. This AR produced in its interior many non-jet major flare eruptions (X- and M- class) that made no CME. During October 20 to 27, in contrast to the major flare eruptions in the interior, six of the homologous jets from the edgemore » resulted in CMEs. Each jet-driven CME (∼200–300 km s{sup −1}) was slower-moving than most CMEs, with angular widths (20°–50°) comparable to that of the base of a coronal streamer straddling the AR and were of the “streamer-puff” variety, whereby the preexisting streamer was transiently inflated but not destroyed by the passage of the CME. Much of the transition-region-temperature plasma in the CME-producing jets escaped from the Sun, whereas relatively more of the transition-region plasma in non-CME-producing jets fell back to the solar surface. Also, the CME-producing jets tended to be faster and longer-lasting than the non-CME-producing jets. Our observations imply that each jet and CME resulted from reconnection opening of twisted field that erupted from the jet base and that the erupting field did not become a plasmoid as previously envisioned for streamer-puff CMEs, but instead the jet-guiding streamer-base loop was blown out by the loop’s twist from the reconnection.« less

PROBABILITY OF CME IMPACT ON EXOPLANETS ORBITING M DWARFS AND SOLAR-LIKE STARS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kay, C.; Opher, M.; Kornbleuth, M., E-mail: ckay@bu.edu

2016-08-01

Solar coronal mass ejections (CMEs) produce adverse space weather effects at Earth. Planets in the close habitable zone of magnetically active M dwarfs may experience more extreme space weather than at Earth, including frequent CME impacts leading to atmospheric erosion and leaving the surface exposed to extreme flare activity. Similar erosion may occur for hot Jupiters with close orbits around solar-like stars. We have developed a model, Forecasting a CME's Altered Trajectory (ForeCAT), which predicts a CME's deflection. We adapt ForeCAT to simulate CME deflections for the mid-type M dwarf V374 Peg and hot Jupiters with solar-type hosts. V374 Peg'smore » strong magnetic fields can trap CMEs at the M dwarfs's Astrospheric Current Sheet, that is, the location of the minimum in the background magnetic field. Solar-type CMEs behave similarly, but have much smaller deflections and do not become trapped at the Astrospheric Current Sheet. The probability of planetary impact decreases with increasing inclination of the planetary orbit with respect to the Astrospheric Current Sheet: 0.5–5 CME impacts per day for M dwarf exoplanets, 0.05–0.5 CME impacts per day for solar-type hot Jupiters. We determine the minimum planetary magnetic field necessary to shield a planet's atmosphere from CME impacts. M dwarf exoplanets require values between tens and hundreds of Gauss. Hot Jupiters around a solar-type star, however, require a more reasonable <30 G. These values exceed the magnitude required to shield a planet from the stellar wind, suggesting that CMEs may be the key driver of atmospheric losses.« less

Comparison of the Effect of Lateral and Backward Walking Training on Walking Function in Patients with Poststroke Hemiplegia: A Pilot Randomized Controlled Trial.

PubMed

Kim, Chang-Yong; Lee, Jung-Sun; Kim, Hyeong-Dong

2017-02-01

The purposes of the present study were to compare the effects of backward and lateral walking training and to identify whether additional backward or lateral walking training would be more effective in increasing the walking function of poststroke patients. Fifty-one subjects with hemiplegic stroke were randomly allocated to 3 groups, each containing 17 subjects: the control group, the backward walking training group, and the lateral walking training group. The walking abilities of each group were assessed using a 10-m walk test and the GAITRite system for spatiotemporal gait. The results show that there were significantly greater posttest increases in gait velocity (F = -12.09, P = 0.02) and stride length (F = -11.50, P = 0.02), decreases in the values of the 10-m walk test (F = -7.10, P = 0.03) (P < 0.05) and double-limb support period (F = 40.15, P = 0.000), and improvements in gait asymmetry (F = 13.88, P = 0.002) (P < 0.01) in subjects in the lateral walking training group compared with those in the other 2 groups. These findings demonstrate that asymmetric gait patterns in poststroke patients could be improved by receiving additional lateral walking training therapy rather than backward walking training. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) understand the potential benefits of backward walking (BW) and lateral walking (LW) training on improving muscle strength and gait; (2) appreciate the potential value of backward and lateral walking gait training in the treatment of hemiplegic stroke patients; and (3) appropriately incorporate backward and lateral walking gait training into the treatment plan of hemiplegic stroke patients. Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Physics of Coupled CME and Flare Systems

DTIC Science & Technology

2016-12-21

AFRL-RV-PS- AFRL-RV-PS- TR-2016-0162 TR-2016-0162 PHYSICS OF COUPLED CME AND FLARE SYSTEMS K. S. Balasubramaniam, et al. 21 December 2016 Final...30 Sep 2016 4. TITLE AND SUBTITLE Physics of Coupled CME and Flare Systems 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 61102F...objectives for this task were: (i) derive measureable physical properties and discernible structural circumstances in solar active regions that

The Interaction of Successive Coronal Mass Ejections: A Review

NASA Astrophysics Data System (ADS)

Lugaz, Noé; Temmer, Manuela; Wang, Yuming; Farrugia, Charles J.

2017-04-01

We present a review of the different aspects associated with the interaction of successive coronal mass ejections (CMEs) in the corona and inner heliosphere, focusing on the initiation of series of CMEs, their interaction in the heliosphere, the particle acceleration associated with successive CMEs, and the effect of compound events on Earth's magnetosphere. The two main mechanisms resulting in the eruption of series of CMEs are sympathetic eruptions, when one eruption triggers another, and homologous eruptions, when a series of similar eruptions originates from one active region. CME - CME interaction may also be associated with two unrelated eruptions. The interaction of successive CMEs has been observed remotely in coronagraphs (with the Large Angle and Spectrometric Coronagraph Experiment - LASCO - since the early 2000s) and heliospheric imagers (since the late 2000s), and inferred from in situ measurements, starting with early measurements in the 1970s. The interaction of two or more CMEs is associated with complex phenomena, including magnetic reconnection, momentum exchange, the propagation of a fast magnetosonic shock through a magnetic ejecta, and changes in the CME expansion. The presence of a preceding CME a few hours before a fast eruption has been found to be connected with higher fluxes of solar energetic particles (SEPs), while CME - CME interaction occurring in the corona is often associated with unusual radio bursts, indicating electron acceleration. Higher suprathermal population, enhanced turbulence and wave activity, stronger shocks, and shock - shock or shock - CME interaction have been proposed as potential physical mechanisms to explain the observed associated SEP events. When measured in situ, CME - CME interaction may be associated with relatively well organized multiple-magnetic cloud events, instances of shocks propagating through a previous magnetic ejecta or more complex ejecta, when the characteristics of the individual eruptions cannot be easily distinguished. CME - CME interaction is associated with some of the most intense recorded geomagnetic storms. The compression of a CME by another and the propagation of a shock inside a magnetic ejecta can lead to extreme values of the southward magnetic field component, sometimes associated with high values of the dynamic pressure. This can result in intense geomagnetic storms, but can also trigger substorms and large earthward motions of the magnetopause, potentially associated with changes in the outer radiation belts. Future in situ measurements in the inner heliosphere by Solar Probe+ and Solar Orbiter may shed light on the evolution of CMEs as they interact, by providing opportunities for conjunction and evolutionary studies.

Facilitating interpersonal interaction and learning online: linking theory and practice.

PubMed

Sargeant, Joan; Curran, Vernon; Allen, Michael; Jarvis-Selinger, Sandra; Ho, Kendall

2006-01-01

An earlier study of physicians' perceptions of interactive online learning showed that these were shaped both by program design and quality and the quality and quantity of interpersonal interaction. We explore instructor roles in enhancing online learning through interpersonal interaction and the learning theories that inform these. This was a qualitative study using focus groups and interviews. Using purposive sampling, 50 physicians were recruited based on their experience with interactive online CME and face-to-face CME. Qualitative thematic and interpretive analysis was used. Two facilitation roles appeared key: creating a comfortable learning environment and enhancing the educational value of electronic discussions. Comfort developed gradually, and specific interventions like facilitating introductions and sharing experiences in a friendly, informative manner were helpful. As in facilitating effective small-group learning, instructors' thoughtful use of techniques that facilitated constructive interaction based on learner's needs and practice demands contributed to the educational value of interpersonal interactions. Facilitators require enhanced skills to engage learners in meaningful interaction and to overcome the transactional distance of online learning. The use of learning theories, including behavioral, cognitive, social, humanistic, and constructivist, can strengthen the educational design and facilitation of online programs. Preparation for online facilitation should include instruction in the roles and techniques required and the theories that inform them.

INTERACTION BETWEEN TWO CORONAL MASS EJECTIONS IN THE 2013 MAY 22 LARGE SOLAR ENERGETIC PARTICLE EVENT

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ding, Liu-Guan; Xu, Fei; Gu, Bin

We investigate the eruption and interaction of two coronal mass ejections (CMEs) during the large 2013 May 22 solar energetic particle event using multiple spacecraft observations. Two CMEs, having similar propagation directions, were found to erupt from two nearby active regions (ARs), AR11748 and AR11745, at ∼08:48 UT and ∼13:25 UT, respectively. The second CME was faster than the first CME. Using the graduated cylindrical shell model, we reconstructed the propagation of these two CMEs and found that the leading edge of the second CME caught up with the trailing edge of the first CME at a height of ∼6 solar radii. Aftermore » about two hours, the leading edges of the two CMEs merged at a height of ∼20 solar radii. Type II solar radio bursts showed strong enhancement during this two hour period. Using the velocity dispersion method, we obtained the solar particle release (SPR) time and the path length for energetic electrons. Further assuming that energetic protons propagated along the same interplanetary magnetic field, we also obtained the SPR time for energetic protons, which were close to that of electrons. These release times agreed with the time when the second CME caught up with the trailing edge of the first CME, indicating that the CME-CME interaction (and shock-CME interaction) plays an important role in the process of particle acceleration in this event.« less

Risk management in obstetric care for family physicians: results of a 10-year project.

PubMed

Nesbitt, Thomas S; Hixon, Allen; Tanji, Jeffrey L; Scherger, Joseph E; Abbott, Dana

2003-01-01

Malpractice issues within the United States remain a critical factor for family physicians providing obstetric care. Although tort reform is being widely discussed, little has been written regarding the malpractice crisis from a risk management perspective. Between 1989 and 1998, a 10-year risk management study at the UC Davis Health System provided a unique collaboration between researchers, a mutual insurance carrier and family physicians practicing obstetrics. Physicians were asked to comply with standardized clinical guidelines, attend continuing medical education (CME) seminars, and submit obstetric medical records for review. Feedback analysis was provided to each physician on their records, and the insurance carrier tracked interim malpractice claims. One hundred and ninety-four physicians participated, attending to 32,831 births. Compliance with project guidelines was 91%. Five closed obstetric cases were reported with only one settlement reported to the National Provider Data Bank. Physicians believed the project was beneficial to their practices. Family physicians practicing obstetrics are willing to participate in a collaborative risk management program and are compliant with standardized clinical guidelines. The monetary award for successful malpractice claims was relatively low. This collaborative risk management model may offer a potential solution to the current malpractice crisis.

Multi-spacecraft Observations of the Coronal and Interplanetary Evolution of a Solar Eruption Associated with Two Active Regions

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hu, Huidong; Liu, Ying D.; Wang, Rui

We investigate the coronal and interplanetary evolution of a coronal mass ejection (CME) launched on 2010 September 4 from a source region linking two active regions (ARs), 11101 and 11103, using extreme ultraviolet imaging, magnetogram, white-light, and in situ observations from SDO , STEREO , SOHO , VEX , and Wind . A potential-field source-surface model is employed to examine the configuration of the coronal magnetic field surrounding the source region. The graduated cylindrical shell model and a triangulation method are applied to determine the kinematics of the CME in the corona and interplanetary space. From the remote sensing andmore » in situ observations, we obtain some key results: (1) the CME was deflected in both the eastward and southward directions in the low corona by the magnetic pressure from the two ARs, and possibly interacted with another ejection, which caused that the CME arrived at VEX that was longitudinally distant from the source region; (2) although VEX was closer to the Sun, the observed and derived CME arrival times at VEX are not earlier than those at Wind , which suggests the importance of determining both the frontal shape and propagation direction of the CME in interplanetary space; and (3) the ICME was compressed in the radial direction while the longitudinal transverse size was extended.« less

Stellar CME candidates: towards a stellar CME-flare relation

NASA Astrophysics Data System (ADS)

Paraskevi Moschou, Sofia; Drake, Jeremy J.; Cohen, Ofer; Alvarado-Gomez, Julian D.; Garraffo, Cecilia

2018-06-01

For decades the Sun has been the only star that allowed for direct CME observations. Recently, with the discovery of multiple extrasolar systems, it has become imperative that the role of stellar CMEs be assessed in the context of exoplanetary habitability. Solar CMEs and flares show a higher association with increasing flaring energy, with strong flares corresponding to large and fast CMEs. As argued in earlier studies, extrasolar environments around active stars are potentially dominated by CMEs, as a result of their extreme flaring activity. This has strong implications for the energy budget of the system and the atmospheric erosion of orbiting planets.Nevertheless, with current instrumentation we are unable to directly observe CMEs in even the closest stars, and thus we have to look for indirect techniques and observational evidence and signatures for the eruption of stellar CMEs. There are three major observational techniques for tracing CME signatures in other stellar systems, namely measuring Type II radio bursts, Doppler shifts in UV/optical lines or transient absorption in the X-ray spectrum. We present observations of the most probable stellar CME candidates captured so far and examine the different observational techniques used together with their levels of uncertainty. Assuming that they were CMEs, we try to asses their kinematic and energetic characteristics and place them in an extension of the well-established solar CME-flare energy scaling law. We finish by discussing future observations for direct measurements.

Constructing an adaptive care model for the management of disease-related symptoms throughout the course of multiple sclerosis--performance improvement CME.

PubMed

Miller, Aaron E; Cohen, Bruce A; Krieger, Stephen C; Markowitz, Clyde E; Mattson, David H; Tselentis, Helen N

2014-01-01

Symptom management remains a challenging clinical aspect of MS. To design a performance improvement continuing medical education (PI CME) activity for better clinical management of multiple sclerosis (MS)-related depression, fatigue, mobility impairment/falls, and spasticity. Ten volunteer MS centers participated in a three-stage PI CME model: A) baseline assessment; B) practice improvement CME intervention; C) reassessment. Expert faculty developed performance measures and activity intervention tools. Designated MS center champions reviewed patient charts and entered data into an online database. Stage C data were collected eight weeks after implementation of the intervention and compared with Stage A baseline data to measure change in performance. Aggregate data from the 10 participating MS centers (405 patient charts) revealed performance improvements in the assessment of all four MS-related symptoms. Statistically significant improvements were found in the documented assessment of mobility impairment/falls (p=0.003) and spasticity (p<0.001). For documentation of care plans, statistically significant improvements were reported for fatigue (p=0.007) and mobility impairment/falls (p=0.040); non-significant changes were noted for depression and spasticity. Our PI CME interventions demonstrated performance improvement in the management of MS-related symptoms. This PI CME model (available at www.achlpicme.org/ms/toolkit) offers a new perspective on enhancing symptom management in patients with MS.

High intensity interval and moderate continuous cycle training in a physical education programme improves health-related fitness in young females.

PubMed

Mazurek, K; Zmijewski, P; Krawczyk, K; Czajkowska, A; Kęska, A; Kapuściński, P; Mazurek, T

2016-06-01

The aim of the study was to investigate the effects of eight weeks of regular physical education classes supplemented with high intensity interval cycle exercise (HIIE) or continuous cycle exercises of moderate intensity (CME). Forty-eight collegiate females exercising in two regular physical education classes per week were randomly assigned to two programmes (HIIE; n = 24 or CME; n = 24) of additional (one session of 63 minutes per week) physical activity for 8 weeks. Participants performed HIIE comprising 2 series of 6x10 s sprinting with maximal pedalling cadence and active recovery pedalling with intensity 65%-75% HRmax or performed CME corresponding to 65%-75% HRmax. Before and after the 8-week programmes, anthropometric data and aero- and anaerobic capacity were measured. Two-way ANOVA revealed a significant time main effect for VO2max (p < 0.001), similar improvements being found in both groups (+12% in HIIE and +11% in CME), despite body mass not changing significantly (p = 0.59; +0.4% in HIIE and -0.1% in CME). A significant main time effect was found for relative fat mass (FM) and fat-free mass (FFM) (p < 0.001 and p < 0.001, respectively). A group x time interaction effect was found for relative FM and FFM (p = 0.018 and p = 0.018); a greater reduction in FM and greater increase in FFM were noted in the CME than the HIIE group. Improvements in anaerobic power were observed in both groups (p < 0.001), but it was greater in the HIIE group (interaction effect, p = 0.022). Weight loss is not mandatory for exercise-induced effects on improving aerobic and anaerobic capacity in collegiate females. Eight weeks of regular physical education classes supplemented with CME sessions are more effective in improving body composition than physical education classes supplemented with HIIE sessions. In contrast to earlier, smaller trials, similar improvements in aerobic capacity were observed following physical activity with additional HIIE or CME sessions.

Obesity, the Endocannabinoid System, and Bias Arising from Pharmaceutical Sponsorship

PubMed Central

McPartland, John M.

2009-01-01

Background Previous research has shown that academic physicians conflicted by funding from the pharmaceutical industry have corrupted evidence based medicine and helped enlarge the market for drugs. Physicians made pharmaceutical-friendly statements, engaged in disease mongering, and signed biased review articles ghost-authored by corporate employees. This paper tested the hypothesis that bias affects review articles regarding rimonabant, an anti-obesity drug that blocks the central cannabinoid receptor. Methods/Principal Findings A MEDLINE search was performed for rimonabant review articles, limited to articles authored by USA physicians who served as consultants for the company that manufactures rimonabant. Extracted articles were examined for industry-friendly bias, identified by three methods: analysis with a validated instrument for monitoring bias in continuing medical education (CME); analysis for bias defined as statements that ran contrary to external evidence; and a tally of misrepresentations about the endocannabinoid system. Eight review articles were identified, but only three disclosed authors' financial conflicts of interest, despite easily accessible information to the contrary. The Takhar CME bias instrument demonstrated statistically significant bias in all the review articles. Biased statements that were nearly identical reappeared in the articles, including disease mongering, exaggerating rimonabant's efficacy and safety, lack of criticisms regarding rimonabant clinical trials, and speculations about surrogate markers stated as facts. Distinctive and identical misrepresentations regarding the endocannabinoid system also reappeared in articles by different authors. Conclusions The findings are characteristic of bias that arises from financial conflicts of interest, and suggestive of ghostwriting by a common author. Resolutions for this scenario are proposed. PMID:19333392

Play-back theatre, theatre laboratory, and role-playing: new tools in investigating the patient-physician relationship in the context of continuing medical education courses.

PubMed

Piccoli, G; Rossetti, M; Dell'Olio, R; Perrotta, L; Mezza, E; Burdese, M; Maddalena, E; Bonetto, A; Jeantet, A; Segoloni, G P

2005-06-01

The aim of this study was to report on the validation of a role-playing approach, using play-back and theatre laboratory in the context of a continuing medical education (CME) course on predialysis and transplantation, to discuss the patient-physician relationship. The course was developed with the help of a theatre director. The role-playing 2-day course was designed to be highly interactive for a small group (15-20 participants), based on a core of case reports (dialysis, transplantation, and return to dialysis after graft failure). Two stages were included: play-back theatre in which experiences told by the participants were mimed by a group of actors, and theatre laboratory in which different aspects of voice and touch were explored. Opinions were gathered by an anonymous semistructured questionnaire completed by all participants. The course obtained a high score from The Ministry of Health (14 credits, 1 per teaching hour). The opinions of the 18 participants were highly positive; all liked the courses. Sixteen of 18 asked to repeat the experience. The strong emotional involvement was an advantage for 15 of 18, sharing emotional aspects of the profession for 10 of 18, and usefulness in clarifying opinions on "dark sides" of our profession for 10 of 18. The positive opinions recorded during this experience, the first experiment with a "psycho-theatrical approach" developed in a CME course in our country, suggest the benefit of implementing nonconventional, educational approaches in a multidisciplinary discussion of the patient-physician relationship in transplantation medicine.

The Flare/CME Connection

NASA Technical Reports Server (NTRS)

Moore, Ron; Falconer, David; Sterling, Alphonse

2008-01-01

We present evidence supporting the view that, while many flares are produced by a confined magnetic explosion that does not produce a CME, every CME is produced by an ejective magnetic explosion that also produces a flare. The evidence is that the observed heliocentric angular width of the full-blown CME plasmoid in the outer corona (at 3 to 20 solar radii) is about that predicted by the standard model for CME production, from the amount of magnetic flux covered by the co-produced flare arcade. In the standard model, sheared and twisted sigmoidal field in the core of an initially closed magnetic arcade erupts. As it erupts, tether-cutting reconnection, starting between the legs of the erupting sigmoid and continuing between the merging stretched legs of the enveloping arcade, simultaneously produces a growing flare arcade and unleashes the erupting sigmoid and arcade to become the low-beta plasmoid (magnetic bubble) that becomes the CME. The flare arcade is the downward product of the reconnection and the CME plasmoid is the upward product. The unleashed, expanding CME plasmoid is propelled into the outer corona and solar wind by its own magnetic field pushing on the surrounding field in the inner and outer corona. This tether-cutting scenario predicts that the amount of magnetic flux in the full-blown CME plasmoid nearly equals that covered by the full-grown flare arcade. This equality predicts (1) the field strength in the flare region from the ratio of the angular width of the CME in the outer corona to angular width of the full-grown flare arcade, and (2) an upper bound on the angular width of the CME in the outer corona from the total magnetic flux in the active region from which the CME explodes. We show that these predictions are fulfilled by observed CMEs. This agreement validates the standard model. The model explains (1) why most CMEs have much greater angular widths than their co-produced flares, and (2) why the radial path of a CME in the outer corona can be laterally far offset from the co-produced flare.

Marketing to increase participation in a Web-based continuing medical education cultural competence curriculum.

PubMed

Estrada, Carlos A; Krishnamoorthy, Periyakaruppan; Smith, Ann; Staton, Lisa; Korf, Michele J; Allison, Jeroan J; Houston, Thomas K

2011-01-01

CME providers may be interested in identifying effective marketing strategies to direct users to specific content. Online advertisements for recruiting participants into activities such as clinical trials, public health programs, and continuing medical education (CME) have been effective in some but not all studies. The purpose of this study was to compare the impact of 2 marketing strategies in the context of an online CME cultural competence curriculum (www.c-comp.org). In an interrupted time-series quasi-experimental design, 2 marketing strategies were tested: (1) wide dissemination to relevant organizations over a period of approximately 4 months, and (2) Internet paid search using Google Ads (5 consecutive 8-week periods--control 1, cultural/CME advertisement, control 2, hypertension/ content advertisement, control 3). Outcome measures were CME credit requests, Web traffic (visits per day, page views, pages viewed per visit), and cost. Overall, the site was visited 19,156 times and 78,160 pages were viewed. During the wide dissemination phase, the proportion of visits requesting CME credit decreased between the first (5.3%) and second (3.3%) halves of this phase (p = .04). During the Internet paid search phase, the proportion of visits requesting CME credit was highest during the cultural/CME advertisement period (control 1, 1.4%; cultural/CME ad, 4.3%; control 2, 1.5%; hypertension/content ad, 0.6%; control 3, 0.8%; p < .001). All measures of Web traffic changed during the Internet paid search phase (p < .01); however, changes were independent of the advertisement periods. The incremental cost for the cultural advertisement per CME credit requested was US $0.64. Internet advertisement focusing on cultural competence and CME was associated with about a threefold increase in requests for CME credit at an incremental cost of under US $1; however, Web traffic changes were independent of the advertisement strategy. Copyright © 2011 The Alliance for Continuing Medical Education, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

The solar cycle variation of the rates of CMEs and related activity

NASA Technical Reports Server (NTRS)

Webb, David F.

1991-01-01

Coronal mass ejections (CMEs) are an important aspect of the physics of the corona and heliosphere. This paper presents results of a study of occurrence frequencies of CMEs and related activity tracers over more than a complete solar activity cycle. To properly estimate occurrence rates, observed CME rates must be corrected for instrument duty cycles, detection efficiencies away from the skyplane, mass detection thresholds, and geometrical considerations. These corrections are evaluated using CME data from 1976-1989 obtained with the Skylab, SMM and SOLWIND coronagraphs and the Helios-2 photometers. The major results are: (1) the occurrence rate of CMEs tends to track the activity cycle in both amplitude and phase; (2) the corrected rates from different instruments are reasonably consistent; and (3) over the long term, no one class of solar activity tracer is better correlated with CME rate than any other (with the possible exception of type II bursts).

CME/CNE Article: A Framework of Care in Multiple Sclerosis, Part 1: Updated Disease Classification and Disease-Modifying Therapy Use in Specific Circumstances.

PubMed

Newsome, Scott D; Aliotta, Philip J; Bainbridge, Jacquelyn; Bennett, Susan E; Cutter, Gary; Fenton, Kaylan; Lublin, Fred; Northrop, Dorothy; Rintell, David; Walker, Bryan D; Weigel, Megan; Zackowski, Kathleen; Jones, David E

2016-01-01

Activity Available Online: To access the article, post-test, and evaluation online, go to http://www.cmscscholar.org. The target audience for this activity is physicians, physician assistants, nursing professionals, and other health-care providers involved in the management of patients with multiple sclerosis (MS). Apply new information about MS to a comprehensive individualized treatment plan for patients with MSIntegrate the team approach into long-term planning in order to optimize rehabilitation care of patients with MSAccreditation Statement: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Consortium of Multiple Sclerosis Centers (CMSC), Nurse Practitioner Alternatives (NPA), and Delaware Media Group. The CMSC is accredited by the ACCME to provide continuing medical education for physicians. The CMSC designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Nurse Practitioner Alternatives (NPA) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. NPA designates this enduring material for 1.0 Continuing Nursing Education credit. Laurie Scudder, DNP, NP, has served as Nurse Planner for this activity. She has disclosed no relevant financial relationships. Disclosures: Francois Bethoux, MD , Editor in Chief of the International Journal of MS Care (IJMSC), has served as Physician Planner for this activity. He has received royalties from Springer Publishing and has received intellectual property rights from Biogen. Laurie Scudder, DNP, NP , has served as Nurse Planner for this activity. She has disclosed no relevant financial relationships. Scott D. Newsome, DO, MSCS (author), has served on scientific advisory boards for Biogen, Genentech, Novartis, and Genzyme, and has performed contracted research (institution received funds) for Biogen, Genentech, and Novartis. Philip J. Aliotta, MD, MSHA, CHCQM, FACS (author), has served on speakers' bureaus for Astellas Pharma, Actavis, Augmenix, and Allergan and has performed contracted research for Allergan. Jacquelyn Bainbridge, PharmD (author), has disclosed no relevant financial relationships. Susan E. Bennett, PT, DPT, EdD, NCS, MSCS (author), has served on speakers' bureaus for Acorda Therapeutics, Biogen, and Medtronic; has received consulting fees from and performed contracted research for Acorda Therapeutics; and is chair of the Clinical Events Committee at Innovative Technologies. Gary Cutter, PhD (author), has participated on Data and Safety Monitoring Committees for AMO Pharma, Apotek, Gilead Pharmaceuticals, Horizon Pharmaceuticals, Modigenetech/Prolor, Merck, Merck/Pfizer, Opko Biologics, Neuren, Sanofi-Aventis, Reata Pharmaceuticals, Receptos/Celgene, Teva Pharmaceuticals, NHLBI (Protocol Review Committee), and NICHD (OPRU Oversight Committee); has received consulting fees from and/or served on speakers' bureaus and scientific advisory boards for Cerespir, Genzyme, Genentech, Innate Therapeutics, Janssen Pharmaceuticals, Klein-Buendel Incorporated, MedImmune, Medday, Nivalis, Novartis, Opexa Therapeutics, Roche, Savara, Somahlution, Teva Pharmaceuticals, Transparency Life Sciences, and TG Therapeutics; and is President of Pythagoras, Inc., a private consulting company located in Birmingham, AL. Kaylan Fenton, CRNP, APNP, MSCN (author), has disclosed no relevant financial relationships. Fred Lublin, MD (author), has received consulting fees/fees for non-CME/CE activities from Bayer HealthCare Pharmaceuticals, Biogen, EMD Serono, Novartis, Teva Neuroscience, Actelion, Sanofi/Genzyme, Acorda, Questcor/Mallinckrodt, Roche/Genentech, MedImmune, Osmotica, Xenoport, Receptos/Celgene, Forward Pharma, Akros, TG Therapeutics, AbbVie, Toyama, Amgen, Medday, Atara Biotherapeutics, Polypharma, Pfizer, Johnson & Johnson, Revalesio, Coronado Bioscience, and Bristol-Myers Squibb; has served on speakers' bureaus for Genentech/Roche and Genzyme/Sanofi; has performed contracted research for Acorda, Biogen, Novartis, Teva Neuroscience, Genzyme, Xenoport, and Receptos; is the co-chief editor of Multiple Sclerosis and Related Disorders ; and has an ownership interest in Cognition Pharmaceuticals. Dorothy Northrop, MSW, ACSW (author), has disclosed no relevant financial relationships. David Rintell, EdD (author), has received consulting fees from Novartis and has served as a patient education speaker for Teva Neuroscience. He started as a salaried employee of Sanofi Genzyme in November 2015. Dr. Rintell's work on this project was completed before he became a salaried employee of Sanofi Genzyme. Bryan D. Walker, MHS, PA-C (author), has served on scientific advisory boards for EMD Serono and Sanofi Genzyme and owns stock in Biogen. Megan Weigel, DNP, ARNP-C, MSCN (author), has received consulting fees from Mallinckrodt, Genzyme, and Genentech, and has served on speakers' bureaus for Bayer Corp, Acorda Therapeutics, Teva Neuroscience, Biogen, Mallinckrodt, Genzyme, Novartis, and Pfizer. Kathleen Zackowski, PhD, OTR, MSCS (author), has performed contracted research for Acorda Therapeutics. David E. Jones, MD (author), has received consulting fees from Biogen and Novartis, and has performed contracted research for Biogen. One anonymous peer reviewer for the IJMSC has performed contracted research (institution received funds) for Novartis, Chugai, and Biogen. Another reviewer has received consulting fees and served on speakers' bureaus for Biogen, Sanofi Genzyme, Genentech, EMD Serono, and Novartis. The third reviewer has disclosed no relevant financial relationships. Lori Saslow, MS (medical writer), has disclosed no relevant financial relationships. The staff at the IJMSC, CMSC, NPA, and Delaware Media Group who are in a position to influence content have disclosed no relevant financial relationships. Note: Disclosures listed for authors are those applicable at the time of their work on this project and within 12 months previously. Financial relationships for some authors may have changed in the interval between the time of their work on this project and publication of the article. Funding/Support: Funding for the Framework of Care consensus conference was provided by the Consortium of Multiple Sclerosis Centers, Mallinckrodt Pharmaceuticals, and Mylan Pharmaceuticals. Method of Participation: Release Date: December 1, 2016 Valid for Credit Through: December 1, 2017 In order to receive CME/CNE credit, participants must: Review the CME/CNE information, including learning objectives and author disclosures.Study the educational content.Complete the post-test and evaluation, which are available at http://www.cmscscholar.org. Statements of Credit are awarded upon successful completion of the post-test with a passing score of >70% and the evaluation. There is no fee to participate in this activity. Disclosure of Unlabeled Use: This CME/CNE activity may contain discussion of published and/or investigational uses of agents that are not approved by the FDA. CMSC, NPA, and Delaware Media Group do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of CMSC, NPA, or Delaware Media Group. Disclaimer: Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any medications, diagnostic procedures, or treatments discussed in this publication should not be used by clinicians or other health-care professionals without first evaluating their patients' conditions, considering possible contraindications or risks, reviewing any applicable manufacturer's product information, and comparing any therapeutic approach with the recommendations of other authorities.

The solar cycle variation of coronal mass ejections and the solar wind mass flux

NASA Technical Reports Server (NTRS)

Webb, David F.; Howard, Russell A.

1994-01-01

Coronal mass ejections (CMEs) are an important aspect of coronal physics and a potentially significant contributor to perturbations of the solar wind, such as its mass flux. Sufficient data on CMEs are now available to permit study of their longer-term occurrency patterns. Here we present the results of a study of CME occurrence rates over more than a complete 11-year solar sunspot cycle and a comparison of these rates with those of other activity related to CMEs and with the solar wind particle flux at 1 AU. The study includes an evaluation of correlations to the CME rates, which include instrument duty cycles, visibility functions, mass detection thresholds, and geometrical considerations. The main results are as follows: (1) The frequency of occurrence of CMEs tends to track the solar activity cycle in both amplitude and phase; (2) the CME rates from different instruments, when corrected for both duty cycles and visibility functions, are reasonably consistent; (3) considering only longer-term averages, no one class of solar activity is better correlated with CME rate than any other; (4) the ratio of the annualized CME to solar wind mass flux tends to track the solar cycle; and (5) near solar maximum, CMEs can provide a significant fraction (i.e., approximately equals 15%) of the average mass flux to the near-ecliptic solar wind.

Correcting LASCO CME Catalogs to Study the Change in CME Rate from Solar Cycle 23 to 24

NASA Astrophysics Data System (ADS)

Hess, P.; Colaninno, R. C.

2017-12-01

While most measures of solar activity declined from SC 23 to SC 24, many CME catalogs that span the entire LASCO mission did not show a similar drop in CME count. The raw CME totals from many catalogs show steady levels between the two cycles . However, these totals are complicated by a doubling of the LASCO image cadence in 2010. We show, using a consistent cadence on the automated Solar Eruption Event Detection System (SEEDS) that the CME count seems to follow the SSN throughout the entire catalog. Because SEEDS is a C2 catalog, the question has been raised if this effect is limited only to small transients that can be eliminated using larger width thresholds or other catalogs that also include C3, to support that this enhanced CME rate relative to the SSN is a real effect. We will also present data from CACTus, CORIMP and CDAW that suggests this is a false assumption, and that all catalogs have their own issues in dealing with the increased LASCO cadence. This evidence points to there being no appreciable difference in the ratio between CME rate and SSN between SC 23 and SC 24. We provide some examples of why these catalogs may be susceptible to a change in data rate, and use this as part of a wider discussion of the nature of automated catalogs and how to properly consider the outputs of these algorithms. While the automated catalogs are an extremely valuable tool for getting a consistent measure of coronal activity, the significant false detection rate of an automated catalog must always be considered. Because of this, the temporal trends of the catalog results relative to one another is a far more valuable diagnostic than a raw total at any one time.

Application of international videoconferences for continuing medical education programs related to laparoscopic surgery.

PubMed

Huang, Ke-Jian; Cen, Gang; Qiu, Zheng-Jun; Jiang, Tao; Cao, Jun; Fu, Chun-Yu

2014-02-01

Continuing medical education (CME) is an effective way for practicing physicians to acquire up-to-date clinical information. We conducted four CME seminars in 2007-2010 endorsed by the Chinese Medical Association Council on Medical Education. Overseas telelectures and live case demonstrations were introduced in each seminar via telemedicine based on a digital video transport system. Network stability and packet loss were recorded. An anonymous mini-questionnaire was conducted to evaluate the satisfaction of attendees regarding the image and sound quality, content selection, and overall evaluation. Four telelectures and five live case demonstrations were successfully conducted. Stability of the network was maintained during each videoconference. High-quality videos of 720 × 480 pixels at the rate of 30 frames per second were shown to the entire group of attendees. The time delay between Shanghai and Fukuoka, Japan, was only 0.3 s, and the packet loss was 0%. We obtained 129 valid responses to the mini-questionnaire from a total of 146 attendees. The majority of the attendees were satisfied with the quality of transmitted images and voices and with the selected contents. The overall evaluation was ranked as excellent or good. Videoconferences are excellent channels for CME programs associated with laparoscopic training.

Application of International Videoconferences for Continuing Medical Education Programs Related to Laparoscopic Surgery

PubMed Central

Huang, Ke-Jian; Cen, Gang; Jiang, Tao; Cao, Jun; Fu, Chun-Yu

2014-01-01

Abstract Background: Continuing medical education (CME) is an effective way for practicing physicians to acquire up-to-date clinical information. Materials and Methods: We conducted four CME seminars in 2007–2010 endorsed by the Chinese Medical Association Council on Medical Education. Overseas telelectures and live case demonstrations were introduced in each seminar via telemedicine based on a digital video transport system. Network stability and packet loss were recorded. An anonymous mini-questionnaire was conducted to evaluate the satisfaction of attendees regarding the image and sound quality, content selection, and overall evaluation. Results: Four telelectures and five live case demonstrations were successfully conducted. Stability of the network was maintained during each videoconference. High-quality videos of 720×480 pixels at the rate of 30 frames per second were shown to the entire group of attendees. The time delay between Shanghai and Fukuoka, Japan, was only 0.3 s, and the packet loss was 0%. We obtained 129 valid responses to the mini-questionnaire from a total of 146 attendees. The majority of the attendees were satisfied with the quality of transmitted images and voices and with the selected contents. The overall evaluation was ranked as excellent or good. Conclusions: Videoconferences are excellent channels for CME programs associated with laparoscopic training. PMID:23758077

The sum of us: considerations on physician-industry relationships.

PubMed

Flores Rebollar, Armando

2017-05-26

This essay describes critically the physician-industry relationships and how the latter influences economically in the realization of continuing medical education (CME), industry expenses in sponsoring the academic events of medical societies, travel costs and enrollment, payment for consultants and speakers. It also refers to the movements that have been created in the academic world to counteract this influence, such as No Free Lunch (Spanish version “NoGracias”) and PharmFree. And the struggles between major scientific medical journals, with editorials and among editorialists on the concept of conflicts of interest. All this seen through the existence of an academic institution in Mexico and the exemplary life of one of its members.

A comparative evaluation of the effect of Internet-based CME delivery format on satisfaction, knowledge and confidence.

PubMed

Curran, Vernon R; Fleet, Lisa J; Kirby, Fran

2010-01-29

Internet-based instruction in continuing medical education (CME) has been associated with favorable outcomes. However, more direct comparative studies of different Internet-based interventions, instructional methods, presentation formats, and approaches to implementation are needed. The purpose of this study was to conduct a comparative evaluation of two Internet-based CME delivery formats and the effect on satisfaction, knowledge and confidence outcomes. Evaluative outcomes of two differing formats of an Internet-based CME course with identical subject matter were compared. A Scheduled Group Learning format involved case-based asynchronous discussions with peers and a facilitator over a scheduled 3-week delivery period. An eCME On Demand format did not include facilitated discussion and was not based on a schedule; participants could start and finish at any time. A retrospective, pre-post evaluation study design comparing identical satisfaction, knowledge and confidence outcome measures was conducted. Participants in the Scheduled Group Learning format reported significantly higher mean satisfaction ratings in some areas, performed significantly higher on a post-knowledge assessment and reported significantly higher post-confidence scores than participants in the eCME On Demand format that was not scheduled and did not include facilitated discussion activity. The findings support the instructional benefits of a scheduled delivery format and facilitated asynchronous discussion in Internet-based CME.

A survey of interprofessional education in chiropractic continuing education in the United States.

PubMed

Bednarz, Edward M; Lisi, Anthony J

2014-10-01

Objective : The purpose of this study is to describe the state of chiropractic continuing education vis-à-vis interprofessional education (IPE) with medical doctors (MD) in a survey of a sample of US doctors of chiropractic (DC) and through a review of policies. Methods : Forty-five chiropractors with experience in interprofessional settings completed an electronic survey of their experiences and perceptions regarding DC-MD IPE in chiropractic continuing education (CE). The licensing bodies of the 50 US states and the District of Columbia were queried to assess the applicability of continuing medical education (CME) to chiropractic relicensure. Results : The majority (89.1%) of survey respondents who attend CE-only events reported that they rarely to never experienced MD-IPE at these activities. Survey respondents commonly attended CME-only events, and 84.5% stated that they commonly to very commonly experienced MD-IPE at these activities. More than half (26 of 51) of the licensing bodies did not provide sufficient information to determine if CME was applicable to DC relicensure. Thirteen jurisdictions (25.5%) do not, and 12 jurisdictions (23.5%) do accept CME credits for chiropractic relicensure. Conclusion : The majority of integrated practice DCs we surveyed reported little to no IPE occurring at CE-only events, yet significant IPE occurring at CME events. However, we found only 23.5% of chiropractic licensing bodies allow CME credit to apply to chiropractic relicensure. These factors may hinder DC-MD IPE in continuing education.

An Analysis of the Origin and Propagation of the Multiple Coronal Mass Ejections of 2010 August 1

NASA Technical Reports Server (NTRS)

Harrison, R. A.; Davies, J. A.; Moestl, C.; Liu, Y.; Temmer, M.; Bisi, M. M.; Eastwood, J. P.; DeKoning, C. A.; Nitta, N.; Rollett, T.;

Improving the effect of FDA-mandated drug safety alerts with Internet-based continuing medical education.

PubMed

Kraus, Carl N; Baldwin, Alan T; McAllister, R G

2013-02-01

The US Food and Drug Administration (FDA) requires risk communication as an element of Risk Evaluation and Mitigation Strategies (REMS) to alert and educate healthcare providers about severe toxicities associated with approved drugs. The educational effectiveness of this approach has not been evaluated. To support the communication plan element of the ipilimumab REMS, a Medscape Safe Use Alert (SUA) letter was distributed by Medscape via email and mobile device distribution to clinicians specified in the REMS. This alert contained the FDA-approved Dear Healthcare Provider (DHCP) letter mandated for distribution. A continuing medical education (CME) activity describing ipilimumab toxicities and the appropriate management was simultaneously posted on the website and distributed to Medscape members. Data were collected over a 6-month period regarding the handling of the letter and the responses to pre- and post-test questions for those who participated in the CME activity. Analysis of the answers to the pre- and posttest questions showed that participation in the CME activity resulted in an improvement in correct answer responses of 47%. Our experience shows that there are likely distinct information sources that are utilized by different HCP groups. The ready availability of a brief CME activity was utilized by 24,063 individuals, the majority of whom showed enhanced understanding of ipilimumab toxicity by improvement in post-test scores, educational data that are not available via implementation of standard safety alert communications. These results demonstrate that improvement in understanding of specific drug toxicities is enhanced by a CME intervention.

Clinical implications of patient-provider agreements in opioid prescribing.

PubMed

Kraus, Carl N; Baldwin, Alan T; Curro, Frederick A; McAllister, R G

2015-01-01

In June, 2012 the United States Food and Drug Administration (FDA) developed a "blueprint" for prescriber education as a means of directing Certified Medical Education (CME) activities that included content which would meet the regulatory requirements of the class-wide, longacting/ extended-release (LA-ER) opioid Risk Evaluation Mitigation Strategies (REMS). Within the blueprint is the suggested adoption of Patient-Provider Agreements (PPAs) to be used in association with opioid prescribing, but, to our knowledge, there have been no reported evaluations of the role played by opioid-agent PPAs in clinical practice, or of the perceptions of this regulatory mandate by clinicians. Therefore, we conducted a survey regarding PPA perceptions by opioid prescribers that was posted for five weeks on a well-trafficked online CME service provider (Medscape). Of the 1,232 respondents (reflecting a 99.5% completion rate), 52.4% treat acute or chronic pain with opioids. The survey identified an improvement of opioid safe-use education (21% of respondents) as the most frequently selected beneficial element of PPAs. Conversely, the challenges to adoption included time constraints (21% of physicians) as well as lack of evidence that PPAs will reduce drug misuse, and the lack of a uniform, patient-friendly PPA. Based on our survey, clinicians consider the PPA of potential value, but data regarding the utility of such an instrument are lacking.

Development and Parameters of a Non-Self-Similar CME Caused by the Eruption of a Quiescent Prominence

NASA Astrophysics Data System (ADS)

Kuzmenko, I. V.; Grechnev, V. V.

2017-10-01

The eruption of a large quiescent prominence on 17 August 2013 and an associated coronal mass ejection (CME) were observed from different vantage points by the Solar Dynamics Observatory (SDO), the Solar-Terrestrial Relations Observatory (STEREO), and the Solar and Heliospheric Observatory (SOHO). Screening of the quiet Sun by the prominence produced an isolated negative microwave burst. We estimated the parameters of the erupting prominence from a radio absorption model and measured them from 304 Å images. The variations of the parameters as obtained by these two methods are similar and agree within a factor of two. The CME development was studied from the kinematics of the front and different components of the core and their structural changes. The results were verified using movies in which the CME expansion was compensated for according to the measured kinematics. We found that the CME mass (3.6 × 10^{15} g) was mainly supplied by the prominence (≈ 6 × 10^{15} g), while a considerable part drained back. The mass of the coronal-temperature component did not exceed 10^{15} g. The CME was initiated by the erupting prominence, which constituted its core and remained active. The structural and kinematical changes started in the core and propagated outward. The CME structures continued to form during expansion, which did not become self-similar up to 25 R_{⊙}. The aerodynamic drag was insignificant. The core formed during the CME rise to 4 R_{⊙} and possibly beyond. Some of its components were observed to straighten and stretch outward, indicating the transformation of tangled structures of the core into a simpler flux rope, which grew and filled the cavity as the CME expanded.

Predicting Major Solar Eruptions

NASA Astrophysics Data System (ADS)

Kohler, Susanna

2016-05-01

Coronal mass ejections (CMEs) and solar flares are two examples of major explosions from the surface of the Sun but theyre not the same thing, and they dont have to happen at the same time. A recent study examines whether we can predict which solar flares will be closely followed by larger-scale CMEs.Image of a solar flare from May 2013, as captured by NASAs Solar Dynamics Observatory. [NASA/SDO]Flares as a Precursor?A solar flare is a localized burst of energy and X-rays, whereas a CME is an enormous cloud of magnetic flux and plasma released from the Sun. We know that some magnetic activity on the surface of the Sun triggers both a flare and a CME, whereas other activity only triggers a confined flare with no CME.But what makes the difference? Understanding this can help us learn about the underlying physical drivers of flares and CMEs. It also might help us to better predict when a CME which can pose a risk to astronauts, disrupt radio transmissions, and cause damage to satellites might occur.In a recent study, Monica Bobra and Stathis Ilonidis (Stanford University) attempt to improve our ability to make these predictions by using a machine-learning algorithm.Classification by ComputerUsing a combination of 6 or more features results in a much better predictive success (measured by the True Skill Statistic; higher positive value = better prediction) for whether a flare will be accompanied by a CME. [Bobra Ilonidis 2016]Bobra and Ilonidis used magnetic-field data from an instrument on the Solar Dynamics Observatory to build a catalog of solar flares, 56 of which were accompanied by a CME and 364 of which were not. The catalog includes information about 18 different features associated with the photospheric magnetic field of each flaring active region (for example, the mean gradient of the horizontal magnetic field).The authors apply a machine-learning algorithm known as a binary classifier to this catalog. This algorithm tries to predict, given a set of features, whether an active region that produces a flare will also produce a CME. Bobra and Ilonidis then use a feature-selection algorithm to try to understand which features distinguish between flaring regions that dont produce a CME and those that do.Predictors of CMEsThe authors reach several interesting conclusions:Under the right conditions, their algorithm is able to predict whether an active region with a given set of features will produce a CME as well as a flare with a fairly high rate of success.None of the 18 features they tested are good predictors in isolation: its necessary to look at a combination of at least 6 features to have success predicting whether a flare will be accompanied by a CME.The features that are the best predictors are all intensive features ones that stay the same independent of the active regions size. Extensive features ones that change as the active region grows or shrinks are less successful predictors.Only the magnetic field properties of the photosphere were considered, so a logical next step is to extend this study to consider properties of the solar corona above active regions as well. In the meantime, these are interesting first results that may well help us better predict these major solar eruptions.BonusCheck out this video for a great description from NASA of the difference between solar flares and CMEs (as well as some awesome observations of both).CitationM. G. Bobra and S. Ilonidis 2016 ApJ 821 127. doi:10.3847/0004-637X/821/2/127

Strong coronal channelling and interplanetary evolution of a solar storm up to Earth and Mars

PubMed Central

Möstl, Christian; Rollett, Tanja; Frahm, Rudy A.; Liu, Ying D.; Long, David M.; Colaninno, Robin C.; Reiss, Martin A.; Temmer, Manuela; Farrugia, Charles J.; Posner, Arik; Dumbović, Mateja; Janvier, Miho; Démoulin, Pascal; Boakes, Peter; Devos, Andy; Kraaikamp, Emil; Mays, Mona L.; Vršnak, Bojan

2015-01-01

The severe geomagnetic effects of solar storms or coronal mass ejections (CMEs) are to a large degree determined by their propagation direction with respect to Earth. There is a lack of understanding of the processes that determine their non-radial propagation. Here we present a synthesis of data from seven different space missions of a fast CME, which originated in an active region near the disk centre and, hence, a significant geomagnetic impact was forecasted. However, the CME is demonstrated to be channelled during eruption into a direction +37±10° (longitude) away from its source region, leading only to minimal geomagnetic effects. In situ observations near Earth and Mars confirm the channelled CME motion, and are consistent with an ellipse shape of the CME-driven shock provided by the new Ellipse Evolution model, presented here. The results enhance our understanding of CME propagation and shape, which can help to improve space weather forecasts. PMID:26011032

A Risk Stratification Tool to Assess Commercial Influences on Continuing Medical Education

ERIC Educational Resources Information Center

Barnes, Barbara E.; Cole, Jeanne G.; King, Catherine Thomas; Zukowski, Rebecca; Allgier-Baker, Tracy; Rubio, Doris McGartland; Thorndyke, Luanne E.

2007-01-01

Introduction: Heightened concerns about industry influence on continuing medical education (CME) have prompted tighter controls on the management of commercial funding and conflict of interest. As a result, CME providers must closely monitor their activities and intervene if bias or noncompliance with accreditation standards is likely. Potential…

Interrater Reliability to Assure Valid Content in Peer Review of CME-Accredited Presentations

ERIC Educational Resources Information Center

Quigg, Mark; Lado, Fred A.

2009-01-01

Introduction: The Accreditation Council for Continuing Medical Education (ACCME) provides guidelines for continuing medical education (CME) materials to mitigate problems in the independence or validity of content in certified activities; however, the process of peer review of materials appears largely unstudied and the reproducibility of…

Community-based faculty: motivation and rewards.

PubMed

Fulkerson, P K; Wang-Cheng, R

1997-02-01

The reasons why practicing physicians precept students in their offices, and the rewards they wish to receive for this work, have not been clearly elucidated. This study determined the reasons for precepting and the rewards expected among a network of preceptors in Milwaukee. A questionnaire was mailed to 120 community-based physician preceptors in a required, third-year ambulatory care clerkship. Respondents were asked to identify why they volunteered and what they considered appropriate recognition or reward. The personal satisfaction derived from the student-teacher interaction was, by far, the most important motivator for preceptors (84%). The most preferred rewards for teaching included clinical faculty appointment, CME and bookstore discounts, computer networking, and workshops for improving skills in clinical teaching. Community-based private physicians who participate in medical student education programs are primarily motivated by the personal satisfaction that they derive from the teaching encounter. An effective preceptor recognition/reward program can be developed using input from the preceptors themselves.

Magnetic Causes of Solar Coronal Mass Ejections: Dominance of the Free Magnetic Energy Over the Magnetic Twist Alone

NASA Technical Reports Server (NTRS)

Falconer, D. A.; Moore, R. L.; Gary, g. A.

2006-01-01

We examine the magnetic causes of coronal mass ejections (CMEs) by examining, along with the correlations of active-region magnetic measures with each other, the correlations of these measures with active-region CME productivity observed in time windows of a few days, either centered on or extending forward from the day of the magnetic measurement. The measures are from 36 vector magnetograms of bipolar active regions observed within -30" of disk center by the Marshal Space Flight Center (MSFC) vector magnetograph. From each magnetogram, we extract six whole-active-region measures twice, once from the original plane-of-the-sky magnetogram and again a h r deprojection of the magnetogram to disk center. Three of the measures are alternative measures of the total nonpotentiality of the active region, two are alternative measures of the overall twist in the active-region's magnetic field, and one is a measure of the magnetic size of the active region (the active region's magnetic flux content). From the deprojected magnetograms, we find evidence that (1) magnetic twist and magnetic size are separate but comparably strong causes of active-region CME Productivity, and (2) the total free magnetic energy in an active region's magnetic field is a stronger determinant of the active region's CME productivity than is the field's overall twist (or helicity) alone. From comparison of results from the non-deprojected magnetograms with corresponding results from the deprojected magnetograms, we find evidence that (for prediction of active-region CME productivity and for further studies of active-region magnetic size as a cause of CMEs), for active regions within approx.30deg of disk center, active-region total nonpotentiality and flux content can be adequately measured from line-of-sight magnetograms, such as from SOH0 MDI.

Nurse practitioners and physician assistants: preparing new providers for hospital medicine at the mayo clinic.

PubMed

Spychalla, Megan T; Heathman, Joanne H; Pearson, Katherine A; Herber, Andrew J; Newman, James S

2014-01-01

Hospital medicine is a growing field with an increasing demand for additional healthcare providers, especially in the face of an aging population. Reductions in resident duty hours, coupled with a continued deficit of medical school graduates to appropriately meet the demand, require an additional workforce to counter the shortage. A major dilemma of incorporating nonphysician providers such as nurse practitioners and physician assistants (NPPAs) into a hospital medicine practice is their varying academic backgrounds and inpatient care experiences. Medical institutions seeking to add NPPAs to their hospital medicine practice need a structured orientation program and ongoing NPPA educational support. This article outlines an NPPA orientation and training program within the Division of Hospital Internal Medicine (HIM) at the Mayo Clinic in Rochester, MN. In addition to a practical orientation program that other institutions can model and implement, the division of HIM also developed supplemental learning modalities to maintain ongoing NPPA competencies and fill learning gaps, including a formal NPPA hospital medicine continuing medical education (CME) course, an NPPA simulation-based boot camp, and the first hospital-based NPPA grand rounds offering CME credit. Since the NPPA orientation and training program was implemented, NPPAs within the division of HIM have gained a reputation for possessing a strong clinical skill set coupled with a depth of knowledge in hospital medicine. The NPPA-physician model serves as an alternative care practice, and we believe that with the institution of modalities, including a structured orientation program, didactic support, hands-on learning, and professional growth opportunities, NPPAs are capable of fulfilling the gap created by provider shortages and resident duty hour restrictions. Additionally, the use of NPPAs in hospital medicine allows for patient care continuity that is otherwise missing with resident practice models.

The American Board of Internal Medicine Maintenance of Certification Examination and State Medical Board Disciplinary Actions: a Population Cohort Study.

PubMed

McDonald, Furman S; Duhigg, Lauren M; Arnold, Gerald K; Hafer, Ruth M; Lipner, Rebecca S

2018-03-07

Some have questioned whether successful performance in the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) program is meaningful. The association of the ABIM Internal Medicine (IM) MOC examination with state medical board disciplinary actions is unknown. To assess risk of disciplinary actions among general internists who did and did not pass the MOC examination within 10 years of initial certification. Historical population cohort study. The population of internists certified in internal medicine, but not a subspecialty, from 1990 through 2003 (n = 47,971). ABIM IM MOC examination. General internal medicine in the USA. The primary outcome measure was time to disciplinary action assessed in association with whether the physician passed the ABIM IM MOC examination within 10 years of initial certification, adjusted for training, certification, demographic, and regulatory variables including state medical board Continuing Medical Education (CME) requirements. The risk for discipline among physicians who did not pass the IM MOC examination within the 10 year requirement window was more than double than that of those who did pass the examination (adjusted HR 2.09; 95% CI, 1.83 to 2.39). Disciplinary actions did not vary by state CME requirements (adjusted HR 1.02; 95% CI, 0.94 to 1.16), but declined with increasing MOC examination scores (Kendall's tau-b coefficient = - 0.98 for trend, p < 0.001). Among disciplined physicians, actions were less severe among those passing the IM MOC examination within the 10-year requirement window than among those who did not pass the examination. Passing a periodic assessment of medical knowledge is associated with decreased state medical board disciplinary actions, an important quality outcome of relevance to patients and the profession.

