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.

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…

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…

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

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.

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…

The role of audience characteristics and external factors in continuing medical education and physician change: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines.

PubMed

Lowe, Mary Martin; Bennett, Nancy; Aparicio, Alejandro

2009-03-01

The Agency for Healthcare Research and Quality (AHRQ) Evidence Report identified and assessed audience characteristics (internal factors) and external factors that influence the effectiveness of continuing medical education (CME) in changing physician behavior. Thirteen studies examined a series of CME audience characteristics (internal factors), and six studies looked at external factors to reinforce the effects of CME in changing behavior. With regard to CME audience characteristics, the 13 studies examined age, gender, practice setting, years in practice, specialty, foreign vs US medical graduate, country of practice, personal motivation, nonmonetary rewards and motivations, learning satisfaction, and knowledge enhancement. With regard to the external characteristics, the six studies looked at the role of regulation, state licensing boards, professional boards, hospital credentialing, external audits, monetary and financial rewards, academic advancement, provision of tools, public demand and expectations, and CME credit. No consistent findings were identified. The AHRQ Evidence Report provides no conclusions about the ways that internal or external factors influence CME effectiveness in changing physician behavior. However, given what is known about how individuals approach learning, it is likely that internal factors play an important role in the design of effective CME. Regulatory and professional organizations are providing new structures, mandates, and recommendations for CME activities that influence the way CME providers design and present activities, supporting a role that is not yet clear for external factors. More research is needed to understand the impact of these factors in enhancing the effectiveness of CME.

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…

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

Online continuing medical education (CME) for GPs: does it work? A systematic review.

PubMed

Thepwongsa, Isaraporn; Kirby, Catherine N; Schattner, Peter; Piterman, Leon

2014-10-01

Numerous studies have assessed the effectiveness of online continuing medical education (CME) designed to improve healthcare professionals' care of patients. The effects of online educational interventions targeted at general practitioners (GP), however, have not been systematically reviewed. A computer search was conducted through seven databases for studies assessing changes in GPs' knowledge and practice, or patient outcomes following an online educational intervention. Eleven studies met the eligibility criteria. Most studies (8/11, 72.7%) found a significant improvement in at least one of the following outcomes: satisfaction, knowledge or practice change. There was little evidence for the impact of online CME on patient outcomes. Variability in study design, characteristics of online and outcome measures limited conclusions on the effects of online CME. Online CME could improve GP satisfaction, knowledge and practices but there are very few well-designed studies that focus on this delivery method of GP education.

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.

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.

Participation of French Hospital Physicians to Continuing Medical Education Events: A Survey with 300 Physicians to Assess Duration, Methods, Financing, and Needs

ERIC Educational Resources Information Center

Maisonneuve, Herve; Touboul, Chantal; Bonnelye, Genevieve; Bertrand, Dominique

2009-01-01

Introduction: Little data on the educational needs and practices of French hospital physicians have been obtained through surveys. Given that continuing medical education (CME) information is now available on http://www.cnfmc.fr and providers are accredited, we investigated CME practices and knowledge of the CME system with the use of a…

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.

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.

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

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.

78 FR 42579 - Self-Regulatory Organizations; Chicago Mercantile Exchange Inc.; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-16

... Change Regarding a Change to Interest Rate Swap Margin Calculation Parameters July 10, 2013. Pursuant to... Interest Rate Swap Margin Parameters Please be advised that beginning 7/15/2013, CME Clearing will utilize a revised set of parameters for the margining of CME cleared Interest Rate Swap Products. The...

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.

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.

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.

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.

Effect of a performance improvement CME activity on management of patients with diabetes.

PubMed

Bird, Gary C; Marian, Kathy; Bagley, Bruce

2013-01-01

Primary care in the United States faces unprecedented challenges from an aging population and the accompanying prevalence of chronic disease. In response, continuing medical education (CME) initiatives have begun to adopt the principles of performance improvement (PI) into their design, although currently there is a dearth of evidence from national initiatives supporting the effectiveness of this methodology. The specific aim of this study was to demonstrate the value of a national PI-CME activity to improve the performance of physicians treating patients with diabetes. We analyzed data from the American Academy of Family Physicians' METRIC® PI-CME activity in a cohort of family physician learners. The study utilized the 3-stage design standard approved for PI-CME. Baseline and follow-up performance data across a range of clinical and systems-based measures were compared in aggregate. Data were assessed for 509 learners who completed the activity. Statistically significant changes occurred both for self-assessment of a range of practice aspects and for diabetes care measures. Learners recognized that the organization of their practices had improved, and mechanisms were in place for better staff feedback, as well as aspects of patient self-management. Based on the clinical data obtained from 11 538 patient charts, 6 out of 8 diabetes measures were significantly improved. The activity appears to have had a positive, measurable impact on the medical practice of learners and suggests that, when appropriately designed and executed, PI-CME on a national scale can be a useful vehicle to influence performance change in physicians and to inform future CME 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.

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.

Impractical CME programs: Influential parameters in Iran.