Effect of a tailor-made continuous medical education program for primary care physicians on self-perception of physicians' roles and quality of care.

PubMed

Twig, Gilad; Lahad, Amnon; Kochba, Ilan; Ezra, Vered; Mandel, Dror; Shina, Avi; Kreiss, Yitshak; Zimlichman, Eyal

2010-09-01

A survey conducted among Israel Defense Force primary care physicians in 2001 revealed that they consider patients' needs more than they do organizational needs and that the education PCPs currently receive is inadequate. In 2003 the medical corps initiated a multi-format continuous medical education program aimed at improving skills in primary care medicine. To measure and analyze the effect of the tailor-made CME program on PCPs' self-perception 3 years after its implementation and correlate it to clinical performance. In 2006 a questionnaire was delivered to a representative sample of PCPs in the IDF. The questionnaire included items on demographic and professional background, statements on self-perception issues, and ranking of roles. We compared the follow-up survey (2006) to the results of the original study (2001) and correlated the survey results with clinical performance as measured through objective indicators. In the 2006 follow-up survey PCPs scored higher on questions dealing with their perception of themselves as case managers (3.8 compared to 4.0 on the 2001 survey on a 5 point scale, P = 0.046), perceived quality of care and education (3.5 vs. 3.8, P = 0.06), and on questions dealing with organizational commitment (3.5 vs. 3.8, P = 0.01). PCPs received higher scores on clinical indicators in the later study (odds ratio 2.05, P < 0.001). PCPs in the IDF perceived themselves more as case managers as compared to the 2001 survey. A tailor-made CME program may have contributed to the improvement in skills and quality of care.

A comparative evaluation of the effect of internet-based CME delivery format on satisfaction, knowledge and confidence

PubMed Central

2010-01-01

Background Internet-based instruction in continuing medical education (CME) has been associated with favorable outcomes. However, more direct comparative studies of different Internet-based interventions, instructional methods, presentation formats, and approaches to implementation are needed. The purpose of this study was to conduct a comparative evaluation of two Internet-based CME delivery formats and the effect on satisfaction, knowledge and confidence outcomes. Methods Evaluative outcomes of two differing formats of an Internet-based CME course with identical subject matter were compared. A Scheduled Group Learning format involved case-based asynchronous discussions with peers and a facilitator over a scheduled 3-week delivery period. An eCME On Demand format did not include facilitated discussion and was not based on a schedule; participants could start and finish at any time. A retrospective, pre-post evaluation study design comparing identical satisfaction, knowledge and confidence outcome measures was conducted. Results Participants in the Scheduled Group Learning format reported significantly higher mean satisfaction ratings in some areas, performed significantly higher on a post-knowledge assessment and reported significantly higher post-confidence scores than participants in the eCME On Demand format that was not scheduled and did not include facilitated discussion activity. Conclusions The findings support the instructional benefits of a scheduled delivery format and facilitated asynchronous discussion in Internet-based CME. PMID:20113493

Solar-Storm/Lunar Atmosphere Model (SSLAM): An Overview of the Effort and Description of the Driving Storm Environment

NASA Technical Reports Server (NTRS)

Farrell, W. M.; Halekas, J. S.; Killen, R. M.; Delroy, G. T.; Gross, N.; Bleacher, V; Krauss-Varben, D.; Hurley, D; Zimmerman, M. I.

2012-01-01

On 29 April 1998, a coronal mass ejection (CME) was emitted from the Sun that had a significant impact on bodies located at 1 AU. The terrestrial magnetosphere did indeed become more electrically active during the storm passage but an obvious question is the effect of such a storm on an exposed rocky body like our Moon. The solar-storm/lunar atmosphere modeling effort (SSLAM) brings together surface interactions, exosphere, plasma, and surface charging models all run with a common driver - the solar storm and CME passage occurring from 1-4 May 1998. We present herein an expanded discussion on the solar driver during the 1-4 May 1998 period that included the passage of an intense coronal mass ejection (CME) that had> 10 times the solar wind density and had a compositional component of He++ that exceeded 20%. We also provide a very brief overview oflhe SSLAM system layout and overarching results. One primary result is that the CME driver plasma can greatly increase the exospheric content via sputtering, with total mass loss rates that approach 1 kg/s during the 2-day CME passage. By analogy, we suggest that CME-related sputtering increases might also be expected during a CME passage by a near-earth asteroid or at the Mars exobase, resulting in an enhanced loss of material.

SU-F-E-07: Web-Based Training for Radiosurgery: Methods and Metrics for Global Reach

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schulz, R; Thomas, E; Popple, R

Purpose: Webinars have become an evolving tool with greater or lesser success in reaching health care providers (HCPs). This study seeks to assess best practices and metrics for success in webinar deployment for optimal global reach. Methods: Webinars have been developed and launched to reach practicing health care providers in the field of radiation oncology and radiosurgery. One such webinar was launched in early February 2016. “Multiple Brain Metastases & Volumetric Modulated Arc Radiosurgery: Refining the Single-Isocenter Technique to Benefit Surgeons and Patients” presented by Drs. Fiveash and Thomas from UAB was submitted to and accredited by the Institute formore » Medical Education as qualifying for CME as well as MDCB for educational credit for dosimetrists, in order to encourage participation. MedicalPhysicsWeb was chosen as the platform to inform attendees regarding the webinar. Further IME accredited the activity for 1 AMA PRA Category 1 credit for physicians & medical physicists. The program was qualified by the ABR in meeting the criteria for self-assessment towards fulfilling MOC requirements. Free SAMs credits were underwritten by an educational grant from Varian Medical Systems. Results: The webinar in question attracted 992 pre-registrants from 66 countries. Outside the US and Canada; 11 were from the Americas; 32 were from Europe; 9 from the Middle East and Africa. Australasia and the Indian subcontinent represented the remaining 14 countries. Pre-registrants included 423 Medical Physicists, 225 Medical Dosimetrists, 24 Radiation Therapists, 66 Radiation Oncologists & other. Conclusion: The effectiveness of CME and SAM-CME programs such as this can be gauged by the high rate of respondents who state an intention to change practice habits, a primary goal of continuing medical education and self-assessment. This webinar succeeded in being the most successful webinar on Medical Physics Web as measured by pre-registration, participation and participation to pre-registration ratio. R.A. Schulz is an employee of Varian Medical Systems.« less

Benefits and Limitations of Text Messages to Stimulate Higher Learning Among Community Providers: Participants' Views of an mHealth Intervention to Support Continuing Medical Education in Vietnam

PubMed Central

Sabin, Lora L; Larson Williams, Anna; Le, Bao Ngoc; Herman, Augusta R; Viet Nguyen, Ha; Albanese, Rebecca R; Xiong, Wenjun; Shobiye, Hezekiah OA; Halim, Nafisa; Tran, Lien Thi Ngoc; McNabb, Marion; Hoang, Hai; Falconer, Ariel; Nguyen, Tam Thi Thanh; Gill, Christopher J

2017-01-01

Background: A randomized controlled trial was conducted in 2015 to evaluate a mobile continuing medical education (mCME) intervention that provided daily text messages to community-based physicians' assistants (CBPAs) in Thai Nguyen Province, Vietnam. Although the intervention failed to improve medical knowledge over a 6-month period, a companion qualitative study provided insights on the views and experiences of intervention participants. Methods: We conducted focus group discussions (FGDs) and in-depth interviews (IDIs) among participants randomized to receive text messages containing either simple medical facts or quiz questions. Trained interviewers collected data immediately following the conclusion of the trial in December 2015. Using semi-structured question guides, respondents were queried on their views of the intervention, positive and negative, and perceived impacts of the intervention. During analysis, after learning that the intervention had failed to increase knowledge among participants, we also examined reasons for lack of improvement in medical knowledge. All analyses were performed in NVivo using a thematic approach. Results: A total of 70 CBPAs engaged in one of 8 FGDs or an IDI. One-half were men; average age among all respondents was 40 years. Most (81%) practiced in rural settings and most (51%) focused on general medicine. The mean length of work experience was 3 years. All respondents made positive comments about the intervention; convenience, relevance, and quick feedback (quiz format) were praised. Downsides encompassed lack of depth of information, weak interaction, technology challenges, and challenging/irrelevant messages. Respondents described perceived impacts encompassing increased motivation, knowledge, collegial discussions, Internet use to search for more information, and clinical skills. Overall, they expressed a desire for the intervention to continue and recommended expansion to other medical professionals. Overreliance on the text messages, lack of effective self-study, and technical/language-based barriers may be potential explanations for intervention failure. Conclusion: As a form of mCME, daily text messages were well-received by community-level health care providers in Vietnam. This mCME approach appears very promising in low-resource environments or where traditional forms of CME are impractical. Future models might consider enhancements to foster linkages to relevant medical materials, improve interaction with medical experts, and tailor medical content to the daily activities of medical staff. PMID:28655802

Benefits and Limitations of Text Messages to Stimulate Higher Learning Among Community Providers: Participants' Views of an mHealth Intervention to Support Continuing Medical Education in Vietnam.

PubMed

Sabin, Lora L; Larson Williams, Anna; Le, Bao Ngoc; Herman, Augusta R; Viet Nguyen, Ha; Albanese, Rebecca R; Xiong, Wenjun; Shobiye, Hezekiah Oa; Halim, Nafisa; Tran, Lien Thi Ngoc; McNabb, Marion; Hoang, Hai; Falconer, Ariel; Nguyen, Tam Thi Thanh; Gill, Christopher J

2017-06-27

A randomized controlled trial was conducted in 2015 to evaluate a mobile continuing medical education (mCME) intervention that provided daily text messages to community-based physicians' assistants (CBPAs) in Thai Nguyen Province, Vietnam. Although the intervention failed to improve medical knowledge over a 6-month period, a companion qualitative study provided insights on the views and experiences of intervention participants. We conducted focus group discussions (FGDs) and in-depth interviews (IDIs) among participants randomized to receive text messages containing either simple medical facts or quiz questions. Trained interviewers collected data immediately following the conclusion of the trial in December 2015. Using semi-structured question guides, respondents were queried on their views of the intervention, positive and negative, and perceived impacts of the intervention. During analysis, after learning that the intervention had failed to increase knowledge among participants, we also examined reasons for lack of improvement in medical knowledge. All analyses were performed in NVivo using a thematic approach. A total of 70 CBPAs engaged in one of 8 FGDs or an IDI. One-half were men; average age among all respondents was 40 years. Most (81%) practiced in rural settings and most (51%) focused on general medicine. The mean length of work experience was 3 years. All respondents made positive comments about the intervention; convenience, relevance, and quick feedback (quiz format) were praised. Downsides encompassed lack of depth of information, weak interaction, technology challenges, and challenging/irrelevant messages. Respondents described perceived impacts encompassing increased motivation, knowledge, collegial discussions, Internet use to search for more information, and clinical skills. Overall, they expressed a desire for the intervention to continue and recommended expansion to other medical professionals. Overreliance on the text messages, lack of effective self-study, and technical/language-based barriers may be potential explanations for intervention failure. As a form of mCME, daily text messages were well-received by community-level health care providers in Vietnam. This mCME approach appears very promising in low-resource environments or where traditional forms of CME are impractical. Future models might consider enhancements to foster linkages to relevant medical materials, improve interaction with medical experts, and tailor medical content to the daily activities of medical staff. © Sabin et al.

Improving the diagnostic workup of hyponatremia in the setting of kidney disease: a continuing medical education (CME) initiative.

PubMed

Golestaneh, Ladan; Neugarten, Joel; Southern, William; Kargoli, Faraj; Raff, Amanda

2017-03-01

Hyponatremia is a common electrolyte disorder and is associated with mortality. We examined the frequency of appropriate testing in response to an episode of inpatient hyponatremia in a large urban hospital to better inform our educational intervention. We then evaluated the impact of a live CME activity with a focus on CKD- and ESRD-associated hyponatremia physiology, on diagnostic practices of audience hospitalist attendings. We performed a retrospective database analysis of all patients admitted to Montefiore Medical Center in 2014 to examine the performance of hospital staff in response to hyponatremia across all CKD stages. We then did a comparative analysis of diagnostic workup orders for hyponatremic patients admitted to audience members of a live CME activity in the 4 months prior as compared to the 4 months after the activity. The prevalence of hyponatremia was 27% in a cohort of hospitalized patients: 41% of these hyponatremia inpatients had CKD, and 11.4% had ESRD. Overall less than 10% of patients had orders written for serum and urine osmolality without a differential pattern based on CKD or ESRD diagnosis. Among the patients admitted to the CME audience hospitalists, urine/serum osmolality and urine sodium orders occurred infrequently overall and did not differ after vs. before the lecture. The frequency of appropriate diagnostic orders written in response to an episode of hyponatremia was very low and did not vary based on degree of CKD. A CME activity with an emphasis on the role of CKD/ESRD in diagnostic accuracy did not improve the order quality in a group of audience hospitalists. Efforts to improve the diagnostic workup of hyponatremia with concomitant kidney disease are crucial to proper management of these patients.

LASCO White-Light Observations of Eruptive Current Sheets Trailing CMEs

NASA Astrophysics Data System (ADS)

Webb, David F.; Vourlidas, Angelos

2016-12-01

Many models of eruptive flares or coronal mass ejections (CMEs) involve formation of a current sheet connecting the ejecting CME flux rope with a magnetic loop arcade. However, there is very limited observational information on the properties and evolution of these structures, hindering progress in understanding eruptive activity from the Sun. In white-light images, narrow coaxial rays trailing the outward-moving CME have been interpreted as current sheets. Here, we undertake the most comprehensive statistical study of CME-rays to date. We use SOHO/LASCO data, which have a higher cadence, larger field of view, and better sensitivity than any previous coronagraph. We compare our results to a previous study of Solar Maximum Mission (SMM) CMEs, in 1984 - 1989, having candidate magnetic disconnection features at the CME base, about half of which were followed by coaxial bright rays. We examine all LASCO CMEs during two periods of minimum and maximum activity in Solar Cycle 23, resulting in many more events, ˜130 CME-rays, than during SMM. Important results include: The occurrence rate of the rays is ˜11 % of all CMEs during solar minimum, but decreases to ˜7 % at solar maximum; this is most likely related to the more complex coronal background. The rays appear on average 3 - 4 hours after the CME core, and are typically visible for three-fourths of a day. The mean observed current sheet length over the ray lifetime is ˜12 R_{⊙}, with the longest current sheet of 18.5 R_{⊙}. The mean CS growth rates are 188 km s^{-1} at minimum and 324 km s^{-1} at maximum. Outward-moving blobs within several rays, which are indicative of reconnection outflows, have average velocities of ˜350 km s^{-1} with small positive accelerations. A pre-existing streamer is blown out in most of the CME-ray events, but half of these are observed to reform within ˜1 day. The long lifetime and long lengths of the CME-rays challenge our current understanding of the evolution of the magnetic field in the aftermath of CMEs.

Accuracy of physician self-assessment compared with observed measures of competence: a systematic review.

PubMed

Davis, David A; Mazmanian, Paul E; Fordis, Michael; Van Harrison, R; Thorpe, Kevin E; Perrier, Laure

2006-09-06

Core physician activities of lifelong learning, continuing medical education credit, relicensure, specialty recertification, and clinical competence are linked to the abilities of physicians to assess their own learning needs and choose educational activities that meet these needs. To determine how accurately physicians self-assess compared with external observations of their competence. The electronic databases MEDLINE (1966-July 2006), EMBASE (1980-July 2006), CINAHL (1982-July 2006), PsycINFO (1967-July 2006), the Research and Development Resource Base in CME (1978-July 2006), and proprietary search engines were searched using terms related to self-directed learning, self-assessment, and self-reflection. Studies were included if they compared physicians' self-rated assessments with external observations, used quantifiable and replicable measures, included a study population of at least 50% practicing physicians, residents, or similar health professionals, and were conducted in the United Kingdom, Canada, United States, Australia, or New Zealand. Studies were excluded if they were comparisons of self-reports, studies of medical students, assessed physician beliefs about patient status, described the development of self-assessment measures, or were self-assessment programs of specialty societies. Studies conducted in the context of an educational or quality improvement intervention were included only if comparative data were obtained before the intervention. Study population, content area and self-assessment domain of the study, methods used to measure the self-assessment of study participants and those used to measure their competence or performance, existence and use of statistical tests, study outcomes, and explanatory comparative data were extracted. The search yielded 725 articles, of which 17 met all inclusion criteria. The studies included a wide range of domains, comparisons, measures, and methodological rigor. Of the 20 comparisons between self- and external assessment, 13 demonstrated little, no, or an inverse relationship and 7 demonstrated positive associations. A number of studies found the worst accuracy in self-assessment among physicians who were the least skilled and those who were the most confident. These results are consistent with those found in other professions. While suboptimal in quality, the preponderance of evidence suggests that physicians have a limited ability to accurately self-assess. The processes currently used to undertake professional development and evaluate competence may need to focus more on external assessment.

Impact of a Pelvic Floor Training Program Among Women with Multiple Sclerosis: A Controlled Clinical Trial.

PubMed

Ferreira, Ana Paula Silva; Pegorare, Ana Beatriz Gomes de Souza; Salgado, Pedro Rippel; Casafus, Filemón Silva; Christofoletti, Gustavo

2016-01-01

The objective of this study was to investigate the effects of two programs for strengthening the pelvic floor on the urinary incontinence of patients with multiple sclerosis (MS). This is a prospective study of the clinical trial type, monitored for 6 mos, in which 24 women in the moderate stage of MS participated in a program of exercises for strengthening the pelvic floor-associated (experimental group) or not (control group) with electrotherapy. The variables analyzed were as follows: quality-of-life, overactivity of the bladder, perineal contraction, and level of anxiety and depression. The statistical procedures involved multivariate analyses of repeated measurements, with a significance of 5%. Initial homogeneity being observed in the anthropometric and clinical variables, both protocols resulted in improvements in quality-of-life (P = 0.001), overactive bladder (P = 0.001), perineal contraction (P = 0.004), and level of anxiety (P = 0.001) and depression (P = 0.001), in relation to the initial comparison. The association of electrotherapy with strengthening exercises increased the improvement of the patients regarding overactive bladder (P = 0.039) and perineal contraction (P = 0.001), in comparison with the control group. The results reinforce the benefit of exercises for strengthening the musculature of the pelvic floor in women with overactive bladder in MS and demonstrate a potential of the action when associated with electrotherapy. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES:: Upon completion of this article, the reader should be able to: (1) Identify common dysfunctions of the lower urinary tract in women with multiple sclerosis; (2) Discuss the relationship between quality-of-life, level of anxiety and depression, degree of perineal contraction, and overactive bladder; and (3) Recognize the benefits promoted by physical therapy for strengthening the pelvic floor in patients with multiple sclerosis. Advanced : The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity.

Costs and Length of Stay for the Acute Care of Patients with Motor-Complete Spinal Cord Injury Following Cervical Trauma: The Impact of Early Transfer to Specialized Acute SCI Center.

PubMed

Richard-Denis, Andréane; Ehrmann Feldman, Debbie; Thompson, Cynthia; Bourassa-Moreau, Étienne; Mac-Thiong, Jean-Marc

2017-07-01

Acute spinal cord injury (SCI) centers aim to optimize outcome following SCI. However, there is no timeframe to transfer patients from regional to SCI centers in order to promote cost-efficiency of acute care. Our objective was to compare costs and length of stay (LOS) following early and late transfer to the SCI center. A retrospective cohort study involving 116 individuals was conducted. Group 1 (n = 87) was managed in an SCI center promptly after the trauma, whereas group 2 (n = 29) was transferred to the SCI center only after surgery. Direct comparison and multivariate linear regression analyses were used to assess the relationship between costs, LOS, and timing to transfer to the SCI center. Length of stay was significantly longer for group 2 (median, 93.0 days) as compared with group 1 (median, 40.0 days; P < 10), and average costs were also higher (median, Canadian $17,920.0 vs. $10,521.6; P = 0.004) for group 2, despite similar characteristics. Late transfer to the SCI center was the main predictive factor of longer LOS and increased costs. Early admission to the SCI center was associated with shorter LOS and lower costs for patients sustaining tetraplegia. Early referral to an SCI center before surgery could lower the financial burden for the health care system. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Determine the optimal timing for transfer of individuals with cervical traumatic spinal cord injury (SCI) in order to decrease acute care resource utilization; (2) Determine benefits of a complete perioperative management in a specialized SCI center; and (3) Identify factors that may influence resource utilization for acute care following motor-complete tetraplegia. Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Marketing to Increase Participation in a Web-Based Continuing Medical Education Cultural Competence Curriculum

ERIC Educational Resources Information Center

Estrada, Carlos A.; Krishnamoorthy, Periyakaruppan; Smith, Ann; Staton, Lisa; Korf, Michele J.; Allison, Jeroan J.; Houston, Thomas K.

2011-01-01

Introduction: CME providers may be interested in identifying effective marketing strategies to direct users to specific content. Online advertisements for recruiting participants into activities such as clinical trials, public health programs, and continuing medical education (CME) have been effective in some but not all studies. The purpose of…

WHY IS THE GREAT SOLAR ACTIVE REGION 12192 FLARE-RICH BUT CME-POOR?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sun, Xudong; Bobra, Monica G.; Hoeksema, J. Todd

Solar active region (AR) 12192 of 2014 October hosts the largest sunspot group in 24 years. It is the most prolific flaring site of Cycle 24 so far, but surprisingly produced no coronal mass ejection (CME) from the core region during its disk passage. Here, we study the magnetic conditions that prevented eruption and the consequences that ensued. We find AR 12192 to be “big but mild”; its core region exhibits weaker non-potentiality, stronger overlying field, and smaller flare-related field changes compared to two other major flare-CME-productive ARs (11429 and 11158). These differences are present in the intensive-type indices (e.g.,more » means) but generally not the extensive ones (e.g., totals). AR 12192's large amount of magnetic free energy does not translate into CME productivity. The unexpected behavior suggests that AR eruptiveness is limited by some relative measure of magnetic non-potentiality over the restriction of background field, and that confined flares may leave weaker photospheric and coronal imprints compared to their eruptive counterparts.« less

Enhancing quality improvements in cancer care through CME activities at a nationally recognized cancer center.

PubMed

Uemura, Marc; Morgan, Robert; Mendelsohn, Mary; Kagan, Jean; Saavedra, Crystal; Leong, Lucille

2013-06-01

Changing healthcare policy will undoubtedly affect the healthcare environment in which providers function. The current Fee for Service reimbursement model will be replaced by Value-Based Purchasing, where higher quality and more efficient care will be emphasized. Because of this, large healthcare organizations and individual providers must adapt to incorporate performance outcomes into patient care. Here, we present a Continuing Medical Education (CME)-based initiative at the City of Hope National Cancer Center that we believe can serve as a model for using CME as a value added component to achieving such a goal.

A statistical study of CME-Preflare associated events

NASA Astrophysics Data System (ADS)

Mawad, Ramy; Youssef, M.

2018-07-01

We investigated the relationship of associated CME-Preflare during the solar period 1996-2010. We found 292 CME-Preflare associated events (∼2%). Those associated events have 0-1 h interval time, popular events occur within half an hour before flare starting time. Post-flares-CME associated events are wider than CME-Preflare associated events. CME-Preflare associated events are ejected from the northern hemisphere during the solar cycle 23rd, while the non-associated CMEs are ejected from the southern hemisphere. Polar CME-Preflare associated events are more energetic than the equatorial events. This means that post-flare-CME associated events are more decelerated than CME-Preflare associated events, CME-Flare associated simultaneously events and other CMEs. The CME-Preflare associated events are slower than the post-flare-CME associated events, and slightly faster than non-associated CME events. Post-flare-CME associated events are in average more massive than Preflare CME associated events and all other CMEs ejected from the Sun. CME-Preflare associated has a mean average speed which is equivalent to the mean average solar wind speed approximately.

Tracking CMEs using data from the Solar Stormwatch project; observing deflections and other properties

NASA Astrophysics Data System (ADS)

Jones, Shannon R.; Barnard, Luke A.; Scott, Christopher J.; Owens, Mathew J.; Wilkinson, Julia

2017-09-01

With increasing technological dependence, society is becoming ever more affected by changes in the near-Earth space environment caused by space weather. The primary driver of these hazards are coronal mass ejections (CMEs). Solar Stormwatch is a citizen science project in which volunteers participated in several activities which characterized CMEs in the remote sensing images from the Sun Earth Connection Coronal and Heliospheric Investigation (SECCHI) instrument package on the twin STEREO spacecraft. Here we analyze the results of the "Track-it-back" activity, in which CMEs were tracked back through the COR1, COR2, and EUVI images. Analysis of the COR1, COR2, and EUVI data together allows CMEs to be studied consistently throughout the whole field of view spanned by these instruments (out to 15 RS). A total of 4783 volunteers took part in this activity, creating a data set containing 23,801 estimates of CME timing, location, and size. We used these data to produce a catalogue of 41 CMEs, which is the first to consistently track CMEs through each of these instruments. We assess how the CME speeds, propagation directions, and widths vary as the CMEs propagate through the fields of view of the different imagers. In particular, we compare the observed CME deflections between the COR1 and COR2 fields of view to the separation between the CME source region and the heliospheric current sheet (HCS), demonstrating that in general, these CMEs appear to deflect toward the HCS, consistent with other modeling studies of CME propagation.

Role of telephone triage in obstetrics.

PubMed

Manning, Nirvana Afsordeh; Magann, Everett F; Rhoads, Sarah J; Ivey, Tesa L; Williams, Donna J

2012-12-01

The telephone has become an indispensable method of communication in the practice of obstetrics. The telephone is one of the primary methods by which the patient makes her appointments and contacts her health care provider for advice, reassurance, and referrals. Current methods of telephone triage include personal at the physicians' office, telephone answering services, labor and delivery nurses, and a dedicated telephone triage system using algorithms. Limitations of telephone triage include the inability of the provider to see the patient and receive visual clues from the interaction and the challenges of obtaining a complete history over the telephone. In addition, there are potential safety and legal issues with telephone triage. To date, there is insufficient evidence to either validate or refute the use of a dedicated telephone triage system compared with a traditional system using an answering service or nurses on labor and delivery. Obstetricians and gynecologists, family physicians. After completing this CME activity, physicians should be better able to analyze the scope of variation in telephone triage across health care providers and categorize the components that go into a successful triage system, assess the current scope of research in telephone triage in obstetrics, evaluate potential safety and legal issues with telephone triage in obstetrics, and identify issues that should be addressed in any institution that is using or implementing a system of telephone triage in obstetrics.

75 FR 67258 - Position Reports for Physical Commodity Swaps

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-02

... Cattle. CME Milk Class III. Comex (``CMX'') Copper Grade 1. CMX Gold. CMX Silver. ICE Futures US (``ICUS... Oats. CME Butter. CME Cheese. CME Dry Whey. CME Hardwood Pulp. CME Lean Hogs. CME Non Fat Dry Milk. CME... contract--The ICE WTI Average Price Option is indirectly linked to a 20.2 listed futures contract because...

Sorting of Clathrin-Independent Cargo Proteins Depends on Rab35 Delivered by Clathrin-Mediated Endocytosis.

PubMed

Dutta, Dipannita; Donaldson, Julie G

2015-09-01

Clathrin-mediated endocytosis (CME) and clathrin-independent endocytosis (CIE) co-exist in most cells but little is known about their communication and coordination. Here we show that when CME was inhibited, endocytosis by CIE continued but endosomal trafficking of CIE cargo proteins was altered. CIE cargo proteins that normally traffic directly into Arf6-associated tubules after internalization and avoid degradation (CD44, CD98 and CD147) now trafficked to lysosomes and were degraded. The endosomal tubules were also absent and Arf6-GTP levels were elevated. The altered trafficking, loss of the tubular endosomal network and elevated Arf6-GTP levels caused by inhibition of CME were rescued by expression of Rab35, a Rab associated with clathrin-coated vesicles, or its effector ACAPs, Arf6 GTPase activating proteins (GAP) that inactivate Arf6. Furthermore, siRNA knockdown of Rab35 recreated the phenotype of CME ablation on CIE cargo trafficking without altering endocytosis of transferrin. These observations suggest that Rab35 serves as a CME detector and that loss of CME, or Rab35 input, leads to elevated Arf6-GTP and shifts the sorting of CIE cargo proteins to lysosomes and degradation. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.

A STEREO Survey of Magnetic Cloud Coronal Mass Ejections Observed at Earth in 2008–2012

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wood, Brian E.; Wu, Chin-Chun; Howard, Russell A.

We identify coronal mass ejections (CMEs) associated with magnetic clouds (MCs) observed near Earth by the Wind spacecraft from 2008 to mid-2012, a time period when the two STEREO spacecraft were well positioned to study Earth-directed CMEs. We find 31 out of 48 Wind MCs during this period can be clearly connected with a CME that is trackable in STEREO imagery all the way from the Sun to near 1 au. For these events, we perform full 3D reconstructions of the CME structure and kinematics, assuming a flux rope (FR) morphology for the CME shape, considering the full complement ofmore » STEREO and SOHO imaging constraints. We find that the FR orientations and sizes inferred from imaging are not well correlated with MC orientations and sizes inferred from the Wind data. However, velocities within the MC region are reproduced reasonably well by the image-based reconstruction. Our kinematic measurements are used to provide simple prescriptions for predicting CME arrival times at Earth, provided for a range of distances from the Sun where CME velocity measurements might be made. Finally, we discuss the differences in the morphology and kinematics of CME FRs associated with different surface phenomena (flares, filament eruptions, or no surface activity).« less

Impact of Major Coronal Mass Ejections on Geospace during 2005 September 7-13

NASA Astrophysics Data System (ADS)

Wang, Yuming; Xue, Xianghui; Shen, Chenglong; Ye, Pinzhong; Wang, S.; Zhang, Jie

2006-07-01

We have analyzed five major CMEs originating from NOAA active region (AR) 808 during the period of 2005 September 7-13, when the AR 808 rotated from the east limb to near solar meridian. Several factors that affect the probability of the CMEs' encounter with the Earth are demonstrated. The solar and interplanetary observations suggest that the second and third CMEs, originating from E67° and E47°, respectively, encountered the Earth, while the first CME originating from E77° missed the Earth, and the last two CMEs, although originating from E39° and E10°, respectively, probably only grazed the Earth. On the basis of our ice cream cone mode and CME deflection model, we find that the CME span angle and deflection are important for the probability of encountering Earth. The large span angles allowed the middle two CMEs to hit the Earth, even though their source locations were not close to the solar central meridian. The significant deflection made the first CME totally miss the Earth even though it also had wide span angle. The deflection may also have made the last CME nearly miss the Earth even though it originated close to the disk center. We suggest that, in order to effectively predict whether a CME will encounter the Earth, the factors of the CME source location, the span angle, and the interplanetary deflection should all be taken into account.

Impact of major coronal mass ejections on geo-space during September 7 -- 13, 2005

NASA Astrophysics Data System (ADS)

Wang, Y.; Xue, X.; Shen, C.; Ye, P.; Wang, S.; Zhang, J.

2006-05-01

We have analyzed five major CMEs originating from NOAA active region (AR) 808 during the period of September 7 to 13, 2005, when the AR 808 rotated from the east limb to near solar meridian. Several factors that affect the probability of the CMEs' encounter with the Earth are demonstrated. The solar and interplanetary observations suggest that the 2nd and 3rd CMEs, originating from E67 and E47 respectively, encountered the Earth, while the 1st CME originating from E77 missed the Earth, and the last two CMEs, originating from E39 and E10 respectively, probably only grazed the Earth. Based on our ice-cream cone model (Xue et al. 2005a) and CME deflection model (Wang et al. 2004b), we find that the CME span angle and deflection are important for the probability of encountering. The large span angles make middle two CMEs hit the Earth, though their source locations were not close to the solar central meridian. The significant deflection makes the first CME totally missed the Earth though it also had wide span angle. The deflection may also make the last CME nearly missed the Earth though it originated close to the disk center. We suggest that, in order to effectively predict whether a CME will encounter the Earth, the factors of the CME source location, the span angle, and the interplanetary deflection should all be taken into account.

Detailed analysis of dynamic evolution of three Active Regions at the photospheric level before flare and CME occurrence

NASA Astrophysics Data System (ADS)

Ye, Yudong; Korsós, M. B.; Erdélyi, R.

2018-01-01

We present a combined analysis of the applications of the weighted horizontal magnetic gradient (denoted as WGM in Korsós et al. (2015)) method and the magnetic helicity tool (Berger and Field, 1984) employed for three active regions (ARs), namely NOAA AR 11261, AR 11283 and AR 11429. We analysed the time series of photospheric data from the Solar Dynamics Observatory taken between August 2011 and March 2012. During this period the three ARs produced a series of flares (eight M- and six X-class) and coronal mass ejections (CMEs). AR 11261 had four M-class flares and one of them was accompanied by a fast CME. AR 11283 had similar activities with two M- and two X-class flares, but only with a slow CME. Finally, AR 11429 was the most powerful of the three ARs as it hosted five compact and large solar flare and CME eruptions. For applying the WGM method we employed the Debrecen sunspot data catalogue, and, for estimating the magnetic helicity at photospheric level we used the Space-weather HMI Active Region Patches (SHARP's) vector magnetograms from SDO/HMI (Solar Dynamics Observatory/Helioseismic and Magnetic Imager). We followed the evolution of the components of the WGM and the magnetic helicity before the flare and CME occurrences. We found a unique and mutually shared behaviour, called the U-shaped pattern, of the weighted distance component of WGM and of the shearing component of the helicity flux before the flare and CME eruptions. This common pattern is associated with the decreasing-receding phases yet reported only known to be a necessary feature prior to solar flare eruption(s) but found now at the same time in the evolution of the shearing helicity flux. This result leads to the conclusions that (i) the shearing motion of photospheric magnetic field may be a key driver for solar eruption in addition to the flux emerging process, and that (ii) the found decreasing-approaching pattern in the evolution of shearing helicity flux may be another precursor indicator for improving the forecasting of solar eruptions.

The Search for Transient Mass Loss Events on Active Stars and Their Impacts

NASA Astrophysics Data System (ADS)

Crosley, Michael K.

2018-01-01

The conditions that determine the potential habitability of exoplanets are very diverse and still poorly understood. Magnetic eruptive events, such as flares and coronal mass ejections (CME's) are one such concern. Stellar flares are routinely observed and on cool stars but clear signatures of stellar CME's have been less forthcoming. CME’s are geoeffective and contribute to space weather. Stellar coronal mass ejections remain experimentally unconstrained, unlike the stellar flare counterpart which are observed ubiquitously across the electromagnetic spectrum. Low frequency radio bursts in the form of a type II burst offer the best means of identifying and constraining the rate and properties of stellar CME’s. CME properties can be further constrained and solar scaling relationships tested by simultaneously preforming flare observations. The interpretation for the multi-wavelength analysis of type II events and their associated flares is tested by fully constrained solar observations. There we find that velocity measurements are typically accurate to within a factor of two and that mass constraints are accurate to within an order of magnitude. We take these lessons and apply them to observations of the nearby, active M dwarf stars YZ Cmi and EQ Peg. These stars have the advantage of being well observed and constrained. Their well documented high flare activity is expected to be accompanied with high CME activity. They have been shown to have low frequency radio bursts in the past, and their constrained coronal properties allows us to extract the information required to interpret the type II burst. We report on 15 hours of Low Frequency Array (10-190 MHz) observations of YZ Cmi and to 64 hours of EQ Peg observations at the Jansky Very Large Array (230-470 MHz), 20 hours of which were observed simultaneously for flares at the Apache Point Observatory. During this time, solar scaling relationships tells us that ~70 large flares should have been produced which would be associated to a corresponding CME as well. From our results we can constraint event properties, detection limits, CME models, and atmospheric models.

Near-Sun and 1 AU magnetic field of coronal mass ejections: a parametric study

NASA Astrophysics Data System (ADS)

Patsourakos, S.; Georgoulis, M. K.

2016-11-01

Aims: The magnetic field of coronal mass ejections (CMEs) determines their structure, evolution, and energetics, as well as their geoeffectiveness. However, we currently lack routine diagnostics of the near-Sun CME magnetic field, which is crucial for determining the subsequent evolution of CMEs. Methods: We recently presented a method to infer the near-Sun magnetic field magnitude of CMEs and then extrapolate it to 1 AU. This method uses relatively easy to deduce observational estimates of the magnetic helicity in CME-source regions along with geometrical CME fits enabled by coronagraph observations. We hereby perform a parametric study of this method aiming to assess its robustness. We use statistics of active region (AR) helicities and CME geometrical parameters to determine a matrix of plausible near-Sun CME magnetic field magnitudes. In addition, we extrapolate this matrix to 1 AU and determine the anticipated range of CME magnetic fields at 1 AU representing the radial falloff of the magnetic field in the CME out to interplanetary (IP) space by a power law with index αB. Results: The resulting distribution of the near-Sun (at 10 R⊙) CME magnetic fields varies in the range [0.004, 0.02] G, comparable to, or higher than, a few existing observational inferences of the magnetic field in the quiescent corona at the same distance. We also find that a theoretically and observationally motivated range exists around αB = -1.6 ± 0.2, thereby leading to a ballpark agreement between our estimates and observationally inferred field magnitudes of magnetic clouds (MCs) at L1. Conclusions: In a statistical sense, our method provides results that are consistent with observations.

Council of Medical Specialty Societies: Committed to Continuing Medical Education Reform

ERIC Educational Resources Information Center

McDonald, Walter J.

2005-01-01

The Council of Medical Specialty Societies (CMSS) recognizes the need for continuing medical education (CME) reform and intends to be actively engaged in that process. While recognizing that CME reform must involve many organizations, the CMSS and particularly the 23 societies that make up the CMSS are in a position to affect many of the needed…

Coronal mass ejection kinematics deduced from white light (Solar Mass Ejection Imager) and radio (Wind/WAVES) observations

NASA Astrophysics Data System (ADS)

Reiner, M. J.; Jackson, B. V.; Webb, D. F.; Mizuno, D. R.; Kaiser, M. L.; Bougeret, J.-L.

2005-09-01

White-light and radio observations are combined to deduce the coronal and interplanetary kinematics of a fast coronal mass ejection (CME) that was ejected from the Sun at about 1700 UT on 2 November 2003. The CME, which was associated with an X8.3 solar flare from W56°, was observed by the Mauna Loa and Solar and Heliospheric Observatory (SOHO) Large-Angle Spectrometric Coronograph (LASCO) coronagraphs to 14 R⊙. The measured plane-of-sky speed of the LASCO CME was 2600 km s-1. To deduce the kinematics of this CME, we use the plane-of-sky white light observations from both the Solar Mass Ejection Imager (SMEI) all-sky camera on board the Coriolis spacecraft and the SOHO/LASCO coronagraph, as well as the frequency drift rate of the low-frequency radio data and the results of the radio direction-finding analysis from the WAVES experiment on the Wind spacecraft. In agreement with the in situ observations for this event, we find that both the white light and radio observations indicate that the CME must have decelerated significantly beginning near the Sun and continuing well into the interplanetary medium. More specifically, by requiring self-consistency of all the available remote and in situ data, together with a simple, but not unreasonable, assumption about the general characteristic of the CME deceleration, we were able to deduce the radial speed and distance time profiles for this CME as it propagated from the Sun to 1 AU. The technique presented here, which is applicable to mutual SMEI/WAVES CME events, is expected to provide a more complete description and better quantitative understanding of how CMEs propagate through interplanetary space, as well as how the radio emissions, generated by propagating CME/shocks, relate to the shock and CME. This understanding can potentially lead to more accurate predictions for the onset times of space weather events, such as those that were observed during this unique period of intense solar activity.

First in-situ observations of exospheric response to CME impact at Mercury

NASA Astrophysics Data System (ADS)

Raines, J. M.; Wallace, K. L.; Sarantos, M.; Jasinski, J. M.; Tracy, P.; Dewey, R. M.; Weberg, M. J.; Slavin, J. A.

2017-12-01

We present the first in-situ observations of enhancements to Mercury's He exosphere generated by CME impact. We analyzed both plasma and magnetic field measurements from the Mercury Surface Space Environment, Geochemistry and Mapping (MESSENGER) spacecraft over a 60-hour period as a coronal mass ejection (CME) passed by the planet. We identified the shock, magnetic cloud and cavity regions of the moderate intensity CME while MESSENGER was in the solar wind. Inside the magnetosphere just after the CME shock passage, we observed a very active dayside magnetosphere, as evident from the high flux plasma parcels passing through the dayside and a broad northern magnetospheric cusp with exceptionally high planetary ion content. All of these signatures indicate substantial reconnection at the dayside magnetopause, making conditions that were excellent for solar wind access to Mercury's surface. The CME appeared to have been particularly enriched in He2+, causing the observed density of solar wind He2+ in the cusp to rise above 0.1 cm-3 and putting it in the top 1% of the over 3200 cusps analyzed. As the low-density CME cavity passed over the planet on the next orbit, the magnetosphere appeared much quieter, with smoother magnetic fields and a smaller, less intense northern cusp but with greatly enhanced He+ content. The elevated He+ observed density continued to increase on subsequent cusp crossings, peaking at 0.1 cm-3 36 hours after CME impact, the highest observed throughout the entire MESSENGER mission. We suggest that the enhancement in He+ indicates an increase to the neutral He exosphere density from the He-enriched CME, a phenomenon observed at the moon, possibly acting as follows: Increased access to the surface from CME-enhanced reconnection, combined with high He2+ flux, enhanced surface implantation. Neutral He atoms were then liberated at an increased rate by surface processes supplying the exosphere, causing a gradual increase in He exosphere density. This led to an increase in He+ abundance through photoionization and charge exchange, which, after acceleration on the dayside, was measured by MESSENGER. These first in-situ observations of exospheric response to CME impact at Mercury have implications for understanding exosphere generation and loss processes, as well space weathering of the planet's surface.

Proceedings of second Indian GAME conference, Mumbai, February, 2016.

PubMed

Srivastava, Vaibhav; Stevenson, Robin; Sanghvi, Shwetal

2016-01-01

The second Indian Global Alliance for Medical Education (GAME) conference on continuing medical education-continuing professional development (CME-CPD) was held in Mumbai in February 2016. The main aim of the meeting was to create a blueprint for further development of CME in India based on best practices from around the world. To that end, delegates had been invited from the USA, the UK and Australasia, who engaged in productive discussions with the major stakeholders of the CME community in India. The latter included clinicians, medical communications representatives and delegates from the pharmaceutical industry. The mandatory CME system already established in Maharashtra was described as an example, which could be exported to other states. The various types of accreditation were discussed, including provider and activity accreditation along with hybrid systems. Recommendations for future development were proposed from workshops comprising clinicians, industry representatives and medical communications agencies.

Anti-inflammatory and anti-hypersensitive effects of the crude extract, fractions and triterpenes obtained from Chrysophyllum cainito leaves in mice.

PubMed

Meira, Nicole Anzanelo; Klein, Luiz Carlos; Rocha, Lilian W; Quintal, Zhelmy Martin; Monache, Franco Delle; Cechinel Filho, Valdir; Quintão, Nara Lins Meira

2014-02-03

Chrysophyllum cainito, popularly known as "star apple", caimito, "abiu-roxo" or "abiu-do-Pará", is a tree of about 25m in height. Besides its culinary use, it is also used in folk medicine for the treatment of diabetes mellitus and several inflammatory diseases. The crude methanolic extract (CME) was submitted to phytochemical studies for obtaining fractions and isolated compounds. They were monitored by thin-layer-chromatography (TLC). The biological activity was evaluated in mice using the carrageenan-induced mechanical hypersensitivity and paw oedema. Biochemical assays, such as myeloperoxidase (MPO) and activity and cytokines levels quantification, were carried out to analyse the involvement of neutrophil migration and IL-1β and TNFα production. Some adverse effects were investigated using the open-field and rota-rod tests, and it was also measured the rectal temperature. This study demonstrates, for the first time, the anti-hypersensitivity and anti-inflammatory effects of CME, fractions and two isolated triterpenes obtained from the leaves of Chrysophyllum cainito on carrageenan-induced hypersensitivity and paw-oedema. The mice treated with CME or chloroform fraction (CHCl3) presented reduction in mechanical hypersensitivity. The effect of the CME seemed to be partially related to the anti-inflammatory activity, as the paw-oedema and MPO activity were also significantly inhibited. The isolated compound Lup-20(29)-en-3β-O-hexanoate demonstrated more reduction of the hypersensitivity than 3β-Lup-20(29)-en-3-yl acetate, suggesting that this molecule might be partially responsible for the biological effects obtained with CME and CHCl3 fractions. Finally, animals treated with CME and CHCl3 did not present changes in locomotor activity, motor performance or body temperature. Our data demonstrates, for the first time, that the crude extract, fractions and pure compounds obtained from the Chrysophyllum cainito leaves possess important anti-hypersensitive properties against inflammatory pain in mice. The mechanisms through which Chrysophyllum cainito exerts its anti-hypersensitive actions are still unclear, and require further investigation; however, this could well constitute a new and attractive alternative for the management of persistent inflammatory and neuropathic pain in humans. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Thermal Chemistry of Cp*W(NO)(CH2CMe3)(H)(L) Complexes (L = Lewis Base).

PubMed

Fabulyak, Diana; Handford, Rex C; Holmes, Aaron S; Levesque, Taleah M; Wakeham, Russell J; Patrick, Brian O; Legzdins, Peter; Rosenfeld, Devon C

2017-01-03

The complexes trans-Cp*W(NO)(CH 2 CMe 3 )(H)(L) (Cp* = η 5 -C 5 Me 5 ) result from the treatment of Cp*W(NO)(CH 2 CMe 3 ) 2 in n-pentane with H 2 (∼1 atm) in the presence of a Lewis base, L. The designation of a particular geometrical isomer as cis or trans indicates the relative positions of the alkyl and hydrido ligands in the base of a four-legged piano-stool molecular structure. The thermal behavior of these complexes is markedly dependent on the nature of L. Some of them can be isolated at ambient temperatures [e.g., L = P(OMe) 3 , P(OPh) 3 , or P(OCH 2 ) 3 CMe]. Others undergo reductive elimination of CMe 4 via trans to cis isomerization to generate the 16e reactive intermediates Cp*W(NO)(L). These intermediates can intramolecularly activate a C-H bond of L to form 18e cis complexes that may convert to the thermodynamically more stable trans isomers [e.g., Cp*W(NO)(PPh 3 ) initially forms cis-Cp*W(NO)(H)(κ 2 -PPh 2 C 6 H 4 ) that upon being warmed in n-pentane at 80 °C isomerizes to trans-Cp*W(NO)(H)(κ 2 -PPh 2 C 6 H 4 )]. Alternatively, the Cp*W(NO)(L) intermediates can effect the intermolecular activation of a substrate R-H to form trans-Cp*W(NO)(R)(H)(L) complexes [e.g., L = P(OMe) 3 or P(OCH 2 ) 3 CMe; R-H = C 6 H 6 or Me 4 Si] probably via their cis isomers. These latter activations are also accompanied by the formation of some Cp*W(NO)(L) 2 disproportionation products. An added complication in the L = P(OMe) 3 system is that thermolysis of trans-Cp*W(NO)(CH 2 CMe 3 )(H)(P(OMe) 3 ) results in it undergoing an Arbuzov-like rearrangement and being converted mainly into [Cp*W(NO)(Me)(PO(OMe) 2 )] 2 , which exists as a mixture of two isomers. All new complexes have been characterized by conventional and spectroscopic methods, and the solid-state molecular structures of most of them have been established by single-crystal X-ray crystallographic analyses.

Individual risk factors for physician boundary violations: the role of attachment style, childhood trauma and maladaptive beliefs.

PubMed

MacDonald, Kai; Sciolla, Andrés F; Folsom, David; Bazzo, David; Searles, Chris; Moutier, Christine; Thomas, Michael L; Borton, Katherine; Norcross, Bill

2015-01-01

The assessment and remediation of boundary-challenged health care professionals is enhanced through examination of individual risk factors. We assessed three such factors - attachment style, childhood trauma and maladaptive beliefs - in 100 attendees (mostly physicians) of a continuing medical education (CME) professional boundaries course. We propose a theoretical model that draws a causal arc from childhood maltreatment through insecure attachment and maladaptive beliefs to elevated risk for boundary violations. We administered the Experiences in Close Relationships Questionnaire Revised (ECR-R), Childhood Trauma Questionnaire (CTQ) and Young Schema Questionnaire (YSQ) to 100 health care professionals attending a CME course on professional boundaries. Experts rated participant autobiographies to determine attachment style and early adversities. Correlations and relationships between self-ratings and expert ratings and among different risk factors were examined. One fifth of participants reported moderate to severe childhood abuse; sixty percent reported moderate to severe emotional neglect. Despite this, average attachment anxiety and attachment avoidance were low, and more than half of participants were rated "secure" by experts. Childhood maltreatment was correlated with attachment anxiety and avoidance and predicted expert-rated insecure attachment and maladaptive beliefs. Our findings support a potential link between childhood adversity and boundary difficulties, partly mediated by insecure attachment and early maladaptive beliefs. Furthermore, these results suggest that boundary education programs and professional wellness programs may be enhanced with a focus on sequelae of childhood maltreatment, attachment and common maladaptive thinking patterns. Copyright © 2015 Elsevier Inc. All rights reserved.

Perceived barriers to completing an e-learning program on evidence-based medicine.

PubMed

Gagnon, Marie-Pierre; Légaré, France; Labrecque, Michel; Frémont, Pierre; Cauchon, Michel; Desmartis, Marie

2007-01-01

The Continuing Professional Development Center of the Faculty of Medicine at Laval University offers an internet-based program on evidence-based medicine (EBM). After one year, only three physicians out of the 40 who willingly paid to register had completed the entire program. This descriptive study aimed to identify physicians' beliefs regarding their completion of this online program. Using theoretical concepts from the Theory of Planned Behaviour, a semi-structured telephone interview guide was developed to assess respondents' attitudes, perceived subjective norms, perceived obstacles and facilitating conditions with respect to completing this internet-based program. Three independent reviewers performed content analysis of the interview transcripts to obtain an appropriate level of reliability. Findings were shared and organised according to theoretical categories of beliefs. A total of 35 physicians (88% response rate) were interviewed. Despite perceived advantages to completing the internet-based program, barriers remained, especially those related to physicians' perceptions of time constraints. Lack of personal discipline and unfamiliarity with computers were also perceived as important barriers. This study offers a theoretical basis to understand physicians' beliefs towards completing an internet-based continuing medical education (CME) program on EBM. Based upon respondents' insights, several modifications were carried out to enhance the uptake of the program by physicians and, therefore, its implementation.

Relationship among knowledge acquisition, motivation to change, and self-efficacy in CME participants.

PubMed

Williams, Betsy W; Kessler, Harold A; Williams, Michael V

2015-01-01

The relationship among an individual's sense of self-efficacy, motivation to change, barriers to change, and the implementation of improvement programs has been reported. This research reports the relationship among self-efficacy, motivation to change, and the acquisition of knowledge in a continuing medical education (CME) activity. The measure of individual sense of self-efficacy was a 4-item scale. The measure of motivation was a 6-item scale following on the work of Prochaska and colleagues. The knowledge acquisition was measured in a simple post measure. The participants were enrolled in a CME activity focused on HIV.  The CME activities had a significant effect on knowledge. Preliminary analysis demonstrates a relationship among the self-efficacy measure, the motivation to change measure, and global intent to change. Specifically, as reported earlier, the sense of efficacy in effecting change in the practice environment is predictive of a high level of motivation to change that, in turn, is predictive of formation of intent to change practice patterns. Interestingly, there were also relationships among the self-efficacy measure, the motivation to change measure, and knowledge acquisition. Finally, as expected, there was a significant relationship between knowledge and intent to change practice.  Further inspection of the motivation to change construct suggests that it mediates the self-efficacy constructs' effect on intent as well as its effect on knowledge acquisition. This new finding suggests that the proximal construct motivation completely masks an important underlying causal relationship that appears to contribute to practice change as well as learning following CME-self-efficacy. © 2015 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education.

Forward Modeling of Coronal Mass Ejection Flux Ropes in the Inner Heliosphere with 3DCORE.

PubMed

Möstl, C; Amerstorfer, T; Palmerio, E; Isavnin, A; Farrugia, C J; Lowder, C; Winslow, R M; Donnerer, J M; Kilpua, E K J; Boakes, P D

2018-03-01

Forecasting the geomagnetic effects of solar storms, known as coronal mass ejections (CMEs), is currently severely limited by our inability to predict the magnetic field configuration in the CME magnetic core and by observational effects of a single spacecraft trajectory through its 3-D structure. CME magnetic flux ropes can lead to continuous forcing of the energy input to the Earth's magnetosphere by strong and steady southward-pointing magnetic fields. Here we demonstrate in a proof-of-concept way a new approach to predict the southward field B z in a CME flux rope. It combines a novel semiempirical model of CME flux rope magnetic fields (Three-Dimensional Coronal ROpe Ejection) with solar observations and in situ magnetic field data from along the Sun-Earth line. These are provided here by the MESSENGER spacecraft for a CME event on 9-13 July 2013. Three-Dimensional Coronal ROpe Ejection is the first such model that contains the interplanetary propagation and evolution of a 3-D flux rope magnetic field, the observation by a synthetic spacecraft, and the prediction of an index of geomagnetic activity. A counterclockwise rotation of the left-handed erupting CME flux rope in the corona of 30° and a deflection angle of 20° is evident from comparison of solar and coronal observations. The calculated Dst matches reasonably the observed Dst minimum and its time evolution, but the results are highly sensitive to the CME axis orientation. We discuss assumptions and limitations of the method prototype and its potential for real time space weather forecasting and heliospheric data interpretation.

Correlation between Angular Widths of CMEs and Characteristics of Their Source Regions

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhao, X. H.; Feng, X. S.; Feng, H. Q.

The angular width of a coronal mass ejection (CME) is an important factor in determining whether the corresponding interplanetary CME (ICME) and its preceding shock will reach Earth. However, there have been very few studies of the decisive factors of the CME’s angular width. In this study, we use the three-dimensional (3D) angular width of CMEs obtained from the Graduated Cylindrical Shell model based on observations of Solar Terrestrial Relations Observatory ( STEREO ) to study the relations between the CME’s 3D width and characteristics of the CME’s source region. We find that for the CMEs produced by active regionsmore » (ARs), the CME width has some correlations with the AR’s area and flux, but these correlations are not strong. The magnetic flux contained in the CME seems to come from only part of the AR’s total flux. For the CMEs produced by flare regions, the correlations between the CME angular width and the flare region’s area and flux are strong. The magnetic flux within those CMEs seems to come from the whole flare region or even from a larger region than the flare. Our findings show that the CME’s 3D angular width can be generally estimated based on observations of Solar Dynamics Observatory for the CME’s source region instead of the observations from coronagraphs on board the Solar and Heliospheric Observatory and STEREO if the two foot points of the CME stay in the same places with no expansion of the CME in the transverse direction until reaching Earth.« less

Forward Modeling of Coronal Mass Ejection Flux Ropes in the Inner Heliosphere with 3DCORE

NASA Astrophysics Data System (ADS)

Möstl, C.; Amerstorfer, T.; Palmerio, E.; Isavnin, A.; Farrugia, C. J.; Lowder, C.; Winslow, R. M.; Donnerer, J. M.; Kilpua, E. K. J.; Boakes, P. D.

2018-03-01

Forecasting the geomagnetic effects of solar storms, known as coronal mass ejections (CMEs), is currently severely limited by our inability to predict the magnetic field configuration in the CME magnetic core and by observational effects of a single spacecraft trajectory through its 3-D structure. CME magnetic flux ropes can lead to continuous forcing of the energy input to the Earth's magnetosphere by strong and steady southward-pointing magnetic fields. Here we demonstrate in a proof-of-concept way a new approach to predict the southward field Bz in a CME flux rope. It combines a novel semiempirical model of CME flux rope magnetic fields (Three-Dimensional Coronal ROpe Ejection) with solar observations and in situ magnetic field data from along the Sun-Earth line. These are provided here by the MESSENGER spacecraft for a CME event on 9-13 July 2013. Three-Dimensional Coronal ROpe Ejection is the first such model that contains the interplanetary propagation and evolution of a 3-D flux rope magnetic field, the observation by a synthetic spacecraft, and the prediction of an index of geomagnetic activity. A counterclockwise rotation of the left-handed erupting CME flux rope in the corona of 30° and a deflection angle of 20° is evident from comparison of solar and coronal observations. The calculated Dst matches reasonably the observed Dst minimum and its time evolution, but the results are highly sensitive to the CME axis orientation. We discuss assumptions and limitations of the method prototype and its potential for real time space weather forecasting and heliospheric data interpretation.

Mass-loss Rates from Coronal Mass Ejections: A Predictive Theoretical Model for Solar-type Stars

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cranmer, Steven R.

Coronal mass ejections (CMEs) are eruptive events that cause a solar-type star to shed mass and magnetic flux. CMEs tend to occur together with flares, radio storms, and bursts of energetic particles. On the Sun, CME-related mass loss is roughly an order of magnitude less intense than that of the background solar wind. However, on other types of stars, CMEs have been proposed to carry away much more mass and energy than the time-steady wind. Earlier papers have used observed correlations between solar CMEs and flare energies, in combination with stellar flare observations, to estimate stellar CME rates. This papermore » sidesteps flares and attempts to calibrate a more fundamental correlation between surface-averaged magnetic fluxes and CME properties. For the Sun, there exists a power-law relationship between the magnetic filling factor and the CME kinetic energy flux, and it is generalized for use on other stars. An example prediction of the time evolution of wind/CME mass-loss rates for a solar-mass star is given. A key result is that for ages younger than about 1 Gyr (i.e., activity levels only slightly higher than the present-day Sun), the CME mass loss exceeds that of the time-steady wind. At younger ages, CMEs carry 10–100 times more mass than the wind, and such high rates may be powerful enough to dispel circumstellar disks and affect the habitability of nearby planets. The cumulative CME mass lost by the young Sun may have been as much as 1% of a solar mass.« less

Expanding CME-flare relations to other stellar systems

NASA Astrophysics Data System (ADS)

Moschou, Sofia P.; Drake, Jeremy J.; Cohen, Ofer

2017-05-01

Stellar activity is one of the main parameters in exoplanet habitability studies. While the effects of UV to X-ray emission from extreme flares on exoplanets are beginning to be investigated, the impact of coronal mass ejections is currently highly speculative because CMEs and their properties cannot yet be directly observed on other stars. An extreme superflare was observed in X-rays on the Algol binary system on August 30 1997, emitting a total of energy 1.4x 10^{37} erg and making it a great candidate for studying the upper energy limits of stellar superflares in solar-type (GK) stars. A simultaneous increase and subsequent decline in absorption during the flare was also observed and interpretted as being caused by a CME. Here we investigate the dynamic properties of a CME that could explain such time-dependent absorption and appeal to trends revealed from solar flare and CME statistics as a guide. Using the ice-cream cone model that is extensively used in solar physics to describe the three-dimensional CME structure, in combination with the temporal profile of the hydrogen column density evolution, we are able to characterize the CME and estimate its kinetic energy and mass. We examine the mass, kinetic and flare X-ray fluence in the context of solar relations to examine the extent to which such relations can be extrapolated to much more extreme stellar events.

Formation of Radio Type II Bursts During a Multiple Coronal Mass Ejection Event

NASA Astrophysics Data System (ADS)

Al-Hamadani, Firas; Pohjolainen, Silja; Valtonen, Eino

2017-12-01

We study the solar event on 27 September 2001 that consisted of three consecutive coronal mass ejections (CMEs) originating from the same active region, which were associated with several periods of radio type II burst emission at decameter-hectometer (DH) wavelengths. Our analysis shows that the first radio burst originated from a low-density environment, formed in the wake of the first, slow CME. The frequency-drift of the burst suggests a low-speed burst driver, or that the shock was not propagating along the large density gradient. There is also evidence of band-splitting within this emission lane. The origin of the first shock remains unclear, as several alternative scenarios exist. The second shock showed separate periods of enhanced radio emission. This shock could have originated from a CME bow shock, caused by the fast and accelerating second or third CME. However, a shock at CME flanks is also possible, as the density depletion caused by the three CMEs would have affected the emission frequencies and hence the radio source heights could have been lower than usual. The last type II burst period showed enhanced emission in a wider bandwidth, which was most probably due to the CME-CME interaction. Only one shock that could reliably be associated with the investigated CMEs was observed to arrive near Earth.

PREDICTING CORONAL MASS EJECTIONS USING MACHINE LEARNING METHODS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bobra, M. G.; Ilonidis, S.

Of all the activity observed on the Sun, two of the most energetic events are flares and coronal mass ejections (CMEs). Usually, solar active regions that produce large flares will also produce a CME, but this is not always true. Despite advances in numerical modeling, it is still unclear which circumstances will produce a CME. Therefore, it is worthwhile to empirically determine which features distinguish flares associated with CMEs from flares that are not. At this time, no extensive study has used physically meaningful features of active regions to distinguish between these two populations. As such, we attempt to domore » so by using features derived from (1) photospheric vector magnetic field data taken by the Solar Dynamics Observatory ’s Helioseismic and Magnetic Imager instrument and (2) X-ray flux data from the Geostationary Operational Environmental Satellite’s X-ray Flux instrument. We build a catalog of active regions that either produced both a flare and a CME (the positive class) or simply a flare (the negative class). We then use machine-learning algorithms to (1) determine which features distinguish these two populations, and (2) forecast whether an active region that produces an M- or X-class flare will also produce a CME. We compute the True Skill Statistic, a forecast verification metric, and find that it is a relatively high value of ∼0.8 ± 0.2. We conclude that a combination of six parameters, which are all intensive in nature, will capture most of the relevant information contained in the photospheric magnetic field.« less

CME productivity associated with Solar Flare peak X-ray emission flux

NASA Astrophysics Data System (ADS)

Suryanarayana, G. S.; Balakrishna, K. M.

2018-05-01

It is often noticed that the occurrence rate of Coronal Mass Ejections (CMEs) increases with increase in flare duration where peak flux too increase. However, there is no complete association between the duration and peak flux. Distinct characteristics have been reported for active regions (ARs) where flares and CMEs occur in contrast to ARs where flares alone occur. It is observed that peak flux of flares is higher when associated with CMEs compared to peak flux of flares with which CMEs are not associated. In other words, it is likely that flare duration and peak flux are independently affected by distinct active region dynamics. Hence, we examine the relative ability of flare duration and peak flux in enhancing the CME productivity. We report that CME productivity is distinctly higher in association with the enhancement of flare peak flux in comparison to corresponding enhancement of flare duration.

USING MULTIPLE-VIEWPOINT OBSERVATIONS TO DETERMINE THE INTERACTION OF THREE CORONAL MASS EJECTIONS OBSERVED ON 2012 MARCH 5

DOE Office of Scientific and Technical Information (OSTI.GOV)

Colaninno, Robin C.; Vourlidas, Angelos, E-mail: robin.colaninno@nrl.navy.mil, E-mail: angelos.vourlidas@jhuapl.edu

2015-12-10

We examine the interaction of three coronal mass ejections (CMEs) that took place on 2012 March 5 at heights less than 20 R{sub ⊙} in the corona. We used a forward fitting model to reconstruct the three-dimensional trajectories and kinematics of the CMEs and determine their interaction in the observations from three viewpoints: Solar and Heliospheric Observatory (SOHO), STEREO-A, and STEREO-B. The first CME (CME-1), a slow-rising eruption near disk center, is already in progress at 02:45 UT when the second CME (CME-2) erupts from AR 11429 on the east limb. These two CMEs are present in the corona not interactingmore » when a third CME (CME-3) erupts from AR 11429 at 03:34 UT. CME-3 has a constant velocity of 1456[±31] km s{sup −1} and drives a shock that is observed as a halo from all viewpoints. We find that the shock driven by CME-3 passed through CME-1 with no observable change in the geometry, trajectory, or velocity of CME-1. However, the elevated temperatures detected in situ when CME-1 reached Earth indicate that the plasma inside CME-1 may have been heated by the passage of the shock. CME-2 is accelerated by CME-3 to more than twice its initial velocity and remains a separate structure ahead of the CME-3 front. CME-2 is deflected 24° northward by CME-3 for a total deflection of 40° from its source region. These results suggest that the collision of CME-2 and CME-3 is superelastic. This work demonstrates the capability and utility of fitting forward models to complex and interacting CMEs observed in the corona from multiple viewpoints.« less

A noncanonical role for dynamin-1 in regulating early stages of clathrin-mediated endocytosis in non-neuronal cells

PubMed Central

Bhave, Madhura; Chen, Zhiming; Chen, Ping-Hung; Wang, Xinxin; Danuser, Gaudenz

2018-01-01

Dynamin Guanosine Triphosphate hydrolases (GTPases) are best studied for their role in the terminal membrane fission process of clathrin-mediated endocytosis (CME), but they have also been proposed to regulate earlier stages of CME. Although highly enriched in neurons, dynamin-1 (Dyn1) is, in fact, widely expressed along with Dyn2 but inactivated in non-neuronal cells via phosphorylation by glycogen synthase kinase-3 beta (GSK3β) kinase. Here, we study the differential, isoform-specific functions of Dyn1 and Dyn2 as regulators of CME. Endogenously expressed Dyn1 and Dyn2 were fluorescently tagged either separately or together in two cell lines with contrasting Dyn1 expression levels. By quantitative live cell dual- and triple-channel total internal reflection fluorescence microscopy, we find that Dyn2 is more efficiently recruited to clathrin-coated pits (CCPs) than Dyn1, and that Dyn2 but not Dyn1 exhibits a pronounced burst of assembly, presumably into supramolecular collar-like structures that drive membrane scission and clathrin-coated vesicle (CCV) formation. Activation of Dyn1 by acute inhibition of GSK3β results in more rapid endocytosis of transferrin receptors, increased rates of CCP initiation, and decreased CCP lifetimes but did not significantly affect the extent of Dyn1 recruitment to CCPs. Thus, activated Dyn1 can regulate early stages of CME that occur well upstream of fission, even when present at low, substoichiometric levels relative to Dyn2. Under physiological conditions, Dyn1 is activated downstream of epidermal growth factor receptor (EGFR) signaling to alter CCP dynamics. We identify sorting nexin 9 (SNX9) as a preferred binding partner to activated Dyn1 that is partially required for Dyn1-dependent effects on early stages of CCP maturation. Together, we decouple regulatory and scission functions of dynamins and report a scission-independent, isoform-specific regulatory role for Dyn1 in CME. PMID:29668686

Chrysophyllum cainito leaves are effective against pre-clinical chronic pain models: Analysis of crude extract, fraction and isolated compounds in mice.

PubMed

Meira, Nicole Anzanelo; Rocha, Lilian W; da Silva, Gislaine F; Quintal, Zhelmy Martin; Delle Monache, Franco; Cechinel Filho, Valdir; Quintão, Nara Lins Meira

2016-05-26

Chrysophyllum cainito L. (Sapotaceae), commonly known as caimito or star apple, is a neotropical tree valued for its ornamental quality and edible fruits. Besides its culinary use, the leaves are also popularly used to treat diabetes mellitus and several inflammatory diseases. This study aimed to complement previous data obtained about the anti-hypersensitivity effects of the crude methanol extract (CME), CHCl3 fraction and isolated compounds obtained from C. cainito. The CME, CHCl3 fraction and two isolated triterpenes identified as 3β-Lup-20(29)-en-3-yl acetate (1) and Lup-20(29)-en-3β-O-hexanoate (2) were evaluated regarding their effects using clinical pain models, such as post-operative, inflammatory and neuropathic pain. Acute inflammatory pain models induced by PGE2, epinephrine, LPS and CFA were also used to improve the knowledge about the mechanism of action. The animals treated with the CME and submitted to PGE2, epinephrine, LPS or CFA had the mechanical hypersensitivity significantly reduced. When repeatedly administered, the CME enhanced the mechanical withdrawal threshold of mice submitted to post-operative pain model, CFA-induced chronic inflammatory pain and two different models of neuropathic pain. In turn, the CHCl3 fraction presented anti-hypersensitivity effect against epinephrine- or LPS-induced hypersensitivity, with a more prominent activity in both the neuropathic pain models. The compound 1 seems to present the same profile of the CHCl3, whereas compound 2 exhibited activity similar to the CME. This data suggests that the CME effect involves interference in the production, release or action of some chemical mediators, such as PGE2, sympathetic amines, cytokines, etc. Part of these effects was observed with the CHCl3 fraction, emphasizing the prominent inhibition of neuropathic pain. The results also demonstrated that part of the CME effects are due to the presence of the triterpenes 1 and 2, but it is important to mention that we cannot discard the effects of countless other compounds presented in the crude extract, acting in a synergic way. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Defining quality criteria for online continuing medical education modules using modified nominal group technique.

PubMed

Shortt, S E D; Guillemette, Jean-Marc; Duncan, Anne Marie; Kirby, Frances

2010-01-01

The rapid increase in the use of the Internet for continuing education by physicians suggests the need to define quality criteria for accredited online modules. Continuing medical education (CME) directors from Canadian medical schools and academic researchers participated in a consensus process, Modified Nominal Group Technique, to develop agreement on the most important quality criteria to guide module development. Rankings were compared to responses to a survey of a subset of Canadian Medical Association (CMA) members. A list of 17 items was developed, of which 10 were deemed by experts to be important and 7 were considered secondary. A quality module would: be needs-based; presented in a clinical format; utilize evidence-based information; permit interaction with content and experts; facilitate and attempt to document practice change; be accessible for later review; and include a robust course evaluation. There was less agreement among CMA members on criteria ranking, with consensus on ranking reached on only 12 of 17 items. In contrast to experts, members agreed that the need to assess performance change as a result of an educational experience was not important. This project identified 10 quality criteria for accredited online CME modules that representatives of Canadian organizations involved in continuing education believe should be taken into account when developing learning products. The lack of practitioner support for documentation of change in clinical behavior may suggest that they favor traditional attendance- or completion-based CME; this finding requires further research.

Solar radio bursts as a tool for space weather forecasting

NASA Astrophysics Data System (ADS)

Klein, Karl-Ludwig; Matamoros, Carolina Salas; Zucca, Pietro

2018-01-01

The solar corona and its activity induce disturbances that may affect the space environment of the Earth. Noticeable disturbances come from coronal mass ejections (CMEs), which are large-scale ejections of plasma and magnetic fields from the solar corona, and solar energetic particles (SEPs). These particles are accelerated during the explosive variation of the coronal magnetic field or at the shock wave driven by a fast CME. In this contribution, it is illustrated how full Sun microwave observations can lead to (1) an estimate of CME speeds and of the arrival time of the CME at the Earth, (2) the prediction of SEP events attaining the Earth. xml:lang="fr"

Oncological outcomes of complete versus conventional mesocolic excision in laparoscopic right hemicolectomy.

PubMed

An, Min Sung; Baik, HyungJoo; Oh, Se Hui; Park, Yo-Han; Seo, Sang Hyuk; Kim, Kwang Hee; Hong, Kwan Hee; Bae, Ki Beom

2018-06-12

Complete mesocolic excision (CME) has been proposed for colon cancer to improve oncological outcomes. The risks and benefits of laparoscopic CME have not been examined fully. We compared short- and long-term outcomes of CME with a conventional mesocolic excision (non-CME) in laparoscopic right hemicolectomy (RHC) for right-sided colon cancer. In total, 115 patients who underwent laparoscopic RHC with stage I-III right-sided colon cancer at Busan Paik Hospital from August 2007 to October 2011 were enrolled in this case-control study. Three trained colorectal surgeons reviewed videos of the surgeries; patients were divided into two groups: those who underwent a CME (CME group, n = 34) and those who underwent a conventional mesocolic excision (non-CME group, n = 81). There was no significant difference between the CME and non-CME groups in operative time, post-operative complications, or hospital stay. However, the CME group had more lymph nodes harvested (P < 0.001) and lower blood loss (P = 0.016) versus the non-CME group. There was no difference in 5-year disease-free survival rate between the groups, but 5-year overall survival rate was 100% in the CME group and 89.49% in the non-CME group (P < 0.05). Laparoscopic RHC with CME is safe and associated with better 5-year overall survival rate than non-CME for patients with stage I-III right-sided colon cancer. Implementation of CME surgery might improve oncological outcomes for patients with right-sided colon cancer. © 2018 Royal Australasian College of Surgeons.

Best practices in specialty pharmacy management.

PubMed

Patterson, Courtney J

2013-01-01

Specialty pharmacy is a growing area of research, utilization, and cost. Because of the unique nature of the diseases treated by specialty pharmaceuticals, such as cancer and rheumatoid arthritis, novel management approaches are needed. Advocate Physician Partners (APP) is an entity within the Advocate Health Care Health System in the Chicago and the central Illinois area. It coordinates the care management and managed care contracting between the Advocate Health Care System and more than 4,000 physicians on the medical staffs of Advocate hospitals. APP has experienced a per-member-per-month (PMPM) increase of less than  3% in oncology intravenous medications spend in 2012. This spend refers to the intravenous medications covered under the medical benefits for APP's health maintenance organization (HMO) population. The spend has consistently been less than national projections, and we believe this is tied to the adoption of several key best practices. Prior to instituting the best practices, the yearly percentage increases for oncology spending were 5.52% (2007 to 2008), 9.39% (2008 to 2009), and 5.29% (2009 to 2010). After instituting best practices during the first quarter of 2011, the increases in PMPM were 3.11% (2010 to 2011) and 2.11% (2011 to 2012), which were below previous years. To describe the best practices of specialty pharmacy management adopted by APP, specifically (a) establishing a content expert and governing bodies, (b) ensuring compliance with policies, and (c) providing educational resources. APP has several key result areas (KRAs). One KRA was compliance with appropriate utilization of intravenous oncology protocols for its HMO population. The protocols for each medication outline the appropriate indication and patient population. These protocols were developed and reviewed by the APP Pharmacy and Technology (PT) committee. The PT-approved indications reflect FDA indications and indications found in national guidelines. The APP KRA target for the utilization of protocols was 80%. The compliance for completing the protocols that correspond to these medications was calculated by tabulating the number of paid claims over the number of completed protocols, resulting in a compliance percentage. APP defined noncompliance as any utilization not outlined in the protocol. Another KRA was physician feedback. APP requires that physicians complete a certain number of continuing medical education (CME) programs provided by APP each year. Feedback from physicians, provided at the end of the CME, were tabulated and utilized for further programs. Additionally, APP strived to increase physician engagement by placing them in key roles that oversaw clinical and business aspects of the organization. In order to meet the KRAs, investigate inappropriate utilization, and become better involved in engaging oncology specialists, APP invested in an oncology clinical pharmacist position. The primary responsibility of the oncology clinical pharmacist was to be a specialty drug resource for the organization with a focus on provider education. The oncology clinical pharmacist was deemed the content expert who developed clinical protocols, educated providers, and encouraged compliance with organizational policies and procedures as it pertained to the KRAs. Since establishing the oncology clinical pharmacist position, APP has seen an increase in protocol compliance. Prior to the institution of this position, the protocol compliance was 62%. In less than 1 year after hiring the oncology clinical pharmacist, the compliance percentage spiked to over 80%. APP has several committees and boards that oversee the clinical and business aspects of the organization. By placing physicians in chairmanship positions of the committees, APP has seen the benefit of handling difficult patient decisions and increased compliance with policies. Lastly, extensive provider education has led to an improved physician satisfaction in the educational initiatives of APP. Greater than 80% of the physicians felt the CME content was relevant to their practices; the content would likely have a positive impact on their practices; and the clinical content was evidence based and accepted by the medical community. By hiring an oncology clinical pharmacist, engaging physicians by placing them in key roles, and providing more specialist-specific education, APP has improved its KRAs and compliance percentages. APP achieved success in containing expenditures for oncology intravenous medications by implementing key best practices combined with traditional management strategies.

Coronal mass ejection (CME) activity of low mass M stars as an important factor for the habitability of terrestrial exoplanets. II. CME-induced ion pick up of Earth-like exoplanets in close-in habitable zones.

PubMed

Lammer, Helmut; Lichtenegger, Herbert I M; Kulikov, Yuri N; Griessmeier, Jean-Mathias; Terada, N; Erkaev, Nikolai V; Biernat, Helfried K; Khodachenko, Maxim L; Ribas, Ignasi; Penz, Thomas; Selsis, Franck

2007-02-01

Atmospheric erosion of CO2-rich Earth-size exoplanets due to coronal mass ejection (CME)-induced ion pick up within close-in habitable zones of active M-type dwarf stars is investigated. Since M stars are active at the X-ray and extreme ultraviolet radiation (XUV) wave-lengths over long periods of time, we have applied a thermal balance model at various XUV flux input values for simulating the thermospheric heating by photodissociation and ionization processes due to exothermic chemical reactions and cooling by the CO2 infrared radiation in the 15 microm band. Our study shows that intense XUV radiation of active M stars results in atmospheric expansion and extended exospheres. Using thermospheric neutral and ion densities calculated for various XUV fluxes, we applied a numerical test particle model for simulation of atmospheric ion pick up loss from an extended exosphere arising from its interaction with expected minimum and maximum CME plasma flows. Our results indicate that the Earth-like exoplanets that have no, or weak, magnetic moments may lose tens to hundreds of bars of atmospheric pressure, or even their whole atmospheres due to the CME-induced O ion pick up at orbital distances

An application of the weighted horizontal magnetic gradient to solar compact and eruptive events

NASA Astrophysics Data System (ADS)

Korsós, M. B.; Ruderman, Michael S.; Erdélyi, R.

2018-01-01

We propose to apply the weighted horizontal magnetic gradient (WGM), introduced in Korsós et al., 2015, for analysing the pre-flare and pre-CME behaviour and evolution of Active Regions (ARs) using the SDO/HMI-Debrecen Data catalogue. To demonstrate the power of investigative capabilities of the WGM method, in terms of flare and CME eruptions, we studied two typical ARs, namely, AR 12158 and AR 12192. The choice of ARs represent canonical cases. AR 12158 produced an X1.6 flare with fast "halo" CME (vlinear = 1267 kms-1) while in AR 12192 there occurred a range of powerful X-class eruptions, i.e. X1.1, X1.6, X3.1, X1.0, X2.0 and X2.0-class energetic flares, interestingly, none with an accompanying CME. The value itself and temporal variation of WGM is found to possess potentially important diagnostic information about the intensity of the expected flare class. Furthermore, we have also estimated the flare onset time from the relationship of duration of converging and diverging motions of the area-weighted barycenters of two subgroups of opposite magnetic polarities. This test turns out not only to provide information about the intensity of the expected flare-class and the flare onset time but may also indicate whether a flare will occur with/without fast CME. We have also found that, in the case when the negative polarity barycenter has moved around and the positive one "remained" at the same coordinates preceding eruption, the flare occurred with fast "halo" CME. Otherwise, when both the negative and the positive polarity barycenters have moved around, the AR produced flares without CME. If these properties found for the movement of the barycenters are generic pre-cursors of CME eruption (or lack of it), identifying them may serve as an excellent pre-condition for refining the forecast of the lift-off of CMEs.

Forward Modeling of Coronal Mass Ejection Flux Ropes in the Inner Heliosphere with 3DCORE

PubMed Central

Amerstorfer, T.; Palmerio, E.; Isavnin, A.; Farrugia, C. J.; Lowder, C.; Winslow, R. M.; Donnerer, J. M.; Kilpua, E. K. J.; Boakes, P. D.

2018-01-01

Abstract Forecasting the geomagnetic effects of solar storms, known as coronal mass ejections (CMEs), is currently severely limited by our inability to predict the magnetic field configuration in the CME magnetic core and by observational effects of a single spacecraft trajectory through its 3‐D structure. CME magnetic flux ropes can lead to continuous forcing of the energy input to the Earth's magnetosphere by strong and steady southward‐pointing magnetic fields. Here we demonstrate in a proof‐of‐concept way a new approach to predict the southward field B z in a CME flux rope. It combines a novel semiempirical model of CME flux rope magnetic fields (Three‐Dimensional Coronal ROpe Ejection) with solar observations and in situ magnetic field data from along the Sun‐Earth line. These are provided here by the MESSENGER spacecraft for a CME event on 9–13 July 2013. Three‐Dimensional Coronal ROpe Ejection is the first such model that contains the interplanetary propagation and evolution of a 3‐D flux rope magnetic field, the observation by a synthetic spacecraft, and the prediction of an index of geomagnetic activity. A counterclockwise rotation of the left‐handed erupting CME flux rope in the corona of 30° and a deflection angle of 20° is evident from comparison of solar and coronal observations. The calculated Dst matches reasonably the observed Dst minimum and its time evolution, but the results are highly sensitive to the CME axis orientation. We discuss assumptions and limitations of the method prototype and its potential for real time space weather forecasting and heliospheric data interpretation. PMID:29780287

SUN-TO-EARTH CHARACTERISTICS OF THE 2012 JULY 12 CORONAL MASS EJECTION AND ASSOCIATED GEO-EFFECTIVENESS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hu, Huidong; Liu, Ying D.; Wang, Rui

We analyze multi-spacecraft observations associated with the 2012 July 12 coronal mass ejection (CME), covering the source region on the Sun from the Solar Dynamics Observatory , stereoscopic imaging observations from the Solar Terrestrial Relations Observatory ( STEREO ), magnetic field characteristics from Mercury Surface, Space Environment, Geochemistry, and Ranging ( MESSENGER ), and type II radio burst and in situ measurements from Wind . A triangulation method based on STEREO stereoscopic observations is employed to determine the kinematics of the CME, and the outcome is compared with the results derived from the type II radio burst using a solarmore » wind electron density model. A Grad–Shafranov technique is applied to Wind in situ data to reconstruct the flux-rope structure and compare it with the observations of the solar source region, which helps in understanding the geo-effectiveness associated with the CME structure. Our conclusions are as follows: (1) the CME undergoes an impulsive acceleration, a rapid deceleration before reaching MESSENGER , and then a gradual deceleration out to 1 au, which should be considered in CME kinematics models; (2) the type II radio burst was probably produced from a high-density interaction region between the CME-driven shock and a nearby streamer or from the shock flank with lower heights, which implies uncertainties in the determination of CME kinematics using solely type II radio bursts; (3) the flux-rope orientation and chirality deduced from in situ reconstructions at Wind agree with those obtained from solar source observations; (4) the prolonged southward magnetic field near the Earth is mainly from the axial component of the largely southward inclined flux rope, which indicates the importance of predicting both the flux-rope orientation and magnetic field components in geomagnetic activity forecasting.« less

Eruptions from the Sun

NASA Astrophysics Data System (ADS)

Kohler, Susanna

2015-11-01

The Sun often exhibits outbursts, launching material from its surface in powerful releases of energy. Recent analysis of such an outburst captured on video by several Sun-monitoring spacecraft may help us understand the mechanisms that launch these eruptions.Many OutburstsSolar jets are elongated, transient structures that are thought to regularly release magnetic energy from the Sun, contributing to coronal heating and solar wind acceleration. Coronal mass ejections (CMEs), on the other hand, are enormous blob-like explosions, violently ejecting energy and mass from the Sun at incredible speeds.But could these two types of events actually be related? According to a team of scientists at the University of Science and Technology of China, they may well be. The team, led by Jiajia Liu, has analyzed observations of a coronal jet that they believe prompted the launch of a powerful CME.Observing an ExplosionGif of a movie of the CME, taken by the Solar Dynamics Observatorys Atmospheric Imaging Assembly at a wavelength of 304. The original movie can be found in the article. [Liu et al.]An army of spacecraft was on hand to witness the event on 15 Jan 2013 including the Solar Dynamics Observatory (SDO), the Solar and Heliospheric Observatory (SOHO), and the Solar Terrestrial Relations Observatory (STEREO). The instruments on board these observatories captured the drama on the northern limb of the Sun as, at 19:32 UT, a coronal jet formed. Just eight minutes later, a powerful CME was released from the same active region.The fact that the jet and CME occurred in the same place at roughly the same time suggests theyre related. But did the initial motions of the CME blob trigger the jet? Or did the jet trigger the CME?Tying It All TogetherIn a recently published study, Liu and collaborators analyzed the multi-wavelength observations of this event to find the heights and positions of the jet and CME. From this analysis, they determined that the coronal jet triggered the release of material to form the CME, which then erupted into space with the jet at its core at speeds of over 1000 km/s.Based on observed clues of the magnetic field configurations, the team has put together a theory for how this event unfolded. They believe that sudden magnetic reconnection in an active region accelerated plasma to form a large-scale coronal jet. This burst of energy also provided a push on a blob of gas, threaded with magnetic field lines, that lay above the jet. The blob then rose, and when the field lines broke, it was released as a CME with the jet at its core.CitationJiajia Liu et al 2015 ApJ 813 115. doi:10.1088/0004-637X/813/2/115

WHY IS A FLARE-RICH ACTIVE REGION CME-POOR?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liu, Lijuan; Wang, Yuming; Shen, Chenglong

Solar active regions (ARs) are the major sources of two of the most violent solar eruptions, namely flares and coronal mass ejections (CMEs). The largest AR in the past 24 years, NOAA AR 12192, which crossed the visible disk from 2014 October 17 to 30, unusually produced more than one hundred flares, including 32 M-class and 6 X-class ones, but only one small CME. Flares and CMEs are believed to be two phenomena in the same eruptive process. Why is such a flare-rich AR so CME-poor? We compared this AR with other four ARs; two were productive in both andmore » two were inert. The investigation of the photospheric parameters based on the SDO /HMI vector magnetogram reveals that the flare-rich AR 12192, as with the other two productive ARs, has larger magnetic flux, current, and free magnetic energy than the two inert ARs but, in contrast to the two productive ARs, it has no strong, concentrated current helicity along both sides of the flaring neutral line, indicating the absence of a mature magnetic structure consisting of highly sheared or twisted field lines. Furthermore, the decay index above the AR 12192 is relatively low, showing strong constraint. These results suggest that productive ARs are always large and have enough current and free energy to power flares, but whether or not a flare is accompanied by a CME is seemingly related to (1) the presence of a mature sheared or twisted core field serving as the seed of the CME, or (2) a weak enough constraint of the overlying arcades.« less

Connecting Coronal Mass Ejections to Their Solar Active Region Sources: Combining Results from the HELCATS and FLARECAST Projects

NASA Astrophysics Data System (ADS)

Murray, Sophie A.; Guerra, Jordan A.; Zucca, Pietro; Park, Sung-Hong; Carley, Eoin P.; Gallagher, Peter T.; Vilmer, Nicole; Bothmer, Volker

2018-04-01

Coronal mass ejections (CMEs) and other solar eruptive phenomena can be physically linked by combining data from a multitude of ground-based and space-based instruments alongside models; however, this can be challenging for automated operational systems. The EU Framework Package 7 HELCATS project provides catalogues of CME observations and properties from the Heliospheric Imagers on board the two NASA/STEREO spacecraft in order to track the evolution of CMEs in the inner heliosphere. From the main HICAT catalogue of over 2,000 CME detections, an automated algorithm has been developed to connect the CMEs observed by STEREO to any corresponding solar flares and active-region (AR) sources on the solar surface. CME kinematic properties, such as speed and angular width, are compared with AR magnetic field properties, such as magnetic flux, area, and neutral line characteristics. The resulting LOWCAT catalogue is also compared to the extensive AR property database created by the EU Horizon 2020 FLARECAST project, which provides more complex magnetic field parameters derived from vector magnetograms. Initial statistical analysis has been undertaken on the new data to provide insight into the link between flare and CME events, and characteristics of eruptive ARs. Warning thresholds determined from analysis of the evolution of these parameters is shown to be a useful output for operational space weather purposes. Parameters of particular interest for further analysis include total unsigned flux, vertical current, and current helicity. The automated method developed to create the LOWCAT catalogue may also be useful for future efforts to develop operational CME forecasting.

Antihyperlipidemic effect of a Rhamnus alaternus leaf extract in Triton-induced hyperlipidemic rats and human HepG2 cells.

PubMed

Tacherfiout, Mustapha; Petrov, Petar D; Mattonai, Marco; Ribechini, Erika; Ribot, Joan; Bonet, M Luisa; Khettal, Bachra

2018-05-01

The Mediterranean buckthorn, Rhamnus alaternus L., is a plant used in traditional medicine in Mediterranean countries. We aimed at characterizing its phenolic compounds and explore potential antihyperlipidemic activity of this plant. The profile of phenolic compounds in R. alaternus leaf crude methanolic extract (CME) and its liquid-liquid extraction-derived fractions were analyzed by high-performance liquid chromatography/electrospray ionization tandem mass spectrometry (HPLC/ESI-MS 2 ). Effects of CME on: circulating lipids in rats with Triton WR-1339-induced hyperlipidemia, intracellular lipid accumulation and expression of genes of fatty acid metabolism in human hepatoma HepG2 cells, and adipogenesis in the 3T3-L1 murine adipocyte cell model were assessed. The HPLC/ESI-MS 2 analytical profile revealed a total of fifteen compounds, of which eleven were identified. Oral CME administration decreased blood levels of cholesterol and triacylglycerols in hyperlipidemic rats (by 60% and 70%, respectively, at 200 mg CME/kg). In HepG2 cells, CME exposure dose-dependently decreased intracellular lipids and up-regulated gene expression of carnitine palmitoyltransferase 1 involved in fatty acid oxidation. In the 3T3-L1 model, CME favored preadipocyte proliferation and adipogenesis, pointing to positive effects on adipose tissue expandability. These results suggest novel uses of R. alaternus by showing that its leaves are rich in flavonoids and flavonoid derivatives with an antihyperlipidemic effect in vivo and in hepatic cells. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

A New Tool for CME Arrival Time Prediction using Machine Learning Algorithms: CAT-PUMA

NASA Astrophysics Data System (ADS)

Liu, Jiajia; Ye, Yudong; Shen, Chenglong; Wang, Yuming; Erdélyi, Robert

2018-03-01

Coronal mass ejections (CMEs) are arguably the most violent eruptions in the solar system. CMEs can cause severe disturbances in interplanetary space and can even affect human activities in many aspects, causing damage to infrastructure and loss of revenue. Fast and accurate prediction of CME arrival time is vital to minimize the disruption that CMEs may cause when interacting with geospace. In this paper, we propose a new approach for partial-/full halo CME Arrival Time Prediction Using Machine learning Algorithms (CAT-PUMA). Via detailed analysis of the CME features and solar-wind parameters, we build a prediction engine taking advantage of 182 previously observed geo-effective partial-/full halo CMEs and using algorithms of the Support Vector Machine. We demonstrate that CAT-PUMA is accurate and fast. In particular, predictions made after applying CAT-PUMA to a test set unknown to the engine show a mean absolute prediction error of ∼5.9 hr within the CME arrival time, with 54% of the predictions having absolute errors less than 5.9 hr. Comparisons with other models reveal that CAT-PUMA has a more accurate prediction for 77% of the events investigated that can be carried out very quickly, i.e., within minutes of providing the necessary input parameters of a CME. A practical guide containing the CAT-PUMA engine and the source code of two examples are available in the Appendix, allowing the community to perform their own applications for prediction using CAT-PUMA.

Properties of Ground Level Enhancement Events and the Associated Solar Eruptions During Solar Cycle 23

NASA Technical Reports Server (NTRS)

Gopalswamy, N.; Xie, H.; Yashiro, S.; Akiyama, S.; Makela, P.; Usokin, I. G.

2012-01-01

Solar cycle 23 witnessed the most complete set of observations of coronal mass ejections (CMEs) associated with the Ground Level Enhancement (GLE) events. We present an overview of the observed properties of the GLEs and those of the two associated phenomena, viz., flares and CMEs, both being potential sources of particle acceleration. Although we do not find a striking correlation between the GLE intensity and the parameters of flares and CMEs, the solar eruptions are very intense involving X-class flares and extreme CME speeds (average approx. 2000 km/s). An M7.1 flare and a 1200 km/s CME are the weakest events in the list of 16 GLE events. Most (80 %) of the CMEs are full halos with the three non-halos having widths in the range 167 to 212 degrees. The active regions in which the GLE events originate are generally large: 1290 msh (median 1010 msh) compared to 934 msh (median: 790 msh) for SEP-producing active regions. For accurate estimation of the CME height at the time of metric type II onset and GLE particle release, we estimated the initial acceleration of the CMEs using flare and CME observations. The initial acceleration of GLE-associated CMEs is much larger (by a factor of 2) than that of ordinary CMEs (2.3 km/sq s vs. 1 km/sq s). We confirmed the initial acceleration for two events for which CME measurements are available in the inner corona. The GLE particle release is delayed with respect to the onset of all electromagnetic signatures of the eruptions: type II bursts, low frequency type III bursts, soft X-ray flares and CMEs. The presence of metric type II radio bursts some 17 min (median: 16 min; range: 3 to 48 min) before the GLE onset indicates shock formation well before the particle release. The release of GLE particles occurs when the CMEs reach an average height of approx 3.09 R(sub s) (median: 3.18 R (sub s) ; range: 1.71 to 4.01 R (sub s) ) for well-connected events (source longitude in the range W20–W90). For poorly connected events, the average CME height at GLE particle release is 66 % larger (mean: 5.18 R (sub s) ; median: 4.61 R (sub s) ; range: 2.75–8.49 R (sub s) ). The longitudinal dependence is consistent with shock accelerations because the shocks from poorly connected events need to expand more to cross the field lines connecting to an Earth observer. On the other hand, the CME height at metric type II burst onset has no longitudinal dependence because electromagnetic signals do not require magnetic connectivity to the observer. For several events, the GLE particle release is very close to the time of first appearance of the CME in the coronagraphic field of view, so we independently confirmed the CME height at particle release. The CME height at metric type II burst onset is in the narrow range 1.29 to 1.8 R(sub s), with mean and median values of 1.53 and 1.47 R(sub s). The CME heights at metric type II burst onset and GLE particle release correspond to the minimum and maximum in the Alfven speed profile. The increase in CME speed between these two heights suggests an increase in Alfvenic Mach number from 2 to 3. The CME heights at GLE particle release are in good agreement with those obtained from the velocity dispersion analysis, including the source longitude dependence. We also discuss the implications of the delay of GLE particle release with respect to complex type III bursts by approx 18 min (median: 16 in; range: 2 to 44 min) for the flare acceleration mechanism. A similar analysis is also performed on the delay of particle release relative to the hard X-ray emission.

Continuing medical education.

PubMed

Todd, D

1987-04-01

With the rapid advances in medical science and increasing complexities of patient care, the need for continuing medical education (CME) is widely accepted by the profession. CME follows general and higher professional training, and should be a life long process. Teaching hospitals and postgraduate professional institutions play vital roles in organising, promoting, and monitoring this activity. CME directorates should be established. University authorities must recognise the important role of medical teachers in postgraduate and continuing medical education, and the staff establishment and terms of service should be held regularly. Medical libraries should have easy borrowing facilities. Self-assessment and audio-visual material are particularly helpful to the busy practitioner and inexpensive local or regional journals of quality can provide pertinent and up-to-date information. All charges for attending scientific meetings and educational material should be tax deductible or subsidized. The effectiveness of CME is difficult to assess and participation is almost impossible to enforce. Much depends on the standard of medical practice wanted by society. Recertification of general practitioners or specialists poses many problems. On the other hand, completion of self-assessment programmes, active participation at medical meetings, contributions to scientific literature, and membership of medical societies with built-in peer review could be monitored and regularly used to evaluate professional status.

Characteristics of Kinematics of a Coronal Mass Ejection During the 2010 August 1 CME-CME Interaction Event

NASA Technical Reports Server (NTRS)

Temmer, Manuela; Vrsnak, Bojan; Rollett, Tanja; Bein, Bianca; de Koning, Curt A.; Liu, Ying; Bosman, Eckhard; Davies, Jackie A.; Mostl, Christian; Zic, Tomislav;

Ensemble Modeling of the July 23, 2012 CME Event

NASA Astrophysics Data System (ADS)

Cash, M. D.; Biesecker, D. A.; Millward, G.; Arge, C. N.; Henney, C. J.

2013-12-01

On July 23, 2012 a large and very fast coronal mass ejection (CME) was observed by STEREO A. This CME was unusual in that the estimates of the speed of the CME ranged from 2125 km/s to 2780 km/s based on dividing the distance of STEREO A from the Sun by the transit time of the CME. Modeling of this CME event with the WSA-Enlil model has also suggested that a very fast speed is required in order to obtain the correct arrival time at 1 AU. We present a systematic study of parameter space for the July 23, 2012 CME event through an ensemble study using the WSA-Enlil model to predict the arrival time of the CME at STEREO A. We investigate how variations in the initial speed, angular width, and direction affect the predicted arrival time. We also explore how variations in the background solar wind influence CME arrival time by using varying ADAPT maps within our ensemble study. Factors involved in the fast transit time of this large CME are discussed and the optimal CME parameters are presented.

Halo Coronal Mass Ejections during Solar Cycle 24: reconstruction of the global scenario and geoeffectiveness

NASA Astrophysics Data System (ADS)

Scolini, Camilla; Messerotti, Mauro; Poedts, Stefaan; Rodriguez, Luciano

2018-02-01

In this study we present a statistical analysis of 53 fast Earth-directed halo CMEs observed by the SOHO/LASCO instrument during the period Jan. 2009-Sep. 2015, and we use this CME sample to test the capabilities of a Sun-to-Earth prediction scheme for CME geoeffectiveness. First, we investigate the CME association with other solar activity features by means of multi-instrument observations of the solar magnetic and plasma properties. Second, using coronagraphic images to derive the CME kinematical properties at 0.1 AU, we propagate the events to 1 AU by means of the WSA-ENLIL+Cone model. Simulation results at Earth are compared with in-situ observations at L1. By applying the pressure balance condition at the magnetopause and a solar wind-Kp index coupling function, we estimate the expected magnetospheric compression and geomagnetic activity level, and compare them with global data records. The analysis indicates that 82% of the CMEs arrived at Earth in the next 4 days. Almost the totality of them compressed the magnetopause below geosynchronous orbits and triggered a geomagnetic storm. Complex sunspot-rich active regions associated with energetic flares result the most favourable configurations from which geoeffective CMEs originate. The analysis of related SEP events shows that 74% of the CMEs associated with major SEPs were geoeffective. Moreover, the SEP production is enhanced in the case of fast and interacting CMEs. In this work we present a first attempt at applying a Sun-to-Earth geoeffectiveness prediction scheme - based on 3D simulations and solar wind-geomagnetic activity coupling functions - to a statistical set of potentially geoeffective halo CMEs. The results of the prediction scheme are in good agreement with geomagnetic activity data records, although further studies performing a fine-tuning of such scheme are needed.

LATERAL OFFSET OF THE CORONAL MASS EJECTIONS FROM THE X-FLARE OF 2006 DECEMBER 13 AND ITS TWO PRECURSOR ERUPTIONS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sterling, Alphonse C.; Moore, Ronald L.; Harra, Louise K., E-mail: alphonse.sterling@nasa.gov, E-mail: ron.moore@nasa.gov, E-mail: lkh@mssl.ucl.ac.uk

2011-12-10

Two GOES sub-C-class precursor eruptions occurred within {approx}10 hr prior to and from the same active region as the 2006 December 13 X4.3-class flare. Each eruption generated a coronal mass ejection (CME) with center laterally far offset ({approx}> 45 Degree-Sign ) from the co-produced bright flare. Explaining such CME-to-flare lateral offsets in terms of the standard model for solar eruptions has been controversial. Using Hinode/X-Ray Telescope (XRT) and EUV Imaging Spectrometer (EIS) data, and Solar and Heliospheric Observatory (SOHO)/Large Angle and Spectrometric Coronagraph (LASCO) and Michelson Doppler Imager (MDI) data, we find or infer the following. (1) The first precursormore » was a 'magnetic-arch-blowout' event, where an initial standard-model eruption of the active region's core field blew out a lobe on one side of the active region's field. (2) The second precursor began similarly, but the core-field eruption stalled in the side-lobe field, with the side-lobe field erupting {approx}1 hr later to make the CME either by finally being blown out or by destabilizing and undergoing a standard-model eruption. (3) The third eruption, the X-flare event, blew out side lobes on both sides of the active region and clearly displayed characteristics of the standard model. (4) The two precursors were offset due in part to the CME originating from a side-lobe coronal arcade that was offset from the active region's core. The main eruption (and to some extent probably the precursor eruptions) was offset primarily because it pushed against the field of the large sunspot as it escaped outward. (5) All three CMEs were plausibly produced by a suitable version of the standard model.« less

An evaluation of venous thromboembolic risk in acutely ill medical patients immobilized at home: the AT-HOME Study.

PubMed

Haas, Sylvia K; Hach-Wunderle, Viola; Mader, Frank H; Ruster, Katherine; Paar, Wilhelm D

2007-01-01

Many risk factors for venous thromboembolism (VTE) in hospitalized medical patients are also present in medical outpatients. VTE prevention represents an important challenge for physicians treating patients at home. The AT-HOME study was a prospective cross-sectional observational study designed to assess awareness of the risk of VTE in immobilized acutely ill medical outpatients among German physicians, many of whom were participating in a national Continuing Medical Education (CME) program designed to raise awareness of VTE. The study involved 1210 medical patients who were acutely confined to bed at home. Physicians performed a subjective assessment of VTE risk, which was rated on a 10-point scale (1 = very low risk; 10 = very high risk). The risk of VTE was also assessed retrospectively by using a scorecard developed for use in hospitalized medical patients. Of the 1210 patients, 198 (16%) had risk scores of 0-4, 319 (26%) had scores of 5 or 6, and 693 (57%) had scores > or =7. Overall, 966 patients (80%) received thromboprophylaxis. The proportion of patients receiving thromboprophylaxis was 0% to 47% in risk score groups 0-4, 76% to 85% in groups 5 and 6, and 90% to 100% in risk score groups 7-10. In the retrospective assessment of VTE risk, 74% of patients were at high risk, 15% were at intermediate risk, and 11% were at low risk. The proportions of patients receiving thromboprophylaxis in these groups were 87%, 61%, and 55%, respectively. The involvement of physicians in educational activities focusing on VTE awareness appeared to create awareness of the risks of VTE in acutely ill medical outpatients.

State of play of CME in Europe in 2015: Proceedings from the Eighth Annual European CME Forum

PubMed Central

Pozniak, Eugene; Jacobson, Anne

2016-01-01

European CME Forum is a not-for-profit organisation that brings together all stakeholder groups with an interest in European continuing medical education (CME) and promote multichannel discussion in an independent and neutral environment. This report summarises the discussions that took place at the 8th Annual European CME Forum in Manchester on 11–12 November 2015. Held at a time of increased scrutiny on the quality and value of the CME, the forum provided a space for attendees to share perspectives on trends, challenges, and opportunities related to European CME accreditation, funding, and regulation. Discussions focused on specific “hot topics” identified through a pre-meeting survey and needs assessment conducted among CME stakeholders in Europe and beyond. Chief among these were issues related to managing the transparency of relationships between industry and healthcare professionals, evolving systems of European CME accreditation, and the future of CME funding. The programme structure included multiple workshops conducted by leaders in the CME field, and plenary sessions that facilitated multidisciplinary interactions with invited guests, including the very learners the CME field is designed to serve. Attendee feedback was gathered to begin shaping the programme for the 9th Annual European CME Forum (#9ECF), which will take place in Amsterdam, The Netherlands, on 9–11 November 2016. PMID:29644124

Photospheric Magnetic Evolution in the WHI Active Regions

NASA Technical Reports Server (NTRS)

Welsch, B. T.; McTiernan, J. M.; Christe, S.

2012-01-01

Sequences of line-of-sight (LOS) magnetograms recorded by the Michelson Doppler Imager are used to quantitatively characterize photospheric magnetic structure and evolution in three active regions that rotated across the Sun s disk during the Whole Heliosphere Interval (WHI), in an attempt to relate the photospheric magnetic properties of these active regions to flares and coronal mass ejections (CMEs). Several approaches are used in our analysis, on scales ranging from whole active regions, to magnetic features, to supergranular scales, and, finally, to individual pixels. We calculated several parameterizations of magnetic structure and evolution that have previously been associated with flare and CME activity, including total unsigned magnetic flux, magnetic flux near polarity-inversion lines, amount of canceled flux, the "proxy Poynting flux," and helicity flux. To catalog flare events, we used flare lists derived from both GOES and RHESSI observations. By most such measures, AR 10988 should have been the most flare- and CME-productive active region, and AR 10989 the least. Observations, however, were not consistent with this expectation: ARs 10988 and 10989 produced similar numbers of flares, and AR 10989 also produced a few CMEs. These results highlight present limitations of statistics-based flare and CME forecasting tools that rely upon line-of-sight photospheric magnetic data alone.

Effects on readiness to change of an educational intervention on depressive disorders for general physicians in primary care based on a modified Prochaska model--a randomized controlled study.

PubMed

Shirazi, M; Zeinaloo, A A; Parikh, S V; Sadeghi, M; Taghva, A; Arbabi, M; Kashani, A Sabouri; Alaeddini, F; Lonka, K; Wahlström, R

2008-04-01

The Prochaska model of readiness to change has been proposed to be used in educational interventions to improve medical care. To evaluate the impact on readiness to change of an educational intervention on management of depressive disorders based on a modified version of the Prochaska model in comparison with a standard programme of continuing medical education (CME). This is a randomized controlled trial within primary care practices in southern Tehran, Iran. The participants included 192 general physicians working in primary care (GPs) were recruited after random selection and randomized to intervention (96) and control (96). Intervention consisted of interactive, learner-centred educational methods in large and small group settings depending on the GPs' stages of readiness to change. Change in stage of readiness to change measured by the modified version of the Prochaska questionnaire was the The final number of participants was 78 (81%) in the intervention arm and 81 (84%) in the control arm. Significantly (P < 0.01), more GPs (57/96 = 59% versus 12/96 = 12%) in the intervention group changed to higher stages of readiness to change. The intervention effect was 46% points (P < 0.001) and 50% points (P < 0.001) in the large and small group setting, respectively. Educational formats that suit different stages of learning can support primary care doctors to reach higher stages of behavioural change in the topic of depressive disorders. Our findings have practical implications for conducting CME programmes in Iran and are possibly also applicable in other parts of the world.

RADIAL FLOW PATTERN OF A SLOW CORONAL MASS EJECTION

DOE Office of Scientific and Technical Information (OSTI.GOV)

Feng, Li; Gan, Weiqun, E-mail: lfeng@pmo.ac.cn; Inhester, Bernd

2015-06-01

Height–time plots of the leading edge of coronal mass ejections (CMEs) have often been used to study CME kinematics. We propose a new method to analyze the CME kinematics in more detail by determining the radial mass transport process throughout the entire CME. Thus, our method is able to estimate not only the speed of the CME front but also the radial flow speed inside the CME. We have applied this method to a slow CME with an average leading edge speed of about 480 km s{sup −1}. In the Lagrangian frame, the speeds of the individual CME mass elementsmore » stay almost constant within 2 and 15 R{sub S}, the range over which we analyzed the CME. Hence, we have no evidence of net radial forces acting on parts of the CME in this range or of a pile up of mass ahead of the CME. We find evidence that the leading edge trajectory obtained by tie-pointing may gradually lag behind the Lagrangian front-side trajectories derived from our analysis. Our results also allow a much more precise estimate of the CME energy. Compared with conventional estimates using the CME total mass and leading edge motion, we find that the latter may overestimate the kinetic energy and the gravitational potential energy.« less

Breakout Reconnection Observed by the TESIS EUV Telescope

NASA Astrophysics Data System (ADS)

Reva, A. A.; Ulyanov, A. S.; Shestov, S. V.; Kuzin, S. V.

2016-01-01

We present experimental evidence of the coronal mass ejection (CME) breakout reconnection, observed by the TESIS EUV telescope. The telescope could observe solar corona up to 2 R⊙ from the Sun center in the Fe 171 Å line. Starting from 2009 April 8, TESIS observed an active region (AR) that had a quadrupolar structure with an X-point 0.5 R⊙ above photosphere. A magnetic field reconstructed from the Michelson Doppler Imager data also has a multipolar structure with an X-point above the AR. At 21:45 UT on April 9, the loops near the X-point started to move away from each other with a velocity of ≈7 km s-1. At 01:15 UT on April 10, a bright stripe appeared between the loops, and the flux in the GOES 0.5-4 Å channel increased. We interpret the loops’ sideways motion and the bright stripe as evidence of the breakout reconnection. At 01:45 UT, the loops below the X-point started to slowly move up. At 15:10 UT, the CME started to accelerate impulsively, while at the same time a flare arcade formed below the CME. After 15:50 UT, the CME moved with constant velocity. The CME evolution precisely followed the breakout model scenario.

Comet Plunge and CME on the Sun

NASA Image and Video Library

2017-12-08

A small comet was streaking towards the Sun when the Sun blew out a "halo" coronal mass ejection (CME) Aug. 19-20, 2013). The CME originated from the far side of the Sun and did not have any interaction with the comet. The comet, only perhaps 30 meters across, was not seen after it went out of view, likely disintegrated by the heat and radiation from the Sun. We call this a "full halo" CME since the front edge of the CME is expanding in all directions around the Sun like a halo. The images were taken by SOHO's coronagraphs in which a disk (red) blocks the Sun and some of the area around it so we can see faint structures beyond that. Here we superimposed the Sun from NASA's SDO. The movie covers about five hours of activity and can be seen here: www.flickr.com/photos/gsfc/9601034896/ Credit: NASA/Goddard/SOHO NASA image use policy. NASA Goddard Space Flight Center enables NASA’s mission through four scientific endeavors: Earth Science, Heliophysics, Solar System Exploration, and Astrophysics. Goddard plays a leading role in NASA’s accomplishments by contributing compelling scientific knowledge to advance the Agency’s mission. Follow us on Twitter Like us on Facebook Find us on Instagram

Simulation of the 23 July 2012 Extreme Space Weather Event: What if This Extremely Rare CME Was Earth Directed?

NASA Technical Reports Server (NTRS)

Ngwira, Chigomezyo M.; Pulkkinen, Antti; Mays, M. Leila; Kuznetsova, Maria M.; Galvin, A. B.; Simunac, Kristin; Baker, Daniel N.; Li, Xinlin; Zheng, Yihua; Glocer, Alex

2013-01-01

Extreme space weather events are known to cause adverse impacts on critical modern day technological infrastructure such as high-voltage electric power transmission grids. On 23 July 2012, NASA's Solar Terrestrial Relations Observatory-Ahead (STEREO-A) spacecraft observed in situ an extremely fast coronal mass ejection (CME) that traveled 0.96 astronomical units (approx. 1 AU) in about 19 h. Here we use the SpaceWeather Modeling Framework (SWMF) to perform a simulation of this rare CME.We consider STEREO-A in situ observations to represent the upstream L1 solar wind boundary conditions. The goal of this study is to examine what would have happened if this Rare-type CME was Earth-bound. Global SWMF-generated ground geomagnetic field perturbations are used to compute the simulated induced geoelectric field at specific ground-based active INTERMAGNET magnetometer sites. Simulation results show that while modeled global SYM-H index, a high-resolution equivalent of the Dst index, was comparable to previously observed severe geomagnetic storms such as the Halloween 2003 storm, the 23 July CME would have produced some of the largest geomagnetically induced electric fields, making it very geoeffective. These results have important practical applications for risk management of electrical power grids.