PubMed

Faghihi, Seyed Aliakbar; Khankeh, Hamid Reza; Hosseini, Seyed Jalil; Soltani Arabshahi, Seyed Kamran; Faghih, Zahra; Shirazi, Mandana

2017-01-01

Background: Traditional approaches in Continuing Medical Education (CME) appear to be ineffective in any improvement of the patients' care, reducing the medical errors, and/or altering physicians' behaviors. However, they are still executed by the CME providers, and are popular among the majority of the physicians. In this study, we aimed to explore the parameters involved in the degree of effectiveness of CME program in Iran. Methods: In this study, 31 participants, consisting of general practitioners, CME experts and providers were recruited to participate in in-depth interviews and field observations concerning experiences with CME. Application was made of the qualitative paradigm along with the qualitative content analysis, using grounded theory data analysis methodology (constant comparative analysis). Results: Based on the participants' experiences, the insufficient consistency between the training program contents and the demands of GPs, in addition to the non-beneficiary programs for the physicians and the non-comprehensive educational designs, created a negative attitude to the continuing education among physicians. This could be defined by an unrealistic continuing education program, which is the main theme here. Conclusion: Impracticable continuing education has created a negative attitude toward the CME programs among physicians so much that they consider these programs less important, resulting in attending the said programs without any specific aim: they dodge absenteeism just to get the credit points. Evidently, promoting CME programs to improve the performance of the physicians requires factual needs assessment over and above adaptation of the contents to the physicians' performance.

Impractical CME programs: Influential parameters in Iran

PubMed Central

Faghihi, Seyed Aliakbar; Khankeh, Hamid Reza; Hosseini, Seyed Jalil; Soltani Arabshahi, Seyed Kamran; Faghih, Zahra; Shirazi, Mandana

2017-01-01

Background: Traditional approaches in Continuing Medical Education (CME) appear to be ineffective in any improvement of the patients’ care, reducing the medical errors, and/or altering physicians' behaviors. However, they are still executed by the CME providers, and are popular among the majority of the physicians. In this study, we aimed to explore the parameters involved in the degree of effectiveness of CME program in Iran. Methods: In this study, 31 participants, consisting of general practitioners, CME experts and providers were recruited to participate in in-depth interviews and field observations concerning experiences with CME. Application was made of the qualitative paradigm along with the qualitative content analysis, using grounded theory data analysis methodology (constant comparative analysis). Results: Based on the participants’ experiences, the insufficient consistency between the training program contents and the demands of GPs, in addition to the non-beneficiary programs for the physicians and the non-comprehensive educational designs, created a negative attitude to the continuing education among physicians. This could be defined by an unrealistic continuing education program, which is the main theme here. Conclusion: Impracticable continuing education has created a negative attitude toward the CME programs among physicians so much that they consider these programs less important, resulting in attending the said programs without any specific aim: they dodge absenteeism just to get the credit points. Evidently, promoting CME programs to improve the performance of the physicians requires factual needs assessment over and above adaptation of the contents to the physicians’ performance. PMID:28638813

DATA-CONSTRAINED CORONAL MASS EJECTIONS IN A GLOBAL MAGNETOHYDRODYNAMICS MODEL

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

Jin, M.; Manchester, W. B.; Van der Holst, B.

We present a first-principles-based coronal mass ejection (CME) model suitable for both scientific and operational purposes by combining a global magnetohydrodynamics (MHD) solar wind model with a flux-rope-driven CME model. Realistic CME events are simulated self-consistently with high fidelity and forecasting capability by constraining initial flux rope parameters with observational data from GONG, SOHO /LASCO, and STEREO /COR. We automate this process so that minimum manual intervention is required in specifying the CME initial state. With the newly developed data-driven Eruptive Event Generator using Gibson–Low configuration, we present a method to derive Gibson–Low flux rope parameters through a handful ofmore » observational quantities so that the modeled CMEs can propagate with the desired CME speeds near the Sun. A test result with CMEs launched with different Carrington rotation magnetograms is shown. Our study shows a promising result for using the first-principles-based MHD global model as a forecasting tool, which is capable of predicting the CME direction of propagation, arrival time, and ICME magnetic field at 1 au (see the companion paper by Jin et al. 2016a).« less

Promoting free online CME for intimate partner violence: what works at what cost?

PubMed

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

2009-01-01

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 discourage IPV training efforts and the use of online CME in general. We promoted an interactive, multimedia, online IPV CME program, which offered free CME credit, to 92,000 California physicians for 24 months. We collected data on user satisfaction, the costs of different promotional strategies, and self-reported user referral source. We evaluated California physician awareness of the promotion via telephone surveys. Over 2 years, the CME program was used by 1869 California physicians (2% of market), who rated the program's overall quality highly (4.52 on a 1-5 scale; 5 = excellent). The average promotional cost per physician user was $75. Direct mail was the most effective strategy, costing $143 each for 821 users. E-promotion via search engine advertising and e-mail solicitation had less reach, but was more cost efficient ($30-$80 per user). Strategies with no direct cost, such as notices in professional newsletters, accounted for 31% (578) of physician users. Phone surveys found that 24% of California physicians were aware of the online IPV CME program after 18 months of promotion. Promoting online CME, even well-received free CME, to busy community physicians requires resources, in this case at least $75 per physician reached. The effective use of promotional resources needs to be considered when developing social marketing strategies to improve community physician practices. Organizations with an interest in promoting online training might consider the use of e-promotion techniques along with conventional promotion strategies.

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…

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.

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.

Theory and practice in continuing medical education.

PubMed

Amin, Z

2000-07-01

Continuing medical education (CME) represents the final and often most poorly understood stage of physician education. The understanding of contemporary theories of physician education and characteristics of effective CME interventions will help CME providers and physician learners to plan productive CME activities and improve learning. This article aims to provide readers with emerging evidences on effective CME, particularly in relation to theories of physician learning and their implications for CME planning. The article also summarises attributes of effective CME interventions. The data and evidence were collected from contemporary medical education journals and published books on medical education. Two electronic databases, Medline and ERIC (Educational Research Information Clearinghouse) were searched for suitable articles. Physician learning is a distinct phenomenon with high inclination towards autonomy and self-directed learning. CME interventions are more likely to be fruitful if they are modelled with strong theoretical background, catered towards individual learning needs and preferences, and focused on the learning component of education. Many widely practised CME interventions fail to be effective as those are not based on the above principles. Evidence suggests that careful planning and evaluation of CME will improve the key measure of physician's performance and health care outcome.

Prediction system of the 1-AU arrival times of CME-associated interplanetary shocks using three-dimensional simulations

NASA Astrophysics Data System (ADS)

den, Mitsue; Amo, Hiroyoshi; Sugihara, Kohta; Takei, Toshifumi; Ogawa, Tomoya; Tanaka, Takashi; Watari, Shinichi

We describe prediction system of the 1-AU arrival times of interplanetary shock waves associated with coromal mass ejections (CMEs). The system is based on modeling of the shock propagation using a three-dimensional adaptive mesh refinement (AMR) code. Once a CME is observed by LASCO/SOHO, firstly ambient solar wind is obtained by numerical simulation, which reproduces the solar wind parameters at that time observed by ACE spacecraft. Then we input the expansion speed and occurrence position data of that CME as initial condtions for an CME model, and 3D simulation of the CME and the shock propagation is perfomed until the shock wave passes the 1-AU. Input the parameters, execution of simulation and output of the result are available on Web, so a person who is not familiar with operation of computer or simulations or is not a researcher can use this system to predict the shock passage time. Simulated CME and shock evolution is visuallized at the same time with simulation and snap shots appear on the web automatically, so that user can follow the propagation. This system is expected to be useful for forecasters of space weather. We will describe the system and simulation model in detail.

American Association of Hip and Knee Surgeons

MedlinePlus

... AAHKS Update Newsletter Hip and Knee Care Top Stories You will receive an email with the meeting ... payment program affects your practice. Learn more. Top Stories Claim CME for AAHKS 2017 To claim CME ...

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.

Validation of Real-time Modeling of Coronal Mass Ejections Using the WSA-ENLIL+Cone Heliospheric Model

NASA Astrophysics Data System (ADS)

Romano, M.; Mays, M. L.; Taktakishvili, A.; MacNeice, P. J.; Zheng, Y.; Pulkkinen, A. A.; Kuznetsova, M. M.; Odstrcil, D.

2013-12-01

Modeling coronal mass ejections (CMEs) is of great interest to the space weather research and forecasting communities. We present recent validation work of real-time CME arrival time predictions at different satellites using the WSA-ENLIL+Cone three-dimensional MHD heliospheric model available at the Community Coordinated Modeling Center (CCMC) and performed by the Space Weather Research Center (SWRC). 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. The quality of model operation is evaluated by comparing its output to a measurable parameter of interest such as the CME arrival time and geomagnetic storm strength. The Kp index is calculated from the relation given in Newell et al. (2007), using solar wind parameters predicted by the WSA-ENLIL+Cone model at Earth. The CME arrival time error is defined as the difference between the predicted arrival time and the observed in-situ CME shock arrival time at the ACE, STEREO A, or STEREO B spacecraft. This study includes all real-time WSA-ENLIL+Cone model simulations performed between June 2011-2013 (over 400 runs) at the CCMC/SWRC. We report hit, miss, false alarm, and correct rejection statistics for all three spacecraft. For hits we show the average absolute CME arrival time error, and the dependence of this error on CME input parameters such as speed, width, and direction. We also present the predicted geomagnetic storm strength (using the Kp index) error for Earth-directed CMEs.

Propagation Characteristics of CMEs Associated with Magnetic Clouds and Ejecta

NASA Astrophysics Data System (ADS)

Kim, R.-S.; Gopalswamy, N.; Cho, K.-S.; Moon, Y.-J.; Yashiro, S.