Major geomagnetic storm due to solar activity (2006-2013).

NASA Astrophysics Data System (ADS)

Tiwari, Bhupendra Kumar

Major geomagnetic storm due to solar activity (2006-2013). Bhupendra Kumar Tiwari Department of Physics, A.P.S.University, Rewa(M.P.) Email: - btiwtari70@yahoo.com mobile 09424981974 Abstract- The geospace environment is dominated by disturbances created by the sun, it is observed that coronal mass ejection (CME) and solar flare events are the causal link to solar activity that produces geomagnetic storm (GMS).CMEs are large scale magneto-plasma structures that erupt from the sun and propagate through the interplanetary medium with speeds ranging from only a few km/s to as large as 4000 km/s. When the interplanetary magnetic field associated with CMEs impinges upon the earth’s magnetosphere and reconnect occur geomagnetic storm. Based on the observation from SOHO/LASCO spacecraft for solar activity and WDC for geomagnetism Kyoto for geomagnetic storm events are characterized by the disturbance storm time (Dst) index during the period 2006-2013. We consider here only intense geomagnetic storm Dst <-100nT, are 12 during 2006-2013.Geomagnetic storm with maximum Dst< -155nT occurred on Dec15, 2006 associated with halo CME with Kp-index 8+ and also verify that halo CME is the main cause to produce large geomagnetic storms.

CME in primary care: the way forward.

PubMed

Olesen, F; Hjortdahl, P

1999-09-01

The paper aims to describe the context for future continuing medical education (CME) in primary care. CME must develop the doctor's ability to look at diseases from a scientifically-based biomedical, psychological, and social perspective. It is a challenge for CME to bridge the gap between scientific evidence, and doctors' knowledge, attitude, and performance, but awareness on how to do this is scarce. CME must be better integrated with quality development, especially with the use of clinical guidelines. This is impeded by insufficient scientific evidence on the impact, advantages, and disadvantages of different CME methods, and by insufficient outcome measures of the effect of CME. Teaching the teachers should also be improved. It is concluded that the time is ripe for a scientific-based development in the conduction of CME. This may be done by establishing national research centres for CME, working together in an international network.

Angiographic Cystoid Macular Edema and Outcomes in the Comparison of Age-Related Macular Degeneration Treatments Trials.

PubMed

Shah, Neepa; Maguire, Maureen G; Martin, Daniel F; Shaffer, James; Ying, Gui-Shuang; Grunwald, Juan E; Toth, Cynthia A; Jaffe, Glenn J; Daniel, Ebenezer

2016-04-01

To describe morphologic and visual outcomes in eyes with angiographic cystoid macular edema (CME) treated with ranibizumab or bevacizumab for neovascular age-related macular degeneration (nAMD). Prospective cohort study within a randomized clinical trial. A total of 1185 CATT study subjects. Baseline fluorescein angiography (FA) images of all CATT study eyes were evaluated for CME. Grading of other characteristics on optical coherence tomography (OCT) and photographic images at baseline and during 2-year follow-up was completed by readers at the CATT Reading Centers. Three groups were created on the basis of baseline CME and intraretinal fluid (IRF) status: (1) CME, (2) IRF without CME, (3) neither CME nor IRF. Visual acuity (VA) and total central retinal thickness (CRT) on OCT at baseline, year 1, and year 2. Among 1131 participants with images of sufficient quality for determining CME and IRF at baseline, 92 (8.1%) had CME, 766 (67.7%) had IRF without CME, and 273 (24.1%) had neither. At baseline, eyes with CME had worse mean VA (letters) than eyes with IRF without CME and eyes with neither CME nor IRF (52 vs. 60 vs. 66 letters, P < 0.001); higher mean total CRT (μm) on OCT (514 vs. 472 vs. 404, P < 0.001); and greater hemorrhage, retinal angiomatous proliferation (RAP) lesions, and classic choroidal neovascularization (CNV). All groups showed improvement in VA at follow-up; however, the CME group started and ended with the worst VA among the 3 groups. Central retinal thickness, although higher at baseline for the CME group, was similar at 1 and 2 years follow-up for all groups. More eyes with CME (65.3%) developed scarring during 2 years of follow-up compared with eyes with IRF without CME (43.8%) and eyes with neither CME nor IRF (32.5%; P < 0.001). In CATT, eyes with CME had worse baseline and follow-up VA, although all groups showed similar rates of improvement in VA during 2 years of follow-up. Cystoid macular edema seems to be a marker for poorer visual outcomes in nAMD because of underlying baseline retinal dysfunction and subsequent scarring. Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

A Stealth CME Bracketed between Slow and Fast Wind Producing Unexpected Geoeffectiveness

NASA Astrophysics Data System (ADS)

He, Wen; Liu, Ying D.; Hu, Huidong; Wang, Rui; Zhao, Xiaowei

2018-06-01

We investigate how a weak coronal mass ejection (CME) launched on 2016 October 8 without obvious signatures in the low corona produced a relatively intense geomagnetic storm. Remote sensing observations from SDO, STEREO, and SOHO and in situ measurements from Wind are employed to track the CME from the Sun to the Earth. Using a graduated cylindrical shell model, we estimate the propagation direction and the morphology of the CME near the Sun. CME kinematics are determined from the wide-angle imaging observations of STEREO A and are used to predict the CME arrival time and speed at the Earth. We compare ENLIL MHD simulation results with in situ measurements to illustrate the background solar wind where the CME was propagating. We also apply a Grad–Shafranov technique to reconstruct the flux-rope structure from in situ measurements in order to understand the geoeffectiveness associated with the CME magnetic field structure. Key results are obtained concerning how a weak CME can generate a relatively intense geomagnetic storm: (1) there were coronal holes at low latitudes, which could produce high speed streams (HSSs) to interact with the CME in interplanetary space; (2) the CME was bracketed between a slow wind ahead and an HSS behind, which enhanced the southward magnetic field inside the CME and gave rise to the unexpected geomagnetic storm.

Comparing Automatic CME Detections in Multiple LASCO and SECCHI Catalogs

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hess, Phillip; Colaninno, Robin C., E-mail: phillip.hess.ctr@nrl.navy.mil, E-mail: robin.colaninno@nrl.navy.mil

With the creation of numerous automatic detection algorithms, a number of different catalogs of coronal mass ejections (CMEs) spanning the entirety of the Solar and Heliospheric Observatory ( SOHO ) Large Angle Spectrometric Coronagraph (LASCO) mission have been created. Some of these catalogs have been further expanded for use on data from the Solar Terrestrial Earth Observatory ( STEREO ) Sun Earth Connection Coronal and Heliospheric Investigation (SECCHI) as well. We compare the results from different automatic detection catalogs (Solar Eruption Event Detection System (SEEDS), Computer Aided CME Tracking (CACTus), and Coronal Image Processing (CORIMP)) to ensure the consistency ofmore » detections in each. Over the entire span of the LASCO catalogs, the automatic catalogs are well correlated with one another, to a level greater than 0.88. Focusing on just periods of higher activity, these correlations remain above 0.7. We establish the difficulty in comparing detections over the course of LASCO observations due to the change in the instrument image cadence in 2010. Without adjusting catalogs for the cadence, CME detection rates show a large spike in cycle 24, despite a notable drop in other indices of solar activity. The output from SEEDS, using a consistent image cadence, shows that the CME rate has not significantly changed relative to sunspot number in cycle 24. These data, and mass calculations from CORIMP, lead us to conclude that any apparent increase in CME rate is a result of the change in cadence. We study detection characteristics of CMEs, discussing potential physical changes in events between cycles 23 and 24. We establish that, for detected CMEs, physical parameters can also be sensitive to the cadence.« less

Perceptions of continuing medical education, professional development, and organizational support in the United Arab Emirates.

PubMed

Younies, Hassan; Berham, Belal; Smith, Pamela C

2010-01-01

This paper investigates the views of health care providers on continuous medical education (CME). To our knowledge, this is one of the first surveys to examine perspectives of CME in the United Arab Emirates (UAE). A 6-part questionnaire focused on the following areas of CME: the workshop leaders/trainers, the training experience, the relevance of CME information provided in the training session, the training approach, the convenience of CME sessions, and organizational support. Results from 147 respondents indicated moderate satisfaction with these 6 CME areas. Respondents did not indicate satisfaction with organizational support received. Furthermore, participants agreed with the importance of CME to professional development. In our sample of UAE health care workers, they agree on the importance and relevance of CME to the development of their profession, even though the majority of health care workers are expatriates. However, several issues must be addressed, such as organizational, logistical, and financial support to attend CME programs. These issues must be addressed in order to sustain the viability of healthcare workers attending CME.

Statistical Study of Magnetic Nonpotential Measures in Confined and Eruptive Flares

NASA Astrophysics Data System (ADS)

Vasantharaju, N.; Vemareddy, P.; Ravindra, B.; Doddamani, V. H.

2018-06-01

Using Solar Dynamics Observatory/Helioseismic and Magnetic Imager vector magnetic field observations, we studied the relation between the degree of magnetic non-potentiality with the observed flare/coronal mass ejection (CME) in active regions (ARs). From a sample of 77 flare/CME cases, we found in general that the degree of non-potentiality is positively correlated with the flare strength and the associated CME speed. Since the magnetic flux in the flare-ribbon area is more related to the reconnection, we trace the strong gradient polarity inversion line (SGPIL) and Schrijver’s R value manually along the flare-ribbon extent. Manually detected SGPIL length and R values show higher correlation with the flare strength and CME speed than automatically traced values without flare-ribbon information. This highlights the difficulty of predicting the flare strength and CME speed a priori from the pre-flare magnetograms used in flare prediction models. Although the total potential magnetic energy proxies show a weak positive correlation, the decrease in free energy exhibits a higher correlation (0.56) with the flare strength and CME speed. Moreover, eruptive flares have thresholds of SGPIL length (31 Mm), R value (1.6 × 1019 Mx), and free energy decrease (2 × 1031 erg) compared to confined flares. In 90% of eruptive flares, the decay-index curve is steeper, reaching {n}crit}=1.5 within 42 Mm, whereas it is beyond this value in >70% of confined flares. While indicating improved statistics in the predictive capability of AR eruptive behavior with flare-ribbon information, our study provides threshold magnetic properties for a flare to be eruptive.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lugaz, N.; Shibata, K.; Downs, C.

We present a numerical investigation of the coronal evolution of a coronal mass ejection (CME) on 2005 August 22 using a three-dimensional thermodynamic magnetohydrodynamic model, the space weather modeling framework. The source region of the eruption was anemone active region (AR) 10798, which emerged inside a coronal hole. We validate our modeled corona by producing synthetic extreme-ultraviolet (EUV) images, which we compare to EIT images. We initiate the CME with an out-of-equilibrium flux rope with an orientation and chirality chosen in agreement with observations of an H{alpha} filament. During the eruption, one footpoint of the flux rope reconnects with streamermore » magnetic field lines and with open field lines from the adjacent coronal hole. It yields an eruption which has a mix of closed and open twisted field lines due to interchange reconnection and only one footpoint line-tied to the source region. Even with the large-scale reconnection, we find no evidence of strong rotation of the CME as it propagates. We study the CME deflection and find that the effect of the Lorentz force is a deflection of the CME by about 3{sup 0} R{sup -1}{sub sun} toward the east during the first 30 minutes of the propagation. We also produce coronagraphic and EUV images of the CME, which we compare with real images, identifying a dimming region associated with the reconnection process. We discuss the implication of our results for the arrival at Earth of CMEs originating from the limb and for models to explain the presence of open field lines in magnetic clouds.« less

Self-reported financial conflicts of interest during scientific presentations in emergency medicine.

PubMed

Birkhahn, Robert H; Fromm, Christian; Larabee, Todd; Diercks, Deborah B

2011-09-01

This study was a review of the scientific abstracts presented at a national conference for the required conflict of interest (COI) disclosure both before the meeting and during presentation. All presenters were given specific instructions regarding COI reporting at the time of abstract acceptance. All poster presentations were required to have a COI statement. Three physicians using standardized data abstraction forms reviewed abstracts accepted for poster presentation at the 2010 annual meeting of the Society for Academic Emergency Medicine (SAEM). Posters were reviewed for the presence of a required COI disclosure statement, and these results were compared to the mandatory continuing medical education (CME) disclosure form that was sent by the presenters to the SAEM central office before the meeting. There were 412 posters accepted for presentation at the 2010 SAEM annual meeting. The reviewers observed 382 (93%) of the total posters for the conference. Sixty-nine abstracts (18%) reported a COI. Only 26 (38%) of these were actually reported to the SAEM office on the CME disclosure form before the meeting; the remaining 62% were found on the poster alone. COI that were reported on the CME disclosure form were found on the poster 46% of the time. The remaining posters without a COI actually displayed the mandatory disclosure statement only 14% of the time. This review of presentations at a national meeting found a lack of compliance with printed guidelines for COI disclosure during scientific presentation. Efforts to increase uniformity and clarity may result in increased compliance. © 2011 by the Society for Academic Emergency Medicine.

Deriving and Constraining 3D CME Kinematic Parameters from Multi-Viewpoint Coronagraph Images

NASA Astrophysics Data System (ADS)

Thompson, B. J.; Mei, H. F.; Barnes, D.; Colaninno, R. C.; Kwon, R.; Mays, M. L.; Mierla, M.; Moestl, C.; Richardson, I. G.; Verbeke, C.

2017-12-01

Determining the 3D properties of a coronal mass ejection using multi-viewpoint coronagraph observations can be a tremendously complicated process. There are many factors that inhibit the ability to unambiguously identify the speed, direction and shape of a CME. These factors include the need to separate the "true" CME mass from shock-associated brightenings, distinguish between non-radial or deflected trajectories, and identify asymmetric CME structures. Additionally, different measurement methods can produce different results, sometimes with great variations. Part of the reason for the wide range of values that can be reported for a single CME is due to the difficulty in determining the CME's longitude since uncertainty in the angle of the CME relative to the observing image planes results in errors in the speed and topology of the CME. Often the errors quoted in an individual study are remarkably small when compared to the range of values that are reported by different authors for the same CME. For example, two authors may report speeds of 700 +- 50 km/sec and 500+-50 km/sec for the same CME. Clearly a better understanding of the accuracy of CME measurements, and an improved assessment of the limitations of the different methods, would be of benefit. We report on a survey of CME measurements, wherein we compare the values reported by different authors and catalogs. The survey will allow us to establish typical errors for the parameters that are commonly used as inputs for CME propagation models such as ENLIL and EUHFORIA. One way modelers handle inaccuracies in CME parameters is to use an ensemble of CMEs, sampled across ranges of latitude, longitude, speed and width. The CMEs simulated in order to determine the probability of a "direct hit" and, for the cases with a "hit," derive a range of possible arrival times. Our study will provide improved guidelines for generating CME ensembles that more accurately sample across the range of plausible values.

The Central Role of Tether-Cutting Reconnection in the Production of CMEs

NASA Technical Reports Server (NTRS)

Moore, Ron; Sterling, Alphonse; Suess, Steve

2007-01-01

This viewgraph presentation describes tether-cutting reconnection in the production of Coronal Mass Ejections (CMEs). The topics include: 1) Birth and Release of the CME Plasmoid; 2) Resulting CME in Outer Corona; 3) Governing Role of Surrounding Field; 4) Testable Prediction of the Standard Scenario Magnetic Bubble CME Model; 5) Lateral Pressure in Outer Corona; 6) Measured Angular Widths of 3 CMEs; 7) LASCO Image of each CME at Final Width; 8) Source of the CME of 2002 May 20; 9) Source of the CME of 1999 Feb 9; 10) Source of the CME of 2003 Nov 4; and 11) Test Results.

Coronal mass ejection (CME) activity of low mass M stars as an important factor for the habitability of terrestrial exoplanets. I. CME impact on expected magnetospheres of Earth-like exoplanets in close-in habitable zones.

PubMed

Khodachenko, Maxim L; Ribas, Ignasi; Lammer, Helmut; Griessmeier, Jean-Mathias; Leitner, Martin; Selsis, Franck; Eiroa, Carlos; Hanslmeier, Arnold; Biernat, Helfried K; Farrugia, Charles J; Rucker, Helmut O

2007-02-01

Low mass M- and K-type stars are much more numerous in the solar neighborhood than solar-like G-type stars. Therefore, some of them may appear as interesting candidates for the target star lists of terrestrial exoplanet (i.e., planets with mass, radius, and internal parameters identical to Earth) search programs like Darwin (ESA) or the Terrestrial Planet Finder Coronagraph/Inferometer (NASA). The higher level of stellar activity of low mass M stars, as compared to solar-like G stars, as well as the closer orbital distances of their habitable zones (HZs), means that terrestrial-type exoplanets within HZs of these stars are more influenced by stellar activity than one would expect for a planet in an HZ of a solar-like star. Here we examine the influences of stellar coronal mass ejection (CME) activity on planetary environments and the role CMEs may play in the definition of habitability criterion for the terrestrial type exoplanets near M stars. We pay attention to the fact that exoplanets within HZs that are in close proximity to low mass M stars may become tidally locked, which, in turn, can result in relatively weak intrinsic planetary magnetic moments. Taking into account existing observational data and models that involve the Sun and related hypothetical parameters of extrasolar CMEs (density, velocity, size, and occurrence rate), we show that Earth-like exoplanets within close-in HZs should experience a continuous CME exposure over long periods of time. This fact, together with small magnetic moments of tidally locked exoplanets, may result in little or no magnetospheric protection of planetary atmospheres from a dense flow of CME plasma. Magnetospheric standoff distances of weakly magnetized Earth-like exoplanets at orbital distances

Emerging science and therapies in non-small-cell lung cancer: targeting the MET pathway.

PubMed

Kris, Mark G; Arenberg, Douglas A; Herbst, Roy S; Riely, Gregory J

2014-11-01

During this enduring, learner-driven, interactive CME webseries, lung cancer specialists will address the science and targeted therapies for the MET pathway in non-small cell lung cancer. Over the past decade, research has evolved in the science of identifying targeted biological changes in DNA and individual cancer cells. Along with the advanced understanding of lung cancer mutations, has come the development of specific targeted therapies that improve patient outcomes. The first step in treating a patient with lung cancer is proper diagnosis and staging, applying to the principles of personalize medicine. Our current understanding of lung cancer is that of a collection of diseases individualized through specific mutations. This CME activity reviews the role of the pulmonologist and pathologist in proper tissue acquisition and analysis. This new era of personalized medicine and clinical research advances has changed the way clinicians evaluate and treat patients with lung cancer. The data on lung cancer cell mutations and newer targeted therapies have improved the progression free survival and quality of life of lung cancer patients. This CME activity is designed to present a practical overview of recent evidenced based data of MET targeted therapies for patients with lung cancer. As research continues to evolve, we continue to advance our understanding in the science of lung cancers involving the MET pathway. Evidenced based data supporting newer targeted therapeutics provides insight on applying treatment for optimal outcomes. This CME activity will focus on the individualized treatment strategies using practical decision making for patients with MET expression. This activity has been designed to meet the educational needs of medical oncologists, pathologists, radiation oncologists, surgeons, pulmonologists, internists, and other healthcare clinicians responsible for the care of patients with lung cancer. Online access:http://www.elseviercme.com/516/.

Difficult physician-patient relationships.

PubMed

Reifsteck, S W

1998-01-01

Changes in the delivery of health care services in the United States are proceeding so rapidly that many providers are asking how the working relationships between doctors and patients will be effected. Accelerated by cost containment, quality improvement and the growth of managed care, these changes have caused some critics to feel that shorter visits and gatekeeper systems will promote an adversarial relationship between physicians and patients. However, proponents of the changing system feel that better prevention, follow-up care and the attention to customer service these plans can offer will lead to increased patient satisfaction and improved doctor-patient communication. Dedicated to addressing these concerns, the Bayer Institute for Health Care Communication was established in 1987 as a continuing medical education program (CME) focusing on this topic. A half-day workshop on clinician-patient communication to enhance health outcomes was introduced in 1992 and a second workshop, "Difficult' Clinician-Patient Relationships," was developed two years later. The two courses discussed in this article are offered to all physicians, residents, medical students, mid-level providers and other interested staff within the Carle system.

Epigallocatechin gallate as a modulator of Campylobacter resistance to macrolide antibiotics.

PubMed

Kurinčič, Marija; Klančnik, Anja; Smole Možina, Sonja

2012-11-01

Comprehensive therapeutic use of macrolides in humans and animals is important in the selection of macrolide-resistant Campylobacter isolates. This study shows high co-resistance to erythromycin, azithromycin, clarithromycin, dirithromycin and tylosin, with contributions from the 23S rRNA gene and drug efflux systems. The CmeABC efflux pump plays an important role in reduced macrolide susceptibility, accompanied by contributions from the CmeDEF efflux pump and potentially a third efflux pump. To improve clinical performance of licensed antibiotics and chemotherapeutic agents, it is important to understand the factors in Campylobacter that affect susceptibility to macrolide antibiotics. Using mutants that lack the functional genes coding for the CmeB and CmeF efflux pump proteins and the CmeR transcriptional repressor, we show that these efflux pumps are potential targets for the development of therapeutic strategies that use a combination of a macrolide with an efflux pump inhibitor (EPI) to restore macrolide efficacy. The natural phenolic compound epigallocatechin gallate (EGCG) has good modulatory activity over the extrusion across the outer membrane of the macrolides tested, both in sensitive and resistant Campylobacter isolates. Comparing EGCG with known chemical EPIs, correlations in the effects on the particular macrolide antibiotics were seen. EGCG modifies Campylobacter multidrug efflux systems and thus could have an impact on restoring macrolide efficacy in resistant strains. Copyright © 2012 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

Correlated Flare and CME Energies for the October/November 2003 Events

NASA Technical Reports Server (NTRS)

Dennis, Brian R.; Haga, Leah; Medlin, Drew; Tolbert, A. Kimberly

2006-01-01

We find a strong correlation between the kinetic energies (KEs) of the coronal mass ejections (CMEs) and the radiated energies of the associated solar flares for the events that occurred during the period of intense solar activity between 18 October and 08 November 2003. CME start times, speeds, mass, and KEs were taken from Gopalswamy et al. (2005), who used SOHO/LASCO observations. The GOES observations of the associated flares were analyzed to find the peak SXR flux, the radiated energy in SXRs (L(sub sxr)), and the radiated energy from the SXR emitting plasma across all wavelengths (L(sub hot)). RHESSI observations were also used to find the energy in non-thermal electrons, ions, and the plasma thermal energy for some events. For two events, SORCE/TIM observations of the total solar irradiance during a flare were also available to give the total radiated flare energy (L(sub total)). We find that the total flare energies of the larger events are of the same order of magnitude as the CME KE with a stronger correlation than has been found in the past for other time intervals. The following rule-of-thumb (good to an order of magnitude for the larger events} can be used to relate flare and CME energies: CME KE l(sub total) 10 L(sub hot) 100 L(sub SXR).

Staying Active: Physical Activity and Exercise

MedlinePlus

... Bulletins Patient Education Green Journal Clinical Updates Practice Management Coding Health Info Technology Professional Liability Managing Your Practice Patient Safety & Quality Payment Reform (MACRA) Education & Events Annual Meeting CME ...

Solar flares associated coronal mass ejection accompanied with DH type II radio burst in relation with interplanetary magnetic field, geomagnetic storms and cosmic ray intensity

NASA Astrophysics Data System (ADS)

Chandra, Harish; Bhatt, Beena

2018-04-01

In this paper, we have selected 114 flare-CME events accompanied with Deca-hectometric (DH) type II radio burst chosen from 1996 to 2008 (i.e., solar cycle 23). Statistical analyses are performed to examine the relationship of flare-CME events accompanied with DH type II radio burst with Interplanetary Magnetic field (IMF), Geomagnetic storms (GSs) and Cosmic Ray Intensity (CRI). The collected sample events are divided into two groups. In the first group, we considered 43 events which lie under the CME span and the second group consists of 71 events which are outside the CME span. Our analysis indicates that flare-CME accompanied with DH type II radio burst is inconsistent with CSHKP flare-CME model. We apply the Chree analysis by the superposed epoch method to both set of data to find the geo-effectiveness. We observed different fluctuations in IMF for arising and decay phase of solar cycle in both the cases. Maximum decrease in Dst during arising and decay phase of solar cycle is different for both the cases. It is noted that when flare lie outside the CME span CRI shows comparatively more variation than the flare lie under the CME span. Furthermore, we found that flare lying under the CME span is more geo effective than the flare outside of CME span. We noticed that the time leg between IMF Peak value and GSs, IMF and CRI is on average one day for both the cases. Also, the time leg between CRI and GSs is on average 0 to 1 day for both the cases. In case flare lie under the CME span we observed high correlation (0.64) between CRI and Dst whereas when flare lie outside the CME span a weak correlation (0.47) exists. Thus, flare position with respect to CME span play a key role for geo-effectiveness of CME.

Influence of obesity assessments on cardiometabolic risks in African and European American women.

PubMed

Brandon, L Jerome; Proctor, Larry; Cole, Calvin L

2014-01-01

African American women (AAW) have increased odds of developing cardiometabolic (CME) risks and cardiovascular diseases (CVD) compared with European American women (EAW). The influence of obesity on other CME risks and the CVD disparity is unclear. The purpose of our study was to develop a CME index and evaluate the obesity and CME risk index relationships based on race. A comparative research design was employed in our study as 213 women (132 AAW; 81 EAW) from the Louisiana Delta were evaluated for CME risk clustering patterns by race, based on BMI, dual energy X-ray absorptiometry % body fat and waist conference. Fasting glucose, triglyceride (TC), high density lipoprotein cholesterol (HDL-C), systolic (SBP) and diastolic blood pressure (DBP) were the measured CME risks. In summary, when the CME indexes were evaluated by obesity classification categories the ones that were CVD risk or near risk for the AAW were SBP and TG. The trend of CME index risk for the EAW was SBP and glucose. The stepwise regression equations indicate that HDL-C and SBP/DBP were the best indicators of the effects of obesity on CME risks in AAW and that SBP/DBP and glucose were the best indicators of CME risks in EAW. Our results indicate that CME risks as evaluated based on obesity categories are different for AAW than for EAW.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liu, Ying D.; Luhmann, Janet G.; Moestl, Christian

We investigate how coronal mass ejections (CMEs) propagate through, and interact with, the inner heliosphere between the Sun and Earth, a key question in CME research and space weather forecasting. CME Sun-to-Earth kinematics are constrained by combining wide-angle heliospheric imaging observations, interplanetary radio type II bursts, and in situ measurements from multiple vantage points. We select three events for this study, the 2012 January 19, 23, and March 7 CMEs. Different from previous event studies, this work attempts to create a general picture for CME Sun-to-Earth propagation and compare different techniques for determining CME interplanetary kinematics. Key results are obtainedmore » concerning CME Sun-to-Earth propagation: (1) the Sun-to-Earth propagation of fast CMEs can be approximately formulated into three phases: an impulsive acceleration, then a rapid deceleration, and finally a nearly constant speed propagation (or gradual deceleration); (2) the CMEs studied here are still accelerating even after the flare maximum, so energy must be continuously fed into the CME even after the time of the maximum heating and radiation has elapsed in the corona; (3) the rapid deceleration, presumably due to interactions with the ambient medium, mainly occurs over a relatively short timescale following the acceleration phase; and (4) CME-CME interactions seem a common phenomenon close to solar maximum. Our comparison between different techniques (and data sets) has important implications for CME observations and their interpretations: (1) for the current cases, triangulation assuming a compact CME geometry is more reliable than triangulation assuming a spherical front attached to the Sun for distances below 50-70 solar radii from the Sun, but beyond about 100 solar radii we would trust the latter more; (2) a proper treatment of CME geometry must be performed in determining CME Sun-to-Earth kinematics, especially when the CME propagation direction is far away from the observer; and (3) our approach to comparing wide-angle heliospheric imaging observations with interplanetary radio type II bursts provides a novel tool in investigating CME propagation characteristics. Future CME observations and space weather forecasting are discussed based on these results.« less

Phytochemical screening and antibacterial activity of Cyclamen persicum Mill tuber extracts.

PubMed

Alkowni, Raed; Jodeh, Shehdeh; Hussein, Fatima; Jaradat, Nidal

2018-01-01

The emerging drug resistance bacteria increased the demand on the discovery of antibiotics from natural sources. This research was aimed to study the antibacterial reactivity; as well as the phytochemicals, of the wild type of Cyclamen persicum, using nine different extraction methods where four solvents (Methanol, Ethanol, Hexane; and Water) were involved with varied extraction periods ranged from 2 up to 10 hours. The antibacterial activity of crude methanol extract (CME) was found as the best method of extraction, with particular emphasis on the method with prolonged extraction time of (10 hrs). The antibacterial activities of produced CME were determined by using agar diffusion method against two of gram-positive bacteria and two gram-negative ones. The CME treated Mueller-Hinton-Agar plates, were exhibited antibacterial effects against the gram-positive bacteria (Staphylococcus aureus and Bacillus subtilis) by showing of inhibition zone after overnight incubation, while nothing was noticed on those of gram negative ones (Pseudomonas aeruginosa and Escherichia coli). These results that proved the antibacterial activity of the Cyclamen persicum tubers were positively tested the Saponin glycosides from plant. In addition to that, methanol solvent could be the useful method for extractions of Cyclamen and can be used in any developing drugs against pathogenic gram positive bacteria.

Decameter Type IV Burst Associated with a Behind-the-limb CME Observed on 7 November 2013

NASA Astrophysics Data System (ADS)

Melnik, V. N.; Brazhenko, A. I.; Konovalenko, A. A.; Dorovskyy, V. V.; Rucker, H. O.; Panchenko, M.; Frantsuzenko, A. V.; Shevchuk, M. V.

2018-03-01

We report on the results of observations of a type IV burst made by the Ukrainian Radio interferometer of the Academy of Sciences (URAN-2) in the frequency range 22 - 33 MHz. The burst is associated with a coronal mass ejection (CME) initiated by a behind-the-limb active region (N05E151) and was also observed by the Nançay Decameter Array (NDA) radio telescope in the frequency band 30 - 60 MHz. The purpose of the article is the determination of the source of this type IV burst. After analysis of the observational data obtained with the URAN-2, the NDA, the Solar-Terrestrial Relations Observatory (STEREO) A and B spacecraft, and the Solar and Heliospheric Observatory (SOHO) spacecraft, we come to the conclusion that the source of the burst is the core of a behind-the-limb CME. We conclude that the radio emission can escape the center of the CME core at a frequency of 60 MHz and originates from the periphery of the core at a frequency of 30 MHz that is due to occultation by the solar corona at the corresponding frequencies. We find plasma densities in these regions assuming the plasma mechanism of radio emission. We show that the frequency drift of the start of the type IV burst is governed by an expansion of the CME core. The type III bursts that were observed against this type IV burst are shown to be generated by fast electrons propagating through the CME core plasma. A type II burst was registered at frequencies of 44 - 64 MHz and 3 - 16 MHz and was radiated by a shock with velocities of about 1000 km s^{-1} and 800 km s^{-1}, respectively.

Ocular Behçet disease: current therapeutic approaches.

PubMed

Evereklioglu, Cem

2011-11-01

To alert physician to timely recognition and current treatment of recurrent hypopyon iridocyclitis or panuveitis in ocular Behçet disease (OBD). Interferon-α, rituximab, intravitreal triamcinolone, and biological response modifiers by tumor necrosis factor inhibitors such as infliximab and adalimumab are being used increasingly for the treatment of severe sight-threatening ocular inflammation including retinal vasculitis and cystoid macular edema (CME). Biological agents offer tremendous potential in the treatment of OBD. Given that OBD predominantly afflicts the younger adults in their most productive years, dermatologist, rheumatologist, internist, or general practitioners supervising patients with oculo-articulo-oromucocutaneous syndromes should be aware of systemic Behçet disease. Early recognition of ocular involvement is important and such patients should strongly be instructed to visit immediately an ophthalmologist, as uveitis management differs from extraocular involvements with high ocular morbidity from sight-threatening complications due to relapsing inflammatory attacks in the posterior segment of the eye. A single infliximab infusion should be considered for the control of acute panuveitis, whereas repeated long-term infliximab infusions were proved to be more effective in reducing the number of episodes in refractory uveoretinitis with faster regression and complete remission of CME.

[Internet-based continuing medical education: as effective as live continuing medical education].

PubMed

Maisonneuve, Hervé; Chabot, Olivier

2009-10-01

E-learning consists in using new multimedia and Internet technologies to improve the quality of learning activities by facilitating access to resources and services, as well as exchanges and remote collaboration. The Internet is used for adult education in most professional domains, but its use for continuing medical education is less developed. Advantages are observed for teachers (e.g., permanent updating, interactive links, illustrations, archiving, and collective intelligence) and for the learners (e.g., accessibility, autonomy, flexibility, and adaptable pace). Research and meta-analyses have shown that e-CME is as effective as live events for immediate and retained learning. English-language educational medical websites that grant CME credits are numerous; few such French-language sites can currently grant credits. Accreditation of websites for CME, in its infancy in Europe, is common in North America.

Misprescribing controlled substances: An evaluation of a professional development program.

PubMed

Dewey, Charlene M; Ghulyan, Marine V; Swiggart, William H

2016-01-01

Controlled prescription drug (CPD) abuse has reached epidemic proportions in the United States. Most physicians attending a 3-day continuing medical education (CME) professional development program (PDP) lack training in identifying risk and in managing patients who misuse CPDs. To address this issue, the authors conducted an evaluation of a PDP that trains physicians on proper prescribing, identifying substance abuse, utilizing screening, brief intervention, and referral to treatment (SBIRT), and implementing motivational interviewing (MI). The authors conducted a program evaluation to assess the efficacy and impact of the PDP on physicians' knowledge and prescribing behaviors. Participants (N = 174) were typically middle-aged (average age of 53 years), male (89%), and physicians (82%) and other health care professionals (18%). Many physicians practice in solo primary care settings (46%). Course evaluations were completed by n = 155 (89%) participants who rated the course and presenters highly (mean 4.8/5 respectively). Physicians' knowledge scores on pre/post assessments increased significantly: pretest (M = 58.7, SD = 13.12) and posttest (M = 78.28, SD = 9.83) (t(173) = 20.06, P ≤ .0001, 95% confidence interval, CI: [-21.51, -17.65]). Almost half of the participants, n = 83/174 (48%), completed the follow-up survey, and 93% agreed/strongly agreed (A/SA) they made professional practice changes. Of participants practicing with an active DEA (Drug Enforcement Administration) registration (n = 57), most agreed/strongly agreed they implemented changes to align their practices with current guidelines (89%), used CPD more appropriately (87%), implemented office policies on prescribing (81%), identified and referred more substance abuse patients to treatment (80%), shared new information/experience from course with other 25 health professionals (93%), and felt the course positively impacted their behaviors personally and professionally (90% and 96%, respectively). This is the first known study evaluating a PDP in this population. Results demonstrated participant satisfaction and improvement in prescribers' knowledge and self-reported prescribing behaviors. However, further study is needed to assess actual clinical practice changes, direct impact on patient outcomes, and rates of recidivism.

Interactions of Dust Grains with Coronal Mass Ejections and Solar Cycle Variations of the F-Coronal Brightness

NASA Technical Reports Server (NTRS)

Ragot, B. R.; Kahler, S. W.

2003-01-01

The density of interplanetary dust increases sunward to reach its maximum in the F corona, where its scattered white-light emission dominates that of the electron K corona above about 3 Solar Radius. The dust will interact with both the particles and fields of antisunward propagating coronal mass ejections (CMEs). To understand the effects of the CME/dust interactions we consider the dominant forces, with and without CMEs. acting on the dust in the 3-5 Solar Radius region. Dust grain orbits are then computed to compare the drift rates from 5 to 3 Solar Radius. for periods of minimum and maximum solar activity, where a simple CME model is adopted to distinguish between the two periods. The ion-drag force, even in the quiet solar wind, reduces the drift time by a significant factor from its value estimated with the Poynting-Robertson drag force alone. The ion-drag effects of CMEs result in even shorter drift times of the large (greater than or approx. 3 microns) dust grains. hence faster depletion rates and lower dust-pain densities, at solar maxima. If dominated by thermal emission, the near-infrared brightness will thus display solar cycle variations close to the dust plane of symmetry. While trapping the smallest of the grains, the CME magnetic fields also scatter the grains of intermediate size (0.1-3 microns) in latitude. If light scattering by small grains close to the Sun dominates the optical brightness. the scattering by the CME magnetic fields will result in a solar cycle variation of the optical brightness distribution not exceeding 100% at high latitudes, with a higher isotropy reached at solar maxima. A good degree of latitudinal isotropy is already reached at low solar activity since the magnetic fields of the quiet solar wind so close to the Sun are able to scatter the small (less than or approx. 3 microns) grains up to the polar regions in only a few days or less, producing strong perturbations of their trajectories in less than half their orbital periods. Finally, we consider possible observable consequences of individual CME/dust interactions. We show that the dust grains very likely have no observable effect on the dynamics of CMEs. The effect of an individual CME on the dust grains, however, might serve as a forecasting tool for the directions and amplitudes of the magnetic fields within the CME.

[Studies on clinical pathophysiology of pseudophakic/aphakic eyes--a journey of 4 decades].

PubMed

Miyake, Kensaku

2008-03-01

My prime years as an ophthalmologist began as intraocular lenses (IOLs) were just entering into the developmental stage, and I took on as my mission to contribute to perfecting safe and reproducible cataract/IOL implantation surgery. Identifying surgical and/or IOL-related complications consumed time; however, these complications soon became predictable and even preventable with the use of sensitive biological parameters and preclinical evaluation. This was a simple goal for me to pursue my studies on cataract/IOL implantation surgery. I discuss in this review article, based on my previous research, clinico-pathophysiological problems of these intra- and postoperative eyes. The early phase of cataract/IOL implantation surgery development began with a debate as to which is physiologically superior: intracapsular cataract extraction (ICCE) or extracapsular cataract extraction (ECCE). From the perspective of transporting substances from intraocular fluids to extraocular space, which we studied using a nonphysiological substance, fluorescein, ECCE was confirmed to be physiologically superior to ICCE. The transport mechanism of both physiological and nonphysiological substances from intraocular fluids (such as vitreous and aqueous humor) is believed to be related to the pathogenesis of various ocular disorders. Following the fluorescein study, I next focused my attention on biosynthesis and active transport of prostaglandin (PG), which are inflammatory mediators. My studies revealed that PG were more likely to accumulate in ICCE eyes than in ECCE eyes; higher intraocular concentration of PG was also confirmed in eyes with persistent aphakic or pseudophakic cystoid macular edema (CME). While conducting the above studies and having made some observations, I postulated another hypothesis on the pathogenesis of aphakic or pseudophakic CME as follows: topical application of nonsteroidal antiinflammatory drugs (NSAIDs) to eyes with PG, which are biosynthesized intra- and postoperatively during the healing process of uveal tissues and lens epithelial cells, prevents CME. Based on this hypothesis experimental studies were then started, and in 1977 I became the first in the world to prove that topical application of indomethacin, one of the NSAIDs, controls the incidence of CME in ICCE eyes. Thereafter, some 40 follow-up studies have been conducted worldwide, and recent meta-analysis has established the efficacy of indomethacin. Macular edema and CME are recently of significant interest as complications in various ocular disorders. Compared to other forms of CME, the pathophysiology of CME associated with aphakic/ pseudophakic eyes is relatively simple, its natural history is well understood and its reproducibility is high. It is possible that the other forms of macular edema or CME having more complicated pathogenesis may be interpreted by understanding the formation mechanism of aphakia/pseudophakic CME. Our studies have shown how chemical mediators (PG) are systematically involved in the development of aphakic/pseudophakic CME, and that they concurrently cause blood-aqueous barrier disruption and CME, decrease oscillatory potential of the full field ERG, and decrease choroidal blood flow at an early postoperative period, and this has recently been proven. All these phenomena, however, can be effectively prevented by topical application of NSAIDs. I believe these findings provide significant information when considering the pathogenesis and treatment of CME associated with other ocular disorders. Using the primitive method of an early phase, I discovered that anti-PG eye drops can treat disrupted blood-aqueous barrier, and confirmed that the blood-aqueous barrier function is indeed a very sensitive function. I next applied fluorophotometry and laser flaremetry. Using blood-aqueous barrier function as a parameter, the following were evaluated: consensual reaction of blood-aqueous barrier disruption, method of IOL fixation, racial differences in disruption of the aqueous barrier function, drugs used perioperatively, biocompatibility of IOL materials, and effects of preservative agents. Research on preservative agents disclosed that the preservative agent in anti-glaucoma drops more strong by induced pseudophakic CME than the anti-glaucoma agent itself. Thus, this introduced a new concept called Our desire to closely observe the endosurface of the iris, ciliary processes and anterior vitreous face, all of which are closely related to phacoemulsification techniques, posterior chamber lens fixation, and active transport of PG, led me to the development of "Posterior video technique" (Miyake-Apple View). The technique since then has been used to evaluate cataract surgical techniques, to analyze complications, to review IOL designs and fixation techniques, to pre-clinically evaluate surgical devices, and to study variations of local anatomy related to cataract/IOL surgery. The method is also useful as an educational as well as a presentational tool, and it has now been accepted world-wide. The pathogenesis of aphakic/pseudophakic CME, physiological evaluation centering on blood-aqueous barrier function, and preclinical evaluation using the Posterior video technique have all played a significant role in establishing today's safe cataract/IOL implantation surgery.

Stationarity and periodicities of linear speed of coronal mass ejection: a statistical signal processing approach

NASA Astrophysics Data System (ADS)

Chattopadhyay, Anirban; Khondekar, Mofazzal Hossain; Bhattacharjee, Anup Kumar

2017-09-01

In this paper initiative has been taken to search the periodicities of linear speed of Coronal Mass Ejection in solar cycle 23. Double exponential smoothing and Discrete Wavelet Transform are being used for detrending and filtering of the CME linear speed time series. To choose the appropriate statistical methodology for the said purpose, Smoothed Pseudo Wigner-Ville distribution (SPWVD) has been used beforehand to confirm the non-stationarity of the time series. The Time-Frequency representation tool like Hilbert Huang Transform and Empirical Mode decomposition has been implemented to unearth the underneath periodicities in the non-stationary time series of the linear speed of CME. Of all the periodicities having more than 95% Confidence Level, the relevant periodicities have been segregated out using Integral peak detection algorithm. The periodicities observed are of low scale ranging from 2-159 days with some relevant periods like 4 days, 10 days, 11 days, 12 days, 13.7 days, 14.5 and 21.6 days. These short range periodicities indicate the probable origin of the CME is the active longitude and the magnetic flux network of the sun. The results also insinuate about the probable mutual influence and causality with other solar activities (like solar radio emission, Ap index, solar wind speed, etc.) owing to the similitude between their periods and CME linear speed periods. The periodicities of 4 days and 10 days indicate the possible existence of the Rossby-type waves or planetary waves in Sun.

WAITING TIMES OF QUASI-HOMOLOGOUS CORONAL MASS EJECTIONS FROM SUPER ACTIVE REGIONS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang Yuming; Liu Lijuan; Shen Chenglong

Why and how do some active regions (ARs) frequently produce coronal mass ejections (CMEs)? These are key questions for deepening our understanding of the mechanisms and processes of energy accumulation and sudden release in ARs and for improving our space weather prediction capability. Although some case studies have been performed, these questions are still far from fully answered. These issues are now being addressed statistically through an investigation of the waiting times of quasi-homologous CMEs from super ARs in solar cycle 23. It is found that the waiting times of quasi-homologous CMEs have a two-component distribution with a separation atmore » about 18 hr. The first component is a Gaussian-like distribution with a peak at about 7 hr, which indicates a tight physical connection between these quasi-homologous CMEs. The likelihood of two or more occurrences of CMEs faster than 1200 km s{sup -1} from the same AR within 18 hr is about 20%. Furthermore, the correlation analysis among CME waiting times, CME speeds, and CME occurrence rates reveals that these quantities are independent of each other, suggesting that the perturbation by preceding CMEs rather than free energy input is the direct cause of quasi-homologous CMEs. The peak waiting time of 7 hr probably characterizes the timescale of the growth of the instabilities triggered by preceding CMEs. This study uncovers some clues from a statistical perspective for us to understand quasi-homologous CMEs as well as CME-rich ARs.« less

CAT-PUMA: CME Arrival Time Prediction Using Machine learning Algorithms

NASA Astrophysics Data System (ADS)

Liu, Jiajia; Ye, Yudong; Shen, Chenglong; Wang, Yuming; Erdélyi, Robert

2018-04-01

CAT-PUMA (CME Arrival Time Prediction Using Machine learning Algorithms) quickly and accurately predicts the arrival of Coronal Mass Ejections (CMEs) of CME arrival time. The software was trained via detailed analysis of CME features and solar wind parameters using 182 previously observed geo-effective partial-/full-halo CMEs and uses algorithms of the Support Vector Machine (SVM) to make its predictions, which can be made within minutes of providing the necessary input parameters of a CME.

Relations between professional medical associations and healthcare industry, concerning scientific communication and continuing medical education: a policy statement from the European Society of Cardiology.

PubMed

2012-01-01

Physicians have an ethical duty to keep up-to-date with current knowledge. Professional medical associations such as the European Society of Cardiology (ESC) support these obligations. In Europe, the costs of continuing medical education (CME) are insufficiently supported from governments and employers; however, medical associations have been criticized for accepting alternative financial support from industry. Medical education and training in research include learning how to assess the quality and reliability of any information. There is some risk of bias in any form of scientific communication including intellectual, professional, and financial and it is essential that in particular, the latter must be acknowledged by full disclosure. It is essential that there is strong collaboration between basic and clinical researchers from academic institutions on the one hand, with engineers and scientists from the research divisions of device and pharmaceutical companies on the other. This is vital so that new diagnostic methods and treatments are developed. Promotion of advances by industry may accelerate their implementation into clinical practice. Universities now frequently exhort their academic staff to protect their intellectual property or commercialize their research. Thus, it is not commercial activity or links per se that have become the target for criticism but the perceived influence of commercial enterprises on clinical decision-making or on messages conveyed by professional medical organizations. This document offers the perspective of the ESC on the current debate, and it recommends how to minimize bias in scientific communications and CME and how to ensure proper ethical standards and transparency in relations between the medical profession and industry. Copyright © 2012. Published by Elsevier España.

Relations between professional medical associations and the health-care industry, concerning scientific communication and continuing medical education: a policy statement from the European Society of Cardiology.

PubMed

2012-06-01

Physicians have an ethical duty to keep up-to-date with current knowledge. Professional medical associations such as the European Society of Cardiology (ESC) support these obligations. In Europe, the costs of continuing medical education (CME) are insufficiently supported from governments and employers; however, medical associations have been criticized for accepting alternative financial support from industry. Medical education and training in research include learning how to assess the quality and reliability of any information. There is some risk of bias in any form of scientific communication including intellectual, professional, and financial and it is essential that in particular, the latter must be acknowledged by full disclosure. It is essential that there is strong collaboration between basic and clinical researchers from academic institutions on the one hand, with engineers and scientists from the research divisions of device and pharmaceutical companies on the other. This is vital so that new diagnostic methods and treatments are developed. Promotion of advances by industry may accelerate their implementation into clinical practice. Universities now frequently exhort their academic staff to protect their intellectual property or commercialize their research. Thus, it is not commercial activity or links per se that have become the target for criticism but the perceived influence of commercial enterprises on clinical decision-making or on messages conveyed by professional medical organizations. This document offers the perspective of the ESC on the current debate, and it recommends how to minimize bias in scientific communications and CME and how to ensure proper ethical standards and transparency in relations between the medical profession and industry.

Relations between professional medical associations and the health-care industry, concerning scientific communication and continuing medical education: a Policy Statement from the European Society of Cardiology.

PubMed

2012-03-01

Physicians have an ethical duty to keep up-to-date with current knowledge. Professional medical associations such as the European Society of Cardiology (ESC) support these obligations. In Europe, the costs of continuing medical education (CME) are insufficiently supported from governments and employers; however, medical associations have been criticized for accepting alternative financial support from industry. Medical education and training in research include learning how to assess the quality and reliability of any information. There is some risk of bias in any form of scientific communication including intellectual, professional, and financial and it is essential that in particular, the latter must be acknowledged by full disclosure. It is essential that there is strong collaboration between basic and clinical researchers from academic institutions on the one hand, with engineers and scientists from the research divisions of device and pharmaceutical companies on the other. This is vital so that new diagnostic methods and treatments are developed. Promotion of advances by industry may accelerate their implementation into clinical practice. Universities now frequently exhort their academic staff to protect their intellectual property or commercialize their research. Thus, it is not commercial activity or links per se that have become the target for criticism but the perceived influence of commercial enterprises on clinical decision-making or on messages conveyed by professional medical organizations. This document offers the perspective of the ESC on the current debate, and it recommends how to minimize bias in scientific communications and CME and how to ensure proper ethical standards and transparency in relations between the medical profession and industry.

Academia-industry collaboration in continuing medical education: description of two approaches.

PubMed

Katz, Harvey P; Goldfinger, Stephen E; Fletcher, Suzanne W

2002-01-01

Although concerns have been raised about industry support of continuing medical education (CME), there are few published reports of academia-industry collaboration in the field. We describe and evaluate Pri-Med, a CME experience for primary care clinicians developed jointly by the Harvard Medical School (HMS) and M/C Communications. Since 1995, 19 Pri-Med conferences have been held in four cities, drawing more than 100,000 primary care clinicians. The educational core of each Pri-Med conference is a 3-day Harvard course, "Current Clinical Issues in Primary Care." Course content is determined by a faculty committee independent of any commercial influence. Revenues from multiple industry sources flow through M/C Communications to the medical school as an educational grant to support primary care education. Pri-Med also offers separate pharmaceutical company-funded symposia. Comparing the two educational approaches during four conferences, 221 HMS talks and 103 symposia were presented. The HMS course covered a wide range with 133 topics; the symposia focused on 30 topics, most of which were linked to recently approved new therapeutic products manufactured by the funders. Both the course and the symposia were highly rated by attendees. When CME presentations for primary care physicians receive direct support from industry, the range of offered topics is narrower than when programs are developed independently of such support. There appear to be no differences in the perceived quality of presentations delivered with and without such support. Our experience suggests that a firewall between program planners and providers of financial support will result in a broader array of educational subjects relevant to the field of primary care.

A Tiny Eruptive Filament as a Flux-Rope Progenitor and Driver of a Large-Scale CME and Wave

NASA Astrophysics Data System (ADS)

Grechnev, V. V.; Uralov, A. M.; Kochanov, A. A.; Kuzmenko, I. V.; Prosovetsky, D. V.; Egorov, Y. I.; Fainshtein, V. G.; Kashapova, L. K.

2016-04-01

A solar eruptive event SOL2010-06-13 observed with the Atmospheric Imaging Assembly (AIA) of the Solar Dynamics Observatory (SDO) has been extensively discussed in the contexts of the CME development and an associated extreme-ultraviolet (EUV) wave-like transient in terms of a shock driven by the apparent CME rim. Continuing the analysis of this event, we have revealed an erupting flux rope, studied its properties, and detected wave signatures inside the developing CME. These findings have allowed us to establish new features in the genesis of the CME and associated EUV wave and to reconcile all of the episodes into a single causally related sequence. i) A hot 11 MK flux rope developed from the structures initially associated with a compact filament system. The flux rope expanded with an acceleration of up to 3 km s-2 one minute before a hard X-ray burst and earlier than any other structures, reached a velocity of 420 km s-1, and then decelerated to about 50 km s-1. ii) The CME development was driven by the expanding flux rope. Closed coronal structures above the rope got sequentially involved in the expansion from below upwards, came closer together, and apparently disappeared to reveal their common envelope, the visible rim, which became the outer boundary of the cavity. The rim was probably associated with the separatrix surface of a magnetic domain, which contained the pre-eruptive filament. iii) The rim formation was associated with a successive compression of the upper active-region structures into the CME frontal structure (FS). When the rim was formed, it resembled a piston. iv) The disturbance responsible for the consecutive CME formation episodes was excited by the flux rope inside the rim, and then propagated outward. EUV structures arranged at different heights started to accelerate, when their trajectories in the distance-time diagram were crossed by that of the fast front of this disturbance. v) Outside the rim and FS, the disturbance propagated like a blast wave, manifesting in a type II radio burst and a leading part of the EUV transient. Its main, trailing part was the FS, which consisted of swept-up 2 MK coronal loops enveloping the expanding rim. The wave decelerated and decayed into a weak disturbance soon afterwards, being not driven by the trailing piston, which slowed down.

Theoretical basis for operational ensemble forecasting of coronal mass ejections

NASA Astrophysics Data System (ADS)

Pizzo, V. J.; de Koning, C.; Cash, M.; Millward, G.; Biesecker, D. A.; Puga, L.; Codrescu, M.; Odstrcil, D.

2015-10-01

We lay out the theoretical underpinnings for the application of the Wang-Sheeley-Arge-Enlil modeling system to ensemble forecasting of coronal mass ejections (CMEs) in an operational environment. In such models, there is no magnetic cloud component, so our results pertain only to CME front properties, such as transit time to Earth. Within this framework, we find no evidence that the propagation is chaotic, and therefore, CME forecasting calls for different tactics than employed for terrestrial weather or hurricane forecasting. We explore a broad range of CME cone inputs and ambient states to flesh out differing CME evolutionary behavior in the various dynamical domains (e.g., large, fast CMEs launched into a slow ambient, and the converse; plus numerous permutations in between). CME propagation in both uniform and highly structured ambient flows is considered to assess how much the solar wind background affects the CME front properties at 1 AU. Graphical and analytic tools pertinent to an ensemble approach are developed to enable uncertainties in forecasting CME impact at Earth to be realistically estimated. We discuss how uncertainties in CME pointing relative to the Sun-Earth line affects the reliability of a forecast and how glancing blows become an issue for CME off-points greater than about the half width of the estimated input CME. While the basic results appear consistent with established impressions of CME behavior, the next step is to use existing records of well-observed CMEs at both Sun and Earth to verify that real events appear to follow the systematic tendencies presented in this study.

GRP75 upregulates clathrin-independent endocytosis through actin cytoskeleton reorganization mediated by the concurrent activation of Cdc42 and RhoA.

PubMed

Chen, Hang; Gao, Zhihui; He, Changzheng; Xiang, Rong; van Kuppevelt, Toin H; Belting, Mattias; Zhang, Sihe

2016-05-01

Therapeutic macromolecules are internalized into the cell by either clathrin-mediated endocytosis (CME) or clathrin-independent endocytosis (CIE). Although some chaperone proteins play an essential role in CME (e.g. Hsc70 in clathrin uncoating), relatively few of these proteins are functionally involved in CIE. We previously revealed a role for the mitochondrial chaperone protein GRP75 in heparan sulfate proteoglycan (HSPG)-mediated, membrane raft-associated macromolecule endocytosis. However, the mechanism underlying this process remains unclear. In this study, using a mitochondrial signal peptide-directed protein trafficking expression strategy, we demonstrate that wild-type GRP75 expression enhanced the uptakes of HSPG and CIE marker cholera toxin B subunit but impaired the uptake of CME marker transferrin. The endocytosis regulation function of GRP75 is largely mediated by its subcellular location in mitochondria and is essentially determined by its ATPase domain. Interestingly, the mitochondrial expression of GRP75 or its ATPase domain significantly stimulates increases in both RhoA and Cdc42 activation, remarkably induces stress fibers and enhances filopodia formation, which collectively results in the promotion of CIE, but the inhibition of CME. Furthermore, silencing of Cdc42 or RhoA impaired the ability of GRP75 overexpression to increase CIE. Therefore, these results suggest that endocytosis vesicle enrichment of GRP75 by mitochondria trafficking upregulates CIE through an actin cytoskeleton reorganization mechanism mediated by the concurrent activation of Cdc42 and RhoA. This finding provides novel insight into organelle-derived chaperone signaling and the regulation of different endocytosis pathways in cells. Copyright © 2016 Elsevier Inc. All rights reserved.