2013-05-01

We have investigated the characteristics of magnetic cloud (MC) and ejecta (EJ) associated coronal mass ejections (CMEs) based on the assumption that all CMEs have a flux rope structure. For this, we used 54 CMEs and their interplanetary counterparts (interplanetary CMEs: ICMEs) that constitute the list of events used by the NASA/LWS Coordinated Data Analysis Workshop (CDAW) on CME flux ropes. We considered the location, angular width, and speed as well as the direction parameter, D. The direction parameter quantifies the degree of asymmetry of the CME shape in coronagraph images, and shows how closely the CME propagation is directed to Earth. For the 54 CDAW events, we found the following properties of the CMEs: i) the average value of D for the 23 MCs (0.62) is larger than that for the 31 EJs (0.49), which indicates that the MC-associated CMEs propagate more directly toward the Earth than the EJ-associated CMEs; ii) comparison between the direction parameter and the source location shows that the majority of the MC-associated CMEs are ejected along the radial direction, while many of the EJ-associated CMEs are ejected non-radially; iii) the mean speed of MC-associated CMEs (946 km s-1) is faster than that of EJ-associated CMEs (771 km s-1). For seven very fast CMEs (≥ 1500 km s-1), all CMEs with large D (≥ 0.4) are associated with MCs and the CMEs with small D are associated with EJs. From the statistical analysis of CME parameters, we found the superiority of the direction parameter. Based on these results, we suggest that the CME trajectory essentially determines the observed ICME structure.

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

[Continuing medical education in Germany--the northrhenian experience].

PubMed

Griebenow, R; Lösche, P; Lehmacher, W; Schmülling, A; Chon, S; Christ, H; Stützer, H; Stosch, Ch

2003-04-04

For Germany there exist only very little data concerning the practice of continuous medical education (CME). The introduction of the CME certificate has made it possible to gather data about the CME activities and their evaluation which are presented here for the northrhenian chamber of physicians. In 2002 the northrhenian academy for CME has certified more than 5500 CME activities and more than 2000 maintenance-of-quality group activities. In addition the evaluation forms of the first 4486 consecutive participants have been evaluated,including those of the northrhenian CME congress on the isle of Norderney. 94 % of the participants had received their license between 1 and 30 years ago and 81 % attended > or = 1 CME activity per month. Currently there exist only very few digital media certified for CME, which is dominated by oral presentations of which 85 % have gained > or = 2 points for the certificate (150 points in 3 years). General practitioners and internists together represented nearly 40 % of the participants, the others represent a broad spectrum of specialties. Topics and presentation were rated as of high quality and clinical relevance, which was also true for sponsored CME. Certified CME is currently dominated by oral presentations which mostly take place outside the working hours and which are rated as of high quality and clinical relevance.

Two-step forecast of geomagnetic storm using coronal mass ejection and solar wind condition

PubMed Central

Kim, R-S; Moon, Y-J; Gopalswamy, N; Park, Y-D; Kim, Y-H

2014-01-01

To forecast geomagnetic storms, we had examined initially observed parameters of coronal mass ejections (CMEs) and introduced an empirical storm forecast model in a previous study. Now we suggest a two-step forecast considering not only CME parameters observed in the solar vicinity but also solar wind conditions near Earth to improve the forecast capability. We consider the empirical solar wind criteria derived in this study (Bz ≤ −5 nT or Ey ≥ 3 mV/m for t≥ 2 h for moderate storms with minimum Dst less than −50 nT) and a Dst model developed by Temerin and Li (2002, 2006) (TL model). Using 55 CME-Dst pairs during 1997 to 2003, our solar wind criteria produce slightly better forecasts for 31 storm events (90%) than the forecasts based on the TL model (87%). However, the latter produces better forecasts for 24 nonstorm events (88%), while the former correctly forecasts only 71% of them. We then performed the two-step forecast. The results are as follows: (i) for 15 events that are incorrectly forecasted using CME parameters, 12 cases (80%) can be properly predicted based on solar wind conditions; (ii) if we forecast a storm when both CME and solar wind conditions are satisfied (∩), the critical success index becomes higher than that from the forecast using CME parameters alone, however, only 25 storm events (81%) are correctly forecasted; and (iii) if we forecast a storm when either set of these conditions is satisfied (∪), all geomagnetic storms are correctly forecasted. PMID:26213515

Two-step forecast of geomagnetic storm using coronal mass ejection and solar wind condition.

PubMed

Kim, R-S; Moon, Y-J; Gopalswamy, N; Park, Y-D; Kim, Y-H

2014-04-01

To forecast geomagnetic storms, we had examined initially observed parameters of coronal mass ejections (CMEs) and introduced an empirical storm forecast model in a previous study. Now we suggest a two-step forecast considering not only CME parameters observed in the solar vicinity but also solar wind conditions near Earth to improve the forecast capability. We consider the empirical solar wind criteria derived in this study ( B z  ≤ -5 nT or E y  ≥ 3 mV/m for t ≥ 2 h for moderate storms with minimum Dst less than -50 nT) and a Dst model developed by Temerin and Li (2002, 2006) (TL model). Using 55 CME- Dst pairs during 1997 to 2003, our solar wind criteria produce slightly better forecasts for 31 storm events (90%) than the forecasts based on the TL model (87%). However, the latter produces better forecasts for 24 nonstorm events (88%), while the former correctly forecasts only 71% of them. We then performed the two-step forecast. The results are as follows: (i) for 15 events that are incorrectly forecasted using CME parameters, 12 cases (80%) can be properly predicted based on solar wind conditions; (ii) if we forecast a storm when both CME and solar wind conditions are satisfied (∩), the critical success index becomes higher than that from the forecast using CME parameters alone, however, only 25 storm events (81%) are correctly forecasted; and (iii) if we forecast a storm when either set of these conditions is satisfied (∪), all geomagnetic storms are correctly forecasted.

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).

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

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

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.

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.

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.

Automatic Determination of the Conic Coronal Mass Ejection Model Parameters

NASA Technical Reports Server (NTRS)

Pulkkinen, A.; Oates, T.; Taktakishvili, A.

2009-01-01

Characterization of the three-dimensional structure of solar transients using incomplete plane of sky data is a difficult problem whose solutions have potential for societal benefit in terms of space weather applications. In this paper transients are characterized in three dimensions by means of conic coronal mass ejection (CME) approximation. A novel method for the automatic determination of cone model parameters from observed halo CMEs is introduced. The method uses both standard image processing techniques to extract the CME mass from white-light coronagraph images and a novel inversion routine providing the final cone parameters. A bootstrap technique is used to provide model parameter distributions. When combined with heliospheric modeling, the cone model parameter distributions will provide direct means for ensemble predictions of transient propagation in the heliosphere. An initial validation of the automatic method is carried by comparison to manually determined cone model parameters. It is shown using 14 halo CME events that there is reasonable agreement, especially between the heliocentric locations of the cones derived with the two methods. It is argued that both the heliocentric locations and the opening half-angles of the automatically determined cones may be more realistic than those obtained from the manual analysis

The Influence of Coronal Mass Ejections on the Mass-loss Rates of Hot-Jupiters

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

Cherenkov, A.; Bisikalo, D.; Fossati, L.

Hot-Jupiters are subject to extreme radiation and plasma flows coming from their host stars. Past ultraviolet Hubble Space Telescope observations, supported by hydrodynamic models, confirmed that these factors lead to the formation of an extended envelope, part of which lies beyond the Roche lobe. We use gas-dynamic simulations to study the impact of time variations in the parameters of the stellar wind, namely that of coronal mass ejections (CMEs), on the envelope of the typical hot-Jupiter HD 209458b. We consider three CMEs characterized by different velocities and densities, taking their parameters from typical CMEs observed for the Sun. The perturbationsmore » in the ram-pressure of the stellar wind during the passage of each CME tear off most of the envelope that is located beyond the Roche lobe. This leads to a substantial increase of the mass-loss rates during the interaction with the CME. We find that the mass lost by the planet during the whole crossing of a CME is of ≈10{sup 15} g, regardless of the CME taken into consideration. We also find that over the course of 1 Gyr, the mass lost by the planet because of CME impacts is comparable to that lost because of high-energy stellar irradiation.« less

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

Testing model for prediction system of 1-AU arrival times of CME-associated interplanetary shocks

NASA Astrophysics Data System (ADS)

Ogawa, Tomoya; den, Mitsue; Tanaka, Takashi; Sugihara, Kohta; Takei, Toshifumi; Amo, Hiroyoshi; Watari, Shinichi

We test a model to predict arrival times of interplanetary shock waves associated with coronal mass ejections (CMEs) using a three-dimensional adaptive mesh refinement (AMR) code. The model is used for the prediction system we develop, which has a Web-based user interface and aims at people who is not familiar with operation of computers and numerical simulations or is not researcher. We apply the model to interplanetary CME events. We first choose coronal parameters so that property of background solar wind observed by ACE space craft is reproduced. Then we input CME parameters observed by SOHO/LASCO. Finally we compare the predicted arrival times with observed ones. We describe results of the test and discuss tendency of the model.

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.

Macular auto-fluorescence is a follow-up parameter for cystoids macular edema.

PubMed

Zhang, XinYuan; Gong, XiaoHong; Wang, YanHong; Wang, NingLi

2015-08-01

This study aimed to evaluate if macular autofluorescence (MAF) is a valuable, non-invasive follow-up parameter for cystoid macular edema. A total of 71 eyes (71 cases) with cystoid macular edema (CME) were included in the study. Macular pigment (MP) was evaluated using HRA2 (infrared) IF and FA models. The density of MP was graded into three categories: without, partial, and normal amount of MP. A comparison was made between the baseline (before the first administration) level and at the fourth month, following three consecutive intravitreal lucentis injections every month. The morphology and distribution of MAF, and the density and distribution of MP were regarded as the main outcome measures. At the baseline visit, all eyes with CME had petaloid/irregular-shaped MAF in the macular area (100%). No MAF was detected in the control eyes (0). There was significant difference in MAF between the CME and normal groups (P=0.000). At the fourth monthly visit, normal levels of MP density without MAF was detected in 68 eyes (95.8%) with the best corrected spectacular visual acuity increasing to at least 1 line accordingly. We conclude that macular MAF can be used as a follow-up parameter for patients with CME. MP and MAF can indirectly reflect the fovea cone function.