CME and Change in Practice: An Alternative Perspective.

ERIC Educational Resources Information Center

Wergin, Jon F.; And Others

1988-01-01

Results of a study by the American College of Cardiology revealed that continuing medical education (CME) courses contain relatively little information that is new to the audience, that other influences on practice interact with CME content, and that change attributable to CME is subtle and often delayed. (JOW)

Sharing Collaborative Designs of Tobacco Cessation Performance Improvement CME Projects

ERIC Educational Resources Information Center

Mullikin, Elizabeth A.; Ales, Mary W.; Cho, Jane; Nelson, Teena M.; Rodrigues, Shelly B.; Speight, Mike

2011-01-01

Introduction: Performance Improvement Continuing Medical Education (PI CME) provides an important opportunity for CME providers to combine educational and quality health care improvement methodologies. Very few CME providers take on the challenges of planning this type of intervention because it is still a new practice and there are limited…

Learning to Collaborate: A Case Study of Performance Improvement CME

ERIC Educational Resources Information Center

Shershneva, Marianna B.; Mullikin, Elizabeth A.; Loose, Anne-Sophie; Olson, Curtis A.

2008-01-01

Introduction: Performance Improvement Continuing Medical Education (PI CME) is a mechanism for joining quality improvement (QI) in health care to continuing medical education (CME) systems together. Although QI practices and CME approaches have been recognized for years, what emerges from their integration is largely unfamiliar, because it…

Are Stellar Storms Bad News for M-Dwarf Planets?

NASA Astrophysics Data System (ADS)

Kohler, Susanna

2016-09-01

Coronal mass ejections (CMEs), enormous releases of energy from the Sun, can have significant space-weather implications for Earth. Do similar storms from smaller stars M dwarfs like V374 Peg, or the nearby Proxima Centauri mean bad news for the planets that these stars host?Volatile StarsDifference in habitable-zone sizes for different stellar types. [NASA]When plasma is released from the Sun in the form of a CME traveling toward Earth, these storms can be powerful enough to disrupt communications and navigational equipment, damage satellites, and cause blackouts even with our planetary magnetic field to protect us! How might planets in the habitable zone of M-dwarf stars fare against similar storms?The first danger for an M dwarfs planets is that the habitable zone lies much closer to the star: it can range from 0.03 to 0.4 AU (i.e., within Mercurys orbit). Being so close to the star definitely makes a planet in an M dwarfs habitable zone vulnerable to storms.Colors indicate the probability of CME impact, for different different stellar latitudes where the CME originated vs. orbital inclination of the planet, (a) without any deflection, and (b) taking into account the CME deflection by the stars magnetic field. Hanging out in an orbit aligned with the current sheet turns out to be a bad idea. [Adapted from Kay et al. 2016]What about the storms themselves? You might think that because M dwarfs are cooler stars, they would be quieter, releasing fewer CMEs with less energy. Surprisingly, the opposite is true: M dwarfs are significantly more active than solar-type stars, and the CMEs are typically ten times more massive than those released from the Sun. Impacts from these powerful outbursts could easily strip any existing planet atmosphere, making a planet much less likely to be habitable. To make matters worse, M dwarfs can remain magnetically active for billions of years: even a star like Proxima Centauri, which is nearly 5 billion years old, isstill relatively active.Dodging Deflected StormsInterestingly, an important factor in the survival of an M dwarfs habitable-zone planet is the plane in which the planets orbit lies. A team of scientists led by Christina Kay (NASA Goddards Solar Physics Laboratory and Boston University) recently modeled CMEs from V374 Peg, a mid-type M dwarf of roughly a third of the Suns mass and radius, to determine how the CMEs propagate and the probability that theyll impact a hypothetical planet in the stars habitable zone.The team shows that traveling CMEs tend to be deflected by the stars magnetic field. Instead of propagating purely radially outward, the CMEs are pushed toward the astrospheric current sheet the minimum point of the background magnetic field which moves around, but is generally located toward the stellar equatorial plane.Kay and collaborators find that planet orbits roughly aligned with the current sheet therefore have a higher probability of getting hit by a CME: around 10%. In contrast, planets with higher-inclination orbits have CME impact probabilities around 1%. These probabilities translate to an impact rate of about 0.55 times per day for a habitable-zone planet around a mid-type M dwarf which is 220 times the average at Earth during solar maximum!Minimum planetary magnetic field strength required to sustain a magnetosphere twice the size of the planetary radius for different CME masses and speeds, for a 1 kG (left) and 20 kG (right) initial CME magnetic field strength. A typical CME requires a field strength of 10100 G. [Adapted from Kay et al. 2016]Is There Hope for Planet Habitability?With this many CME impacts even outside of the current-sheet plane, how can a planet hope to survive? The key lies in having a strong magnetic field to protect the planet. Such a field would deflect the charged particles from the CME, preventing the CME from stripping the planets atmosphere.Kay and collaborators calculate that a habitable-zone mid-type M-dwarf exoplanet would need a planetary magnetic field between tens and hundreds of Gauss 1 to 2 orders of magnitude more than that of Earth to protect itself from these CMEs: difficult to muster, but not impossible!These results provide some interesting food for thought as we continue to discover new exoplanets orbiting M-dwarf stars.CitationC. Kay et al 2016 ApJ 826 195. doi:10.3847/0004-637X/826/2/195

Determination of Geometric and Kinematical Parameters of Coronal Mass Ejections Using STEREO Data

NASA Astrophysics Data System (ADS)

Fainshtein, V. G.; Tsivileva, D. M.; Kashapova, L. K.

2010-03-01

We present a new, relatively simple and fast method to determine true geometric and kinematical CME parameters from simultaneous STEREO A, B observations of CMEs. These parameters are the three-dimensional direction of CME propagation, velocity and acceleration of CME front, CME angular sizes and front position depending on time. The method is based on the assumption that CME shape may be described by a modification of so-called ice-cream cone models. The method has been tested for several CMEs.

Participation of National Medical Associations in quality improvement activities - International comparison and the Israeli case

PubMed Central

2014-01-01

Background Many countries have devoted considerable efforts in an attempt to improve the performance of their health care systems. National Medical Associations (NMAs), along with other stakeholders, play a part in the promotion of such activities. The purpose of this paper is to explore the nature and level of participation of NMAs in activities of quality improvement in medicine, with a specific emphasis on Israel. Methods The authors conducted a survey among NMAs around the world inquiring as to their involvement in three central aspects of quality improvement: clinical guidelines, quality measurement and continuing medical education (CME). In addition, they conducted a review of the literature in order to gather more information and complete the data collected in the survey. The findings were processed and analyzed comparatively. Results Most of the NMAs surveyed participate in quality improvement activities at least to some extent. NMAs' main involvement is in the regulation of CME and they are involved to a much lesser extent in the preparation of clinical guidelines and in quality measurement. In Israel, the Israeli Medical Association (IMA) has a dominant role in both the preparation of clinical guidelines and the regulation of CME credits. Discussion It is possible that the expertise maintained by the profession, coupled with the organizational power of the NMA as a union, is viewed as beneficial for regulating educational activities in medicine such as CME. Conversely, the issuing of clinical guidelines is usually regarded as a typical scientific activity, and therefore often rests in the hands of professional medical societies. Quality measurement is regarded as a distinctive administrative tool and is usually found in the province of governments. Based on the typology that we introduced in our previous paper, we discovered that the extent of NMAs’ involvement in quality improvement coincides with the mode of governance of the health care system. Conclusions The nature and level of participation of NMAs in activities of quality improvement varies widely. Collaboration of NMAs in this field with other stakeholders is not uncommon, and may contribute to the further development of quality improvement in medicine. PMID:24808940

VLA Measurements of Faraday Rotation through Coronal Mass Ejections

NASA Astrophysics Data System (ADS)

Kooi, Jason E.; Fischer, Patrick D.; Buffo, Jacob J.; Spangler, Steven R.

2017-04-01

Coronal mass ejections (CMEs) are large-scale eruptions of plasma from the Sun, which play an important role in space weather. Faraday rotation is the rotation of the plane of polarization that results when a linearly polarized signal passes through a magnetized plasma such as a CME. Faraday rotation is proportional to the path integral through the plasma of the electron density and the line-of-sight component of the magnetic field. Faraday-rotation observations of a source near the Sun can provide information on the plasma structure of a CME shortly after launch. We report on simultaneous white-light and radio observations made of three CMEs in August 2012. We made sensitive Very Large Array (VLA) full-polarization observations using 1 - 2 GHz frequencies of a constellation of radio sources through the solar corona at heliocentric distances that ranged from 6 - 15 R_{⊙}. Two sources (0842+1835 and 0900+1832) were occulted by a single CME, and one source (0843+1547) was occulted by two CMEs. In addition to our radioastronomical observations, which represent one of the first active hunts for CME Faraday rotation since Bird et al. ( Solar Phys., 98, 341, 1985) and the first active hunt using the VLA, we obtained white-light coronagraph images from the Large Angle and Spectrometric Coronagraph (LASCO) C3 instrument to determine the Thomson-scattering brightness [BT], providing a means to independently estimate the plasma density and determine its contribution to the observed Faraday rotation. A constant-density force-free flux rope embedded in the background corona was used to model the effects of the CMEs on BT and Faraday rotation. The plasma densities (6 - 22×103 cm^{-3}) and axial magnetic-field strengths (2 - 12 mG) inferred from our models are consistent with the modeling work of Liu et al. ( Astrophys. J., 665, 1439, 2007) and Jensen and Russell ( Geophys. Res. Lett., 35, L02103, 2008), as well as previous CME Faraday-rotation observations by Bird et al. (1985).

The soft X-ray coronal mass ejection above solar limb of 1998 April 23

NASA Astrophysics Data System (ADS)

Chen, Xiao-juan

Using the observational materials of SXT/HXT aboard satellite Yohkoh and the Nobeyama Radioheliograph (NoRH) on 1998-04-23, a comprehensive study of the soft X-ray coronal mass ejection (CME) above solar SE limb shows that there were two magnetic dipolar sources (MDSs), one magnetic capacity belt (MCB) between the MDSs, one neutral current sheet (NCS) and some rare activation sources (ASs). When the MCB was changed by the ASs to become a magnetic energy belt (MEB), both mass and energy were concentrated to form the NCS. When the MDSs were connected by the MEB, the NCS was formed and the CME occurred. Mass was ejected not only from the NCS, but also from the whole MEB. The expanding loop of the CME had the two MDSs as footpoints. The top of the loop was always inclined towards the footpoint of the weaker source, and its locus marks the NCS.

Determination of CME 3D parameters based on a new full ice-cream cone model

NASA Astrophysics Data System (ADS)

Na, Hyeonock; Moon, Yong-Jae

2017-08-01

In space weather forecast, it is important to determine three-dimensional properties of CMEs. Using 29 limb CMEs, we examine which cone type is close to a CME three-dimensional structure. We find that most CMEs have near full ice-cream cone structure which is a symmetrical circular cone combined with a hemisphere. We develop a full ice-cream cone model based on a new methodology that the full ice-cream cone consists of many flat cones with different heights and angular widths. By applying this model to 12 SOHO/LASCO halo CMEs, we find that 3D parameters from our method are similar to those from other stereoscopic methods (i.e., a triangulation method and a Graduated Cylindrical Shell model). In addition, we derive CME mean density (ρmean=Mtotal/Vcone) based on the full ice-cream cone structure. For several limb events, we determine CME mass by applying the Solarsoft procedure (e.g., cme_mass.pro) to SOHO/LASCO C3 images. CME volumes are estimated from the full ice-cream cone structure. From the power-law relationship between CME mean density and its height, we estimate CME mean densities at 20 solar radii (Rs). We will compare the CME densities at 20 Rs with their corresponding ICME densities.

Deflected Propagation of CMEs and Its Importance on the CME Arrival Forecasting

NASA Astrophysics Data System (ADS)

Wang, Yuming; Zhuang, Bin; Shen, Chenglong

2017-04-01

As the most important driver of severe space weather, coronal mass ejections (CMEs) and their geoeffectiveness have been studied intensively. Previous statistical studies have shown that not all the front-side halo CMEs are geoeffective, and not all non-recurrent geomagnetic storms can be tracked back to a CME. These phenomena may cause some failed predictions of the geoeffectiveness of CMEs. The recent notable event exhibiting such a failure was on 2015 March 15 when a fast CME originated from the west hemisphere. Space Weather Prediction Center (SWPC) of NOAA initially forecasted that the CME would at most cause a very minor geomagnetic disturbance labeled as G1. However, the CME produced the largest geomagnetic storm so far, at G4 level with the provisional Dst value of -223 nT, in the current solar cycle 24 [e.g., Kataoka et al., 2015; Wang et al., 2016]. Such an unexpected phenomenon naturally raises the first question for the forecasting of the geoeffectiveness of a CME, i.e., whether or not a CME will hit the Earth even though we know the source location and initial kinematic properties of the CME. A full understanding of the propagation trajectory, e.g., the deflected propagation, of a CME from the Sun to 1 AU is the key. With a few cases, we show the importance of the deflection effect in the space weather forecasting. An automated CME arrival forecasting system containing a deflected propagation model is presented.

Predicting the Magnetic Field of Earth-Impacting CMEs

NASA Technical Reports Server (NTRS)

Kay, C.; Gopalswamy, N.; Reinard, A.; Opher, M.

2017-01-01

Predicting the impact of coronal mass ejections (CMEs) and the southward component of their magnetic field is one of the key goals of space weather forecasting. We present a new model, the ForeCAT In situ Data Observer (FIDO), for predicting the in situ magnetic field of CMEs. We first simulate a CME using ForeCAT, a model for CME deflection and rotation resulting from the background solar magnetic forces. Using the CME position and orientation from ForeCAT, we then determine the passage of the CME over a simulated spacecraft. We model the CME's magnetic field using a force-free flux rope and we determine the in situ magnetic profile at the synthetic spacecraft. We show that FIDO can reproduce the general behavior of four observed CMEs. FIDO results are very sensitive to the CME's position and orientation, and we show that the uncertainty in a CME's position and orientation from coronagraph images corresponds to a wide range of in situ magnitudes and even polarities. This small range of positions and orientations also includes CMEs that entirely miss the satellite. We show that two derived parameters (the normalized angular distance between the CME nose and satellite position and the angular difference between the CME tilt and the position angle of the satellite with respect to the CME nose) can be used to reliably determine whether an impact or miss occurs. We find that the same criteria separate the impacts and misses for cases representing all four observed CMEs.

Global Energetics of Solar Flares. VI. Refined Energetics of Coronal Mass Ejections

NASA Astrophysics Data System (ADS)

Aschwanden, Markus J.

2017-09-01

In this study, we refine the coronal mass ejection (CME) model that was presented in an earlier study of the global energetics of solar flares and associated CMEs and apply it to all (860) GOES M- and X-class flare events observed during the first seven years (2010-2016) of the Solar Dynamics Observatory (SDO) mission. The model refinements include (1) the CME geometry in terms of a 3D volume undergoing self-similar adiabatic expansion, (2) the solar gravitational deceleration during the propagation of the CME, which discriminates between eruptive and confined CMEs, (3) a self-consistent relationship between the CME center-of-mass motion detected during EUV dimming and the leading-edge motion observed in white-light coronagraphs, (4) the equipartition of the CME’s kinetic and thermal energies, and (5) the Rosner-Tucker-Vaiana scaling law. The refined CME model is entirely based on EUV-dimming observations (using Atmospheric Imager Assembly (AIA)/SDO data) and complements the traditional white-light scattering model (using Large-Angle and Spectrometric Coronagraph Experiment (LASCO)/Solar and Heliospheric Observatory data), and both models are independently capable of determining fundamental CME parameters. Comparing the two methods, we find that (1) LASCO is less sensitive than AIA in detecting CMEs (in 24% of the cases), (2) CME masses below {m}{cme}≲ {10}14 g are underestimated by LASCO, (3) AIA and LASCO masses, speeds, and energies agree closely in the statistical mean after the elimination of outliers, and (4) the CME parameters speed v, emission measure-weighted flare peak temperature T e , and length scale L are consistent with the following scaling laws: v\\propto {T}e1/2, v\\propto {({m}{cme})}1/4, and {m}{cme}\\propto {L}2.

USING ONLINE MARKETING TO INCREASE PARTICIPATION IN A WEB-BASED CONTINUING MEDICAL EDUCATION CULTURAL COMPETENCE CURRICULUM

PubMed Central

Estrada, Carlos A.; Krishnamoorthy, Periyakaruppan; Smith, Ann; Staton, Lisa; Korf, Michele J.; Allison, Jeroan J.; Houston, Thomas K.

2012-01-01

Introduction CME providers may be interested in identifying effective marketing strategies to direct users to specific content. The use of online advertisements to recruit participants for clinical trials, public health programs, and Continuing Medical Education (CME) has been shown to be effective in some but not all studies. The purpose of this study was to compare the impact of two marketing strategies in the context of an online CME cultural competence curriculum (www.c-comp.org). Methods In an interrupted time-series quasi-experimental design, two marketing strategies were tested: a) wide dissemination to relevant organizations over a period of approximately four months, and b) Internet paid search using Google Ads (five consecutive eight-week periods--control 1, cultural/ CME advertisement, control 2, hypertension/ content advertisement, control 3). Outcome measures were CME credit requests, Web traffic (visits per day, page views, pages viewed per visit), and cost. Results Overall, the site was visited 19,156 times and 78,160 pages were viewed. During the wide dissemination phase, the proportion of visits requesting CME credit decreased between the first (5.3%) and second halves (3.3%) of this phase (p= .04). During the Internet paid search phase, the proportion of visits requesting CME credit was highest during the cultural/ CME advertisement period (control 1, 1.4%; cultural/CME ad, 4.3%; control 2, 1.5%; hypertension/content ad, 0.6%; control 3, 0.8%; p<.001). All measures of Web traffic changed during the Internet paid search phase (p<.01); however, changes were independent of the advertisement periods. The incremental cost for the cultural advertisement per CME credit requested was $0.64US. Discussion Internet advertisement focusing on cultural competence and CME was associated with about a three-fold increase in requests for CME credit at an incremental cost of under $1; however, Web traffic changes were independent of the advertisement strategy. PMID:21425356

The Width of a Solar Coronal Mass Ejection and the Source of the Driving Magnetic Explosion: A Test of the Standard Scenario for CME Production

NASA Technical Reports Server (NTRS)

Moore, Ronald L.; Sterling, Alphonse C.; Suess, Steven T.

2007-01-01

We show that the strength (B(sub F1are)) of the magnetic field in the area covered by the flare arcade following a CME-producing ejective solar eruption can be estimated from the final angular width (Final Theta(sub CME)) of the CME in the outer corona and the final angular width (Theta(sub Flare)) of the flare arcade: B(sub Flare) approx. equals 1.4[(Final Theta(sub CME)/Theta(sub Flare)] (exp 2)G. We assume (1) the flux-rope plasmoid ejected from the flare site becomes the interior of the CME plasmoid; (2) in the outer corona (R > 2 (solar radius)) the CME is roughly a "spherical plasmoid with legs" shaped like a lightbulb; and (3) beyond some height in or below the outer corona the CME plasmoid is in lateral pressure balance with the surrounding magnetic field. The strength of the nearly radial magnetic field in the outer corona is estimated from the radial component of the interplanetary magnetic field measured by Ulysses. We apply this model to three well-observed CMEs that exploded from flare regions of extremely different size and magnetic setting. One of these CMEs was an over-and-out CME, that is, in the outer corona the CME was laterally far offset from the flare-marked source of the driving magnetic explosion. In each event, the estimated source-region field strength is appropriate for the magnetic setting of the flare. This agreement (1) indicates that CMEs are propelled by the magnetic field of the CME plasmoid pushing against the surrounding magnetic field; (2) supports the magnetic-arch-blowout scenario for over-and-out CMEs; and (3) shows that a CME's final angular width in the outer corona can be estimated from the amount of magnetic flux covered by the source-region flare arcade.

Real­-Time Ensemble Forecasting of Coronal Mass Ejections Using the Wsa-Enlil+Cone Model

NASA Astrophysics Data System (ADS)

Mays, M. L.; Taktakishvili, A.; Pulkkinen, A. A.; Odstrcil, D.; MacNeice, P. J.; Rastaetter, L.; LaSota, J. A.

2014-12-01

Ensemble forecasting of coronal mass ejections (CMEs) provides significant information in that it provides an estimation of the spread or uncertainty in CME arrival time predictions. Real-time ensemble modeling of CME propagation is performed by forecasters at the Space Weather Research Center (SWRC) using the WSA-ENLIL+cone model available at the Community Coordinated Modeling Center (CCMC). To estimate the effect of uncertainties in determining CME input parameters on arrival time predictions, a distribution of n (routinely n=48) CME input parameter sets are generated using the CCMC Stereo CME Analysis Tool (StereoCAT) which employs geometrical triangulation techniques. These input parameters are used to perform n different simulations yielding an ensemble of solar wind parameters at various locations of interest, including a probability distribution of CME arrival times (for hits), and geomagnetic storm strength (for Earth-directed hits). We present the results of ensemble simulations for a total of 38 CME events in 2013-2014. For 28 of the ensemble runs containing hits, the observed CME arrival was within the range of ensemble arrival time predictions for 14 runs (half). The average arrival time prediction was computed for each of the 28 ensembles predicting hits and using the actual arrival time, an average absolute error of 10.0 hours (RMSE=11.4 hours) was found for all 28 ensembles, which is comparable to current forecasting errors. Some considerations for the accuracy of ensemble CME arrival time predictions include the importance of the initial distribution of CME input parameters, particularly the mean and spread. When the observed arrivals are not within the predicted range, this still allows the ruling out of prediction errors caused by tested CME input parameters. Prediction errors can also arise from ambient model parameters such as the accuracy of the solar wind background, and other limitations. Additionally the ensemble modeling sysem was used to complete a parametric event case study of the sensitivity of the CME arrival time prediction to free parameters for ambient solar wind model and CME. The parameter sensitivity study suggests future directions for the system, such as running ensembles using various magnetogram inputs to the WSA model.

Evidence for a current sheet forming in the wake of a coronal mass ejection from multi-viewpoint coronagraph observations

NASA Astrophysics Data System (ADS)

Patsourakos, S.; Vourlidas, A.

2011-01-01

Context. Ray-like features observed by coronagraphs in the wake of coronal mass ejections (CMEs) are sometimes interpreted as the white light counterparts of current sheets (CSs) produced by the eruption. The 3D geometry of these ray-like features is largely unknown and its knowledge should clarify their association to the CS and place constraints on CME physics and coronal conditions. Aims: If these rays are related to field relaxation behind CMEs, therefore representing current sheets, then they should be aligned to the CME axis. With this study we test these important implications for the first time. Methods: An example of such a post-CME ray was observed by various coronagraphs, including these of the Sun Earth Connection Coronal and Heliospheric investigation (SECCHI) onboard the Solar Terrestrial Relations Observatory (STEREO) twin spacecraft and the Large Angle Spectrometric Coronagraph (LASCO) onboard the Solar and Heliospheric Observatory (SOHO). The ray was observed in the aftermath of a CME which occurred on 9 April 2008. The twin STEREO spacecraft were separated by about 48° on that day. This significant separation combined with a third “eye” view supplied by LASCO allow for a truly multi-viewpoint observation of the ray and of the CME. We applied 3D forward geometrical modeling to the CME and to the ray as simultaneously viewed by SECCHI-A and B and by SECCHI-A and LASCO, respectively. Results: We found that the ray can be approximated by a rectangular slab, nearly aligned with the CME axis, and much smaller than the CME in both terms of thickness and depth (≈0.05 and 0.15 R⊙ respectively). The ray electron density and temperature were substantially higher than their values in the ambient corona. We found that the ray and CME are significantly displaced from the associated post-CME flaring loops. Conclusions: The properties and location of the ray are fully consistent with the expectations of the standard CME theories for post-CME current sheets. Therefore, our multi-viewpoint observations supply strong evidence that the observed post-CME ray is indeed related to a post-CME current sheet. Movies are only available in electronic form at http://www.aanda.org

Combining Stereo SECCHI COR2 and HI1 Images for Automatic CME Front Edge Tracking

NASA Technical Reports Server (NTRS)

Kirnosov, Vladimir; Chang, Lin-Ching; Pulkkinen, Antti

2016-01-01

COR2 coronagraph images are the most commonly used data for coronal mass ejection (CME) analysis among the various types of data provided by the STEREO (Solar Terrestrial Relations Observatory) SECCHI (Sun-Earth Connection Coronal and Heliospheric Investigation) suite of instruments. The field of view (FOV) in COR2 images covers 215 solar radii (Rs) that allow for tracking the front edge of a CME in its initial stage to forecast the lead-time of a CME and its chances of reaching the Earth. However, estimating the lead-time of a CME using COR2 images gives a larger lead-time, which may be associated with greater uncertainty. To reduce this uncertainty, CME front edge tracking should be continued beyond the FOV of COR2 images. Therefore, heliospheric imager (HI1) data that covers 1590 Rs FOV must be included. In this paper, we propose a novel automatic method that takes both COR2 and HI1 images into account and combine the results to track the front edges of a CME continuously. The method consists of two modules: pre-processing and tracking. The pre-processing module produces a set of segmented images, which contain the signature of a CME, for both COR2 and HI1 separately. In addition, the HI1 images are resized and padded, so that the center of the Sun is the central coordinate of the resized HI1 images. The resulting COR2 andHI1 image set is then fed into the tracking module to estimate the position angle (PA) and track the front edge of a CME. The detected front edge is then used to produce a height-time profile that is used to estimate the speed of a CME. The method was validated using 15 CME events observed in the period from January 1, 2008 to August 31, 2009. The results demonstrate that the proposed method is effective for CME front edge tracking in both COR2 and HI1 images. Using this method, the CME front edge can now be tracked automatically and continuously in a much larger range, i.e., from 2 to 90 Rs, for the first time. These improvement scan greatly help in making the quantitative CME analysis more accurate and have the potential to assist in space weather forecasting.

The SCEC Community Modeling Environment(SCEC/CME): A Collaboratory for Seismic Hazard Analysis

NASA Astrophysics Data System (ADS)

Maechling, P. J.; Jordan, T. H.; Minster, J. B.; Moore, R.; Kesselman, C.

2005-12-01

The SCEC Community Modeling Environment (SCEC/CME) Project is an NSF-supported Geosciences/IT partnership that is actively developing an advanced information infrastructure for system-level earthquake science in Southern California. This partnership includes SCEC, USC's Information Sciences Institute (ISI), the San Diego Supercomputer Center (SDSC), the Incorporated Institutions for Research in Seismology (IRIS), and the U.S. Geological Survey. The goal of the SCEC/CME is to develop seismological applications and information technology (IT) infrastructure to support the development of Seismic Hazard Analysis (SHA) programs and other geophysical simulations. The SHA application programs developed on the Project include a Probabilistic Seismic Hazard Analysis system called OpenSHA. OpenSHA computational elements that are currently available include a collection of attenuation relationships, and several Earthquake Rupture Forecasts (ERFs). Geophysicists in the collaboration have also developed Anelastic Wave Models (AWMs) using both finite-difference and finite-element approaches. Earthquake simulations using these codes have been run for a variety of earthquake sources. Rupture Dynamic Model (RDM) codes have also been developed that simulate friction-based fault slip. The SCEC/CME collaboration has also developed IT software and hardware infrastructure to support the development, execution, and analysis of these SHA programs. To support computationally expensive simulations, we have constructed a grid-based scientific workflow system. Using the SCEC grid, project collaborators can submit computations from the SCEC/CME servers to High Performance Computers at USC and TeraGrid High Performance Computing Centers. Data generated and archived by the SCEC/CME is stored in a digital library system, the Storage Resource Broker (SRB). This system provides a robust and secure system for maintaining the association between the data seta and their metadata. To provide an easy-to-use system for constructing SHA computations, a browser-based workflow assembly web portal has been developed. Users can compose complex SHA calculations, specifying SCEC/CME data sets as inputs to calculations, and calling SCEC/CME computational programs to process the data and the output. Knowledge-based software tools have been implemented that utilize ontological descriptions of SHA software and data can validate workflows created with this pathway assembly tool. Data visualization software developed by the collaboration supports analysis and validation of data sets. Several programs have been developed to visualize SCEC/CME data including GMT-based map making software for PSHA codes, 4D wavefield propagation visualization software based on OpenGL, and 3D Geowall-based visualization of earthquakes, faults, and seismic wave propagation. The SCEC/CME Project also helps to sponsor the SCEC UseIT Intern program. The UseIT Intern Program provides research opportunities in both Geosciences and Information Technology to undergraduate students in a variety of fields. The UseIT group has developed a 3D data visualization tool, called SCEC-VDO, as a part of this undergraduate research program.

The Relationship Between CME Properties in the CDAW, CACTUS and SEEDS Catalogs and ?25 MeV Solar Proton Event Intensities

NASA Astrophysics Data System (ADS)

Richardson, I. G.; von Rosenvinge, T. T.; Cane, H. V.

2013-12-01

The existence of a correlation between the intensity of solar energetic proton (SEP) events and the speed of the associated coronal mass ejection near the Sun is well known, and is often interpreted as evidence for particle acceleration at CME-driven shocks. However, this correlation is far from perfect and might be improved by taking other parameters into consideration (e.g., CME width). In studies of cycle 23 SEP events, values of CME speed, width and other parameters were typically taken from the CDAWWeb LASCO CME catalog. This is compiled 'by hand' from examination of LASCO images by experienced observers. Other automated LASCO CME catalogs have now been developed, e.g., CACTUS (Royal Observatory of Belgium) and SEEDS (George Mason University), but the basic CME parameters do not always agree with those from the CDAWweb catalog since they are not determined in the same way. For example the 'CME speed' might be measured at a specific position angle against the plane of the sky in one catalog, or be the average of speeds taken along the CME front in another. Speeds may also be based on linear or higher order fits to the coronagraph images. There will also be projection effects in these plane of the sky speeds. Similarly, CME widths can vary between catalogs and are dependent on how they are defined. For example, the CDAW catalog lists any CME that surrounds the occulting disk as a 'halo' (360 deg. width) CME even though the CME may be highly-asymmetric and originate from a solar event far from central meridian. Another catalog may give a smaller width for the same CME. The problem of obtaining the 'true' CME width is especially acute for assessing the relationship between CME width and SEP properties when using the CDAW catalog since a significant fraction, if not the majority, of the CMEs associated with major SEP events are reported to be halo CMEs. In principle, observations of CMEs from the STEREO A and B spacecraft, launched in late 2006, might be used to overcome some of these problems. In particular, a spacecraft in quadrature with the solar source of an SEP event should observe the 'true' width and speed of the associated CME. However, STEREO CME parameters are derived using the CACTUS method, and cannot be directly compared with the LASCO CDAW catalog values that have been so widely used for many years. In this study, we will examine the relationship between the properties of CMEs in various catalogs and the intensities of a large sample of particle events that include ˜25 MeV protons in cycles 23 and 24. In particular, we will compare the proton intensity-speed relationships obtained using the CDAW, CACTUS and SEEDS LASCO catalogs, and also using the CACTUS values from whichever spacecraft (STEREO A, B or SOHO) is best in quadrature with the solar event. We will also examine whether there is any correlation between the width of the CMEs in the automated catalogs and proton intensity, and whether a combination of CME speed and width might improve the correlation with proton intensity.

Multiple pharmacological targets, cytotoxicity, and phytochemical profile of Aphloia theiformis (Vahl.) Benn.

PubMed

Picot, Marie Carene Nancy; Bender, Onur; Atalay, Arzu; Zengin, Gokhan; Loffredo, Loïc; Hadji-Minaglou, Francis; Mahomoodally, Mohamad Fawzi

2017-05-01

Aphloia theiformis (Vahl.) Benn. (AT) is traditionally used in Sub-Saharan African countries including Mauritius as a biomedicine for the management of several diseases. However, there is a dearth of experimental studies to validate these claims. We endeavoured to evaluate the inhibitory effects of crude aqueous extract as traditionally used together with the crude methanol extracts of AT leaves on urease, angiotensin (I) converting enzyme (ACE), acetylcholinesterase (AChE), cholesterol esterase (CEase), glycogen phosphorylase a (GPa), and glycation in vitro. The crude extract showing potent activity against the studied enzymes was further partitioned using different solvents of increasing polarity. The enzyme inhibitory and antiglycation activities of each fraction was assessed. Kinetic of inhibition of the active crude extract/fractions on the aforementioned enzymes was consequently determined using Lineweaver-Burk plots. An ultra-high performance liquid chromatography (UHPLC-UV/MS) system was used to establish the phytochemical profile of AT. The real time cell analysis system (iCELLigence™) was used to monitor any cellular cytotoxicity of AT. Crude methanolextract (CME) was a potent inhibitor of the studied enzymes, with IC 50 ranging from 696.22 to 19.73μg/mL. CME (82.5%) significantly (p<0.05) inhibited glycation and was comparable to aminoguanidine (81.5%). Ethyl acetate and n-butanol fractions of CME showed non-competitive, competitive, and uncompetitive mode of inhibition against ACE, CEase, and AChE respectively. Mangiferin, a xanthone glucoside was present in CME, ethyl acetate, and n-butanol fractions. Active extract/fractions were found to be non-cytotoxic (IC 50 >20μg/mL) according to the U.S National Cancer Institute plant screening program. This study has established baseline data that tend to justify the traditional use of AT and open new avenues for future biomedicine development. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

76 FR 54275 - Self-Regulatory Organizations; Chicago Mercantile Exchange, Inc.; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-31

... Change To Reflect Differences in Proprietary Trading Exchange Fees Based on Ownership of CME Group Shares.... equity member firm. Clearing members with shares are those clearing members that maintain CME Group Class... members that maintain CME Group Class A shares in accordance with CME Rule 106.J. Equity Member Firm...

Using Focus Groups for Strategic Planning in a CME Unit

ERIC Educational Resources Information Center

Takhar, Jatinder; Tipping, Jane

2008-01-01

The University of Western Ontario, having established a fully functional continuing medical education (CME) office over the last 4 years, needed to plan the future for its academic CME unit. It needs a method for evaluating the progress and shaping the organizational future of the CME unit. A literature search and consultations suggested focus…

Medical communication companies and industry grants.

PubMed

Rothman, Sheila M; Brudney, Karen F; Adair, Whitney; Rothman, David J

2013-12-18

Medical communication companies (MCCs) are among the most significant health care stakeholders, supported mainly by drug and device companies. How MCCs share or protect physicians' personal data requires greater transparency. To explore the financial relationships between MCCs and drug and device companies, to describe the characteristics of the large MCCs, and to explore whether they accurately represent themselves to physicians. We combined data from the 2010 grant registries of 14 pharmaceutical and device companies; grouped recipients into categories such as MCCs, academic medical centers, disease-targeted advocacy organizations, and professional associations; and created a master list of 19,272 grants. Determine the distribution of funds from drug and device companies to various entities and assess the characteristics of large MCCs. Of the 6493 recipients of more than $657 million grant awards from drug and device companies, 18 of 363 MCCs received 26%, academic medical centers received 21%, and disease-targeted organizations received 15%. For-profit MCCs received 77% of funds (208 of 363). Among the top 5% of MCCs, 14 of 18 were for-profit. All 18 offered continuing medical education: 14 offered live and 17 offered online CME courses. All required physicians to provide personal data. Ten stated that they shared information with unnamed third parties. Eight stated they did not share information, but almost all added exceptions. None required explicit physician consent to their sharing policies. Medical communication companies receive substantial support from drug and device companies. Physicians who interact with MCCs should be aware that all require personal data from the physician and some share these data with unnamed third parties.

The value of EHR-based assessment of physician competency: An investigative effort with internal medicine physicians.

PubMed

Venta, Kimberly; Baker, Erin; Fidopiastis, Cali; Stanney, Kay

2017-12-01

The purpose of this study was to investigate the potential of developing an EHR-based model of physician competency, named the Skill Deficiency Evaluation Toolkit for Eliminating Competency-loss Trends (Skill-DETECT), which presents the opportunity to use EHR-based models to inform selection of Continued Medical Education (CME) opportunities specifically targeted at maintaining proficiency. The IBM Explorys platform provided outpatient Electronic Health Records (EHRs) representing 76 physicians with over 5000 patients combined. These data were used to develop the Skill-DETECT model, a predictive hybrid model composed of a rule-based model, logistic regression model, and a thresholding model, which predicts cognitive clinical skill deficiencies in internal medicine physicians. A three-phase approach was then used to statistically validate the model performance. Subject Matter Expert (SME) panel reviews resulted in a 100% overall approval rate of the rule based model. Area under the receiver-operating characteristic curves calculated for each logistic regression curve resulted in values between 0.76 and 0.92, which indicated exceptional performance. Normality, skewness, and kurtosis were determined and confirmed that the distribution of values output from the thresholding model were unimodal and peaked, which confirmed effectiveness and generalizability. The validation has confirmed that the Skill-DETECT model has a strong ability to evaluate EHR data and support the identification of internal medicine cognitive clinical skills that are deficient or are of higher likelihood of becoming deficient and thus require remediation, which will allow both physician and medical organizations to fine tune training efforts. Copyright © 2017 Elsevier B.V. All rights reserved.

CME Flux Rope and Shock Identifications and Locations: Comparison of White Light Data, Graduated Cylindrical Shell Model, and MHD Simulations

NASA Technical Reports Server (NTRS)

Schmidt, J. M.; Cairns, Iver H.; Xie, Hong; St. Cyr, O. C.; Gopalswamy, N.

2016-01-01

Coronal mass ejections (CMEs) are major transient phenomena in the solar corona that are observed with ground-based and spacecraft-based coronagraphs in white light or with in situ measurements by spacecraft. CMEs transport mass and momentum and often drive shocks. In order to derive the CME and shock trajectories with high precision, we apply the graduated cylindrical shell (GCS) model to fit a flux rope to the CME directed toward STEREO A after about 19:00 UT on 29 November 2013 and check the quality of the heliocentric distance-time evaluations by carrying out a three-dimensional magnetohydrodynamic (MHD) simulation of the same CME with the Block Adaptive Tree Solar-Wind Roe Upwind Scheme (BATS-R-US) code. Heliocentric distances of the CME and shock leading edges are determined from the simulated white light images and magnetic field strength data. We find very good agreement between the predicted and observed heliocentric distances, showing that the GCS model and the BATS-R-US simulation approach work very well and are consistent. In order to assess the validity of CME and shock identification criteria in coronagraph images, we also compute synthetic white light images of the CME and shock. We find that the outer edge of a cloud-like illuminated area in the observed and predicted images in fact coincides with the leading edge of the CME flux rope and that the outer edge of a faint illuminated band in front of the CME leading edge coincides with the CME-driven shock front.

CME Interaction with Large-Scale Coronal Structures

NASA Technical Reports Server (NTRS)

Gopalswarny, Nat

2012-01-01

This talk presents some key observations that highlight the importance of CME interaction with other large scale structures such as CMEs and coronal holes . Such interactions depend on the phase of the solar cycle: during maximum, CMEs are ejected more frequently, so CME-CME interaction becomes dominant. During the rise phase, the polar coronal holes are strong, so the interaction between polar coronal holes and CMEs is important, which also leads to a possible increase in the number of interplanetary CMEs observed as magnetic clouds. During the declining phase, there are more equatorial coronal holes, so CMEs originating near these coronal holes are easily deflected. CMEs can be deflected toward and away from the Sun-Earth line resulting in interesting geospace consequences. For example, the largest geomagnetic storm of solar cycle 23 was due to a CME that was deflected towards the Sun-earth line from E22. CME deflection away from the Sun-Earth line diminishes the chance of a CME producing a geomagnetic storm. CME interaction in the coronagraphic field of view was first identified using enhanced radio emission, which is an indication of acceleration of low energy (approx.10 keV) electrons in the interaction site. CME interaction, therefore, may also have implications for proton acceleration. For example, solar energetic particle events typically occur with a higher intensity, whenever multiple CMEs occur in quick succession from the same source region. CME deflection may also have implications to the arrival of energetic particles to earth because magnetic connectivity may be changed by the interaction. I illustrate the above points using examples from SOHO, STEREO, Wind, and ACE data .

Initiation and Early Evolution of the Coronal Mass Ejection on 2009 May 13 from Extreme-ultraviolet and White-light Observations

NASA Astrophysics Data System (ADS)

Reva, A. A.; Ulyanov, A. S.; Bogachev, S. A.; Kuzin, S. V.

2014-10-01

We present the results of the observations of a coronal mass ejection (CME) that occurred on 2009 May 13. The most important feature of these observations is that the CME was observed from the very early stage (the solar surface) up to a distance of 15 solar radii (R ⊙). Below 2 R ⊙, we used the data from the TESIS extreme-ultraviolet telescopes obtained in the Fe 171 Å and He 304 Å lines, and above 2 R ⊙, we used the observations of the LASCO C2 and C3 coronagraphs. The CME was formed at a distance of 0.2-0.5R ⊙ from the Sun's surface as a U-shaped structure, which was observed both in the 171 Å images and in the white light. Observations in the He 304 Å line showed that the CME was associated with an erupting prominence, which was not located above—as the standard model predicts—but rather in the lowest part of the U-shaped structure close to the magnetic X point. The prominence location can be explained with the CME breakout model. Estimates showed that CME mass increased with time. The CME trajectory was curved—its heliolatitude decreased with time. The CME started at a latitude of 50° and reached the ecliptic plane at distances of 2.5 R ⊙. The CME kinematics can be divided into three phases: initial acceleration, main acceleration, and propagation with constant velocity. After the CME, onset GOES registered a sub-A-class flare.

Using the Coronal Evolution to Successfully Forward Model CMEs' In Situ Magnetic Profiles

NASA Astrophysics Data System (ADS)

Kay, C.; Gopalswamy, N.

2017-12-01

Predicting the effects of a coronal mass ejection (CME) impact requires knowing if impact will occur, which part of the CME impacts, and its magnetic properties. We explore the relation between CME deflections and rotations, which change the position and orientation of a CME, and the resulting magnetic profiles at 1 AU. For 45 STEREO-era, Earth-impacting CMEs, we determine the solar source of each CME, reconstruct its coronal position and orientation, and perform a ForeCAT (Forecasting a CME's Altered Trajectory) simulation of the coronal deflection and rotation. From the reconstructed and modeled CME deflections and rotations, we determine the solar cycle variation and correlations with CME properties. We assume no evolution between the outer corona and 1 AU and use the ForeCAT results to drive the ForeCAT In situ Data Observer (FIDO) in situ magnetic field model, allowing for comparisons with ACE and Wind observations. We do not attempt to reproduce the arrival time. On average FIDO reproduces the in situ magnetic field for each vector component with an error equivalent to 35% of the average total magnetic field strength when the total modeled magnetic field is scaled to match the average observed value. Random walk best fits distinguish between ForeCAT's ability to determine FIDO's input parameters and the limitations of the simple flux rope model. These best fits reduce the average error to 30%. The FIDO results are sensitive to changes of order a degree in the CME latitude, longitude, and tilt, suggesting that accurate space weather predictions require accurate measurements of a CME's position and orientation.

USING ForeCAT DEFLECTIONS AND ROTATIONS TO CONSTRAIN THE EARLY EVOLUTION OF CMEs

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kay, C.; Opher, M.; Colaninno, R. C.

2016-08-10

To accurately predict the space weather effects of the impacts of coronal mass ejection (CME) at Earth one must know if and when a CME will impact Earth and the CME parameters upon impact. In 2015 Kay et al. presented Forecasting a CME’s Altered Trajectory (ForeCAT), a model for CME deflections based on the magnetic forces from the background solar magnetic field. Knowing the deflection and rotation of a CME enables prediction of Earth impacts and the orientation of the CME upon impact. We first reconstruct the positions of the 2010 April 8 and the 2012 July 12 CMEs frommore » the observations. The first of these CMEs exhibits significant deflection and rotation (34° deflection and 58° rotation), while the second shows almost no deflection or rotation (<3° each). Using ForeCAT, we explore a range of initial parameters, such as the CME’s location and size, and find parameters that can successfully reproduce the behavior for each CME. Additionally, since the deflection depends strongly on the behavior of a CME in the low corona, we are able to constrain the expansion and propagation of these CMEs in the low corona.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bein, B. M.; Temmer, M.; Veronig, A. M.

Using combined STEREO-A and STEREO-B EUVI, COR1, and COR2 data, we derive deprojected coronal mass ejection (CME) kinematics and CME ''true'' mass evolutions for a sample of 25 events that occurred during 2007 December to 2011 April. We develop a fitting function to describe the CME mass evolution with height. The function considers both the effect of the coronagraph occulter, at the beginning of the CME evolution, and an actual mass increase. The latter becomes important at about 10-15 R{sub Sun} and is assumed to mostly contribute up to 20 R{sub Sun }. The mass increase ranges from 2% tomore » 6% per R{sub Sun} and is positively correlated to the total CME mass. Due to the combination of COR1 and COR2 mass measurements, we are able to estimate the ''true'' mass value for very low coronal heights (<3 R{sub Sun }). Based on the deprojected CME kinematics and initial ejected masses, we derive the kinetic energies and propelling forces acting on the CME in the low corona (<3 R{sub Sun }). The derived CME kinetic energies range between 1.0-66 Multiplication-Sign 10{sup 23} J, and the forces range between 2.2-510 Multiplication-Sign 10{sup 14} N.« less

Asymmetry in the CME-CME interaction process for the events from 2011 February 14-15

DOE Office of Scientific and Technical Information (OSTI.GOV)

Temmer, M.; Veronig, A. M.; Peinhart, V.

2014-04-20

We present a detailed study of the interaction process of two coronal mass ejections (CMEs) successively launched on 2011 February 14 (CME1) and 2011 February 15 (CME2). Reconstructing the three-dimensional shape and evolution of the flux ropes, we verify that the two CMEs interact. The frontal structure of both CMEs, measured along different position angles (PAs) over the entire latitudinal extent, reveals differences in the kinematics for the interacting flanks and the apexes. The interaction process is strongly PA-dependent in terms of timing as well as kinematical evolution. The central interaction occurs along PA-100°, which shows the strongest changes inmore » kinematics. During interaction, CME1 accelerates from ∼400 km s{sup –1} to ∼700 km s{sup –1} and CME2 decelerates from ∼1300 km s{sup –1} to ∼600 km s{sup –1}. Our results indicate that a simplified scenario such as inelastic collision may not be sufficient to describe the CME-CME interaction. The magnetic field structures of the intertwining flux ropes and the momentum transfer due to shocks each play an important role in the interaction process.« less

Conditions for the existence of Kelvin-Helmholtz instability in a CME

NASA Astrophysics Data System (ADS)

Jatenco-Pereira, Vera; Páez, Andrés; Falceta-Gonçalves, Diego; Opher, Merav

2015-08-01

The presence of Kelvin-Helmholtz instability (KHI) in the sheaths of the Coronal Mass Ejection (CME) has motivated several analysis and simulations to test their existence. In the present work we assume the existence of the KHI and propose a method to identify the regions where it is possible the development of KHI for a CME propagating in a fast and slow solar wind. We build functions for the velocities, densities and magnetic fields for two different zones of interaction between the solar wind and a CME. Based on the theory of magnetic KHI proposed by Chandrasekhar (1961) and we found conditions for the existence of KHI in the CME sheaths. Using this method it is possible to determine the range of parameters, in particular CME magnetic fields in which the KHI could exist. We conclude that KHI may exist in the two CME flanks and it is perceived that the zone with boundaries with the slow solar wind is more appropriated for the formation of the KHI.

Continuing medical education and professional revalidation in Europe: five case examples.

PubMed

Maisonneuve, Hervé; Matillon, Yves; Negri, Alfonso; Pallarés, Luis; Vigneri, Ricardo; Young, Howard L

2009-01-01

Since reliable information is scarce to describe continuing medical education (CME) and revalidation in Europe, we carried out a survey in 5 selected countries (France, Germany, Italy, Spain, and the United Kingdom). A tested questionnaire was sent to 2 experts per country (except in Germany), during August-September 2004. In the analyzed countries medical societies, medical associations, and employers are the main CME providers. Pharmaceutical industry sponsorship accounts on the average for more than 50% of the CME financing in those countries. In all 5 countries, CME accreditation systems exist; the national health authorities and medical associations are mainly responsible for them. In France, Italy, and Germany CME is mandatory; in Spain and the United Kingdom it is voluntary. CME credits/points are mainly used for professional career purposes. Revalidation systems have not been introduced in any of these countries, although in the United Kingdom it is being introduced as part of a relicensing process. Recommendations for the implementation of a European system of CME/CPD harmonization are made by the authors.

Medical education and communication companies involved in CME: an updated profile.

PubMed

Peterson, Eric D; Overstreet, Karen M; Parochka, Jacqueline N; Lemon, Michael R

2008-01-01

Medical Education and Communication Companies (MECCs) represent approximately 21% of the providers accredited by the Accreditation Council for Continuing Medical Education (ACCME), yet relatively little is known about these organizations in the greater continuing medical education (CME) community. Two prior studies described them, but powerful changes in the regulatory environment have impacted the structure and organization of these companies. The investigators administered a 32-item questionnaire to a select sample of 157 MECCs involved in CME, achieving a response rate of 50.3%. Of the responding organizations, 87% were accredited by the ACCME, with 27% also holding accreditation from the Accreditation Council for Pharmacy Education and the American Nurses Credentialing Center Commission on Accreditation. Eighty-six percent reported no immediate involvement of the company in promotional activities. Fifty-three percent of the survey responders reported being part of a larger organization that included companies involved in promotion, and 88% of these organizations reported implementation of firewalls designed to protect the independence of certified education. The survey reveals a sector that is largely privately held and moving from an organizational model that included both certified and promotional activities to one that includes only certified education. These changes, along with the implementation of firewalls to protect certified education from the promotional interests of other companies within their own corporate structure, may help to alleviate concerns about the independence of CME produced by MECCs. However, because MECCs continue to receive the majority of their support from commercial interests, the influence of funding is likely to be an area of lingering concern.

ON THE ROLE OF THE BACKGROUND OVERLYING MAGNETIC FIELD IN SOLAR ERUPTIONS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nindos, A.; Patsourakos, S.; Wiegelmann, T., E-mail: anindos@cc.uoi.gr

2012-03-20

The primary constraining force that inhibits global solar eruptions is provided by the overlying background magnetic field. Using magnetic field data from both the Helioseismic and Magnetic Imager aboard the Solar Dynamics Observatory and the spectropolarimeter of the Solar Optical Telescope aboard Hinode, we study the long-term evolution of the background field in active region AR11158 that produced three major coronal mass ejections (CMEs). The CME formation heights were determined using EUV data. We calculated the decay index -(z/B)({partial_derivative}B/{partial_derivative}z) of the magnetic field B (i.e., how fast the field decreases with height, z) related to each event from the timemore » of the active region emergence until well after the CMEs. At the heights of CME formation, the decay indices were 1.1-2.1. Prior to two of the events, there were extended periods (of more than 23 hr) where the related decay indices at heights above the CME formation heights either decreased (up to -15%) or exhibited small changes. The decay index related to the third event increased (up to 118%) at heights above 20 Mm within an interval that started 64 hr prior to the CME. The magnetic free energy and the accumulated helicity into the corona contributed the most to the eruptions by their increase throughout the flux emergence phase (by factors of more than five and more than two orders of magnitude, respectively). Our results indicate that the initiation of eruptions does not depend critically on the temporal evolution of the variation of the background field with height.« less

A tale of Congress, continuing medical education, and the history of medicine.

PubMed

Partin, Clyde; Kushner, Howard I; Horton, Mary E Kollmer

2014-04-01

Well-intentioned attempts by the Senate Finance Committee to improve the content and quality of continuing medical education (CME) offerings had the unanticipated consequence of decimating academically oriented history of medicine conferences. New guidelines intended to keep CME courses free of commercial bias from the pharmaceutical industry were worded in a fashion that caused CME officials at academic institutions to be reluctant to offer CME credit for history of medicine gatherings. At the 2013 annual conference of the American Association for the History of Medicine, we offered a novel solution for determining CME credit in line with current guidelines. We asked attendees to provide narrative critiques for each presentation for which they desired CME credit. In this essay, we evaluate the efficacy of this approach.

CMEs in the Heliosphere: I. A Statistical Analysis of the Observational Properties of CMEs Detected in the Heliosphere from 2007 to 2017 by STEREO/HI-1

NASA Astrophysics Data System (ADS)

Harrison, R. A.; Davies, J. A.; Barnes, D.; Byrne, J. P.; Perry, C. H.; Bothmer, V.; Eastwood, J. P.; Gallagher, P. T.; Kilpua, E. K. J.; Möstl, C.; Rodriguez, L.; Rouillard, A. P.; Odstrčil, D.

2018-05-01

We present a statistical analysis of coronal mass ejections (CMEs) imaged by the Heliospheric Imager (HI) instruments on board NASA's twin-spacecraft STEREO mission between April 2007 and August 2017 for STEREO-A and between April 2007 and September 2014 for STEREO-B. The analysis exploits a catalogue that was generated within the FP7 HELCATS project. Here, we focus on the observational characteristics of CMEs imaged in the heliosphere by the inner (HI-1) cameras, while following papers will present analyses of CME propagation through the entire HI fields of view. More specifically, in this paper we present distributions of the basic observational parameters - namely occurrence frequency, central position angle (PA) and PA span - derived from nearly 2000 detections of CMEs in the heliosphere by HI-1 on STEREO-A or STEREO-B from the minimum between Solar Cycles 23 and 24 to the maximum of Cycle 24; STEREO-A analysis includes a further 158 CME detections from the descending phase of Cycle 24, by which time communication with STEREO-B had been lost. We compare heliospheric CME characteristics with properties of CMEs observed at coronal altitudes, and with sunspot number. As expected, heliospheric CME rates correlate with sunspot number, and are not inconsistent with coronal rates once instrumental factors/differences in cataloguing philosophy are considered. As well as being more abundant, heliospheric CMEs, like their coronal counterparts, tend to be wider during solar maximum. Our results confirm previous coronagraph analyses suggesting that CME launch sites do not simply migrate to higher latitudes with increasing solar activity. At solar minimum, CMEs tend to be launched from equatorial latitudes, while at maximum, CMEs appear to be launched over a much wider latitude range; this has implications for understanding the CME/solar source association. Our analysis provides some supporting evidence for the systematic dragging of CMEs to lower latitude as they propagate outwards.

A Statistical Study of CME Properties and of the Correlation Between Flares and CMEs over Solar Cycles 23 and 24

NASA Astrophysics Data System (ADS)

Compagnino, A.; Romano, P.; Zuccarello, F.

2017-01-01

We investigated some properties of coronal mass ejections (CMEs), such as speed, acceleration, polar angle, angular width, and mass, using data acquired by the Large Angle Spectrometric Coronagraph (LASCO) onboard the Solar and Heliospheric Observatory (SOHO) from 31 July 1997 to 31 March 2014, i.e. during the Solar Cycles 23 and 24. We used two CME catalogs: one provided by the Coordinated Data Analysis Workshops (CDAW) Data Center and one obtained by the Computer Aided CME Tracking software (CACTus) detection algorithm. For each dataset, we found that the number of CMEs observed during the peak of Cycle 24 was higher than or comparable to the number during Cycle 23, although the photospheric activity during Cycle 24 was weaker than during Cycle 23. Using the CMEs detected by CACTus, we noted that the number of events [N] is of the same order of magnitude during the peaks of the two cycles, but the peak of the CME distribution during Cycle 24 is more extended in time (N > 1500 during 2012 and 2013). We ascribe the discrepancy between the CDAW and CACTus results to the observer bias for CME definition in the CDAW catalog. We also used a dataset containing 19,811 flares of C-, M-, and X-class observed by the Geostationary Operational Environmental Satellite (GOES) during the same period. Using both datasets, we studied the relationship between the mass ejected by the CMEs and the flux emitted during the corresponding flares: we found 11,441 flares that were temporally correlated with CMEs for CDAW and 9120 for CACTus. Moreover, we found a log-linear relationship between the flux of the flares integrated from the start to end in the 0.1 - 0.8 nm range and the CME mass. We also found some differences in the mean CMEs velocity and acceleration between the events associated with flares and those that were not.

Role of flotillins in the endocytosis of GPCR in salivary gland epithelial cells.

PubMed

Park, Moon-Yong; Kim, Nahyun; Wu, Li-Ling; Yu, Guang-Yan; Park, Kyungpyo

2016-08-05

Endocytosis has numerous functions in cellular homeostasis. Defects in the endocytic pathway of receptors may lead to dysfunction of salivary gland secretion. Therefore, elucidating the complex mechanisms of endocytosis may facilitate solutions for disease treatment and prevention. The muscarinic type 3 receptor (M3R), a G-protein-coupled receptor (GPCR) located in the plasma membrane, is involved in numerous physiological activities such as smooth muscle contraction and saliva secretion. M3R enters cells through clathrin-mediated endocytosis (CME), while flotillins (flot-1 and -2), highly conserved proteins residing in lipid-raft microdomains, make use of clathrin-independent endocytosis (CIE) for their internalization. Since these two proteins use two discrete pathways for endocytic entry, the association of flotillins with CME is poorly understood. We examined whether flotillins play a role in CME of M3R using immunoblotting, immunocytochemistry, confocal immunofluorescence microscopy, co-immunoprecipitation, and RNA interference techniques in secretory epithelial cells. Upon stimulation with a cholinergic agonist, M3R, flot-1, and flot-2 each internalized from the plasma membrane into intracellular sites. The addition of chlorpromazine and cytochalasin D, well-known inhibitors of CME, inhibited internalization of M3R via CME. Filipin III and methyl-β-cyclodextrin (mβCD) acting as lipid raft inhibitors disrupted internalization of flot-1/2 via CIE. Interestingly, filipin III and mβCD slightly reduced expression level of M3R whereas chlorpromazine and cytochalasin D did not affect internalization of the flotillin isoforms. M3R and flot-1/2 colocalized and interacted with each other as they entered the cytosol during limited periods of incubation. Moreover, knockdown of flot-1 or -2 by flotillin-specific siRNA prevented internalization and reduced the endocytic efficiency of M3R. Our results suggest that flot-1 and -2 are partially involved in CME of M3R by facilitating its internalization. Copyright © 2016 Elsevier Inc. All rights reserved.

MULTI-VIEWPOINT OBSERVATIONS OF A WIDELY DISTRIBUTED SOLAR ENERGETIC PARTICLE EVENT: THE ROLE OF EUV WAVES AND WHITE-LIGHT SHOCK SIGNATURES

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kouloumvakos, A.; Patsourakos, S.; Nindos, A.

2016-04-10

On 2012 March 7, two large eruptive events occurred in the same active region within 1 hr from each other. Each consisted of an X-class flare, a coronal mass ejection (CME), an extreme-ultraviolet (EUV) wave, and a shock wave. The eruptions gave rise to a major solar energetic particle (SEP) event observed at widely separated (∼120°) points in the heliosphere. From multi-viewpoint energetic proton recordings we determine the proton release times at STEREO B and A (STB, STA) and the first Lagrange point (L1) of the Sun–Earth system. Using EUV and white-light data, we determine the evolution of the EUVmore » waves in the low corona and reconstruct the global structure and kinematics of the first CME’s shock, respectively. We compare the energetic proton release time at each spacecraft with the EUV waves’ arrival times at the magnetically connected regions and the timing and location of the CME shock. We find that the first flare/CME is responsible for the SEP event at all three locations. The proton release at STB is consistent with arrival of the EUV wave and CME shock at the STB footpoint. The proton release time at L1 was significantly delayed compared to STB. Three-dimensional modeling of the CME shock shows that the particle release at L1 is consistent with the timing and location of the shock’s western flank. This indicates that at L1 the proton release did not occur in low corona but farther away from the Sun. However, the extent of the CME shock fails to explain the SEP event observed at STA. A transport process or a significantly distorted interplanetary magnetic field may be responsible.« less

Real-time Ensemble Forecasting of Coronal Mass Ejections using the WSA-ENLIL+Cone Model

NASA Astrophysics Data System (ADS)

Mays, M. L.; Taktakishvili, A.; Pulkkinen, A. A.; MacNeice, P. J.; Rastaetter, L.; Kuznetsova, M. M.; Odstrcil, D.

2013-12-01

Ensemble forecasting of coronal mass ejections (CMEs) provides significant information in that it provides an estimation of the spread or uncertainty in CME arrival time predictions due to uncertainties in determining CME input parameters. Ensemble modeling of CME propagation in the heliosphere is performed by forecasters at the Space Weather Research Center (SWRC) using the WSA-ENLIL cone model available at the Community Coordinated Modeling Center (CCMC). SWRC is an in-house research-based operations team at the CCMC which provides interplanetary space weather forecasting for NASA's robotic missions and performs real-time model validation. A distribution of n (routinely n=48) CME input parameters are generated using the CCMC Stereo CME Analysis Tool (StereoCAT) which employs geometrical triangulation techniques. These input parameters are used to perform n different simulations yielding an ensemble of solar wind parameters at various locations of interest (satellites or planets), including a probability distribution of CME shock arrival times (for hits), and geomagnetic storm strength (for Earth-directed hits). Ensemble simulations have been performed experimentally in real-time at the CCMC since January 2013. We present the results of ensemble simulations for a total of 15 CME events, 10 of which were performed in real-time. The observed CME arrival was within the range of ensemble arrival time predictions for 5 out of the 12 ensemble runs containing hits. The average arrival time prediction was computed for each of the twelve ensembles predicting hits and using the actual arrival time an average absolute error of 8.20 hours was found for all twelve ensembles, which is comparable to current forecasting errors. Some considerations for the accuracy of ensemble CME arrival time predictions include the importance of the initial distribution of CME input parameters, particularly the mean and spread. When the observed arrivals are not within the predicted range, this still allows the ruling out of prediction errors caused by tested CME input parameters. Prediction errors can also arise from ambient model parameters such as the accuracy of the solar wind background, and other limitations. Additionally the ensemble modeling setup was used to complete a parametric event case study of the sensitivity of the CME arrival time prediction to free parameters for ambient solar wind model and CME.

Initiation and early evolution of a Coronal Mass Ejection on May 13, 2009 from EUV and white-light observations

NASA Astrophysics Data System (ADS)

Reva, Anton; Kuzin, Sergey; Bogachev, Sergey; Ulyanov, Artyom

In this talk we present results of the observations of a CME, which occurred on May 13, 2009. The most important feature of these observations is that the CME was observed from the very beginning stage (the solar surface) up to the distance of 15 solar radii (R_⊙). Below 2 R_⊙ we used the data from the TESIS EUV telescopes obtained in the Fe 171 Å and He 304 Å lines, and above 2 R_⊙ we used the observations of the LASCO C2 and C3 coronagraphs. Using data of these three instruments, we have studied the evolution of the CME in details. The CME had a curved trajectory -- its helio-latitude decreased with time. The mass ejection originated at a latitudes of about 50(°) and reached the ecliptic plane at a distance of 2.5 R_⊙ from the Sun’s center. The CME velocity and acceleration increased as the CME went away from the Sun. At the distance of 15 R_⊙ from the Sun’s center the CME had a velocity of 250 km/s and an acceleration of 5 m/s(2) . The CME was not associated with a flare, and didn’t have an impulsive acceleration phase. The mass ejection had U-shaped structure which was observed both in the 171 Å images and in white-light. The CME was formed at a distance of about 0.2 -- 0.5 R_⊙ from the Sun’s surface. Observations in the line 304 Å showed that the CME was associated with the erupting prominence, which was located in the lowest part of the U-shaped structure close to the X-point of the magnetic reconnection. The prominence disappeared at the height of 0.4 R_⊙ above the solar limb. Some aspects of these observations can’t be explained in the standard CME model, which predicts that the prominence should be located inside the U-shaped structure, and the CME should be associated with a flare and have an impulsive acceleration phase.

Silica- and germania-based dual-ligand sol-gel organic-inorganic hybrid sorbents combining superhydrophobicity and π-π interaction. The role of inorganic substrate in sol-gel capillary microextraction.

PubMed

Seyyal, Emre; Malik, Abdul

2017-04-29

Principles of sol-gel chemistry were utilized to create silica- and germania-based dual-ligand surface-bonded sol-gel coatings providing enhanced performance in capillary microextraction (CME) through a combination of ligand superhydrophobicity and π-π interaction. These organic-inorganic hybrid coatings were prepared using sol-gel precursors with bonded perfluorododecyl (PF-C 12 ) and phenethyl (PhE) ligands. Here, the ability of the PF-C 12 ligand to provide enhanced hydrophobic interaction was advantageously combined with π-π interaction capability of the PhE moiety to attain the desired sorbent performance in CME. The effect of the inorganic sorbent component on microextraction performance of was explored by comparing microextraction characteristics of silica- and germania-based sol-gel sorbents. The germania-based dual-ligand sol-gel sorbent demonstrated superior CME performance compared to its silica-based counterpart. Thermogravimetric analysis (TGA) of the created silica- and germania-based dual-ligand sol-gel sorbents suggested higher carbon loading on the germania-based sorbent. This might be indicative of more effective condensation of the organic ligand-bearing sol-gel-active chemical species to the germania-based sol-gel network (than to its silica-based counterpart) evolving in the sol solution. The type and concentration of the organic ligands were varied in the sol-gel sorbents to fine-tune extraction selectivity toward different classes of analytes. Specific extraction (SE) values were used for an objective comparison of the prepared sol-gel CME sorbents. The sorbents with higher content of PF-C 12 showed remarkable affinity for aliphatic hydrocarbons. Compared to their single-ligand sol-gel counterparts, the dual-ligand sol-gel coatings demonstrated significantly superior CME performance in the extraction of alkylbenzenes, providing up to ∼65.0% higher SE values. The prepared sol-gel CME coatings provided low ng L -1 limit of detections (LOD) (4.2-26.3 ng L -1 ) for environmentally important analytes including polycyclic aromatic hydrocarbons, ketones and aliphatic hydrocarbons. In CME-GC experiments (n = 5), the capillary-to-capillary RSD value was ∼2.1%; such a low RSD value is indicative of excellent reproducibility of the sol-gel method used for the preparation of these CME coatings. The dual-ligand sol-gel coating provided stable performance in capillary microextraction of analytes from saline samples. Copyright © 2017 Elsevier B.V. All rights reserved.

Correlation of the CME Productivity of Solar Active Regions with Measures of their Global Nonpotentiality from Vector Magnetograms: Baseline Results

NASA Technical Reports Server (NTRS)

Falconer, David A.; Moore, Ron L.; Gary, G. Allen; Six, N. Frank (Technical Monitor)

2001-01-01

From conventional magnetograms and chromospheric and coronal images, it is known qualitatively that the fastest coronal mass ejections (CMEs) are magnetic explosions from sunspot active regions in which the magnetic field is globally strongly sheared and twisted from its minimum-energy potential configuration. In this paper, we present measurements from active-region vector magnetograms that begin to quantify the dependence of the CME productivity of an active region on the global nonpotentiality of its magnetic field. From each of 17 magnetograms of 12 bipolar active regions, we obtain a measure of the size of the active region (the magnetic flux content, phi) and three different measures of the global nonpotentiality (L(sub SS), the length of strong-shear, strong-field main neutral line; I(sub N), the net electric current arching from one polarity to the other; and alpha = muI(subN/phi), a flux-normalized measure of the field twist).

On the Collision Nature of Two Coronal Mass Ejections: A Review

NASA Astrophysics Data System (ADS)

Shen, Fang; Wang, Yuming; Shen, Chenglong; Feng, Xueshang

2017-08-01

Observational and numerical studies have shown that the kinematic characteristics of two or more coronal mass ejections (CMEs) may change significantly after a CME collision. The collision of CMEs can have a different nature, i.e. inelastic, elastic, and superelastic processes, depending on their initial kinematic characteristics. In this article, we first review the existing definitions of collision types including Newton's classical definition, the energy definition, Poisson's definition, and Stronge's definition, of which the first two were used in the studies of CME-CME collisions. Then, we review the recent research progresses on the nature of CME-CME collisions with the focus on which CME kinematic properties affect the collision nature. It is shown that observational analysis and numerical simulations can both yield an inelastic, perfectly inelastic, merging-like collision, or a high possibility of a superelastic collision. Meanwhile, previous studies based on a 3D collision picture suggested that a low approaching speed of two CMEs is favorable for a superelastic nature. Since CMEs are an expanding magnetized plasma structure, the CME collision process is quite complex, and we discuss this complexity. Moreover, the models used in both observational and numerical studies contain many limitations. All of the previous studies on collisions have not shown the separation of two colliding CMEs after a collision. Therefore the collision between CMEs cannot be considered as an ideal process in the context of a classical Newtonian definition. In addition, many factors are not considered in either observational analysis or numerical studies, e.g. CME-driven shocks and magnetic reconnections. Owing to the complexity of the CME collision process, a more detailed and in-depth observational analysis and simulation work are needed to fully understand the CME collision process.

Initiation and early evolution of the coronal mass ejection on 2009 May 13 from extreme-ultraviolet and white-light observations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Reva, A. A.; Ulyanov, A. S.; Bogachev, S. A.

2014-10-01

We present the results of the observations of a coronal mass ejection (CME) that occurred on 2009 May 13. The most important feature of these observations is that the CME was observed from the very early stage (the solar surface) up to a distance of 15 solar radii (R {sub ☉}). Below 2 R {sub ☉}, we used the data from the TESIS extreme-ultraviolet telescopes obtained in the Fe 171 Å and He 304 Å lines, and above 2 R {sub ☉}, we used the observations of the LASCO C2 and C3 coronagraphs. The CME was formed at a distancemore » of 0.2-0.5R {sub ☉} from the Sun's surface as a U-shaped structure, which was observed both in the 171 Å images and in the white light. Observations in the He 304 Å line showed that the CME was associated with an erupting prominence, which was not located above—as the standard model predicts—but rather in the lowest part of the U-shaped structure close to the magnetic X point. The prominence location can be explained with the CME breakout model. Estimates showed that CME mass increased with time. The CME trajectory was curved—its heliolatitude decreased with time. The CME started at a latitude of 50° and reached the ecliptic plane at distances of 2.5 R {sub ☉}. The CME kinematics can be divided into three phases: initial acceleration, main acceleration, and propagation with constant velocity. After the CME, onset GOES registered a sub-A-class flare.« less

Observations of the Coronal Mass Ejection with a Complex Acceleration Profile

NASA Astrophysics Data System (ADS)

Reva, A. A.; Kirichenko, A. S.; Ulyanov, A. S.; Kuzin, S. V.

2017-12-01

We study the coronal mass ejection (CME) with a complex acceleration profile. The event occurred on 2009 April 23. It had an impulsive acceleration phase, an impulsive deceleration phase, and a second impulsive acceleration phase. During its evolution, the CME showed signatures of different acceleration mechanisms: kink instability, prominence drainage, flare reconnection, and a CME–CME collision. The special feature of the observations is the usage of the TESIS EUV telescope. The instrument could image the solar corona in the Fe 171 Å line up to a distance of 2 {R}ȯ from the center of the Sun. This allows us to trace the CME up to the LASCO/C2 field of view without losing the CME from sight. The onset of the CME was caused by kink instability. The mass drainage occurred after the kink instability. The mass drainage played only an auxiliary role: it decreased the CME mass, which helped to accelerate the CME. The first impulsive acceleration phase was caused by the flare reconnection. We observed the two-ribbon flare and an increase of the soft X-ray flux during the first impulsive acceleration phase. The impulsive deceleration and the second impulsive acceleration phases were caused by the CME–CME collision. The studied event shows that CMEs are complex phenomena that cannot be explained with only one acceleration mechanism. We should seek a combination of different mechanisms that accelerate CMEs at different stages of their evolution.

Interactions between Coronal Mass Ejections Viewed in Coordinated Imaging and In Situ Observations

NASA Technical Reports Server (NTRS)

Liu, Ying D.; Luhmann, Janet G.; Moestl, Christian; Martinez-Oliveros, Juan C.; Bale, Stewart D.; Lin, Robert P.; Harrison, Richard A.; Temmer, Manuela; Webb, David F.; Odstrcil, Dusan

2013-01-01

The successive coronal mass ejections (CMEs) from 2010 July 30 - August 1 present us the first opportunity to study CME-CME interactions with unprecedented heliospheric imaging and in situ observations from multiple vantage points. We describe two cases of CME interactions: merging of two CMEs launched close in time and overtaking of a preceding CME by a shock wave. The first two CMEs on August 1 interact close to the Sun and form a merged front, which then overtakes the July 30 CME near 1 AU, as revealed by wide-angle imaging observations. Connections between imaging observations and in situ signatures at 1 AU suggest that the merged front is a shock wave, followed by two ejecta observed at Wind which seem to have already merged. In situ measurements show that the CME from July 30 is being overtaken by the shock at 1 AU and is significantly compressed, accelerated and heated. The interaction between the preceding ejecta and shock also results in variations in the shock strength and structure on a global scale, as shown by widely separated in situ measurements from Wind and STEREO B. These results indicate important implications of CME-CME interactions for shock propagation, particle acceleration and space weather forecasting.

Plasma Radiation and Acceleration Effectiveness of CME-driven Shocks

NASA Astrophysics Data System (ADS)

Gopalswamy, N.; Schmidt, J. M.

2008-05-01

CME-driven shocks are effective radio radiation generators and accelerators for Solar Energetic Particles (SEPs). We present simulated 3 D time-dependent radio maps of second order plasma radiation generated by CME- driven shocks. The CME with its shock is simulated with the 3 D BATS-R-US CME model developed at the University of Michigan. The radiation is simulated using a kinetic plasma model that includes shock drift acceleration of electrons and stochastic growth theory of Langmuir waves. We find that in a realistic 3 D environment of magnetic field and solar wind outflow of the Sun the CME-driven shock shows a detailed spatial structure of the density, which is responsible for the fine structure of type II radio bursts. We also show realistic 3 D reconstructions of the magnetic cloud field of the CME, which is accelerated outward by magnetic buoyancy forces in the diverging magnetic field of the Sun. The CME-driven shock is reconstructed by tomography using the maximum jump in the gradient of the entropy. In the vicinity of the shock we determine the Alfven speed of the plasma. This speed profile controls how steep the shock can grow and how stable the shock remains while propagating away from the Sun. Only a steep shock can provide for an effective particle acceleration.

Plasma radiation and acceleration effectiveness of CME-driven shocks

NASA Astrophysics Data System (ADS)

Schmidt, Joachim

CME-driven shocks are effective radio radiation generators and accelerators for Solar Energetic Particles (SEPs). We present simulated 3 D time-dependent radio maps of second order plasma radiation generated by CME-driven shocks. The CME with its shock is simulated with the 3 D BATS-R-US CME model developed at the University of Michigan. The radiation is simulated using a kinetic plasma model that includes shock drift acceleration of electrons and stochastic growth theory of Langmuir waves. We find that in a realistic 3 D environment of magnetic field and solar wind outflow of the Sun the CME-driven shock shows a detailed spatial structure of the density, which is responsible for the fine structure of type II radio bursts. We also show realistic 3 D reconstructions of the magnetic cloud field of the CME, which is accelerated outward by magnetic buoyancy forces in the diverging magnetic field of the Sun. The CME-driven shock is reconstructed by tomography using the maximum jump in the gradient of the entropy. In the vicinity of the shock we determine the Alfven speed of the plasma. This speed profile controls how steep the shock can grow and how stable the shock remains while propagating away from the Sun. Only a steep shock can provide for an effective particle acceleration.

76 FR 72414 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-23

... participating in a CME activity to determine the degree to which the learning activities with integrated EHC... awareness of and willingness to learn about results from comparative effectiveness research studies. The... learning programs for delivery through the Eisenberg Center for Clinical Decisions and Communications...

CPG2 Recruits Endophilin B2 to the Cytoskeleton for Activity-Dependent Endocytosis of Synaptic Glutamate Receptors.

PubMed

Loebrich, Sven; Benoit, Marc Robert; Konopka, Jaclyn Aleksandra; Cottrell, Jeffrey Richard; Gibson, Joanne; Nedivi, Elly

2016-02-08

Internalization of glutamate receptors at the postsynaptic membrane via clathrin-mediated endocytosis (CME) is a key mechanism for regulating synaptic strength. A role for the F-actin cytoskeleton in CME is well established, and recently, PKA-dependent association of candidate plasticity gene 2 (CPG2) with the spine-cytoskeleton has been shown to mediate synaptic glutamate receptor internalization. Yet, how the endocytic machinery is physically coupled to the actin cytoskeleton to facilitate glutamate receptor internalization has not been demonstrated. Moreover, there has been no distinction of endocytic-machinery components that are specific to activity-dependent versus constitutive glutamate receptor internalization. Here, we show that CPG2, through a direct physical interaction, recruits endophilin B2 (EndoB2) to F-actin, thus anchoring the endocytic machinery to the spine cytoskeleton and facilitating glutamate receptor internalization. Regulation of CPG2 binding to the actin cytoskeleton by protein kinase A directly impacts recruitment of EndoB2 and clathrin. Specific disruption of EndoB2 or the CPG2-EndoB2 interaction impairs activity-dependent, but not constitutive, internalization of both NMDA- and AMPA-type glutamate receptors. These results demonstrate that, through direct interactions with F-actin and EndoB2, CPG2 physically bridges the spine cytoskeleton and the endocytic machinery, and this tripartite association is critical specifically for activity-dependent CME of synaptic glutamate receptors. Copyright © 2016 Elsevier Ltd. All rights reserved.

Mitochondrial uncouplers inhibit clathrin-mediated endocytosis largely through cytoplasmic acidification

PubMed Central

Dejonghe, Wim; Kuenen, Sabine; Mylle, Evelien; Vasileva, Mina; Keech, Olivier; Viotti, Corrado; Swerts, Jef; Fendrych, Matyáš; Ortiz-Morea, Fausto Andres; Mishev, Kiril; Delang, Simon; Scholl, Stefan; Zarza, Xavier; Heilmann, Mareike; Kourelis, Jiorgos; Kasprowicz, Jaroslaw; Nguyen, Le Son Long; Drozdzecki, Andrzej; Van Houtte, Isabelle; Szatmári, Anna-Mária; Majda, Mateusz; Baisa, Gary; Bednarek, Sebastian York; Robert, Stéphanie; Audenaert, Dominique; Testerink, Christa; Munnik, Teun; Van Damme, Daniël; Heilmann, Ingo; Schumacher, Karin; Winne, Johan; Friml, Jiří; Verstreken, Patrik; Russinova, Eugenia

2016-01-01

ATP production requires the establishment of an electrochemical proton gradient across the inner mitochondrial membrane. Mitochondrial uncouplers dissipate this proton gradient and disrupt numerous cellular processes, including vesicular trafficking, mainly through energy depletion. Here we show that Endosidin9 (ES9), a novel mitochondrial uncoupler, is a potent inhibitor of clathrin-mediated endocytosis (CME) in different systems and that ES9 induces inhibition of CME not because of its effect on cellular ATP, but rather due to its protonophore activity that leads to cytoplasm acidification. We show that the known tyrosine kinase inhibitor tyrphostinA23, which is routinely used to block CME, displays similar properties, thus questioning its use as a specific inhibitor of cargo recognition by the AP-2 adaptor complex via tyrosine motif-based endocytosis signals. Furthermore, we show that cytoplasm acidification dramatically affects the dynamics and recruitment of clathrin and associated adaptors, and leads to reduction of phosphatidylinositol 4,5-biphosphate from the plasma membrane. PMID:27271794

The 2015 Summer Solstice Storm: One of the Major Geomagnetic Storms of Solar Cycle 24 Observed at Ground Level

NASA Astrophysics Data System (ADS)

Augusto, C. R. A.; Navia, C. E.; de Oliveira, M. N.; Nepomuceno, A. A.; Raulin, J. P.; Tueros, E.; de Mendonça, R. R. S.; Fauth, A. C.; Vieira de Souza, H.; Kopenkin, V.; Sinzi, T.

2018-05-01

We report on the 22 - 23 June 2015 geomagnetic storm that occurred at the summer solstice. There have been fewer intense geomagnetic storms during the current solar cycle, Solar Cycle 24, than in the previous cycle. This situation changed after mid-June 2015, when one of the largest solar active regions (AR 12371) of Solar Cycle 24 that was located close to the central meridian, produced several coronal mass ejections (CMEs) associated with M-class flares. The impact of these CMEs on the Earth's magnetosphere resulted in a moderate to severe G4-class geomagnetic storm on 22 - 23 June 2015 and a G2 (moderate) geomagnetic storm on 24 June. The G4 solstice storm was the second largest (so far) geomagnetic storm of Cycle 24. We highlight the ground-level observations made with the New-Tupi, Muonca, and the CARPET El Leoncito cosmic-ray detectors that are located within the South Atlantic Anomaly (SAA) region. These observations are studied in correlation with data obtained by space-borne detectors (ACE, GOES, SDO, and SOHO) and other ground-based experiments. The CME designations are taken from the Computer Aided CME Tracking (CACTus) automated catalog. As expected, Forbush decreases (FD) associated with the passing CMEs were recorded by these detectors. We note a peculiar feature linked to a severe geomagnetic storm event. The 21 June 2015 CME 0091 (CACTus CME catalog number) was likely associated with the 22 June summer solstice FD event. The angular width of CME 0091 was very narrow and measured {˜} 56° degrees seen from Earth. In most cases, only CME halos and partial halos lead to severe geomagnetic storms. We perform a cross-check analysis of the FD events detected during the rise phase of Solar Cycle 24, the geomagnetic parameters, and the CACTus CME catalog. Our study suggests that narrow angular-width CMEs that erupt in a westward direction from the Sun-Earth line can lead to moderate and severe geomagnetic storms. We also report on the strong solar proton radiation storm that began on 21 June. We did not find a signal from this SEP at ground level. The details of these observations are presented.

Online Continuing Medical Education for the Latin American Nephrology Community.

PubMed

Margolis, Alvaro; Gonzalez-Martinez, Francisco; Noboa, Oscar; Abbud-Filho, Mario; Lorier, Leticia; Nin, Marcelo; Silvariño, Ricardo; García, Sofía; Pefaur, Jacqueline; Greloni, Gustavo C; Noronha, Irene L; Lopez, Antonio; Ribeiro-Alves, María A; Tanús, Roberto; Fernández-Cean, Juan

2015-01-01

A continuing medical education (CME) course was implemented for Latin American nephrologists in 2013. The topic was Immunopathology in native and transplanted kidneys. The course was given in Spanish and Portuguese. The activities included a distance education seven-week asynchronous online modality with multiple educational strategies. Thirty hours of study workload were estimated to complete the course. Four hundred and ninety-eight physicians coming from 18 countries registered for the course; 442 of them participated in it. Of those who participated, 51% received a certificate of completion and 29% a certificate of participation. Sixty-five percent of registrants participated in the case discussions. Eighty-six percent were very satisfied and 13% were satisfied. Lack of time to devote to the course was the main limitation expressed (62%), while Internet access or difficulties in the use of technology were considered by only 12 and 6% of participants, respectively. There was a significant increase in knowledge between before and after the course; the average grade increased from 64 to 83%. In conclusion, technology-enabled education demonstrated potential to become an instrument for Latin American nephrologists.

GLOBAL ENERGETICS OF SOLAR FLARES. IV. CORONAL MASS EJECTION ENERGETICS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Aschwanden, Markus J., E-mail: aschwanden@lmsal.com

2016-11-01

This study entails the fourth part of a global flare energetics project, in which the mass m {sub cme}, kinetic energy E {sub kin}, and the gravitational potential energy E {sub grav} of coronal mass ejections (CMEs) is measured in 399 M and X-class flare events observed during the first 3.5 years of the Solar Dynamics Observatory (SDO) mission, using a new method based on the EUV dimming effect. EUV dimming is modeled in terms of a radial adiabatic expansion process, which is fitted to the observed evolution of the total emission measure of the CME source region. The modelmore » derives the evolution of the mean electron density, the emission measure, the bulk plasma expansion velocity, the mass, and the energy in the CME source region. The EUV dimming method is truly complementary to the Thomson scattering method in white light, which probes the CME evolution in the heliosphere at r ≳ 2 R {sub ⊙}, while the EUV dimming method tracks the CME launch in the corona. We compare the CME parameters obtained in white light with the LASCO/C2 coronagraph with those obtained from EUV dimming with the Atmospheric Imaging Assembly onboard the SDO for all identical events in both data sets. We investigate correlations between CME parameters, the relative timing with flare parameters, frequency occurrence distributions, and the energy partition between magnetic, thermal, nonthermal, and CME energies. CME energies are found to be systematically lower than the dissipated magnetic energies, which is consistent with a magnetic origin of CMEs.« less

Improving Our Understanding of the 3D Coronal Evolution of CME Propagation

NASA Astrophysics Data System (ADS)

Hess Webber, Shea A.; Thompson, Barbara J.; Ireland, Jack; Kwon, Ryun Young

2017-08-01

An improved understanding of the kinematic properties of CMEs and CME-associated phenomena has several impacts: 1) a less ambiguous method of mapping propagating structures into their inner coronal manifestations, 2) a clearer view of the relationship between the “main” CME and CME-associated brightenings, and 3) an improved identification of the heliospheric sources of shocks, Type II bursts, and SEPs. We present the results of a mapping technique that facilitates the separation of CMEs and CME-associated brightenings (such as shocks) from background corona. The Time Convolution Mapping Method (TCMM) segments coronagraph data to identify the time history of coronal evolution, the advantage being that the spatiotemporal evolution profiles allow users to separate features with different propagation characteristics. For example, separating “main” CME mass from CME-associated brightenings or shocks is a well-known obstacle, which the TCMM aids in differentiating. A TCMM CME map is made by first recording the maximum value each individual pixel in the image reaches during the traversal of the CME. Then the maximum value is convolved with an index to indicate the time that the pixel reached that value. The TCMM user is then able to identify continuous “kinematic profiles,” indicating related kinematic behavior, and also identify breaks in the profiles that indicate a discontinuity in kinematic history (i.e. different structures or different propagation characteristics). The maps obtained from multiple spacecraft viewpoints (i.e., STEREO and SOHO) can then be fit with advanced structural models to obtain the 3D properties of the evolving phenomena.

Impact of continuing medical education in cancer diagnosis on GP knowledge, attitude and readiness to investigate - a before-after study.

PubMed

Toftegaard, Berit Skjødeberg; Bro, Flemming; Falborg, Alina Zalounina; Vedsted, Peter

2016-07-26

Continuing medical education (CME) in earlier cancer diagnosis was launched in Denmark in 2012 as part of the Danish National Cancer Plan. The CME programme was introduced to improve the recognition among general practitioners (GPs) of symptoms suggestive of cancer and improve the selection of patients requiring urgent investigation. This study aims to explore the effect of CME on GP knowledge about cancer diagnosis, attitude towards own role in cancer detection, self-assessed readiness to investigate and cancer risk assessment of urgently referred patients. We conducted a before-after study in the Central Denmark Region including 831 GPs assigned to one of eight geographical clusters. All GPs were invited to participate in the CME at three-week intervals between clusters. A questionnaire focusing on knowledge, attitude and clinical vignettes was sent to each GP one month before and seven months after the CME. The GPs were also asked to assess the risk of cancer in patients urgently referred to a fast-track cancer pathway during an eight-month period. CME-participating GPs were compared with reference (non-participating) GPs by analysing before-after differences. One quarter of all GPs participated in the CME. 202 GPs (24.3 %) completed both the baseline and the follow-up questionnaires. 532 GPs (64.0 %) assessed the risk of cancer before the CME and 524 GPs (63.1 %) assessed the risk of cancer after the CME in urgently referred consecutive patients. Compared to the reference group, CME-participating GPs statistically significantly improved their understanding of a rational probability of diagnosing cancer among patients urgently referred for suspected cancer, increased their knowledge of cancer likelihood in a 50-year-old referred patient and lowered the assessed risk of cancer in urgently referred patients. The standardised CME lowered the GP-assessed cancer risk of urgently referred patients, whereas the effect on knowledge about cancer diagnosis and attitude towards own role in cancer detection was limited. No effect was found on the GPs' readiness to investigate. CME may be effective for optimising the interpretation of cancer symptoms and thereby improve the selection of patients for urgent cancer referral. NCT02069470 on ClinicalTrials.gov. Retrospectively registered, 1/29/2014.

Application of manures to mitigate the harmful effects of electrokinetic remediation of heavy metals on soil microbial properties in polluted soils.

PubMed

Tahmasbian, Iman; Safari Sinegani, Ali Akbar; Nguyen, Thi Thu Nhan; Che, Rongxiao; Phan, Thuc D; Hosseini Bai, Shahla

2017-12-01

Ethylenediaminetetraacetic acid (EDTA) used with electrokinetic (EK) to remediate heavy metal-polluted soils is a toxic chelate for soil microorganisms. Therefore, this study aimed to evaluate the effects of alternative organic chelates to EDTA on improving the microbial properties of a heavy metal-polluted soil subjected to EK. Cow manure extract (CME), poultry manure extract (PME) and EDTA were applied to a lead (Pb) and zinc (Zn)-polluted calcareous soil which were subjected to two electric intensities (1.1 and 3.3 v/cm). Soil carbon pools, microbial activity, microbial abundance (e.g., fungal, actinomycetes and bacterial abundances) and diethylenetriaminepentaacetic acid (DTPA)-extractable Pb and Zn (available forms) were assessed in both cathodic and anodic soils. Applying the EK to soil decreased all the microbial variables in the cathodic and anodic soils in the absence or presence of chelates. Both CME and PME applied with two electric intensities decreased the negative effect of EK on soil microbial variables. The lowest values of soil microbial variables were observed when EK was combined with EDTA. The following order was observed in values of soil microbial variables after treating with EK and chelates: EK + CME or EK + PME > EK > EK + EDTA. The CME and PME could increase the concentrations of available Pb and Zn, although the increase was less than that of EDTA. Overall, despite increasing soil available Pb and Zn, the combination of EK with manures (CME or PME) mitigated the negative effects of using EK on soil microbial properties. This study suggested that the synthetic chelates such as EDTA could be replaced with manures to alleviate the environmental risks of EK application.

A Second Las17 Monomeric Actin-Binding Motif Functions in Arp2/3-Dependent Actin Polymerization During Endocytosis

PubMed Central

Feliciano, Daniel; Tolsma, Thomas O.; Farrell, Kristen B.; Aradi, Al; Di Pietro, Santiago M.

2018-01-01

During clathrin-mediated endocytosis (CME), actin assembly provides force to drive vesicle internalization. Members of the Wiskott–Aldrich syndrome protein (WASP) family play a fundamental role stimulating actin assembly. WASP family proteins contain a WH2 motif that binds globular actin (G-actin) and a central-acidic motif that binds the Arp2/3 complex, thus promoting the formation of branched actin filaments. Yeast WASP (Las17) is the strongest of five factors promoting Arp2/3-dependent actin polymerization during CME. It was suggested that this strong activity may be caused by a putative second G-actin-binding motif in Las17. Here, we describe the in vitro and in vivo characterization of such Las17 G-actin-binding motif (LGM) and its dependence on a group of conserved arginine residues. Using the yeast two-hybrid system, GST-pulldown, fluorescence polarization and pyrene-actin polymerization assays, we show that LGM binds G-actin and is necessary for normal Arp2/3-mediated actin polymerization in vitro. Live-cell fluorescence microscopy experiments demonstrate that LGM is required for normal dynamics of actin polymerization during CME. Further, LGM is necessary for normal dynamics of endocytic machinery components that are recruited at early, intermediate and late stages of endocytosis, as well as for optimal endocytosis of native CME cargo. Both in vitro and in vivo experiments show that LGM has relatively lower potency compared to the previously known Las17 G-actin-binding motif, WH2. These results establish a second G-actin-binding motif in Las17 and advance our knowledge on the mechanism of actin assembly during CME. PMID:25615019

Sun-to-Earth simulations of geo-effective Coronal Mass Ejections with EUHFORIA: a heliospheric-magnetospheric model chain approach

NASA Astrophysics Data System (ADS)

Scolini, C.; Verbeke, C.; Gopalswamy, N.; Wijsen, N.; Poedts, S.; Mierla, M.; Rodriguez, L.; Pomoell, J.; Cramer, W. D.; Raeder, J.

2017-12-01

Coronal Mass Ejections (CMEs) and their interplanetary counterparts are considered to be the major space weather drivers. An accurate modelling of their onset and propagation up to 1 AU represents a key issue for more reliable space weather forecasts, and predictions about their actual geo-effectiveness can only be performed by coupling global heliospheric models to 3D models describing the terrestrial environment, e.g. magnetospheric and ionospheric codes in the first place. In this work we perform a Sun-to-Earth comprehensive analysis of the July 12, 2012 CME with the aim of testing the space weather predictive capabilities of the newly developed EUHFORIA heliospheric model integrated with the Gibson-Low (GL) flux rope model. In order to achieve this goal, we make use of a model chain approach by using EUHFORIA outputs at Earth as input parameters for the OpenGGCM magnetospheric model. We first reconstruct the CME kinematic parameters by means of single- and multi- spacecraft reconstruction methods based on coronagraphic and heliospheric CME observations. The magnetic field-related parameters of the flux rope are estimated based on imaging observations of the photospheric and low coronal source regions of the eruption. We then simulate the event with EUHFORIA, testing the effect of the different CME kinematic input parameters on simulation results at L1. We compare simulation outputs with in-situ measurements of the Interplanetary CME and we use them as input for the OpenGGCM model, so to investigate the magnetospheric response to solar perturbations. From simulation outputs we extract some global geomagnetic activity indexes and compare them with actual data records and with results obtained by the use of empirical relations. Finally, we discuss the forecasting capabilities of such kind of approach and its future improvements.

Evolution and propagation of the July 23, 2012, CME-driven shock: A 3-D MHD simulation result

NASA Astrophysics Data System (ADS)

Wu, S. T.; Dryer, Ph D., M.; Liou, K.; Wu, C. C.

2016-12-01

The interplanetary shock associated with the July 23, 2012 CME event is studied with the H3DMHD 3-D magnetohydrodynamic (MHD) simulation model. This backside CME event has been actively studied, probably due to its extremely fast propagating speed ( 2000 km/s) and large magnetic field magnitude ( 100 nT) at 1 AU. Some workers even compared this even with the Carrington event. In this study we focus on the acceleration and deceleration of the shock at the cobpoints. The H3DMHD is a data (photospheric magnetic field) driven model, which combines the HAF kinematic model for regions sunward of 18 Rs and the 3DMHD ideal MHD model for antisunward of 18 Rs up to 1.5 AU. To simulate the CME a gaussian velocity pulse is manually applied to the inner simulation boundary at 2.5 Rs above the flare site, with the initial peak velocity ( 3000 km/s) taken from the coronagraph measurements. In situ measurements of the solar wind parameters at STEREO-A are used to validate the simulation result, in particular the arrival time of the shock at STEREO-A. It is found, for this particular event, the CME-driven shock strength varies significantly across the shock surface. In general, the shock strength slowly weakened while propagating outward but stayed hypersonic (> Mach 5) for a cone shape region of a few 10's of degrees surrounding the shock nose. We will discuss our result in the context of the acceleration/deceleration of shock in a much slower background solar wind and the relationship of the shock strength with the flux of solar energetic particles observed by STEREO-A.

New Aspects of a Lid-Removal Mechanism in the Onset of a SEP-Producing Eruption Sequence

NASA Technical Reports Server (NTRS)

Sterling, Alphonse C.; Moore, Ronald L.; Falconer, David A.; Knox, Javon M.

2014-01-01

We examine a sequence of two ejective eruptions from a single active region on 2012 January 23, using magnetograms and EUV images from SDO/HMI and SDO/AIA, and EUV images from STEREO. Cheng et al. (2013) showed that the first eruption's ("Eruption 1'') flux rope was apparent only in "hotter'' AIA channels, and that it removed overlying field that allowed the second eruption (``Eruption 2'') to begin via ideal MHD instability; here we say Eruption 2 began via a ``lid removal'' mechanism. We show that during Eruption-1's onset, its flux rope underwent ``tether weakening'' (TW) reconnection with the field of an adjacent active region. Standard flare loops from Eruption 1 developed over Eruption-2's flux rope and enclosed filament, but these overarching new loops were unable to confine that flux rope/filament. Eruption-1's flare loops, from both TW reconnection and standard-flare-model internal reconnection, were much cooler than Eruption-2's flare loops (GOES thermal temperatures of approx. 9 MK compared to approx. 14 MK). This eruption sequence produced a strong solar energetic particle (SEP) event (10 MeV protons, >10(exp 3) pfu for 43 hrs), apparently starting when Eruption-2's CME blasted through Eruption-1's CME at 5-10 R_s. This occurred because the two CMEs originated in close proximity and in close time sequence: Eruption-1's fast rise started soon after the TW reconnection; the lid removal by Eruption-1's ejection triggered the slow onset of Eruption 2; and Eruption-2's CME, which started approx. 1 hr later, was three times faster than Eruption-1's CME.

Transforming in-situ observations of CME-driven shock accelerated protons into the shock's reference frame.

NASA Astrophysics Data System (ADS)

Robinson, I. M.; Simnett, G. M.

2005-07-01

We examine the solar energetic particle event following solar activity from 14, 15 April 2001 which includes a "bump-on-the-tail" in the proton energy spectra at 0.99 AU from the Sun. We find this population was generated by a CME-driven shock which arrived at 0.99 AU around midnight 18 April. As such this population represents an excellent opportunity to study in isolation, the effects of proton acceleration by the shock. The peak energy of the bump-on-the-tail evolves to progressively lower energies as the shock approaches the observing spacecraft at the inner Lagrange point. Focusing on the evolution of this peak energy we demonstrate a technique which transforms these in-situ spectral observations into a frame of reference co-moving with the shock whilst making allowance for the effects of pitch angle scattering and focusing. The results of this transform suggest the bump-on-the-tail population was not driven by the 15 April activity but was generated or at least modulated by a CME-driven shock which left the Sun on 14 April. The existence of a bump-on-the-tail population is predicted by models in Rice et al. (2003) and Li et al. (2003) which we compare with observations and the results of our analysis in the context of both the 14 April and 15 April CMEs. We find an origin of the bump-on-the-tail at the 14 April CME-driven shock provides better agreement with these modelled predictions although some discrepancy exists as to the shock's ability to accelerate 100 MeV protons. Keywords. Solar physics, astrophysics and astronomy (Energetic particles; Flares and mass ejections) Space plasma physics (Transport processes)

Online continuing medical education as a key link for successful noncommunicable disease self-management: the CASALUD™ Model.

PubMed

Gallardo-Rincón, Héctor; Saucedo-Martínez, Rodrigo; Mujica-Rosales, Ricardo; Lee, Evan M; Israel, Amy; Torres-Beltran, Braulio; Quijano-González, Úrsula; Atkinson, Elena Rose; Kuri-Morales, Pablo; Tapia-Conyer, Roberto

2017-01-01

The purpose of this study is to evaluate how the benefits of online continuing medical education (CME) provided to health care professionals traveled along a patient "educational chain". In this study, the educational chain begins with the influence that CME can have on the quality of health care, with subsequent influence on patient knowledge, disease self-management, and disease biomarkers. A total of 422 patients with at least one noncommunicable disease (NCD) treated in eight different Mexican public health clinics were followed over 3 years. All clinics were participants in the CASALUD Model, an NCD care model for primary care, where all clinic staff were offered CME. Data were collected through a questionnaire on health care, patient disease knowledge, and self-management behaviors; blood samples and anthropometric measurements were collected to measure patient disease biomarkers. Between 2013 and 2015, the indexes measuring quality of health care, patient health knowledge, and diabetes self-management activities rose moderately but significantly (from 0.54 to 0.64, 0.80 to 0.84, and 0.62 to 0.67, respectively). Performing self-care activities - including owning and using a glucometer and belonging to a disease support group - saw the highest increase (from 0.65 to 0.75). A1C levels increased between 2013 and 2015 from 7.95 to 8.41% (63-68 mmol/mol) ( P <0.001), and blood pressure decreased between 2014 and 2015 from 143.7/76.8 to 137.5/74.4 (systolic/diastolic reported in mmHg) ( P <0.001). The mean levels of other disease biomarkers remained statistically unchanged, despite the improvements seen in the previous "links" of the educational chain. Online CME can effect certain changes in the educational chain linking quality of health care, patient knowledge, and self-management behaviors. However, in order to assure adequate NCD control, the entire health care system must be improved in tandem. Online CME programs, such as CASALUD's, are feasible strategies for impacting changes in disease self-management at a clinic level throughout a country.

Online continuing medical education as a key link for successful noncommunicable disease self-management: the CASALUD™ Model

PubMed Central

Gallardo-Rincón, Héctor; Saucedo-Martínez, Rodrigo; Mujica-Rosales, Ricardo; Lee, Evan M; Israel, Amy; Torres-Beltran, Braulio; Quijano-González, Úrsula; Atkinson, Elena Rose; Kuri-Morales, Pablo; Tapia-Conyer, Roberto

2017-01-01

Purpose The purpose of this study is to evaluate how the benefits of online continuing medical education (CME) provided to health care professionals traveled along a patient “educational chain”. In this study, the educational chain begins with the influence that CME can have on the quality of health care, with subsequent influence on patient knowledge, disease self-management, and disease biomarkers. Methods A total of 422 patients with at least one noncommunicable disease (NCD) treated in eight different Mexican public health clinics were followed over 3 years. All clinics were participants in the CASALUD Model, an NCD care model for primary care, where all clinic staff were offered CME. Data were collected through a questionnaire on health care, patient disease knowledge, and self-management behaviors; blood samples and anthropometric measurements were collected to measure patient disease biomarkers. Results Between 2013 and 2015, the indexes measuring quality of health care, patient health knowledge, and diabetes self-management activities rose moderately but significantly (from 0.54 to 0.64, 0.80 to 0.84, and 0.62 to 0.67, respectively). Performing self-care activities – including owning and using a glucometer and belonging to a disease support group – saw the highest increase (from 0.65 to 0.75). A1C levels increased between 2013 and 2015 from 7.95 to 8.41% (63–68 mmol/mol) (P<0.001), and blood pressure decreased between 2014 and 2015 from 143.7/76.8 to 137.5/74.4 (systolic/diastolic reported in mmHg) (P<0.001). The mean levels of other disease biomarkers remained statistically unchanged, despite the improvements seen in the previous “links” of the educational chain. Conclusion Online CME can effect certain changes in the educational chain linking quality of health care, patient knowledge, and self-management behaviors. However, in order to assure adequate NCD control, the entire health care system must be improved in tandem. Online CME programs, such as CASALUD’s, are feasible strategies for impacting changes in disease self-management at a clinic level throughout a country. PMID:29089779

Management of pregnancy in women with genetic disorders, Part 1: Disorders of the connective tissue, muscle, vascular, and skeletal systems.

PubMed

Chetty, Shilpa Prema; Shaffer, Brian L; Norton, Mary E

2011-11-01

Due to early diagnosis and increasingly effective medical advances, the number of women with various genetic syndromes who are undergoing pregnancy is increasing, and this represents an important issue for providers of obstetric care. Each year more women with genetic disease reach childbearing age. Advances in assisted reproductive technology have enabled pregnancy in a cohort of woman who may experience impaired fertility due to their underlying diagnosis. Management of these women requires coordination of care by healthcare providers from multiple specialties to optimize outcomes. Potentially serious medical issues specific to each diagnosis often exist in the preconception, antepartum, intrapartum, and postpartum periods, all of which must be recognized to allow timely diagnosis and treatment. The fetus may also face issues related to risk for inheritance of the genetic disorder itself, as well as risks related to the chronic disease status of the mother. This article will explore the issues faced by women with various genetic disorders that may affect connective tissue, muscular, vascular, and skeletal systems. Obstetricians & Gynecologists and Family Physicians. After the completing the CME activity, physicians should be better able to classify the cardiovascular manifestations observed in Marfan syndrome and Ehlers-Danlos, evaluate prenatal diagnostic options and limitations for various genetic syndromes, assess the risks to the fetus in women with various genetic syndromes. Determine whether there is a preferred mode of delivery for pregnant patients with various genetic syndromes described in this paper.

Phenotypic expression of polycystic ovary syndrome in South Asian women.

PubMed

Mehta, Jaya; Kamdar, Vikram; Dumesic, Daniel

2013-03-01

Polycystic ovary syndrome (PCOS) occurs in 6% to 10% of women and, as the most common worldwide endocrinopathy of reproductive-aged women, is linked to a constellation of reproductive and metabolic abnormalities, including anovulatory infertility, hirsutism, acne, and insulin resistance in association with metabolic syndrome. Despite a genetic component to PCOS, ethnicity plays an important role in the phenotypic expression of PCOS, with South Asian PCOS women having more severe reproductive and metabolic symptoms than other ethnic groups. South Asians with PCOS seek medical care at an earlier age for reproductive abnormalities; have a higher degree of hirsutism, infertility, and acne; and experience lower live birth rates following in vitro fertilization than do whites with PCOS. Similarly, South Asians with PCOS have a higher prevalence of insulin resistance and metabolic syndrome than do other PCOS-related ethnic groups of a similar body mass index. Inheritance of PCOS appears to have a complex genetic basis, including genetic differences based on ethnicity, which interact with lifestyle and other environmental factors to affect PCOS phenotypic expression. Obstetricians and Gynecologists, Family Physicians Learning Objectives: After completing this CME activity, physicians should be better able to state an ethnic difference in reproductive dysfunction between South Asian and white women with polycystic ovary syndrome (PCOS), state an ethnic difference in metabolic dysfunction between South Asian and white women with PCOS, identify a genetic abnormality found in South Asian women with PCOS, and list 2 environmental factors that predispose South Asian women to metabolic dysfunction.

The Width of a CME and the Source of the Driving Magnetic Explosion

NASA Technical Reports Server (NTRS)

Moore, R. L.; Sterling, A. C.; Suess, S. T.

2007-01-01

We show that the strength of the magnetic field in the area covered by the flare arcade following a CME-producing ejective solar eruption can be estimated from the final angular width of the CME in the outer corona and the final angular width of the flare arcade. We assume (1) the flux-rope plasmoid ejected from the flare site becomes the interior of the CME plasmoid, (2) in the outer corona the CME is roughly a "spherical plasmoid with legs" shaped like a light bulb, and (3) beyond some height in or below the outer corona the CME plasmoid is in lateral pressure balance with the surrounding magnetic field. The strength of the nearly radial magnetic field in the outer corona is estimated from the radial component of the interplanetary magnetic field measured by Ulysses. We apply this model to three well-observed CMEs that exploded from flare regions of extremely different size and magnetic setting. In each event, the estimated source-region field strength is appropriate for the magnetic setting of the flare. This agreement indicates via the model that CMEs (1) are propelled by the magnetic field of the CME plasmoid pushing against the surrounding magnetic field, and (2) can explode from flare regions that are laterally far offset from the radial path of the CME in the outer corona.

Influence of Convective Effect of Solar Winds on the CME Transit Time

NASA Astrophysics Data System (ADS)

Sun, Lu-yuan

2017-10-01

Based on an empirical model for predicting the transit time of coronal mass ejections (CMEs) proposed by Gopalswamy, 52 CME events which are related to the geomagnetic storms of Dst < -50 nT, and 10 CME events which caused extremely strong geomagnetic storms (Dst < -200 nT) in 1996- 2007 are selected, and combined with the observational data of the interplanetary solar winds that collected by the ACE satellite at 1AU, to analyze the influence of convective effect of ambient solar winds on the prediction of the CME transit time when it arrives at a place of 1 AU. After taking the convective effect of ambient solar winds into account, the standard deviation of predictions is reduced from 16.5 to 11.4 hours for the 52 CME events, and the prediction error is less than 15 hours for 68% of these events; while the standard deviation of predictions is reduced from 10.6 to 6.5 hours for the 10 CME events that caused extremely strong geomagnetic storms, and the prediction error is less than 5 hours for 6 of the 10 events. These results show that taking the convective effect of ambient solar winds into account can reduce the standard deviation of the predicted CME transit time, hence the convective effect of solar winds plays an important role for predicting the transit times of CME events.

Associations between teaching effectiveness and participant self-reflection in continuing medical education.

PubMed

Ratelle, John T; Bonnes, Sara L; Wang, Amy T; Mahapatra, Saswati; Schleck, Cathy D; Mandrekar, Jayawant N; Mauck, Karen F; Beckman, Thomas J; Wittich, Christopher M

2017-07-01

Effective medical educators can engage learners through self-reflection. However, little is known about the relationships between teaching effectiveness and self-reflection in continuing medical education (CME). We aimed to determine associations between presenter teaching effectiveness and participant self-reflection in conference-based CME. This cross-sectional study evaluated presenters and participants at a national CME course. Participants provided CME teaching effectiveness (CMETE) ratings and self-reflection scores for each presentation. Overall CMETE and CME self-reflection scores (five-point Likert scale with one as strongly disagree and five as strongly agree) were averaged for each presentation. Correlations were measured among self-reflection, CMETE, and presentation characteristics. In total, 624 participants returned 430 evaluations (response, 68.9%) for the 38 presentations. Correlation between CMETE and self-reflection was medium (Pearson correlation, 0.3-0.5) or large (0.5-1.0) for most presentations (n = 33, 86.9%). Higher mean (SD) CME reflection scores were associated with clinical cases (3.66 [0.12] vs. 3.48 [0.14]; p = 0.003) and audience response (3.66 [0.12] vs. 3.51 [0.14]; p = 0.005). To our knowledge, this is the first study to show a relationship between teaching effectiveness and participant self-reflection in conference-based CME. Presenters should consider using clinical cases and audience response systems to increase teaching effectiveness and promote self-reflection among CME learners.

Global Energetics in Solar Flares and Coronal Mass Ejections

NASA Astrophysics Data System (ADS)

Aschwanden, Markus J.

2017-08-01

We present a statistical study of the energetics of coronal mass ejections (CME) and compare it with the magnetic, thermal, and nonthermal energy dissipated in flares. The physical parameters of CME speeds, mass, and kinetic energies are determined with two different independent methods, i.e., the traditional white-light scattering method using LASCO/SOHO data, and the EUV dimming method using AIA/SDO data. We analyze all 860 GOES M- and X-class flare events observed during the first 7 years (2010-2016) of the SDO mission. The new ingredients of our CME modeling includes: (1) CME geometry in terms of a self-similar adiabatic expansion, (2) DEM analysis of CME mass over entire coronal temperature range, (3) deceleration of CME due to gravity force which controls the kinetic and potentail CME energy as a function of time, (4) the critical speed that controls eruptive and confined CMEs, (5) the relationship between the center-of-mass motion during EUV dimming and the leading edge motion observed in white-light coronagraphs. Novel results are: (1) Physical parameters obtained from both the EUV dimming and white-light method can be reconciled; (2) the equi-partition of CME kinetic and thermal flare energy; (3) the Rosner-Tucker-Vaiana scaling law. We find that the two methods in EUV and white-light wavelengths are highly complementary and yield more complete models than each method alone.