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.

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.

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.

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…

Do Continuing Medical Education Articles Foster Shared Decision Making?

ERIC Educational Resources Information Center

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

2010-01-01

Introduction: 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…

Solar Energetic Particle Forecasting Algorithms and Associated False Alarms

NASA Astrophysics Data System (ADS)

Swalwell, B.; Dalla, S.; Walsh, R. W.

2017-11-01

Solar energetic particle (SEP) events are known to occur following solar flares and coronal mass ejections (CMEs). However, some high-energy solar events do not result in SEPs being detected at Earth, and it is these types of event which may be termed "false alarms". We define two simple SEP forecasting algorithms based upon the occurrence of a magnetically well-connected CME with a speed in excess of 1500 km s^{-1} (a "fast" CME) or a well-connected X-class flare and analyse them with respect to historical datasets. We compare the parameters of those solar events which produced an enhancement of {>} 40 MeV protons at Earth (an "SEP event") and the parameters of false alarms. We find that an SEP forecasting algorithm based solely upon the occurrence of a well-connected fast CME produces fewer false alarms (28.8%) than an algorithm which is based solely upon a well-connected X-class flare (50.6%). Both algorithms fail to forecast a relatively high percentage of SEP events (53.2% and 50.6%, respectively). Our analysis of the historical datasets shows that false-alarm X-class flares were either not associated with any CME, or were associated with a CME slower than 500 km s^{-1}; false-alarm fast CMEs tended to be associated with flare classes lower than M3. A better approach to forecasting would be an algorithm which takes as its base the occurrence of both CMEs and flares. We define a new forecasting algorithm which uses a combination of CME and flare parameters, and we show that the false-alarm ratio is similar to that for the algorithm based upon fast CMEs (29.6%), but the percentage of SEP events not forecast is reduced to 32.4%. Lists of the solar events which gave rise to {>} 40 MeV protons and the false alarms have been derived and are made available to aid further study.

Continuing medical education, continuing professional development, and knowledge translation: improving care of older patients by practicing physicians.

PubMed

Thomas, David C; Johnston, Bree; Dunn, Kathel; Sullivan, Gail M; Brett, Belle; Matzko, Marilyn; Levine, Sharon A

2006-10-01

Many community-based internists and family physicians lack familiarity with geriatrics knowledge and best practices, but they face overwhelming fiscal and time barriers to expanding their skills and improving their behavior in the care of older people. Traditional lecture-and-slide-show continuing medical education (CME) programs have been shown to be relatively ineffective in changing this target group's practice. The challenge for geriatrics educators, then, is to devise CME programs that are highly accessible to practicing physicians, that will have an immediate and significant effect on practitioners' behavior, and that are financially viable. Studies of CME have shown that the most effective programs for knowledge translation in these circumstances involve what is known as active-mode learning, which relies on interactive, targeted, and multifaceted techniques. A systematic literature review, supplemented by structured interviews, was performed to inventory active-mode learning techniques for geriatrics knowledge and skills in the United States. Thirteen published articles met the criteria, and leaders of 28 active-mode CME programs were interviewed. This systematic review indicates that there is a substantial experience in geriatrics training for community-based physicians, much of which is unpublished and incompletely evaluated. It appears that the most effective methods to change behaviors involved multiple educational efforts such as written materials or toolkits combined with feedback and strong communication channels between instructors and learners.

Coronal mass ejection hits mercury: A.I.K.E.F. hybrid-code results compared to MESSENGER data

NASA Astrophysics Data System (ADS)

Exner, W.; Heyner, D.; Liuzzo, L.; Motschmann, U.; Shiota, D.; Kusano, K.; Shibayama, T.

2018-04-01

Mercury is the closest orbiting planet around the sun and is therefore embedded in an intensive and highly varying solar wind. In-situ data from the MESSENGER spacecraft of the plasma environment near Mercury indicates that a coronal mass ejection (CME) passed the planet on 23 November 2011 over the span of the 12 h MESSENGER orbit. Slavin et al. (2014) derived the upstream parameters of the solar wind at the time of that orbit, and were able to explain the observed MESSENGER data in the cusp and magnetopause segments of MESSENGER's trajectory. These upstream parameters will be used for our first simulation run. We use the hybrid code A.I.K.E.F. which treats ions as individual particles and electrons as a mass-less fluid, to conduct hybrid simulations of Mercury's magnetospheric response to the impact of the CME on ion gyro time scales. Results from the simulation are in agreement with magnetic field measurements from the inner day-side magnetosphere and the bow-shock region. However, at the planet's nightside, Mercury's plasma environment seemed to be governed by different solar wind conditions, in conclusion, Mercury's interaction with the CME is not sufficiently describable by only one set of upstream parameters. Therefore, to simulate the magnetospheric response while MESSENGER was located in the tail region, we use parameters obtained from the MHD solar wind simulation code SUSANOO (Shiota et al. (2014)) for our second simulation run. The parameters of the SUSANOO model achieve a good agreement of the data concerning the plasma tail crossing and the night-side approach to Mercury. However, the polar and closest approach are hardly described by both upstream parameters, namely, neither upstream dataset is able to reproduce the MESSENGER crossing of Mercury's magnetospheric cusp. We conclude that the respective CME was too variable on the timescale of the MESSENGER orbit to be described by only two sets of upstream conditions. Our results suggest locally strong and highly variable dynamics of the CME on timescales of 15 min while MESSENGER was near closest approach.