Hidradenitis Suppurativa

MedlinePlus

... involved areas should be cleaned daily using an antibacterial soap, as this will reduce any odor associated ... 7/6/2016 Disclosure to members regarding CME activities Calendar more 10/9/2018 » 10/13/2018 ...

Verification of real-time WSA-ENLIL+Cone simulations of CME arrival-time at the CCMC/SWRC from 2010-2016

NASA Astrophysics Data System (ADS)

Wold, A. M.; Mays, M. L.; Taktakishvili, A.; Odstrcil, D.; MacNeice, P. J.; Jian, L. K.

2017-12-01

The Wang-Sheeley-Arge (WSA)-ENLIL+Cone model is used extensively in space weather operations world-wide to model CME propagation. As such, it is important to assess its performance. We present validation results of the WSA-ENLIL+Cone model installed at the Community Coordinated Modeling Center (CCMC) and executed in real-time by the CCMC/Space Weather Research Center (SWRC). CCMC/SWRC uses the WSA-ENLIL+Cone model to predict CME arrivals at NASA missions throughout the inner heliosphere. In this work we compare model predicted CME arrival-times to in-situ ICME leading edge measurements near Earth, STEREO-A and STEREO-B for simulations completed between March 2010-December 2016 (over 1,800 CMEs). We report hit, miss, false alarm, and correct rejection statistics for all three spacecraft. For all predicted CME arrivals, the hit rate is 0.5, and the false alarm rate is 0.1. For the 273 events where the CME was predicted to arrive at Earth, STEREO-A, or STEREO-B and we observed an arrival (hit), the mean absolute arrival-time prediction error was 10.4 ± 0.9 hours, with a tendency to early prediction error of -4.0 hours. We show the dependence of the arrival-time error on CME input parameters. We also explore the impact of the multi-spacecraft observations used to initialize the model CME inputs by comparing model verification results before and after the STEREO-B communication loss (since September 2014) and STEREO-A side-lobe operations (August 2014-December 2015). There is an increase of 1.7 hours in the CME arrival time error during single, or limited two-viewpoint periods, compared to the three-spacecraft viewpoint period. This trend would apply to a future space weather mission at L5 or L4 as another coronagraph viewpoint to reduce CME arrival time errors compared to a single L1 viewpoint.

Structure-Specific Movement Patterns in Patients With Chronic Low Back Dysfunction Using Lumbar Combined Movement Examination.

PubMed

Monie, Aubrey P; Price, Roger I; Lind, Christopher R P; Singer, Kevin P

2017-06-01

A test-retest cohort study was conducted to assess the use of a novel computer-aided, combined movement examination (CME) to measure change in low back movement after pain management intervention in 17 cases of lumbar spondylosis. Additionally we desired to use a CME normal reference range (NRR) to compare and contrast movement patterns identified from 3 specific structural pathologic conditions: intervertebral disc, facet joint, and nerve root compression. Computer-aided CME was used before and after intervention, in a cohort study design, to record lumbar range of movement along with pain, disability, and health self-report questionnaires in 17 participants who received image-guided facet, epidural, and/or rhizotomy intervention. In the majority of cases, CME was reassessed after injection together with 2 serial self-reports after an average of 2 and 14 weeks. A minimal clinically important difference of 30% was used to interpret meaningful change in self-reports. A CME NRR (n = 159) was used for comparison with the 17 cases. Post hoc observation included subgrouping cases into 3 discrete pathologic conditions, intervertebral disc, facet dysfunction, and nerve root compression, in order to report intergroup differences in CME movement. Seven of the 17 participants stated that a "combined" movement was their most painful CME direction. Self-report outcome data indicated that 4 participants experienced significant improvement in health survey, 5 improved by ≥30% on low back function, and 8 reported that low back pain was more bothersome than stiffness, 6 of whom achieved the minimal clinically important difference for self-reported pain. Subgrouping of cases into structure-specific groups provided insight to different CME movement patterns. The use of CME assists in identifying atypical lumbar movement relative to an age and sex NRR. Data from this study, exemplified by representative case studies, provide preliminary evidence for distinct intervertebral disc, facet joint, and nerve root compression CME movement patterns in cases of chronic lumbar spondylosis. Copyright © 2017. Published by Elsevier Inc.

Source Regions of the Type II Radio Burst Observed During a CME-CME Interaction on 2013 May 22

NASA Technical Reports Server (NTRS)

Makela, P.; Gopalswamy, N.; Reiner, M. J.; Akiyama, S.; Krupar, V.

2016-01-01

We report on our study of radio source regions during the type II radio burst on 2013 May 22 based on direction finding analysis of the Wind/WAVES and STEREO/WAVES (SWAVES) radio observations at decameter-hectometric wavelengths. The type II emission showed an enhancement that coincided with the interaction of two coronal mass ejections (CMEs) launched in sequence along closely spaced trajectories. The triangulation of the SWAVES source directions posited the ecliptic projections of the radio sources near the line connecting the Sun and the STEREO-A spacecraft. The WAVES and SWAVES source directions revealed shifts in the latitude of the radio source, indicating that the spatial location of the dominant source of the type II emission varies during the CME-CME interaction. The WAVES source directions close to 1MHz frequencies matched the location of the leading edge of the primary CME seen in the images of the LASCO/C3 coronagraph. This correspondence of spatial locations at both wavelengths confirms that the CME-CME interaction region is the source of the type II enhancement. Comparison of radio and white-light observations also showed that at lower frequencies scattering significantly affects radio wave propagation.

Tracking Energetics of a CME Core in the Low Solar Corona

NASA Astrophysics Data System (ADS)

Kocher, M.; Landi, E.; Lepri, S. T.

2017-12-01

In order to understand the processes that generate CMEs, and develop the ability to predict their evolution and geoeffectiveness, it is very important to determine how the plasma properties within coronal mass ejections (CME) evolve through their journey from the low corona through the solar environment. This study uses a combination of remote-sensing and in-situ observations of a filament eruption (that later formed the core of the CME) that left the Sun on August 4th, 2011 - shortly after an M-class flare. Separate absorption and emission diagnostic techniques are utilized to compute time-evolution estimates of the density and temperature of multiple plasma parcels within the filament using SDO/AIA EUV images. Twin STEREO spacecraft observations are used to estimate the height, speed, and acceleration of the CME at corresponding times. These observation-based densities, temperatures, and speeds allowed us to use the Michigan Ionization Code to compute the ionization history of this CME in the low solar corona. Along with the thermal and kinetic properties of this CME, we present a comparison with existing CME evolution models and draw inferences on its heating and acceleration.

Carbachol-mediated endocytosis of NHE3 involves a clathrin-independent mechanism requiring lipid rafts and Cdc42.

PubMed

Zachos, Nicholas C; Alamelumangpuram, Bharath; Lee, Luke J; Wang, Peng; Kovbasnjuk, Olga

2014-01-01

In intestinal epithelial cells, acute regulation of the brush border Na(+)/H(+) exchanger, NHE3, usually occurs by changes in endocytosis and/or exocytosis. Constitutive NHE3 endocytosis involves clathrin. Carbachol (CCH), which elevates intracellular Ca(2+) ([Ca(2+)]i), decreases NHE3 activity and stimulates endocytosis; however, the mechanism involved in calcium-mediated endocytosis of NHE3 is unclear. A pool of NHE3 resides in lipid rafts, which contributes to basal, but not cAMP-mediated, NHE3 trafficking, suggesting that an alternative mechanism exists for NHE3 endocytosis. Cdc42 was demonstrated to play an integral role in some cases of cholesterol-sensitive, clathrin-independent endocytosis. Therefore, the current study was designed to test the hypotheses that (1) clathrin-mediated endocytosis (CME) is involved in constitutive, but not CCH-mediated, endocytosis of NHE3, and (2) CCH-mediated endocytosis of NHE3 occurs through a lipid raft, activated Cdc42-dependent pathway that does not involve clathrin. The role of Cdc42 and lipid rafts on NHE3 activity and endocytosis were investigated in polarized Caco-2/BBe cells using pharmacological and shRNA knockdown approaches. Basal NHE3 activity was increased in the presence of CME blockers (chlorpromazine; K(+) depletion) supporting previous reports that constitutive NHE3 endocytosis is clathrin dependent. In contrast, CCH-inhibition of NHE3 activity was abolished in Caco-2/BBe cells treated with MβCD (to disrupt lipid rafts) as well as in Cdc42 knockdown cells but was unaffected by CME blockers. CCH-mediated inhibition of NHE3 activity is not dependent on clathrin and involves lipid rafts and requires Cdc42. © 2014 S. Karger AG, Basel.

Carbachol-Mediated Endocytosis of NHE3 Involves a Clathrin-Independent Mechanism Requiring Lipid Rafts and Cdc42

PubMed Central

Zachos, Nicholas C.; Alamelumangpuram, Bharath; Lee, Luke J.; Wang, Peng; Kovbasnjuk, Olga

2014-01-01

Background In intestinal epithelial cells, acute regulation of the brush border Na+/H+ exchanger, NHE3, usually occurs by changes in endocytosis and/or exocytosis. Constitutive NHE3 endocytosis involves clathrin. Carbachol (CCH), which elevates intracellular Ca2+ ([Ca2+]i), decreases NHE3 activity and stimulates endocytosis; however, the mechanism involved in calcium-mediated endocytosis of NHE3 is unclear. A pool of NHE3 resides in lipid rafts, which contributes to basal, but not cAMP-mediated, NHE3 trafficking, suggesting that an alternative mechanism exists for NHE3 endocytosis. Cdc42 was demonstrated to play an integral role in some cases of cholesterol-sensitive, clathrin-independent endocytosis. Therefore, the current study was designed to test the hypotheses that (1) clathrin-mediated endocytosis (CME) is involved in constitutive, but not CCH-mediated, endocytosis of NHE3, and (2) CCH-mediated endocytosis of NHE3 occurs through a lipid raft, activated Cdc42-dependent pathway that does not involve clathrin. Methods The role of Cdc42 and lipid rafts on NHE3 activity and endocytosis were investigated in polarized Caco-2/BBe cells using pharmacological and shRNA knockdown approaches. Results Basal NHE3 activity was increased in the presence of CME blockers (chlorpromazine; K+ depletion) supporting previous reports that constitutive NHE3 endocytosis is clathrin dependent. In contrast, CCH-inhibition of NHE3 activity was abolished in Caco-2/BBe cells treated with MβCD (to disrupt lipid rafts) as well as in Cdc42 knockdown cells but was unaffected by CME blockers. Conclusion CCH-mediated inhibition of NHE3 activity is not dependent on clathrin and involves lipid rafts and requires Cdc42. PMID:24713550

Correlated fluorescence-atomic force microscopy studies of the clathrin mediated endocytosis in SKMEL cells

NASA Astrophysics Data System (ADS)

Hor, Amy; Luu, Anh; Kang, Lin; Scott, Brandon; Bailey, Elizabeth; Hoppe, Adam; Smith, Steve

2017-02-01

Clathrin-mediated endocytosis (CME) is one of the central pathways for cargo transport into cells, and plays a major role in the maintenance of cellular functions, such as intercellular signaling, nutrient intake, and turnover of plasma membrane in cells. The clathrin-mediated endocytosis process involves invagination and formation of clathrin-coated vesicles. However, the biophysical mechanisms of vesicle formation are still debated. Currently, there are two models describing membrane bending during the formation of clathrin cages: the first involves the deposition of all clathrin molecules to the plasma membrane, forming a flat lattice prior to membrane bending, whereas in the second model, membrane bending happens simultaneously as the clathrin arrives to the site to form a clathrin-coated cage. We investigate clathrin vesicle formation mechanisms through the utilization of tapping-mode atomic force microscopy for high resolution topographical imaging in neutral buffer solution of unroofed cells exposing the inner membrane, combined with fluorescence imaging to definitively label intracellular constituents with specific fluorophores (actin filaments labeled with green phalloidin and clathrin coated vesicles with the fusion protein Tq2) in SKMEL (Human Melanoma) cells. An extensive statistical survey of many hundreds of CME events, at various stages of progression, are observed via this method, allowing inferences about the dominant mechanisms active in CME in SKMEL cells. Results indicate a mixed model incorporating aspects of both the aforementioned mechanisms for CME.

Monometallic Ni(0) and Heterobimetallic Ni(0) /Au(I) Complexes of Tripodal Phosphine Ligands: Characterization in Solution and in the Solid State and Catalysis.

PubMed

Cluff, Kyle J; Bhuvanesh, Nattamai; Blümel, Janet

2015-07-06

The tridentate chelate nickel complexes [(CO)Ni{(PPh2 CH2 )3 CMe}] (2), [(CO)Ni{(PPh2 CH2 CH2 )3 SiMe}] (6), and [Ph3 PNi{(PPh2 CH2 CH2 )3 SiMe}] (7), as well as the bidentate complex [(CO)2 Ni{(PPh2 CH2 )2 CMeCH2 PPh2 }] (3) and the heterobimetallic complex [(CO)2 Ni{(PPh2 CH2 )2 CMeCH2 Ph2 PAuCl}] (4), have been synthesized and fully characterized in solution. All (1) H and (13) C NMR signal assignments are based on 2D-NMR methods. Single crystal X-ray structures have been obtained for all complexes. Their (31) P CP/MAS (cross polarization with magic angle spinning) NMR spectra have been recorded and the isotropic lines identified. The signals were assigned with the help of their chemical shift anisotropy (CSA) data. All complexes have been tested regarding their catalytic activity for the cyclotrimerization of phenylacetylene. Whereas complexes 2-4 display low catalytic activity, complex 7 leads to quantitative conversion of the substrate within four hours and is highly selective throughout the catalytic reaction. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

3D numerical study of the propagation characteristics of a consequence of coronal mass ejections in a structured ambient solar wind

NASA Astrophysics Data System (ADS)

Zhou, Y.; Feng, X. S.

2015-12-01

CMEs have been identified as a prime causal link between solar activity and large, nonrecurrent geomagnetic storm. In order to improve geomagnetic storm predictions, a careful study of CME's propagation characteristics is important. Here, we analyze and quantitatively study the evolution and propagation characteristics of coronal mass ejections (CMEs) launched at several positions into a structured real ambient solar wind by using a three-dimensional (3D) numerical magnetohydrodynamics (MHD) simulation. The ambient solar wind structure during Carrington rotation 2095 is selected, which is an appropriate around activity minimum and declining phase. The CME is initiated by a simple spherical plasmoid model: a spheromak magnetic structure with high speed, high pressure and high plasma density plasmoid. We present a detailed analysis of the plasma, magnetic field, geoeffectiveness, and composition signatures of these CMEs. Results show that the motion and local appearance of a CME in interplanetary space is strongly affected by its interaction with the background solar wind structure, including its velocity, density, and magnetic structures. The simulations show that the initial launched position substantially affects the IP evolution of the CMEs influencing the propagation velocity, the shape, the trajectory and even the geo-effectiveness

Deflection and Distortion of CME internal magnetic flux rope due to the interaction with a structured solar wind

NASA Astrophysics Data System (ADS)

Shiota, D.; Iju, T.; Hayashi, K.; Fujiki, K.; Tokumaru, M.; Kusano, K.

2016-12-01

CMEs are the most violent driver of geospace disturbances, and therefore their arrival to the Earth position is an important factor in space weather forecast. The dynamics of CME propagation is strongly affected by the interaction with background solar wind. To understand the interaction between a CME and background solar wind, we performed three-dimensional MHD simulations of the propagation of a CME with internal twisted magnetic flux rope into a structured bimodal solar wind. We compared three different cases in which an identical CME is launched into an identical bimodal solar wind but the launch dates of the CME are different. Each position relative to the boundary between slow and fast solar winds becomes almost in the slow wind stream region, almost in the fast wind stream region, or in vicinity of the boundary of the fast and slow solar wind stream (that grows to CIR). It is found that the CME is most distorted and deflected eastward in the case near the CIR, in contrast to the other two cases. The maximum strength of southward magnetic field at the Earth position is also highest in the case near CIR. The results are interpreted that the dynamic pressure gradient due to the back reaction from pushing the ahead slow wind stream and due to the collision behind fast wind stream hinders the expansion of the CME internal flux rope into the direction of the solar wind velocity gradient. As a result, the expansion into the direction to the velocity gradient is slightly enhanced and results in the enhanced deflection and distortion of the CME and its internal flux rope. These results support the pileup accident hypothesis proposed by Kataoka et al. (2015) to form unexpectedly geoeffective solar wind structure.

The Formation and Early Evolution of a Coronal Mass Ejection and its Associated Shock Wave on 2014 January 8

NASA Astrophysics Data System (ADS)

Wan, Linfeng; Cheng, Xin; Shi, Tong; Su, Wei; Ding, M. D.

2016-08-01

In this paper, we study the formation and early evolution of a limb coronal mass ejection (CME) and its associated shock wave that occurred on 2014 January 8. The extreme ultraviolet (EUV) images provided by the Atmospheric Imaging Assembly (AIA) on board the Solar Dynamics Observatory disclose that the CME first appears as a bubble-like structure. Subsequently, its expansion forms the CME and causes a quasi-circular EUV wave. Interestingly, both the CME and the wave front are clearly visible at all of the AIA EUV passbands. Through a detailed kinematical analysis, it is found that the expansion of the CME undergoes two phases: a first phase with a strong but transient lateral over-expansion followed by a second phase with a self-similar expansion. The temporal evolution of the expansion velocity coincides very well with the variation of the 25-50 keV hard X-ray flux of the associated flare, which indicates that magnetic reconnection most likely plays an important role in driving the expansion. Moreover, we find that, when the velocity of the CME reaches ˜600 km s-1, the EUV wave starts to evolve into a shock wave, which is evidenced by the appearance of a type II radio burst. The shock’s formation height is estimated to be ˜0.2 R sun, which is much lower than the height derived previously. Finally, we also study the thermal properties of the CME and the EUV wave. We find that the plasma in the CME leading front and the wave front has a temperature of ˜2 MK, while that in the CME core region and the flare region has a much higher temperature of ≥8 MK.

Problematic protocols: An overview of medical research protocols not approved by the LUMC medical ethics review committee.

PubMed

Tersmette, Derek Gideon; Engberts, Dirk Peter

2017-01-01

The Committee for Medical Ethics (CME) of Leiden University Medical Center (LUMC) was established as the first medical ethics reviewing committee (MREC) in the Netherlands. In the period 2000-2010 the CME received 2,162 protocols for review. Some of these protocols were never approved. Until now, there has existed neither an overview of these failed protocols nor an overview of the reasons for their failure. This report draws on data from the digital database, the physical archives, and the minutes of the meetings of the CME. Additional information has been obtained from the Central Committee on Research involving Human Subjects (CCRH) and survey-based research. Protocols were itemized based on characteristic features and their reviewing procedures were analyzed. In total, 1,952 out of 2,162 research protocols submitted during 2000-2010 (90.3%) were approved by the CME; 210 of 2,162 protocols (9.7%) were not approved. Of these 210 protocols, 177 failed due to reasons not related to CME reviewing. In 15 cases CME reviewing led to protocol failure, while another 10 protocols were rejected outright. Eight of the 210 submitted protocols without approval had been conducted prior to submission. In the aforementioned period, little protocol failure occurred. For the most part, protocol failure was caused by problems that are not CME related. This type of failure has several identifiable factors, none of which have anything to do with the ethical reviewing procedure by the CME. A mere 1.2% of protocols failed due to ethical review. Unacceptable burden and risks to the subject and an inadequate methodology are the most common reasons for this CME-related protocol failure.

The Significance of the Influence of the CME Deflection in Interplanetary Space on the CME Arrival at Earth

NASA Astrophysics Data System (ADS)

Zhuang, Bin; Wang, Yuming; Shen, Chenglong; Liu, Siqing; Wang, Jingjing; Pan, Zonghao; Li, Huimin; Liu, Rui

2017-08-01

As one of the most violent astrophysical phenomena, coronal mass ejections (CMEs) have strong potential space weather effects. However, not all Earth-directed CMEs encounter the Earth and produce geo-effects. One reason is the deflected propagation of CMEs in interplanetary space. Although there have been several case studies clearly showing such deflections, it has not yet been statistically assessed how significantly the deflected propagation would influence the CME’s arrival at Earth. We develop an integrated CME-arrival forecasting (iCAF) system, assembling the modules of CME detection, three-dimensional (3D) parameter derivation, and trajectory reconstruction to predict whether or not a CME arrives at Earth, and we assess the deflection influence on the CME-arrival forecasting. The performance of iCAF is tested by comparing the two-dimensional (2D) parameters with those in the Coordinated Data Analysis Workshop (CDAW) Data Center catalog, comparing the 3D parameters with those of the gradual cylindrical shell model, and estimating the success rate of the CME Earth-arrival predictions. It is found that the 2D parameters provided by iCAF and the CDAW catalog are consistent with each other, and the 3D parameters derived by the ice cream cone model based on single-view observations are acceptable. The success rate of the CME-arrival predictions by iCAF with deflection considered is about 82%, which is 19% higher than that without deflection, indicating the importance of the CME deflection for providing a reliable forecasting. Furthermore, iCAF is a worthwhile project since it is a completely automatic system with deflection taken into account.

mCME project V.2.0: randomised controlled trial of a revised SMS-based continuing medical education intervention among HIV clinicians in Vietnam.

PubMed

Gill, Christopher J; Le, Ngoc Bao; Halim, Nafisa; Chi, Cao Thi Hue; Nguyen, Viet Ha; Bonawitz, Rachael; Hoang, Pham Vu; Nguyen, Hoang Long; Huong, Phan Thi Thu; Larson Williams, Anna; Le, Ngoc Anh; Sabin, Lora

2018-01-01

Continuing medical education (CME) is indispensable, but costs are a barrier. We tested the effectiveness of a novel mHealth intervention (mCME V.2.0) promoting CME among Vietnamese HIV clinicians. We enrolled HIV clinicians from three provinces near Hanoi. The 6-month intervention consisted of (1) daily short message service multiple-choice quiz questions, (2) daily linked readings, (3) links to online CME courses and (4) feedback messages describing the performance of the participant relative to the group. Control participants had equal access to the online CME courses. Our primary endpoint was utilisation of the online CME courses; secondary endpoints were self-study behaviour, performance on a standardised medical exam and job satisfaction. From 121 total HIV clinicians in the three provinces, 106 (87.6%) enrolled, and 48/53 intervention (90%) and 47/53 control (89%) participants completed the endline evaluations. Compared with controls, intervention participants were more likely to use the CME courses (risk ratio (RR) 2.3, 95% CI 1.4 to 3.8, accounting for 83% of course use (P<0.001)). Intervention participants increased self-study behaviours over controls in terms of use of medical textbooks (P<0.01), consulting with colleagues (P<0.01), searching on the internet (P<0.001), using specialist websites (P=0.02), consulting the Vietnam HIV/AIDS treatment guidelines (P=0.02) and searching the scientific literature (P=0.09). Intervention participants outperformed controls on the exam (+23% vs +12% score gains, P=0.05) and had higher job satisfaction. The mCME V.2.0 intervention improved self-study behaviour, medical knowledge and job satisfaction. This approach has potential for expansion in Vietnam and similar settings. NCT02381743.

Prediction of CMEs and Type II Bursts from Sun to Earth

NASA Astrophysics Data System (ADS)

Cairns, I. H.; Schmidt, J. M.; Gopalswamy, N.; van der Holst, B.

2017-12-01

Most major space weather events are due to fast CMEs and their shocks interacting with Earth's magnetosphere. SImilarly, type II solar radio bursts are well-known signatures of CMEs and their shocks moving through the corona and solar wind. The properties of the space weather events and the type II radio bursts depend sensitively on the CME velocity, shape, and evolution as functions of position and time, as well as on the magnetic field vector in the coronal and solar wind plasma, downstream of the CME shock, and inside the CME. We report simulations of CMEs and type II bursts from the Sun to Earth with the Space Weather Modelling Framework (2015 and 2016 versions), set up carefully using relevant data, and a kinetic radio emission theory. Excellent agreement between observations, simulations, and theory are found for the coronal (metric) type II burst of 7 September 2014 and associated CME, including the lack of radio emission in the solar wind beyond about 10 solar radii. Similarly, simulation of a CME and type II burst from the Sun to 1 AU over the period 29 November - 1 December 2013 yield excellent agreement for the radio burst from 10 MHz to 30 kHz for STEREO A and B and Wind, arrival of the CME at STEREO A within 1 hour reported time, deceleration of the CME in agreement with the Gopalswamy et al. [2011] observational analyses, and Bz rotations at STEREO A from upstream of the CME shock to within the CME. These results provide strong support for the type II theory and also that the Space WeatherModeling Framework can accurately predict the properties and evolution of CMEs and the interplanetary magnetic field and plasma from the Sun to 1 AU when sufficiently carefully initialized.

The SCEC Community Modeling Environment (SCEC/CME) - An Overview of its Architecture and Current Capabilities

NASA Astrophysics Data System (ADS)

Maechling, P. J.; Jordan, T. H.; Minster, B.; Moore, R.; Kesselman, C.; SCEC ITR Collaboration

2004-12-01

The Southern California Earthquake Center (SCEC), in collaboration with the San Diego Supercomputer Center, the USC Information Sciences Institute, the Incorporated Research Institutions for Seismology, and the U.S. Geological Survey, is developing the Southern California Earthquake Center Community Modeling Environment (CME) under a five-year grant from the National Science Foundation's Information Technology Research (ITR) Program jointly funded by the Geosciences and Computer and Information Science & Engineering Directorates. The CME system is an integrated geophysical simulation modeling framework that automates the process of selecting, configuring, and executing models of earthquake systems. During the Project's first three years, we have performed fundamental geophysical and information technology research and have also developed substantial system capabilities, software tools, and data collections that can help scientist perform systems-level earthquake science. The CME system provides collaborative tools to facilitate distributed research and development. These collaborative tools are primarily communication tools, providing researchers with access to information in ways that are convenient and useful. The CME system provides collaborators with access to significant computing and storage resources. The computing resources of the Project include in-house servers, Project allocations on USC High Performance Computing Linux Cluster, as well as allocations on NPACI Supercomputers and the TeraGrid. The CME system provides access to SCEC community geophysical models such as the Community Velocity Model, Community Fault Model, Community Crustal Motion Model, and the Community Block Model. The organizations that develop these models often provide access to them so it is not necessary to use the CME system to access these models. However, in some cases, the CME system supplements the SCEC community models with utility codes that make it easier to use or access these models. In some cases, the CME system also provides alternatives to the SCEC community models. The CME system hosts a collection of community geophysical software codes. These codes include seismic hazard analysis (SHA) programs developed by the SCEC/USGS OpenSHA group. Also, the CME system hosts anelastic wave propagation codes including Kim Olsen's Finite Difference code and Carnegie Mellon's Hercules Finite Element tool chain. The CME system can execute a workflow, that is, a series of geophysical computations using the output of one processing step as the input to a subsequent step. Our workflow capability utilizes grid-based computing software that can submit calculations to a pool of computing resources as well as data management tools that help us maintain an association between data files and metadata descriptions of those files. The CME system maintains, and provides access to, a collection of valuable geophysical data sets. The current CME Digital Library holdings include a collection of 60 ground motion simulation results calculated by a SCEC/PEER working group and a collection of Greens Functions calculated for 33 TriNet broadband receiver sites in the Los Angeles area.

Feasibility of a Knowledge Translation CME Program: "Courriels Cochrane"

ERIC Educational Resources Information Center

Pluye, Pierre; Grad, Roland; Granikov, Vera; Theriault, Guylene; Fremont, Pierre; Burnand, Bernard; Mercer, Jay; Marlow, Bernard; Arroll, Bruce; Luconi, Francesca; Legare, France; Labrecque, Michel; Ladouceur, Roger; Bouthillier, France; Sridhar, Soumya Bindiganavile; Moscovici, Jonathan

2012-01-01

Introduction: Systematic literature reviews provide best evidence, but are underused by clinicians. Thus, integrating Cochrane reviews into continuing medical education (CME) is challenging. We designed a pilot CME program where summaries of Cochrane reviews ("Courriels Cochrane") were disseminated by e-mail. Program participants…

The effect of oral acetazolamide on cystoid macular edema in hydroxychloroquine retinopathy: a case report.

PubMed

Hong, Eun Hee; Ahn, Seong Joon; Lim, Han Woong; Lee, Byung Ro

2017-07-12

Hydroxychloroquine (HCQ) retinopathy can accompany other retinal complications such as cystoid macular edema (CME), which leads to central visual loss. We report a case of CME with HCQ retinopathy that improved with the use of oral acetazolamide, and discussed the possible mechanisms of CME in HCQ retinopathy using multimodal imaging modalities. A 62-year-old patient with systemic lupus erythematosus (SLE) and HCQ retinopathy developed bilateral CME with visual decline. Fluorescein angiography (FA) showed fluorescein leakage in the macular and midperipheral area. After treatment with oral acetazolamide (250 mg/day) for one month, CME was completely resolved, best corrected visual acuity (BCVA) improved from 20/50 to 20/25, and FA examination showed decreased dye leakage in the macular and midperipheral areas. In cases of vision loss in HCQ retinopathy, it is important to consider not only progression of maculopathy, but also development of CME, which can be effectively treated with oral acetazolamide.

Constraints on particle density evolution within a CME at Mercury

NASA Astrophysics Data System (ADS)

Exner, W.; Liuzzo, L.; Heyner, D.; Feyerabend, M.; Motschmann, U. M.; Glassmeier, K. H.; Shiota, D.; Kusano, K.

2017-12-01

Mercury (RM=2440) is the closest orbiting planet around the Sun and is embedded in an intensive and highly varying solar wind.Mercury's intrinsic dipole with a southward magnetic moment is aligned with the rotation axis and has a northward offset of 0.2 RM.In-situ data from the MESSENGER spacecraft of the magnetic environment near Mercury indicate that a coronal mass ejection (CME) passed the planet on 8 May 2012. The data constrain the direction and magnitude of the CME magnetic field but no information on its particle density could be determined.We apply the hybrid (kinetic ions, electron fluid) code A.I.K.E.F. to study the interaction of Mercury's magnetosphere with the CME.We use MESSENGER magnetic field observations as well as simulation results to constrain the evolution of the particle density inside the CME.We show that within a 24-hour period the particle density within the CME had to vary between 1-100 cm-3 in order to explain MESSENGER magnetic field observations.

Juvenile X-linked retinoschisis responsive to intravitreal corticosteroids.

PubMed

Ansari, Waseem H; Browne, Andrew W; Singh, Rishi P

2017-04-01

To report the case of an adult male with X-linked retinoschisis (XLRS) who presented with cystoid macular edema (CME) that responded consistently to treatment with intravitreal steroids. A 39 year old male with unilateral presentation of CME after repair of a retinal detachment secondary to XLRS responded initially to an injection of intravitreal triamcinolone acetonide (IVTA). Central subfield thickness on OCT was reduced. Three months later, the CME recurred and he was unresponsive to topical treatment so repeat IVTA was given, and the CME once again was reduced dramatically. After the next recurrence, intravitreal dexamethasone implant treatment was initiated and successful at treating recurrences in 3 month intervals for 5 additional injections. Finally, an intravitreal fluocinolone acetonide implant was surgically placed with control of CME. Corticosteroids have never been reported to be effective in CME related to XLRS. Here, we document a case of a man who successfully had decrease of intraretinal fluid and schisis with treatment of intravitreal corticosteroids as demonstrated by spectral domain optical coherence tomography.

Improving continuing medical education by enhancing interactivity: lessons from Iran.

PubMed

Faghihi, Seyed Aliakbar; Khankeh, Hamid Reza; Hosseini, Seyed Jalil; Soltani Arabshahi, Seyed Kamran; Faghih, Zahra; Parikh, Sagar V; Shirazi, Mandana

2016-04-01

Continuing Medical Education (CME) has been considered as a lifelong commitment for doctors to provide the optimal care for patients. Despite a long history of creating CME programs, outcomes are far from ideal. The present qualitative study aims to clarify the barriers affecting effectiveness of the CME programs in Iran based on the experiences of general practitioners. Sixteen general practitioners were recruited to participate in in-depth interviews and field observations concerning experiences with CME. The study was performed using a qualitative content analysis method. The codes, categories and themes were explored through an inductive process in which the researchers moved from specific to general. The participants' experiences identified a number of barriers, particularly insufficient interaction with the instructors; additional problems included the teachers' use of an undifferentiated approach; unreal and abstract CME; and ignorance of the diverse reasons to participate in CME. Based on the study results, there are multiple barriers to effective implementation of CME in Iran. The key barriers include insufficient interaction between the trainees and providers, which must be considered by other stakeholders and program designers. Such interactions would facilitate improved program design, invite more specific tailoring of the education to the participants, allow for more effective educational methods and set the stage for outcome evaluation from the learners actually applying their new knowledge in practice. Replication of these findings with another sample would improve confidence in these recommendations, but these findings are broadly consistent with findings in the educational literature on improving the efficacy of CME.

Solar Energetic Particle Events and CME Accelerations in the Low Corona: MLSO Observations

NASA Astrophysics Data System (ADS)

St Cyr, O. C.; Kahler, S. W.; Richardson, I. G.; Cane, H. V.; Xie, H.; Burkepile, J.

2016-12-01

The low solar corona (< 2.5 Rs) is the region in which maximum coronal mass ejection (CME) acceleration occurs and where Type II radio observations suggest that shock formation occurs (Mäkelä et al., 2015). It is therefore a key region for investigations of solar energetic particle (SEP) acceleration by CME-driven shocks. Observations very low in the corona are necessary to detect the rapid CME accelerations leading to shock formation and to assess the speeds of CMEs through the middle corona. However, these observations cannot be made by space borne coronagraphs in which CME trajectories above the occulting disk are usually characterized by a single (constant) speed: e.g., 80% of the speeds in the compilation of SMM CMEs (Burkepile and St. Cyr, 1993) and SOHO LASCO CMEs (St. Cyr et al., 2000). The Mk3/Mk4/K-Cor coronameters at the Mauna Loa Solar Observatory are able to measure the initial accelerations of CMEs low in the corona (i.e., < 2 Rs). We examine a subset of CMEs that were associated with SEP events between 1980-present. The subset is based on the CME launch occurring between 16 UT - 01 UT - the MLSO observing window. In most cases, the CME accelerations are significantly larger than those measured by spaceborne coronagraphs (e.g., SMM, Solwind, LASCO, SECCHI). We will present the preliminary results of a comparison of the SEP parameters with initial CME accelerations in the MLSO coronagraph field of view.

Promoting networks between evidence-based medicine and values-based medicine in continuing medical education

PubMed Central

2013-01-01

Background In recent years, medical practice has followed two different paradigms: evidence-based medicine (EBM) and values-based medicine (VBM). There is an urgent need to promote medical education that strengthens the relationship between these two paradigms. This work is designed to establish the foundations for a continuing medical education (CME) program aimed at encouraging the dialogue between EBM and VBM by determining the values relevant to everyday medical activities. Methods A quasi-experimental, observational, comparative, prospective and qualitative study was conducted by analyzing through a concurrent triangulation strategy the correlation between healthcare personnel-patient relationship, healthcare personnel's life history, and ethical judgments regarding dilemmas that arise in daily clinical practice. In 2009, healthcare personnel working in Mexico were invited to participate in a free, online clinical ethics course. Each participant responded to a set of online survey instruments before and after the CME program. Face-to-face semi-structured interviews were conducted with healthcare personnel, focusing on their views and representations of clinical practice. Results The healthcare personnel's core values were honesty and respect. There were significant differences in the clinical practice axiology before and after the course (P <0.001); notably, autonomy climbed from the 10th (order mean (OM) = 8.00) to the 3rd position (OM = 5.86). In ethical discernment, the CME program had an impact on autonomy (P ≤0.0001). Utilitarian autonomy was reinforced in the participants (P ≤0.0001). Regarding work values, significant differences due to the CME intervention were found in openness to change (OC) (P <0.000), self-transcendence (ST) (P <0.001), and self-enhancement (SE) (P <0.019). Predominant values in life history, ethical discernment and healthcare personnel-patient relation were beneficence, respect and compassion, respectively. Conclusions The healthcare personnel participating in a CME intervention in clinical ethics improved high-order values: Openness to change (OC) and Self Transcendence (ST), which are essential to fulfilling the healing ends of medicine. The CME intervention strengthened the role of educators and advisors with respect to healthcare personnel. The ethical values developed by healthcare professionals arise from their life history and their professional formation. PMID:23414220

Promoting networks between evidence-based medicine and values-based medicine in continuing medical education.

PubMed

Altamirano-Bustamante, Myriam M; Altamirano-Bustamante, Nelly F; Lifshitz, Alberto; Mora-Magaña, Ignacio; de Hoyos, Adalberto; Avila-Osorio, María Teresa; Quintana-Vargas, Silvia; Aguirre, Jorge A; Méndez, Jorge; Murata, Chiharu; Nava-Diosdado, Rodrigo; Martínez-González, Oscar; Calleja, Elisa; Vargas, Raúl; Mejía-Arangure, Juan Manuel; Cortez-Domínguez, Araceli; Vedrenne-Gutiérrez, Fernand; Sueiras, Perla; Garduño, Juan; Islas-Andrade, Sergio; Salamanca, Fabio; Kumate-Rodríguez, Jesús; Reyes-Fuentes, Alejandro

2013-02-15

In recent years, medical practice has followed two different paradigms: evidence-based medicine (EBM) and values-based medicine (VBM). There is an urgent need to promote medical education that strengthens the relationship between these two paradigms. This work is designed to establish the foundations for a continuing medical education (CME) program aimed at encouraging the dialogue between EBM and VBM by determining the values relevant to everyday medical activities. A quasi-experimental, observational, comparative, prospective and qualitative study was conducted by analyzing through a concurrent triangulation strategy the correlation between healthcare personnel-patient relationship, healthcare personnel's life history, and ethical judgments regarding dilemmas that arise in daily clinical practice.In 2009, healthcare personnel working in Mexico were invited to participate in a free, online clinical ethics course. Each participant responded to a set of online survey instruments before and after the CME program. Face-to-face semi-structured interviews were conducted with healthcare personnel, focusing on their views and representations of clinical practice. The healthcare personnel's core values were honesty and respect. There were significant differences in the clinical practice axiology before and after the course (P <0.001); notably, autonomy climbed from the 10th (order mean (OM) = 8.00) to the 3rd position (OM = 5.86). In ethical discernment, the CME program had an impact on autonomy (P ≤0.0001). Utilitarian autonomy was reinforced in the participants (P ≤0.0001). Regarding work values, significant differences due to the CME intervention were found in openness to change (OC) (P <0.000), self-transcendence (ST) (P <0.001), and self-enhancement (SE) (P <0.019). Predominant values in life history, ethical discernment and healthcare personnel-patient relation were beneficence, respect and compassion, respectively. The healthcare personnel participating in a CME intervention in clinical ethics improved high-order values: Openness to change (OC) and Self Transcendence (ST), which are essential to fulfilling the healing ends of medicine. The CME intervention strengthened the role of educators and advisors with respect to healthcare personnel. The ethical values developed by healthcare professionals arise from their life history and their professional formation.

Effects of the η(5)-C5H4(i)Pr Ligand on the Properties Exhibited by Its Tungsten Nitrosyl Complexes.

PubMed

Fabulyak, Diana; Baillie, Rhett A; Patrick, Brian O; Legzdins, Peter; Rosenfeld, Devon C

2016-02-15

Reaction of Na[η(5)-C5H4(i)Pr] with W(CO)6 in refluxing THF for 4 days generates a solution of Na[(η(5)-C5H4(i)Pr)W(CO)3] that when treated with N-methyl-N-nitroso-p-toluenesulfonamide at ambient temperatures affords (η(5)-C5H4(i)Pr)W(NO)(CO)2 (1) that is isolable in good yield as an analytically pure orange oil. Treatment of 1 with an equimolar amount of I2 in Et2O at ambient temperatures affords (η(5)-C5H4(i)Pr)W(NO)I2 (2) as a dark brown solid in excellent yield. Sequential treatment at low temperatures of 2 with 0.5 equiv of Mg(CH2CMe3)2 and Mg(CH2CH═CMe2)2 in Et2O produces the alkyl allyl complex, (η(5)-C5H4(i)Pr)W(NO)(CH2CMe3)(η(3)-CH2CHCMe2) (3), as a thermally sensitive yellow liquid. Complex 3 may also be synthesized, albeit in low yield, in one vessel at low temperatures by reacting 1 first with 1 equiv of PCl5 and then with the binary magnesium reagents specified above. Interestingly, similar treatment of 1 in Et2O with PCl5 and only 0.5 equiv of Mg(CH2CH═CMe2)2 results in the formation of the unusual complex (η(5)-C5H4(i)Pr)W(NO)(PCl2CMe2CH═CH2)Cl2 (4), which probably is formed via a metathesis reaction of the binary magnesium reagent with (η(5)-C5H4(i)Pr)W(NO)(PCl3)Cl2. The C-D activation of C6D6 by complex 3 has been investigated and compared to that exhibited by its η(5)-C5Me5, η(5)-C5Me4H, and η(5)-C5Me4(n)Pr analogues. Kinetic analyses of the various activations have established that the presence of the η(5)-C5H4(i)Pr ligand significantly increases the rate of the reaction, an outcome that can be attributed to a combination of steric and electronic factors. In addition, mechanistic studies have established that in solution 3 loses neopentane under ambient conditions to generate exclusively the 16e η(2)-diene intermediate complex (η(5)-C5H4(i)Pr)W(NO)(η(2)-CH2═CMeCH═CH2), which then effects the subsequent C-D activations. This behavior contrasts with that exhibited by the η(5)-C5Me5 analogue of 3 which forms both η(2)-diene and η(2)-allene intermediates upon thermolysis. Sixteen-electron (η(5)-C5H4(i)Pr)W(NO)(η(2)-CH2═CMeCH═CH2) has been isolated as its 18e PMe3 adduct. All new organometallic complexes have been characterized by conventional spectroscopic and analytical methods, and the solid-state molecular structures of two of them have been established by single-crystal X-ray crystallographic analyses.

Improved Cardiovascular Prevention Using Best CME Practices: A Randomized Trial

ERIC Educational Resources Information Center

Laprise, Rejean; Thivierge, Robert; Gosselin, Gilbert; Bujas-Bobanovic, Maja; Vandal, Sylvie; Paquette, Daniel; Luneau, Micheline; Julien, Pierre; Goulet, Serge; Desaulniers, Jean; Maltais, Paule

2009-01-01

Introduction: It was hypothesized that after a continuing medical education (CME) event, practice enablers and reinforcers addressing main clinical barriers to preventive care would be more effective in improving general practitioners' (GPs) adherence to cardiovascular guidelines than a CME event only. Methods: A cluster-randomized trial was…

78 FR 64038 - Self-Regulatory Organizations; Chicago Mercantile Exchange Inc.; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-25

... transparency for over-the-counter derivatives markets, promoting the prompt and accurate clearance of... a derivatives clearing organization. The new CME rule simply specifies that CME will discharge any... Proposed Rule Change CME is registered as a derivatives clearing organization (``DCO'') with the Commodity...

Recent VLA Measurements of CME-Induced Faraday Rotation

NASA Astrophysics Data System (ADS)

Kooi, Jason; Thomas, Najma; Guy, Michael; Spangler, Steven R.

2018-01-01

Observations of Faraday rotation, the change in polarization position angle of linearly polarized radiation as it propagates through a magnetized plasma, have been used for decades to determine the strength and structure of the coronal magnetic field and plasma density. Similarly, observations of Faraday rotation through a coronal mass ejection (CME) have the potential to improve our understanding of the CME’s plasma structure. We report recent results from simultaneous white-light coronagraph and radio observations made of a CME in July 2015. We made radio observations using the Karl G. Jansky Very Large Array (VLA) at 1 - 2 GHz frequencies of a set of cosmic radio sources through the solar corona at heliocentric distances that ranged between 8 - 23 solar radii. A unique aspect of these observations is that the CME occulted several of these radio sources and, therefore, our Faraday rotation measurements provide information on the plasma structure in different regions of the CME. We successfully measured CME-induced Faraday rotation along multiple lines of sight because we made special arrangements with the staff at the National Radio Astronomy Observatory to trigger VLA observations when a candidate CME appeared low in the corona in near real-time images from the Large Angle and Spectrometric Coronagraph (LASCO) C2 instrument.

Effect of gravitational stratification on the propagation of a CME

NASA Astrophysics Data System (ADS)

Pagano, P.; Mackay, D. H.; Poedts, S.

2013-12-01

Context. Coronal mass ejections (CMEs) are the most violent phenomenon found on the Sun. One model that explains their occurrence is the flux rope ejection model. A magnetic flux rope is ejected from the solar corona and reaches the interplanetary space where it interacts with the pre-existing magnetic fields and plasma. Both gravity and the stratification of the corona affect the early evolution of the flux rope. Aims: Our aim is to study the role of gravitational stratification on the propagation of CMEs. In particular, we assess how it influences the speed and shape of CMEs and under what conditions the flux rope ejection becomes a CME or when it is quenched. Methods: We ran a set of MHD simulations that adopt an eruptive initial magnetic configuration that has already been shown to be suitable for a flux rope ejection. We varied the temperature of the backgroud corona and the intensity of the initial magnetic field to tune the gravitational stratification and the amount of ejected magnetic flux. We used an automatic technique to track the expansion and the propagation of the magnetic flux rope in the MHD simulations. From the analysis of the parameter space, we evaluate the role of gravitational stratification on the CME speed and expansion. Results: Our study shows that gravitational stratification plays a significant role in determining whether the flux rope ejection will turn into a full CME or whether the magnetic flux rope will stop in the corona. The CME speed is affected by the background corona where it travels faster when the corona is colder and when the initial magnetic field is more intense. The fastest CME we reproduce in our parameter space travels at ~850 km s-1. Moreover, the background gravitational stratification plays a role in the side expansion of the CME, and we find that when the background temperature is higher, the resulting shape of the CME is flattened more. Conclusions: Our study shows that although the initiation mechanisms of the CME are purely magnetic, the background coronal plasma plays a key role in the CME propagation, and full MHD models should be applied when one focuses especially on the production of a CME from a flux rope ejection. Movies are available in electronic form at http://www.aanda.org

High resolution solar observations in the context of space weather prediction

NASA Astrophysics Data System (ADS)

Yang, Guo

Space weather has a great impact on the Earth and human life. It is important to study and monitor active regions on the solar surface and ultimately to predict space weather based on the Sun's activity. In this study, a system that uses the full power of speckle masking imaging by parallel processing to obtain high-spatial resolution images of the solar surface in near real-time has been developed and built. The application of this system greatly improves the ability to monitor the evolution of solar active regions and to predict the adverse effects of space weather. The data obtained by this system have also been used to study fine structures on the solar surface and their effects on the upper solar atmosphere. A solar active region has been studied using high resolution data obtained by speckle masking imaging. Evolution of a pore in an active region presented. Formation of a rudimentary penumbra is studied. The effects of the change of the magnetic fields on the upper level atmosphere is discussed. Coronal Mass Ejections (CMEs) have a great impact on space weather. To study the relationship between CMEs and filament disappearance, a list of 431 filament and prominence disappearance events has been compiled. Comparison of this list with CME data obtained by satellite has shown that most filament disappearances seem to have no corresponding CME events. Even for the limb events, only thirty percent of filament disappearances are associated with CMEs. A CME event that was observed on March 20, 2000 has been studied in detail. This event did not show the three-parts structure of typical CMEs. The kinematical and morphological properties of this event were examined.

DESTABILIZATION OF A SOLAR PROMINENCE/FILAMENT FIELD SYSTEM BY A SERIES OF EIGHT HOMOLOGOUS ERUPTIVE FLARES LEADING TO A CME

DOE Office of Scientific and Technical Information (OSTI.GOV)

Panesar, Navdeep K.; Moore, Ronald L.; Sterling, Alphonse C.

2015-09-20

Homologous flares are flares that occur repetitively in the same active region, with similar structure and morphology. A series of at least eight homologous flares occurred in active region NOAA 11237 over 2011 June 16–17. A nearby prominence/filament was rooted in the active region, and situated near the bottom of a coronal cavity. The active region was on the southeast solar limb as seen from the Solar Dynamics Observatory/Atmospheric Imaging Assembly, and on the disk as viewed from the Solar TErrestrial RElations Observatory/EUVI-B. The dual perspective allows us to study in detail behavior of the prominence/filament material entrained in themore » magnetic field of the repeatedly erupting system. Each of the eruptions were mainly confined, but expelled hot material into the prominence/filament cavity system (PFCS). The field carrying and containing the ejected hot material interacted with the PFCS and caused it to inflate, resulting in a step-wise rise of the PFCS approximately in step with the homologous eruptions. The eighth eruption triggered the PFCS to move outward slowly, accompanied by a weak coronal dimming. As this slow PFCS eruption was underway, a final “ejective” flare occurred in the core of the active region, resulting in strong dimming in the EUVI-B images and expulsion of a coronal mass ejection (CME). A plausible scenario is that the repeated homologous flares could have gradually destabilized the PFCS, and its subsequent eruption removed field above the acitive region and in turn led to the ejective flare, strong dimming, and CME.« less

Using Social Media to Improve Continuing Medical Education: A Survey of Course Participants

PubMed Central

Wang, Amy T.; Sandhu, Nicole P.; Wittich, Christopher M.; Mandrekar, Jayawant N.; Beckman, Thomas J.

2012-01-01

Objective To determine continuing medical education (CME) course participants' use of social media (SM) and their attitudes about the value of SM for enhancing CME education and to examine associations between participants' characteristics and attitudes toward SM. Participants and Methods We conducted a cross-sectional survey and validation study of 539 participants at a Mayo Clinic Internal Medicine CME course in November 2011. The Social Media Use and Perception Instrument (SMUPI) consisted of 10 items (5-point Likert scales) and categorical response options. The main outcome measures were psychometric characteristics of the SMUPI scale, course participants' use of SM, and their attitudes regarding the importance of SM for enhancing CME. Results Of 539 CME course participants, 327 (61%) responded to the SMUPI survey. Most respondents (291 [89%]) reported using SM, with the most common types being YouTube (189 of the 327 participants [58%]) and Facebook (163 of 327 [50%]). Factor analysis revealed a 2-dimensional assessment of course participants' attitudes. Internal consistency reliability (Cronbach α) was excellent for factor 1 (0.94), factor 2 (0.89), and overall (0.94). The CME course participants' favorable attitudes toward SM were associated with younger age (20-29 years, mean score 3.13; 30-39 years, 3.40; 40-49 years, 3.39; 50-59 years, 3.18; 60-69 years, 2.93; and ≥70 years, 2.92; P=.02), using SM frequently (never, mean score 2.49; less than once monthly, 2.75; once monthly, 3.21; weekly, 3.31; and daily, 3.81; P<.0001), and professional degree (PhD, mean score 3.00; MD, 3.05; DO, 3.35; PA, 3.42; and NP, 3.50; P=.01). Conclusion We describe the first validated measure of CME course participants' use of and attitudes toward SM. Our results suggest that CME course directors should guide SM strategies toward more youthful, technology-savvy CME participants and that SM will become increasingly worthwhile in CME as younger learners continue to enter the profession. PMID:23141117

Diagnosis and incidence risk of clinical canine monocytic ehrlichiosis under field conditions in Southern Europe.

PubMed

René-Martellet, Magalie; Lebert, Isabelle; Chêne, Jeanne; Massot, Raphaël; Leon, Marta; Leal, Ana; Badavelli, Stefania; Chalvet-Monfray, Karine; Ducrot, Christian; Abrial, David; Chabanne, Luc; Halos, Lénaïg

2015-01-06

Canine Monocytic Ehrlichiosis (CME), due to the bacterium Ehrlichia canis and transmitted by the brown dog tick Rhipicephalus sanguineus, is a major tick-borne disease in southern Europe. In this area, infections with other vector-borne pathogens (VBP) are also described and result in similar clinical expression. The aim of the present study was to evaluate the incidence risk of clinical CME in those endemic areas and to assess the potential involvement of other VBP in the occurrence of clinical and/or biological signs evocative of the disease. The study was conducted from April to November 2011 in veterinary clinics across Italy, Spain and Portugal. Sick animals were included when fitting at least three clinical and/or biological criteria compatible with ehrlichiosis. Serological tests (SNAP®4Dx, SNAP®Leish tests, Idexx, USA) and diagnostic PCR for E. canis, Anaplasma platys, Anaplasma phagocytophilum, Babesia spp, Hepatozoon canis and Leishmania infantum detection were performed to identify the etiological agents. Ehrlichiosis was considered when three clinical and/or biological suggestive signs were associated with at least one positive paraclinical test (serology or PCR). The annual incidence risk was calculated and data were geo-referenced for map construction. The probabilities of CME and other vector-borne diseases when facing clinical and/or biological signs suggestive of CME were then evaluated. A total of 366 dogs from 78 veterinary clinics were enrolled in the survey. Among them, 99 (27%) were confirmed CME cases, which allowed an estimation of the average annual incidence risk of CME amongst the investigated dog population to be 0.08%. Maps showed an increasing gradient of CME incidence risk from northern towards southern areas, in particular in Italy. It also suggested the existence of hot-spots of infections by VBP in Portugal. In addition, the detection of other VBP in the samples was common and the study demonstrated that a dog with clinical signs evocative of CME is as likely to be positive to Ehrlichia canis as to another VBP. The study confirms the endemicity of CME in southern Europe and highlights the difficulties encountered by veterinarians to differentiate CME from other vector-borne diseases under field conditions.

Verification of real-time WSA-ENLIL+Cone simulations of CME arrival-time at the CCMC from 2010 to 2016

NASA Astrophysics Data System (ADS)

Wold, Alexandra M.; Mays, M. Leila; Taktakishvili, Aleksandre; Jian, Lan K.; Odstrcil, Dusan; MacNeice, Peter

2018-03-01

The Wang-Sheeley-Arge (WSA)-ENLIL+Cone model is used extensively in space weather operations world-wide to model coronal mass ejection (CME) propagation. As such, it is important to assess its performance. We present validation results of the WSA-ENLIL+Cone model installed at the Community Coordinated Modeling Center (CCMC) and executed in real-time by the CCMC space weather team. CCMC uses the WSA-ENLIL+Cone model to predict CME arrivals at NASA missions throughout the inner heliosphere. In this work we compare model predicted CME arrival-times to in situ interplanetary coronal mass ejection leading edge measurements at Solar TErrestrial RElations Observatory-Ahead (STEREO-A), Solar TErrestrial RElations Observatory-Behind (STEREO-B), and Earth (Wind and ACE) for simulations completed between March 2010 and December 2016 (over 1,800 CMEs). We report hit, miss, false alarm, and correct rejection statistics for all three locations. For all predicted CME arrivals, the hit rate is 0.5, and the false alarm rate is 0.1. For the 273 events where the CME was predicted to arrive at Earth, STEREO-A, or STEREO-B, and was actually observed (hit event), the mean absolute arrival-time prediction error was 10.4 ± 0.9 h, with a tendency to early prediction error of -4.0 h. We show the dependence of the arrival-time error on CME input parameters. We also explore the impact of the multi-spacecraft observations used to initialize the model CME inputs by comparing model verification results before and after the STEREO-B communication loss (since September 2014) and STEREO-A sidelobe operations (August 2014-December 2015). There is an increase of 1.7 h in the CME arrival time error during single, or limited two-viewpoint periods, compared to the three-spacecraft viewpoint period. This trend would apply to a future space weather mission at L5 or L4 as another coronagraph viewpoint to reduce CME arrival time errors compared to a single L1 viewpoint.

Forecasting Propagation and Evolution of CMEs in an Operational Setting: What Has Been Learned

NASA Technical Reports Server (NTRS)

Zheng, Yihua; Macneice, Peter; Odstrcil, Dusan; Mays, M. L.; Rastaetter, Lutz; Pulkkinen, Antti; Taktakishvili, Aleksandre; Hesse, Michael; Kuznetsova, M. Masha; Lee, Hyesook;

Forecasting propagation and evolution of CMEs in an operational setting: What has been learned

NASA Astrophysics Data System (ADS)

Zheng, Yihua; Macneice, Peter; Odstrcil, Dusan; Mays, M. L.; Rastaetter, Lutz; Pulkkinen, Antti; Taktakishvili, Aleksandre; Hesse, Michael; Masha Kuznetsova, M.; Lee, Hyesook; Chulaki, Anna

2013-10-01

of the major types of solar eruption, coronal mass ejections (CMEs) not only impact space weather, but also can have significant societal consequences. CMEs cause intense geomagnetic storms and drive fast mode shocks that accelerate charged particles, potentially resulting in enhanced radiation levels both in ions and electrons. Human and technological assets in space can be endangered as a result. CMEs are also the major contributor to generating large amplitude Geomagnetically Induced Currents (GICs), which are a source of concern for power grid safety. Due to their space weather significance, forecasting the evolution and impacts of CMEs has become a much desired capability for space weather operations worldwide. Based on our operational experience at Space Weather Research Center at NASA Goddard Space Flight Center (http://swrc.gsfc.nasa.gov), we present here some of the insights gained about accurately predicting CME impacts, particularly in relation to space weather operations. These include: 1. The need to maximize information to get an accurate handle of three-dimensional (3-D) CME kinetic parameters and therefore improve CME forecast; 2. The potential use of CME simulation results for qualitative prediction of regions of space where solar energetic particles (SEPs) may be found; 3. The need to include all CMEs occurring within a 24 h period for a better representation of the CME interactions; 4. Various other important parameters in forecasting CME evolution in interplanetary space, with special emphasis on the CME propagation direction. It is noted that a future direction for our CME forecasting is to employ the ensemble modeling approach.

Anomalous chiral transport in heavy ion collisions from Anomalous-Viscous Fluid Dynamics

NASA Astrophysics Data System (ADS)

Shi, Shuzhe; Jiang, Yin; Lilleskov, Elias; Liao, Jinfeng

2018-07-01

Chiral anomaly is a fundamental aspect of quantum theories with chiral fermions. How such microscopic anomaly manifests itself in a macroscopic many-body system with chiral fermions, is a highly nontrivial question that has recently attracted significant interest. As it turns out, unusual transport currents can be induced by chiral anomaly under suitable conditions in such systems, with the notable example of the Chiral Magnetic Effect (CME) where a vector current (e.g. electric current) is generated along an external magnetic field. A lot of efforts have been made to search for CME in heavy ion collisions, by measuring the charge separation effect induced by the CME transport. A crucial challenge in such effort, is the quantitative prediction for the CME signal. In this paper, we develop the Anomalous-Viscous Fluid Dynamics (AVFD) framework, which implements the anomalous fluid dynamics to describe the evolution of fermion currents in QGP, on top of the neutral bulk background described by the VISH2+1 hydrodynamic simulations for heavy ion collisions. With this new tool, we quantitatively and systematically investigate the dependence of the CME signal to a series of theoretical inputs and associated uncertainties. With realistic estimates of initial conditions and magnetic field lifetime, the predicted CME signal is quantitatively consistent with measured change separation data in 200GeV Au-Au collisions. Based on analysis of Au-Au collisions, we further make predictions for the CME observable to be measured in the planned isobaric (Ru-Ru v.s. Zr-Zr) collision experiment, which could provide a most decisive test of the CME in heavy ion collisions.

Vascular extravasation of contrast medium in radiological examinations: University of California San Diego Health System Experience.

PubMed

Niv, Galia; Costa, Matthew; Kicak, Patricia; Richman, Katherine

2014-06-01

Extravasation is a well-recognized complication estimated to be between 0.1% and 0.9% of contrast medium administrations. According to the UC San Diego (UCSD) health system policy, all contrast medium extravasation (CME) reports are reviewed by the department of Risk Management, and the appropriate action is taken. Despite this strategy, a decrease in the incidence of CME could not be demonstrated. The aims of this study were to determine the frequency, management, and outcome of CME in UC San Diego patients and to assess the knowledge regarding CME among radiology technologists based on policy and guidelines. The secondary aim was to assess the manual ability of the radiology technologists in the performance of the procedure. The study has 2 parts; the first was retrospective, including data collection and interpretation of all radiology procedures using intravenous contrast medium injection between January 1, 2010, and September 30, 2011, and the second was prospective, including proactive observations and knowledge questionnaire. There were 83 (0.48%) cases of CME of 17,200 patients, 54 women (0.64%) and 29 men (0.33%), P = 0.005. The patients with CME were older, and their cannula was inserted in other departments than Radiology Department, P < 0.000. There was a gap between the high theoretical knowledge that was found in the knowledge questionnaire and its implementation that was demonstrated in the proactive observation. Our data demonstrate that sex, age, and where the cannula was inserted are predictive factors for CME. We believe that CME could be prevented by proper educational program and establishment of efficient strategy.

Improving continuing medical education by enhancing interactivity: lessons from Iran

PubMed Central

FAGHIHI, SEYED ALIAKBAR; KHANKEH, HAMID REZA; HOSSEINI, SEYED JALIL; SOLTANI ARABSHAHI, SEYED KAMRAN; FAGHIH, ZAHRA; PARIKH, SAGAR V.; SHIRAZI, MANDANA

2016-01-01

Introduction Continuing Medical Education (CME) has been considered as a lifelong commitment for doctors to provide the optimal care for patients. Despite a long history of creating CME programs, outcomes are far from ideal. The present qualitative study aims to clarify the barriers affecting effectiveness of the CME programs in Iran based on the experiences of general practitioners. Methods Sixteen general practitioners were recruited to participate in in-depth interviews and field observations concerning experiences with CME. The study was performed using a qualitative content analysis method. The codes, categories and themes were explored through an inductive process in which the researchers moved from specific to general. Results The participants’ experiences identified a number of barriers, particularly insufficient interaction with the instructors; additional problems included the teachers’ use of an undifferentiated approach; unreal and abstract CME; and ignorance of the diverse reasons to participate in CME. Conclusion Based on the study results, there are multiple barriers to effective implementation of CME in Iran. The key barriers include insufficient interaction between the trainees and providers, which must be considered by other stakeholders and program designers. Such interactions would facilitate improved program design, invite more specific tailoring of the education to the participants, allow for more effective educational methods and set the stage for outcome evaluation from the learners actually applying their new knowledge in practice. Replication of these findings with another sample would improve confidence in these recommendations, but these findings are broadly consistent with findings in the educational literature on improving the efficacy of CME. PMID:27104199

Faraday Rotation as a Probe of Coronal Mass Ejections

NASA Astrophysics Data System (ADS)

Kooi, J. E.; Spangler, S. R.; Kassim, N. E.

2016-12-01

Coronal mass ejections (CMEs) are large-scale eruptions of plasma from the Sun that play an important role in space weather. Although CMEs have been an active field of research since their discovery in the 1970s, there is still much to understand about the plasma structure of CMEs. Faraday rotation (FR) is the rotation of the plane of polarization that results when a linearly polarized signal passes through a magnetized plasma such as a CME. FR observations of a source near the Sun can provide information on the plasma structure of a CME shortly after launch. We made sensitive Very Large Array (VLA) full-polarization observations in August, 2012, using 1 — 2 GHz frequencies of a "constellation" of radio sources through the solar corona at heliocentric distances that ranged from 6 — 15 solar radii. Of the nine sources observed, three were occulted by CMEs. In addition to our radioastronomical observations, which represent one of the first active hunts for CME Faraday rotation since Bird et al. (1985) and the first active hunt using the VLA, we obtained white-light coronagraph images from the LASCO/C3 instrument to determine the Thomson scattering brightness, BT, providing a means to independently estimate the plasma density and determine its contribution to the observed Faraday rotation. A constant density force-free flux rope embedded in the background corona was used to model the effects of the CMEs on BT and FR. The single flux rope model successfully reproduces the observed BT and FR profiles for two sources. The third source (0843+1547) was occulted by two CMEs and, therefore, we modeled observations of this source using two flux ropes embedded in the background corona. The two flux rope model successfully reproduces both BT and FR profiles for 0843+1547 and, in particular, the two flux rope model successfully replicates the appropriate slope in FR before and after occultation by the second CME and predicts the observed change in sign to FR > 0 at the end of the observing session. The plasma densities (6 — 22 × 103 cm-3) and axial magnetic field strengths (2 — 12 mG) inferred from our models are consistent with the modeling work of Liu et al. (2007) and Jensen et al. (2008), as well as previous CME FR observations by Bird et al. (1985). This work was supported at the University of Iowa by grant ATM09-56901.

General physicians' perspective of sleep apnea from a developing country.

PubMed

Hussain, Syed Fayyaz; Zahid, Sumaiya; Haqqee, Raana; Khan, Javaid Ahmed

2003-06-01

To assess the knowledge of general physicians about the diagnosis and management of obstructive sleep apnea (OSA), a self-administered questionnaire, containing 15 questions, was distributed to 160 doctors attending a pulmonary CME program in March 2002. After 15 minutes of response time, the questionnaires were collected. The data were entered and analyzed using SPSS (Version 10.0) software. One hundred and twenty (75%) questionnaires were returned. Only 41% of responders had ever read an article about OSA and 36% had suspected it at least once in their practice. The majority (61-77%) of responders were aware of the common symptoms of OSA, but 55% did not recognize its association with hypertension. A significant number of doctors were not aware that OSA could occur in non-obese individuals (33%), women (42%) and children (39%). Only 25% of responders recognized that a history and blood tests were insufficient to make a reliable diagnosis of OSA. Half of the responders were aware of CPAP therapy for OSA, whereas 18% would have prescribed sedatives to treat sleep disturbances in OSA.

Wide and Narrow CMEs and Their Source Explosions Observed at the Spring 2003 SOHO-Sun-Ulysses Quadrature

NASA Technical Reports Server (NTRS)

Suess, Steven; Corti, G.; Poletto, G.; Sterling, A.; Moore, R.

2006-01-01

At the time of the spring 2003 Ulysses-SOHO-Sun quadrature, Ulysses was off the East limb of the Sun at 14.5 degrees north latitude and 4.91 AU. LASCO/C2 images show small transient events that originated from near the limb on May 25, 26 and 27 in the north-east quadrant, along with a large Coronal Mass Ejection (CME) that originated from an active region near disk center on May 26. Ulysses data bear clear signatures of the large CME, specifically including an enhanced abundance of highly ionized Fe. SOHO/UVCS spectra at 1.75 solar radii, near the radial direction to Ulysses, give no evidence of emission from high temperature lines, even for the large CME: instead, for the small events, occasional transient high emission in cool lines was observed, such as the CIII 977 Angstrom line usually absent at coronal levels. Each of these events lasted ca. 1 hour or less and never affected lines from ions forming above ca. 106K. Compact eruptions in Helium 304 Angstrom EIT images, related to the small UVCS transients, were observed at the limb of the Sun over the same period. At least one of these surge events produced a narrow CME observed in LASCO/C2. Most probably all these events are compact magnetic explosions (surges/jets, from around a small island of included polarity) which ejected cool material from lower levels. Ulysses data have been analyzed to find evidence of the cool, narrow CME events, but none or little was found. This puzzling scenario, where events seen by UVCS have no in situ counterparts and vice versa, can be partially explained once the region where the large CME originated is recognized as being at the center of the solar disk so that the CME material was actually much further from the Sun than the 1.7 Rsun height of the UVCS slit off the limb. Conversely, the narrow events may simply have missed Ulysses or been too brief for reliable signatures in composition and ionization state. A basic feature demonstrated by these observations is that large magnetic explosions produce wide-angle CMEs whereas compact magnetic explosions produce narrow CMEs. The results show that quadrature observations need some luck to be successfull: that is, events must be in the plane of the sky to allow SOHO/UVCS and Ulysses to sample the same plasma. This will most easily occur in winter 2007 and winter 2008, when the quadrature geometry will allow for prolonged observations.

A Reflective Learning Framework to Evaluate CME Effects on Practice Reflection

ERIC Educational Resources Information Center

Leung, Kit H.; Pluye, Pierre; Grad, Roland; Weston, Cynthia

2010-01-01

Introduction: The importance of reflective practice is recognized by the adoption of a reflective learning model in continuing medical education (CME), but little is known about how to evaluate reflective learning in CME. Reflective learning seldom is defined in terms of specific cognitive processes or observable performances. Competency-based…

Developing an Instrument to Measure Bias in CME

ERIC Educational Resources Information Center

Takhar, Jatinder; Dixon, Dave; Donahue, Jill; Marlow, Bernard; Campbell, Craig; Silver, Ivan; Eadie, Jason; Monette, Celine; Rohan, Ivan; Sriharan, Abi; Raymond, Kathryn; Macnab, Jennifer

2007-01-01

Introduction: The pharmaceutical industry, by funding over 60% of programs in the United States and Canada, plays a major role in continuing medical education (CME), but there are concerns about bias in such CME programs. Bias is difficult to define, and currently no tool is available to measure it. Methods: Representatives from industry and…

Super- and sub-critical regions in shocks driven by radio-loud and radio-quiet CMEs

PubMed Central

Bemporad, Alessandro; Mancuso, Salvatore

2012-01-01

White-light coronagraphic images of Coronal Mass Ejections (CMEs) observed by SOHO/LASCO C2 have been used to estimate the density jump along the whole front of two CME-driven shocks. The two events are different in that the first one was a “radio-loud” fast CME, while the second one was a “radio quiet” slow CME. From the compression ratios inferred along the shock fronts, we estimated the Alfvén Mach numbers for the general case of an oblique shock. It turns out that the “radio-loud” CME shock is initially super-critical around the shock center, while later on the whole shock becomes sub-critical. On the contrary, the shock associated with the “radio-quiet” CME is sub-critical at all times. This suggests that CME-driven shocks could be efficient particle accelerators at the shock nose only at the initiation phases of the event, if and when the shock is super-critical, while at later times they lose their energy and the capability to accelerate high energetic particles. PMID:25685431

Comparison of the CME-associated shock arrival times at the earth using the WSA-ENLIL model with three cone models

NASA Astrophysics Data System (ADS)

Jang, S.; Moon, Y.; Na, H.

2012-12-01

We have made a comparison of CME-associated shock arrival times at the earth based on the WSA-ENLIL model with three cone models using 29 halo CMEs from 2001 to 2002. These halo CMEs have cone model parameters from Michalek et al. (2007) as well as their associated interplanetary (IP) shocks. For this study we consider three different cone models (an asymmetric cone model, an ice-cream cone model and an elliptical cone model) to determine CME cone parameters (radial velocity, angular width and source location), which are used for input parameters of the WSA-ENLIL model. The mean absolute error (MAE) of the arrival times for the elliptical cone model is 10 hours, which is about 2 hours smaller than those of the other models. However, this value is still larger than that (8.7 hours) of an empirical model by Kim et al. (2007). We are investigating several possibilities on relatively large errors of the WSA-ENLIL cone model, which may be caused by CME-CME interaction, background solar wind speed, and/or CME density enhancement.

A Monster CME Obscuring a Demon Star Flare

NASA Astrophysics Data System (ADS)

Moschou, Sofia-Paraskevi; Drake, Jeremy J.; Cohen, Ofer; Alvarado-Gomez, Julian D.; Garraffo, Cecilia

2017-12-01

We explore the scenario of a coronal mass ejection (CME) being the cause of the observed continuous X-ray absorption of the 1997 August 30 superflare on the eclipsing binary Algol (the Demon Star). The temporal decay of the absorption is consistent with absorption by a CME undergoing self-similar evolution with uniform expansion velocity. We investigate the kinematic and energetic properties of the CME using the ice cream cone model for its three-dimensional structure in combination with the observed profile of the hydrogen column density decline with time. Different physically justified length scales were used that allowed us to estimate lower and upper limits of the possible CME characteristics. Further consideration of the maximum available magnetic energy in starspots leads us to quantify its mass as likely lying in the range 2× {10}21 {--} 2× {10}22 g and kinetic energy in the range 7× {10}35 {--} 3× {10}38 erg. The results are in reasonable agreement with extrapolated relations between flare X-ray fluence and CME mass and kinetic energy derived for solar CMEs.

Flux rope evolution in interplanetary coronal mass ejections: the 13 May 2005 event

NASA Astrophysics Data System (ADS)

Manchester, W. B., IV; van der Holst, B.; Lavraud, B.

2014-06-01

Coronal mass ejections (CMEs) are a dramatic manifestation of solar activity that release vast amounts of plasma into the heliosphere, and have many effects on the interplanetary medium and on planetary atmospheres, and are the major driver of space weather. CMEs occur with the formation and expulsion of large-scale magnetic flux ropes from the solar corona, which are routinely observed in interplanetary space. Simulating and predicting the structure and dynamics of these interplanetary CME magnetic fields are essential to the progress of heliospheric science and space weather prediction. We discuss the simulation of the 13 May 2005 CME event in which we follow the propagation of a flux rope from the solar corona to beyond Earth orbit. In simulating this event, we find that the magnetic flux rope reconnects with the interplanetary magnetic field, to evolve to an open configuration and later reconnects to reform a twisted structure sunward of the original rope. Observations of the 13 May 2005 CME magnetic field near Earth suggest that such a rearrangement of magnetic flux by reconnection may have occurred.

A soft x-ray coronal mass ejection occurred on solar limb on 1998 April 23

NASA Astrophysics Data System (ADS)

Cheng, X. J.

2001-11-01

Using some data observed with SXT/HXT aboard Yohkoh and the Nobeyama Radioheliograph (NoRH) on 1998 April 23, a comprehensive study on the soft X-ray coronal mass ejection (CME) on solar SE limb shows there were two magnetic dipole sources (MDSs), one magnetic capacity belt (MCB) between MDSs, one neutral current sheet (NCS) and only a few activation sources (ASs). During the MCB was changed by the ASs into a magnetic energy belt (MEB), the material and energy both concentrated to the NCS in the course of its formation. When the MDSs were put through by the MEB, the NCS formed and the CME occurred. The matter ejected not only from the NCS, but also from the whole MEB. The expanding loop of the CME had two footprints, they were just the MDSs. The head of the expanding loop always tended to the foot point of weak source. The locus of the head was just neutral line. From this, the position of NCS also could be determined.

Cultural competence education for practicing physicians: lessons in cultural humility, nonjudgmental behaviors, and health beliefs elicitation.

PubMed

Kutob, Randa M; Bormanis, John; Crago, Marjorie; Harris, John M; Senf, Janet; Shisslak, Catherine M

2013-01-01

Although numerous studies have examined cultural competence training, debate still exists about efficacious approaches to this training. Furthermore, little focus has been placed on training and evaluating practicing physicians. A skills-based course on culturally competent diabetes care was developed and subsequently tested in a controlled trial of primary physicians caring for patients enrolled in one state's Medicaid program. We hypothesized that physicians completing the course would show higher levels of self-reported cultural competence as measured by a Cultural Competence Assessment Tool (CCAT) than those in the control group. Differences in CCAT subscale scores were also compared. Ninety physicians completed the study, with 41 in the control and 49 in the intervention group. Most were female (66%), with an average age of 44, and 12 years in practice. There were no significant differences on total CCAT score (212.7 ± 26.7 for control versus 217.2 ± 28.6 for intervention, p = .444) or subscales measuring cultural knowledge. There were significant positive differences on the subscales measuring physicians' nonjudgmental attitudes/behaviors (subscale score 2.38 ± 0.46 for control versus 2.69 ± 0.52 for intervention, p = .004) and future likelihood of eliciting patients' beliefs about diabetes and treatment preferences (3.11 ± 0.53 for control versus 3.37 ± 0.45 for intervention, p = .014). There was, however, a significant negative difference on the subscale measuring cultural self-awareness (3.48 ± 0.36 for control versus 3.26 ± 0.48 for intervention, p = .018). A predominantly skills-based approach to training physicians did not change aggregate measures of cultural competence, but did affect key attitudes and behaviors, which may better reflect the goals of cultural competence training. Copyright © 2013 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

Conditions for the existence of Kelvin-Helmholtz instability in a CME

NASA Astrophysics Data System (ADS)

Páez, Andrés; Jatenco-Pereira, Vera; Falceta-Gonçcalves, Diego; Opher, Merav

The presence of Kelvin-Helmholtz instability (KHI) in the sheaths of Coronal Mass Ejections (CMEs) has been proposed and observed by several authors in the literature. In the present work, we assume their existence and propose a method to constrain the local properties, like the CME magnetic field intensity for the development of KHI. We study a CME in the initiation phase interacting with the slow solar wind (Zone I) and with the fast solar wind (Zone II). Based on the theory of magnetic KHI proposed by Chandrasekhar (1961) we found the radial heliocentric interval for the KHI existence, in particular we constrain it with the CME magnetic field intensity. We conclude that KHI may exist in both CME Zones but it is perceived that Zone I is more appropriated for the KHI formation.

Deflected Propagation of Coronal Mass Ejections: One of the Key Issues in Space Weather Forecasting

NASA Astrophysics Data System (ADS)

Wang, Y.; Shen, C.; Zhuang, B.; Pan, Z.

2016-12-01

As the most important driver of severe space weather, coronal mass ejections (CMEs) and their geoeffectiveness have been studied intensively. Previous statistical studies have shown that not all the front-side halo CMEs are geoeffective, and not all non-recurrent geomagnetic storms can be tracked back to a CME. These phenomena may cause some failed predictions of the geoeffectiveness of CMEs. The recent notable event exhibiting such a failure was on 2015 March 15 when a fast CME originated from the west hemisphere. Space Weather Prediction Center (SWPC) of NOAA initially forecasted that the CME would at most cause a very minor geomagnetic disturbance labeled as G1. However, the CME produced the largest geomagnetic storm so far, at G4 level with the provisional Dst value of -223 nT, in the current solar cycle 24 [e.g., Kataoka et al., 2015; Wang et al., 2016]. Such an unexpected phenomenon naturally raises the first question for the forecasting of the geoeffectiveness of a CME, i.e., whether or not a CME will hit the Earth even though we know the source location and initial kinematic properties of the CME. A full understanding of the propagation trajectory, e.g., the deflected propagation, of a CME from the Sun to 1 AU is the key. With a few cases, we show the importance of the deflection effect in the space weather forecasting. An automated CME arrival forecasting system containing a deflected propagation model is presented. References:[1] Kataoka, R., D. Shiota, E. Kilpua, and K. Keika, Pileup accident hypothesis of magnetic storm on 17 March 2015, Geophys. Res. Lett., 42, 5155-5161, 2015.[2] Wang, Yuming, Quanhao Zhang, Jiajia Liu, Chenglong Shen, Fang Shen, Zicai Yang, T. Zic, B. Vrsnak, D. F. Webb, Rui Liu, S. Wang, Jie Zhang, Q. Hu, and B. Zhuang, On the Propagation of a Geoeffective Coronal Mass Ejection during March 15 - 17, 2015, J. Geophys. Res., accepted, doi:10.1002/2016JA022924, 2016.

Flare-CME characteristics from Sun to Earth combining observations and modeling

NASA Astrophysics Data System (ADS)

Temmer, Manuela; Thalmann, Julia K.; Dissauer, Karin; Veronig, Astrid M.; Tschernitz, Johannes; Hinterreiter, Jürgen; Rodriguez, Luciano

2017-04-01

We analyze the well observed flare-CME event from October 1, 2011 (SOL2011-10-01T09:18) covering the complete chain of action - from Sun to Earth - for a better understanding of the dynamic evolution of the CME and its embedded magnetic field. We study in detail the solar surface and atmosphere from SDO and ground-based instruments associated to the flare-CME and also track the CME signature offlimb from combined EUV and white-light data with STEREO. By applying 3D reconstruction techniques (GCS, total mass) to stereoscopic STEREO-SoHO coronagraph data, we track the temporal and spatial evolution of the CME in interplanetary space and derive its geometry and 3D-mass. We combine the GCS and Lundquist model results to derive the axial flux and helicity of the MC from in situ measurements (Wind). This is compared to nonlinear force-free (NLFF) model results as well as to the reconnected magnetic flux derived from the flare ribbons (flare reconnection flux) and the magnetic flux encompassed by the associated dimming (dimming flux). We find that magnetic reconnection processes were already ongoing before the start of the impulsive flare phase, adding magnetic flux to the flux rope before its final eruption. The dimming flux increases by more than 25% after the end of the flare, indicating that magnetic flux is still added to the flux rope after eruption. Hence, the derived flare reconnection flux is most probably a lower limit for estimating the magnetic flux within the flux rope. We obtain that the magnetic helicity and axial magnetic flux are reduced in interplanetary space by ˜50% and 75%, respectively, possibly indicating to an erosion process. A mass increase of 10% for the CME is observed over the distance range from about 4-20 Rs. The temporal evolution of the CME associated core dimming regions supports the scenario that fast outflows might supply additional mass to the rear part of the CME.

Topological Evolution of a Fast Magnetic Breakout CME in 3-Dimensions

NASA Technical Reports Server (NTRS)

Lynch, B. J.; Antiochos, S. K.; DeVore, C. R.; Luhmann, J. G.; Zurbuchen, T. H.

2008-01-01

W present the extension of the magnetic breakout model for CME initiation to a fully 3-dimensional, spherical geometry. Given the increased complexity of the dynamic magnetic field interactions in 3-dimensions, we first present a summary of the well known axisymmetric breakout scenario in terms of the topological evolution associated with the various phases of the eruptive process. In this context, we discuss the completely analogous topological evolution during the magnetic breakout CME initiation process in the simplest 3-dimensional multipolar system. We show that an extended bipolar active region embedded in an oppositely directed background dipole field has all the necessary topological features required for magnetic breakout, i.e. a fan separatrix surface between the two distinct flux systems, a pair of spine fieldlines, and a true 3-dimensional coronal null point at their intersection. We then present the results of a numerical MHD simulation of this 3-dimensional system where boundary shearing flows introduce free magnetic energy, eventually leading to a fast magnetic breakout CME. The eruptive flare reconnection facilitates the rapid conversion of this stored free magnetic energy into kinetic energy and the associated acceleration causes the erupting field and plasma structure to reach an asymptotic eruption velocity of greater than or approx. equal to 1100 km/s over an approx.15 minute time period. The simulation results are discussed using the topological insight developed to interpret the various phases of the eruption and the complex, dynamic, and interacting magnetic field structures.

A FAST PROPAGATING EXTREME-ULTRAVIOLET WAVE ASSOCIATED WITH A MINI-FILAMENT ERUPTION

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zheng Ruisheng; Jiang Yunchun; Yang Jiayan

The fast extreme-ultraviolet (EUV) waves (>1000 km s{sup -1}) in the solar corona were very rare in the past. Taking advantage of the high temporal and spatial resolution of the Solar Dynamics Observatory observations, we present a fast EUV wave associated with a mini-filament eruption, a C1.0 flare, and a coronal mass ejection (CME) on 2011 September 30. The event took place at the periphery between two active regions (ARs). The mini-filament rapidly erupted as a blowout jet associated with a flare and a CME. The CME front was likely developed from the large-scale overlying loops. The wave onset wasmore » nearly simultaneous with the start of the jet and the flare. The wave departed far from the flare center and showed a close location relative to the rapid jet. The wave had an initial speed of about 1100 km s{sup -1} and a slight deceleration in the last phase, and the velocity decreased to about 500 km s{sup -1}. The wave propagated in a narrow angle extent, likely to avoid the ARs on both sides. All the results provide evidence that the fast EUV wave was a fast-mode MHD wave. The wave resisted being driven by the CME, because it opened up the large-scale loops and its front likely formed later than the wave. The wave was most likely triggered by the jet, due to their close timing and location relations.« less

Can We Predict CME Deflections Based on Solar Magnetic Field Configuration Alone?

NASA Astrophysics Data System (ADS)

Kay, C.; Opher, M.; Evans, R. M.

2013-12-01

Accurate space weather forecasting requires knowledge of the trajectory of coronal mass ejections (CMEs), including predicting CME deflections close to the Sun and through interplanetary space. Deflections of CMEs occur due to variations in the background magnetic field or solar wind speed, magnetic reconnection, and interactions with other CMEs. Using our newly developed model of CME deflections due to gradients in the background solar magnetic field, ForeCAT (Kay et al. 2013), we explore the questions: (a) do all simulated CMEs ultimately deflect to the minimum in the background solar magnetic field? (b) does the majority of the deflection occur in the lower corona below 4 Rs? ForeCAT does not include temporal variations in the magnetic field of active regions (ARs), spatial variations in the background solar wind speed, magnetic reconnection, or interactions with other CMEs. Therefore we focus on the effects of the steady state solar magnetic field. We explore two different Carrington Rotations (CRs): CR 2029 (April-May 2005) and CR 2077 (November-December 2008). Little is known about how the density and magnetic field fall with distance in the lower corona. We consider four density models derived from observations (Chen 1996, Mann et al. 2003, Guhathakurta et al. 2006, Leblanc et al. 1996) and two magnetic field models (PFSS and a scaled model). ForeCAT includes drag resulting from both CME propagation and deflection through the background solar wind. We vary the drag coefficient to explore the effect of drag on the deflection at 1 AU.

Radial Diffusion study of the 1 June 2013 CME event using MHD simulations.

NASA Astrophysics Data System (ADS)

Patel, M.; Hudson, M.; Wiltberger, M. J.; Li, Z.; Boyd, A. J.

2016-12-01

The June 1, 2013 storm was a CME-shock driven geomagnetic storm (Dst = -119 nT) that caused a dropout affecting all radiation belt electron energies measured by the Energetic Particle, Composition and Thermal Plasma Suite (ECT) instrument on Van Allen Probes at higher L-shells following dynamic pressure enhancement in the solar wind. Lower energies (up to about 700 keV) were enhanced by the storm while MeV electrons were depleted throughout the belt. We focus on depletion through radial diffusion caused by the enhanced ULF wave activity due to the CME-shock. This study utilities the Lyon-Fedder-Mobarry (LFM) model, a 3D global magnetospheric simulation code based on the ideal MHD equations, coupled with the Magnetosphere Ionosphere Coupler (MIX) and Rice Convection Model (RCM). The MHD electric and magnetic fields with equations described by Fei et al. [JGR, 2006] are used to calculate radial diffusion coefficients (DLL). These DLL values are input into a radial diffusion code to recreate the dropouts observed by the Van Allen Probes. The importance of understanding the complex role that ULF waves play in radial transport and the effects of CME-driven storms on the relativistic energy electrons in the radiation belts can be accomplished using MHD simulations to obtain diffusion coefficients, initial phase space density and the outer boundary condition from the ECT instrument suite and a radial diffusion model to reproduce observed fluxes which compare favorably with Van Allen Probes ECT measurements.

Evolutionary Changes on the Way to Clathrin-Mediated Endocytosis in Animals

PubMed Central

Dergai, Mykola; Iershov, Anton; Novokhatska, Olga; Pankivskyi, Serhii; Rynditch, Alla

2016-01-01

Endocytic pathways constitute an evolutionarily ancient system that significantly contributed to the eukaryotic cell architecture and to the diversity of cell type–specific functions and signaling cascades, in particular of metazoans. Here we used comparative proteomic studies to analyze the universal internalization route in eukaryotes, clathrin-mediated endocytosis (CME), to address the issues of how this system evolved and what are its specific features. Among 35 proteins crucially required for animal CME, we identified a subset of 22 proteins common to major eukaryotic branches and 13 gradually acquired during evolution. Based on exploration of structure–function relationship between conserved homologs in sister, distantly related and early diverged branches, we identified novel features acquired during evolution of endocytic proteins on the way to animals: Elaborated way of cargo recruitment by multiple sorting proteins, structural changes in the core endocytic complex AP2, the emergence of the Fer/Cip4 homology domain-only protein/epidermal growth factor receptor substrate 15/intersectin functional complex as an additional interaction hub and activator of AP2, as well as changes in late endocytic stages due to recruitment of dynamin/sorting nexin 9 complex and involvement of the actin polymerization machinery. The evolutionary reconstruction showed the basis of the CME process and its subsequent step-by-step development. Documented changes imply more precise regulation of the pathway, as well as CME specialization for the uptake of specific cargoes and cell type-specific functions. PMID:26872775

Hepatoprotective and toxicological studies of Salvia bucharica methanolic extract in rabbits.

PubMed

Ahmad, Mansoor; Muhammed, Shafi; Mehjabeen, -; Jahan, Noor

2014-11-01

Most of the species of genus Salvia are famous for having medicinal properties due to their chemical constituents. Salvia bucharica (Lamiacea) is found in Balochistan near Quetta in Hannaurak and Kalat. It is used in traditional system of medicine and claims to cure liver ailments. In current study crude methanolic extract (CME) of Salvia bucharica was obtained from the leaves and tested for hepatoprotective activity and possible toxicity in rabbits. Liver toxicity was induced in rabbits by administration of carbon tetra chloride (CCl4) and evaluated by biochemical tests and histopathology of tissues. In this study rabbits were divided in to 3 groups (5 rabbit in each group). Rabbits of group I (control) were administered only vehicle (0.9% sodium chloride) orally. Rabbits of group II were given CCl4 and group III were treated with CCl4 and S. bucharica CME orally. For hepatoprotective effect serum enzyme level and total protein level were calculated. Histopathology of liver sections of rabbits was also carried out to observe protective effect. Biochemical, hematological and histoptahological parameters were studied on rabbits for toxicological studies. S. bucharica CME showed significant liver protection with reduction in total bilirubin, direct bilirubin, Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), Alkaline phosphatase (ALP), gamma glutamyl transpeptidase (γ-GT). And decrease in Albumin and globulin. In toxicological studies, biochemical and histoptahological parameters showed no significant toxicity in liver, heart and kidneys. It is concluded that S. bucharica CME showed hepatoprotective effects with nontoxic profile.

Ultraviolet Observations of Coronal Mass Ejection Impact on Comet 67P/Churyumov–Gerasimenko by Rosetta Alice

NASA Astrophysics Data System (ADS)

Noonan, John W.; Stern, S. Alan; Feldman, Paul D.; Broiles, Thomas; Wedlund, Cyril Simon; Edberg, Niklas J. T.; Schindhelm, Eric; Parker, Joel Wm.; Keeney, Brian A.; Vervack, Ronald J., Jr.; Steffl, Andrew J.; Knight, Matthew M.; Weaver, Harold A.; Feaga, Lori M.; A’Hearn, Michael; Bertaux, Jean-Loup

2018-07-01

The Alice ultraviolet spectrograph on the European Space Agency Rosetta spacecraft observed comet 67P/Churyumov–Gerasimenko in its orbit around the Sun for just over two years. Alice observations taken in 2015 October, two months after perihelion, show large increases in the comet’s Lyβ, O I 1304, O I 1356, and C I 1657 Å atomic emission that initially appeared to indicate gaseous outbursts. However, the Rosetta Plasma Consortium instruments showed a coronal mass ejection (CME) impact at the comet coincident with the emission increases, suggesting that the CME impact may have been the cause of the increased emission. The presence of the semi-forbidden O I 1356 Å emission multiplet is indicative of a substantial increase in dissociative electron impact emission from the coma, suggesting a change in the electron population during the CME impact. The increase in dissociative electron impact could be a result of the interaction between the CME and the coma of 67P or an outburst coincident with the arrival of the CME. The observed dissociative electron impact emission during this period is used to characterize the O2 content of the coma at two peaks during the CME arrival. The mechanism that could cause the relationship between the CME and UV emission brightness is not well constrained, but we present several hypotheses to explain the correlation.

Dependence of the Peak Fluxes of Solar Energetic Particles on CME 3D Parameters from STEREO and SOHO

DOE Office of Scientific and Technical Information (OSTI.GOV)

Park, Jinhye; Moon, Y.-J.; Lee, Harim, E-mail: jinhye@khu.ac.kr

We investigate the relationships between the peak fluxes of 18 solar energetic particle (SEP) events and associated coronal mass ejection (CME) 3D parameters (speed, angular width, and separation angle) obtained from SOHO , and STEREO-A / B for the period from 2010 August to 2013 June. We apply the STEREO CME Analysis Tool (StereoCAT) to the SEP-associated CMEs to obtain 3D speeds and 3D angular widths. The separation angles are determined as the longitudinal angles between flaring regions and magnetic footpoints of the spacecraft, which are calculated by the assumption of a Parker spiral field. The main results are asmore » follows. (1) We find that the dependence of the SEP peak fluxes on CME 3D speed from multiple spacecraft is similar to that on CME 2D speed. (2) There is a positive correlation between SEP peak flux and 3D angular width from multiple spacecraft, which is much more evident than the relationship between SEP peak flux and 2D angular width. (3) There is a noticeable anti-correlation ( r = −0.62) between SEP peak flux and separation angle. (4) The multiple-regression method between SEP peak fluxes and CME 3D parameters shows that the longitudinal separation angle is the most important parameter, and the CME 3D speed is secondary on SEP peak flux.« less

Coronal Current Sheet Evolution in the Aftermath of a CME

NASA Technical Reports Server (NTRS)

Bemporad, A.; Poletto, G.; Suess, S. T.; Ko, Y.-K.; Schwadron, N. A.; Elliott, H. A.; Raymond, J. C.

2005-01-01

We report on SOHO-UVCS observations of coronal restructuring following a Coronal Mass Ejection (CME) on November 26, 2002, at the time of a SOHO-Ulysses quadrature campaign. Starting about 3 hours after the CME, which was directed towards Ulysses, UVCS began taking spectra at 1.7 solar radii, covering emission from both cool and hot plasma. Observations continued, with occasional gaps, for more than 2 days. Emission in the 974.8 Angstrom line of [Fe XVIII], indicating temperatures above 6x10(6) K, was observed throughout the campaign in a spatially limited location. Comparison with EIT images shows the [Fe XVIII] emission to overlie a growing post-flare loop system formed in the aftermath of the CME. The emission most likely originates in a current sheet overlying the arcade. Analysis of the [Fe XVIII] emission allows us to infer the evolution of physical parameters in the current sheet over the entire span of our observations: in particular, we give the temperature vs. time in the current sheet and estimate the density. Ulysses was directly above the location of the CME and intercepted the ejecta. High ionization state Fe was detected by SWICS throughout the magnetic cloud associated with the CME, although the rapid temporal variation suggests bursty, rather than smooth, reconnection in the coronal current sheet. Both the remote and in situ observations are compared with predictions of theoretical CME models.

Current Sheet Evolution in the Aftermath of a CME Event

NASA Technical Reports Server (NTRS)

Bemporad, A.; Poletto, G.; Suess, S. T.; Ko, Y.-K.; Schwadron, N. A.; Elliott, H. A.; Raymond, J. C.

2005-01-01

We report on SOHO-UVCS observations of the coronal restructuring following a Coronal Mass Ejection (CME) on November 26,2002, at the time of a SOHO-Ulysses quadrature campaign. Starting about 3 hours after a CME in the NW quadrant, UVCS began taking spectra at 1.7 solar radius, covering emission from both cool and hot plasma. Observations continued, with occasional gaps, for more than 2 days. Emission in the 974.8 Angstrom line of [Fe XVIII], indicating temperatures above 6 x 10(exp 6) K, was observed throughout the campaign in a spatially limited location. Comparison with EIT images shows the Fe XVIII emission to overlie a growing post-flare loop system formed in the aftermath of the CME. The emission most likely originates in a current sheet overlying the arcade. Analysis of the [Fe XVIII] emission allows us to infer the evolution of physical parameters in the current sheet over the entire span of our observations: in particular, we give the temperature vs. time in the current sheet and estimate the density. At the time of the quadrature, Ulysses was directly above the location of the CME and intercepted the ejecta. High ionization state Fe was detected by Ulysses-SWICS throughout the magnetic cloud associated with the CME. Both the remote and in situ observations are compared with predictions of theoretical CME models.

Measuring Classroom Management Expertise (CME) of Teachers: A Video-Based Assessment Approach and Statistical Results

ERIC Educational Resources Information Center

König, Johannes

2015-01-01

The study aims at developing and exploring a novel video-based assessment that captures classroom management expertise (CME) of teachers and for which statistical results are provided. CME measurement is conceptualized by using four video clips that refer to typical classroom management situations in which teachers are heavily challenged…

Evaluating Conflicts of Interest in Research Presented in CME Venues

ERIC Educational Resources Information Center

Davis, Nancy L.; Galliher, James M.; Spano, Mindy S.; Main, Deborah S.; Brannigan, Michael; Pace, Wilson D.

2008-01-01

Introduction: There is much in the literature regarding the potential for commercial bias in clinical research and in continuing medical education (CME), but no studies were found regarding the potential for bias in reporting original research in CME venues. This pilot study investigated the presence of perceived bias in oral and print content of…

Two Distinct Types of CME-flare Relationships Based on SOHO and STEREO Observations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jang, Soojeong; Moon, Yong-Jae; Kim, Rok-Soon

In this paper, we present two distinct types of coronal mass ejection (CME)-flare relationships according to their observing time differences using 107 events from 2010 to 2013. The observing time difference, Δ T , is defined as flare peak time minus CME first appearance time at Solar Terrestrial Relations Observatory ( STEREO ) COR1 field of view. There are 41 events for group A (Δ T < 0) and 66 events for group B (Δ T ≥ 0). We compare CME 3D parameters (speed and kinetic energy) based on multi-spacecraft data ( SOlar and Heliospheric Observatory ( SOHO ) andmore » STEREO A and B ) and their associated flare properties (peak flux, fluence, and duration). Our main results are as follows. First, there are better relationships between CME and flare parameters for group B than that of group A. In particular, CME 3D kinetic energy for group B is well correlated with flare fluence with the correlation coefficient of 0.67, which is much stronger than that (cc = 0.31) of group A. Second, the events belonging to group A have short flare durations of less than 1 hr (mean = 21 minutes), while the events for group B have longer durations up to 4 hr (mean = 81 minutes). Third, the mean value of height at peak speed for group B is 4.05 Rs, which is noticeably higher than that of group A (1.89 Rs). This is well correlated with the CME acceleration duration (cc = 0.75). A higher height at peak speed and a longer acceleration duration of CME for group B could be explained by the fact that magnetic reconnections for group B continuously occur for a longer time than those for group A.« less

The Radial Speed - Expansion Speed Relation for Earth-Directed CMEs

NASA Astrophysics Data System (ADS)

Makela, P. A.; Gopalswamy, N.; Yashiro, S.

2013-12-01

The propagation speed of Earth-directed coronal mass ejections (CMEs) is an essential parameter needed in space weather forecasting. However, the true propagation speed of Earth-directed CMEs cannot be measured accurately from coronagraph images taken from Earth's view. In order to circumvent the inaccuracies of speed measurements due to the projection effects, empirical relations expressing the radial speed (Vrad) of the CME as a function of the CME expansion speed (Vexp) have been suggested. Vexp is defined as the apparent speed the CME is spreading in the coronagraph's field of view. During 2010-2012 STEREO spacecraft provided a side view of Earth-directed CMEs, allowing measurements of true CME speeds and widths. In a case study of the 2011 February 15 CME Gopalswamy et al. (2012) compared three Vrad-Vexp relations (flat cone, full or shallow ice cream cone - Gopalswamy et al., 2009) and found the closest match with the observations for the (full ice cream cone) relation Vrad = 1/2(1 + cot w)Vexp, where w is the half width of the CME. Using the STEREO/SECCHI and SOHO/LASCO observations during this opportune period, we expand this analysis to a larger set of Earth-directed CMEs. We compare the computed CME speed estimates with the measured true speeds and estimate the accuracy of the Vrad-Vexp relations. References: Gopalswamy, N. et al. (2009), The expansion and radial speeds of coronal mass ejections, Cent. Eur. Astrophys. Bull., 33, 115. Gopalswamy, N. et al. (2012), The relationship between the expansion speed and radial speed of CMEs confirmed using quadrature observations of the 2011 February 15 CME, Sun and Geosphere, 7(1), 7.

The Width of a Solar Coronal Mass Ejection and the Source of the Driving Magnetic Explosion

NASA Technical Reports Server (NTRS)

Moore, Ronald L.; Sterling, Alphonse C.; Suess, Steven T.

2007-01-01

We show that the strength of the magnetic field in the area covered by the flare arcade following a CME-producing ejective solar eruption can be estimated from the final angular width of the CME in the outer corona and the final angular width of the flare arcade. We assume (1) the flux-rope plasmoid ejected from the flare site becomes the interior of the CME plasmoid, (2) in the outer corona (R greater than 2R(sub Sun)) the CME is roughly a spherical plasmoid with legs shaped like a light bulb, and (3) beyond some height in or below the outer corona the CME plasmoid is in lateral pressure balance with the surrounding magnetic field. The strength of the nearly radial magnetic field in the outer corona is estimated from the radial component of the interplanetary magnetic field measured by Ulysses. We apply this model to three well-observed CMEs that exploded from flare regions of extremely different size and magnetic setting. One of these CMEs is an over-and-out CME that exploded from a laterally far offset compact ejective flare. In each event, the estimated source-region field strength is appropriate for the magnetic setting of the flare. This agreement (1) indicates that CMEs are propelled by the magnetic field of the CME plasmoid pushing against the surrounding magnetic field, (2) supports the magnetic-arch-blowout scenario for over-and-out CMEs, and (3) shows that a CME s final angular width in the outer corona can be estimated from the amount of magnetic flux covered by the source-region flare arcade.

3D Polarized Imaging of Coronal Mass Ejections: Chirality of a CME

NASA Astrophysics Data System (ADS)

DeForest, C. E.; de Koning, C. A.; Elliott, H. A.

2017-12-01

We report on a direct polarimetric determination of the chirality of a coronal mass ejection (CME), using the physics of Thomson scattering applied to synoptic polarized images from the Solar Terrestrial Relations Observatories/COR2 coronagraph. We confirmed the determination using in situ magnetic field measurements of the same CME with the ACE spacecraft. CME chirality is related to the helicity ejected from the solar corona along with the mass and field entrained in the CME. It is also important to prediction of the space-weather-relevant Z component of the CME magnetic field. Hence, remote measurement of CME chirality is an important step toward both understanding CME physics and predicting geoeffectiveness of individual CMEs. The polarimetric properties of Thomson scattering are well known and can, in principle, be used to measure the 3D structure of imaged objects in the solar corona and inner heliosphere. However, reduction of that principle to practice has been limited by the twin difficulties of background subtraction and the signal-to-noise ratio in coronagraph data. Useful measurements of the 3D structure require relative photometry at a few percent precision level in each linear polarization component of the K corona. This corresponds to a relative photometric precision of order 10-4 in direct images of the sky before subtraction of the F corona and related signal. Our measurement was enabled by recent developments in signal processing, which enable a better separation of the photometric signal from noise in the synoptic COR2 data. We discuss the relevance of this demonstration measurement to future instrument requirements, and to the future measurements of 3D structures in CMEs and other solar wind features.

Studying the Kinematic Behavior of Coronal Mass Ejections and Other Solar Phenomena using the Time-Convolution Mapping Method

NASA Astrophysics Data System (ADS)

Hess Webber, Shea A.; Thompson, Barbara J.; Kwon, Ryun Young; Ireland, Jack

2018-01-01

An improved understanding of the kinematic properties of CMEs and CME-associated phenomena has several impacts: 1) a less ambiguous method of mapping propagating structures into their inner coronal manifestations, 2) a clearer view of the relationship between the “main” CME and CME-associated brightenings, and 3) an improved identification of the heliospheric sources of shocks, Type II bursts, and SEPs. We present the results of a mapping technique that facilitates the separation of CMEs and CME-associated brightenings (such as shocks) from background corona. The Time Convolution Mapping Method (TCMM) segments coronagraph data to identify the time history of coronal evolution, the advantage being that the spatiotemporal evolution profiles allow users to separate features with different propagation characteristics. For example, separating “main” CME mass from CME-associated brightenings or shocks is a well-known obstacle, which the TCMM aids in differentiating. A TCMM CME map is made by first recording the maximum value each individual pixel in the image reaches during the traversal of the CME. Then the maximum value is convolved with an index to indicate the time that the pixel reached that value. The TCMM user is then able to identify continuous “kinematic profiles,” indicating related kinematic behavior, and also identify breaks in the profiles that indicate a discontinuity in kinematic history (i.e. different structures or different propagation characteristics). The maps obtained from multiple spacecraft viewpoints (i.e., STEREO and SOHO) can then be fit with advanced structural models to obtain the 3D properties of the evolving phenomena. We will also comment on the TCMM's further applicability toward the tracking of prominences, coronal hole boundaries and coronal cavities.

Forecast of geomagnetic storms using CME parameters and the WSA-ENLIL model

NASA Astrophysics Data System (ADS)

Moon, Y.; Lee, J.; Jang, S.; Na, H.; Lee, J.

2013-12-01

Intense geomagnetic storms are caused by coronal mass ejections (CMEs) from the Sun and their forecast is quite important in protecting space- and ground-based technological systems. The onset and strength of geomagnetic storms depend on the kinematic and magnetic properties of CMEs. Current forecast techniques mostly use solar wind in-situ measurements that provide only a short lead time. On the other hand, techniques using CME observations near the Sun have the potential to provide 1-3 days of lead time before the storm occurs. Therefore, one of the challenging issues is to forecast interplanetary magnetic field (IMF) southward components and hence geomagnetic storm strength with a lead-time on the order of 1-3 days. We are going to answer the following three questions: (1) when does a CME arrive at the Earth? (2) what is the probability that a CME can induce a geomagnetic storm? and (3) how strong is the storm? To address the first question, we forecast the arrival time and other physical parameters of CMEs at the Earth using the WSA-ENLIL model with three CME cone types. The second question is answered by examining the geoeffective and non-geoeffective CMEs depending on CME observations (speed, source location, earthward direction, magnetic field orientation, and cone-model output). The third question is addressed by examining the relationship between CME parameters and geomagnetic indices (or IMF southward component). The forecast method will be developed with a three-stage approach, which will make a prediction within four hours after the solar coronagraph data become available. We expect that this study will enable us to forecast the onset and strength of a geomagnetic storm a few days in advance using only CME parameters and the physics-based models.

CME Arrival-time Validation of Real-time WSA-ENLIL+Cone Simulations at the CCMC/SWRC

NASA Astrophysics Data System (ADS)

Wold, A. M.; Mays, M. L.; Taktakishvili, A.; Jian, L.; Odstrcil, D.; MacNeice, P. J.

2016-12-01

The Wang-Sheeley-Arge (WSA)-ENLIL+Cone model is used extensively in space weather operations worldwide to model CME propagation, as such it is important to assess its performance. We present validation results of the WSA-ENLIL+Cone model installed at the Community Coordinated Modeling Center (CCMC) and executed in real-time by the CCMC/Space Weather Research Center (SWRC). The SWRC is a CCMC sub-team that provides space weather services to NASA robotic mission operators and science campaigns, and also prototypes new forecasting models and techniques. CCMC/SWRC uses the WSA-ENLIL+Cone model to predict CME arrivals at NASA missions throughout the inner heliosphere. In this work we compare model predicted CME arrival-times to in-situ ICME shock observations near Earth (ACE, Wind), STEREO-A and B for simulations completed between March 2010 - July 2016 (over 1500 runs). We report hit, miss, false alarm, and correct rejection statistics for all three spacecraft. For hits we compute the bias, RMSE, and average absolute CME arrival time error, and the dependence of these errors on CME input parameters. We compare the predicted geomagnetic storm strength (Kp index) to the CME arrival time error for Earth-directed CMEs. The predicted Kp index is computed using the WSA-ENLIL+Cone plasma parameters at Earth with a modified Newell et al. (2007) coupling function. We also explore the impact of the multi-spacecraft observations on the CME parameters used initialize the model by comparing model validation results before and after the STEREO-B communication loss (since September 2014) and STEREO-A side-lobe operations (August 2014-December 2015). This model validation exercise has significance for future space weather mission planning such as L5 missions.

Efficacy of an integrated continuing medical education (CME) and quality improvement (QI) program on radiation oncologist (RO) clinical practice

DOE Office of Scientific and Technical Information (OSTI.GOV)

Leong, Cheng Nang; Shakespeare, Thomas Philip; North Coast Cancer Institute, Coffs Harbour

2006-12-01

Purpose: There has been little radiation oncologist (RO)-specific research in continuing medical education (CME) or quality improvement (QI) program efficacy. Our aim was to evaluate a CME/QI program for changes in RO behavior, performance, and adherence to department protocols/studies over the first 12 months of the program. Methods and Materials: The CME/QI program combined chart audit with feedback (C-AWF), simulation review AWF (SR-AWF), reminder checklists, and targeted CME tutorials. Between April 2003 and March 2004, management of 75 patients was evaluated by chart audit with feedback (C-AWF) and 178 patients via simulation review audit (SR-AWF) using a validated instrument. Scoresmore » were presented, and case management was discussed with individualized educational feedback. RO behavior and performance was compared over the first year of the program. Results: Comparing the first and second 6 months, there was a significant improvement in mean behavior (12.7-13.6 of 14, p = 0.0005) and RO performance (7.6-7.9 of 8, p = 0.018) scores. Protocol/study adherence significantly improved from 90.3% to 96.6% (p = 0.005). A total of 50 actions were generated, including the identification of learning needs to direct CME tutorials, the systematic change of suboptimal RO practice, and the alteration of deficient management of 3% of patients audited during the program. Conclusion: An integrated CME/QI program combining C-AWF, SR-AWF, QI reminders, and targeted CME tutorials effectively improved targeted RO behavior and performance over a 12-month period. There was a corresponding increase in departmental protocol and study adherence.« less

Fast and ultrafast endocytosis.

PubMed

Watanabe, Shigeki; Boucrot, Emmanuel

2017-08-01

Clathrin-mediated endocytosis (CME) is the main endocytic pathway supporting housekeeping functions in cells. However, CME may be too slow to internalize proteins from the cell surface during certain physiological processes such as reaction to stress hormones ('fight-or-flight' reaction), chemotaxis or compensatory endocytosis following exocytosis of synaptic vesicles or hormone-containing vesicles. These processes take place on a millisecond to second timescale and thus require very rapid cellular reaction to prevent overstimulation or exhaustion of the response. There are several fast endocytic processes identified so far: macropinocytosis, activity-dependent bulk endocytosis (ABDE), fast-endophilin-mediated endocytosis (FEME), kiss-and-run and ultrafast endocytosis. All are clathrin-independent and are not constitutively active but may use different molecular mechanisms to rapidly remove receptors and proteins from the cell surface. Here, we review our current understanding of fast and ultrafast endocytosis, their functions, and molecular mechanisms. Copyright © 2017 Elsevier Ltd. All rights reserved.

Deciphering dynamics of clathrin-mediated endocytosis in a living organism

PubMed Central

Heidotting, Spencer P.; Huber, Scott D.

2016-01-01

Current understanding of clathrin-mediated endocytosis (CME) dynamics is based on detection and tracking of fluorescently tagged clathrin coat components within cultured cells. Because of technical limitations inherent to detection and tracking of single fluorescent particles, CME dynamics is not characterized in vivo, so the effects of mechanical cues generated during development of multicellular organisms on formation and dissolution of clathrin-coated structures (CCSs) have not been directly observed. Here, we use growth rates of fluorescence signals obtained from short CCS intensity trace fragments to assess CME dynamics. This methodology does not rely on determining the complete lifespan of individual endocytic assemblies. Therefore, it allows for real-time monitoring of spatiotemporal changes in CME dynamics and is less prone to errors associated with particle detection and tracking. We validate the applicability of this approach to in vivo systems by demonstrating the reduction of CME dynamics during dorsal closure of Drosophila melanogaster embryos. PMID:27458134