Determining the Evolution and Propagation of CME Flux Ropes from the Sun to Earth

NASA Astrophysics Data System (ADS)

Palmerio, E.; Kilpua, E.; Mierla, M.; Rodriguez, L.; Isavnin, A.; Zhukov, A.

2017-12-01

Coronal mass ejections (CMEs) are the main drivers of space weather phenomena at the Earth. They form in the solar atmosphere as helical magnetic field structures known as flux ropes. The key parameter that defines the ability of a CME to drive geomagnetic storms is the North-South magnetic field component. One of the most significant problems in current long-term space weather forecasts is that there is no practical method to measure the magnetic structure of CMEs routinely in the corona. The magnetic structure of erupting flux ropes can however be inferred based on the properties of the CME's source region characteristics, e.g.filament details, coronal EUV arcades, X-ray/EUV sigmoids, taking into account nearby coronal and photospheric features. These proxies are useful for reconstructing the "instrinsic flux rope type" at the time of the eruption. However, the knowledge of the flux rope's magnetic structure at the Sun does not always imply a successful prediction of the magnetic structure at the Earth. This is because CMEs can change their orientation due to deflections, rotations, and deformations. We present here examples of CMEs for which we have determined their magnetic structure when launched from the Sun by using a synthesis of indirect proxies based on multiwavelength remote-sensing observations. When compared to their in situ counterparts, these CMEs present a different magnetic configuration, implying a high amount of rotation of their central axis during their propagation. We study the early evolution of these CMEs both on the solar disk and in coronagraph images though different techniques, e.g. forward modelling and tie-pointing technique. When possible, we study the CME structure in situ at other planets. We aim at determining where the rotation occurs and the rate of rotation during the CME evolution from the Sun to Earth, and possibly estimating the causes of such a high amount of rotation.

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.

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

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…

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…

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.

Comparison of interplanetary CME arrival times and solar wind parameters based on the WSA-ENLIL model with three cone types and observations

NASA Astrophysics Data System (ADS)

Jang, Soojeong; Moon, Y.-J.; Lee, Jae-Ok; Na, Hyeonock

2014-09-01

We have made a comparison between coronal mass ejection (CME)-associated shock propagations based on the Wang-Sheeley-Arge (WSA)-ENLIL model using three cone types and in situ observations. For this we use 28 full-halo CMEs, whose cone parameters are determined and their corresponding interplanetary shocks were observed at the Earth, from 2001 to 2002. We consider three different cone types (an asymmetric cone model, an ice cream cone model, and an elliptical cone model) to determine 3-D CME cone parameters (radial velocity, angular width, and source location), which are the input values of the WSA-ENLIL model. The mean absolute error of the CME-associated shock travel times for the WSA-ENLIL model using the ice-cream cone model is 9.9 h, which is about 1 h smaller than those of the other models. We compare the peak values and profiles of solar wind parameters (speed and density) with in situ observations. We find that the root-mean-square errors of solar wind peak speed and density for the ice cream and asymmetric cone model are about 190 km/s and 24/cm3, respectively. We estimate the cross correlations between the models and observations within the time lag of ± 2 days from the shock travel time. The correlation coefficients between the solar wind speeds from the WSA-ENLIL model using three cone types and in situ observations are approximately 0.7, which is larger than those of solar wind density (cc ˜0.6). Our preliminary investigations show that the ice cream cone model seems to be better than the other cone models in terms of the input parameters of the WSA-ENLIL model.

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.

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.

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.

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

Lu, Lei; Feng, Li; Liu, Siming

We present a detailed study of an Earth-directed coronal mass ejection (full-halo CME) event that happened on 2011 February 15, making use of white-light observations by three coronagraphs and radio observations by Wind /WAVES. We applied three different methods to reconstruct the propagation direction and traveling distance of the CME and its driven shock. We measured the kinematics of the CME leading edge from white-light images observed by Solar Terrestrial Relations Observatory ( STEREO ) A and B , tracked the CME-driven shock using the frequency drift observed by Wind /WAVES together with an interplanetary density model, and obtained themore » equivalent scattering centers of the CME by the polarization ratio (PR) method. For the first time, we applied the PR method to different features distinguished from LASCO/C2 polarimetric observations and calculated their projections onto white-light images observed by STEREO-A and STEREO-B . By combining the graduated cylindrical shell (GCS) forward modeling with the PR method, we proposed a new GCS-PR method to derive 3D parameters of a CME observed from a single perspective at Earth. Comparisons between different methods show a good degree of consistence in the derived 3D results.« less

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

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.

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.

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.

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.

Impact of Performance Improvement Continuing Medical Education on Cardiometabolic Risk Factor Control: The COSEHC Initiative

PubMed Central

Joyner, JaNae; Moore, Michael A.; Simmons, Debra R.; Forrest, Brian; Yu-Isenberg, Kristina; Piccione, Ron; Caton, Kirt; Lackland, Daniel T.; Ferrario, Carlos M.

2016-01-01

Introduction The Consortium for Southeastern Hypertension Control (COSEHC) implemented a study to assess benefits of a performance improvement continuing medical education (PI CME) activity focused on cardiometabolic risk factor management in primary care patients. Methods Using the plan-do-study-act (PDSA) model as the foundation, this PI CME activity aimed at improving practice gaps by integrating evidence-based clinical interventions, physician-patient education, processes of care, performance metrics, and patient outcomes. The PI CME intervention was implemented in a group of South Carolina physician practices, while a comparable physician practice group served as a control. Performance outcomes at 6 months included changes in patients’ cardiometabolic risk factor values and control rates from baseline. We also compared changes in diabetic, African American, the elderly (> 65 years), and female patient subpopulations and in patients with uncontrolled risk factors at baseline. Results Only women receiving health care by intervention physicians showed a statistical improvement in their cardiometabolic risk factors as evidenced by a −3.0 mg/dL and a −3.5 mg/dL decrease in mean LDL cholesterol and non-HDL cholesterol, respectively, and a −7.0 mg/dL decrease in LDL cholesterol among females with uncontrolled baseline LDL cholesterol values. No other statistical differences were found. Discussion These data demonstrate that our PI CME activity is a useful strategy in assisting physicians to improve their management of cardiometabolic control rates in female patients with abnormal cholesterol control. Other studies that extend across longer PI CME PDSA periods may be needed to demonstrate statistical improvements in overall cardiometabolic treatment goals in men, women, and various subpopulations. PMID:24648361

Endometrial Cancer

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 ...

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.

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.

Exercise during Pregnancy

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 ...

Dysmenorrhea: Painful Periods

MedlinePlus

... 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 Overview CREOG Meetings Calendar ...

Media and Body Image

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 ...

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

Deflections of Fast Coronal Mass Ejections and the Properties of Associated Solar Energetic Particle Events

NASA Technical Reports Server (NTRS)

Kahler, S. W.; Akiyama, S.; Gopalswamy, N.

2012-01-01

The onset times and peak intensities of solar energetic particle (SEP) events at Earth have long been thought to be influenced by the open magnetic fields of coronal holes (CHs). The original idea was that a CH lying between the solar SEP source region and the magnetic footpoint of the 1 AU observer would result in a delay in onset and/or a decrease in the peak intensity of that SEP event. Recently, Gopalswamy et al. showed that CHs near coronal mass ejection (CME) source regions can deflect fast CMEs from their expected trajectories in space, explaining the appearance of driverless shocks at 1 AU from CMEs ejected near solar central meridian (CM). This suggests that SEP events originating in CME-driven shocks may show variations attributable to CH deflections of the CME trajectories. Here, we use a CH magnetic force parameter to examine possible effects of CHs on the timing and intensities of 41 observed gradual E approx 20 MeV SEP events with CME source regions within 20 deg. of CM. We find no systematic CH effects on SEP event intensity profiles. Furthermore, we find no correlation between the CME leading-edge measured position angles and SEP event properties, suggesting that the widths of CME-driven shock sources of the SEPs are much larger than the CMEs. Independently of the SEP event properties, we do find evidence for significant CME deflections by CH fields in these events

Chiral magnetic currents with QGP medium response in heavy-ion collisions at RHIC and LHC energies

NASA Astrophysics Data System (ADS)

She, Duan; Feng, Sheng-Qin; Zhong, Yang; Yin, Zhong-Bao

2018-03-01

We calculate the electromagnetic current with a more realistic approach in the RHIC and LHC energy regions in the article. We take the partons formation time as the initial time of the magnetic field response of QGP medium. The maximum electromagnetic current and the time-integrated current are two important characteristics of the chiral magnetic effect (CME), which can characterize the intensity and duration of fluctuations of CME. We consider the finite frequency response of CME to a time-varying magnetic field, find a significant impact from QGP medium feedback, and estimate the generated electromagnetic current as a function of time, beam energy and impact parameter.

Comparison of the WSA-ENLIL model with three CME cone types

NASA Astrophysics Data System (ADS)

Jang, Soojeong; Moon, Y.; Na, H.

2013-07-01

We have made a comparison of the CME-associated shock propagation based on the WSA-ENLIL model with three cone types using 29 halo CMEs from 2001 to 2002. These halo CMEs have cone model parameters as well as their associated interplanetary (IP) shocks. For this study we consider three different cone types (an asymmetric cone model, an ice-cream cone model and an elliptical cone model) to determine 3-D CME parameters (radial velocity, angular width and source location), which are the input values of the WSA-ENLIL model. The mean absolute error (MAE) of the arrival times for the asymmetric cone model is 10.6 hours, which is about 1 hour smaller than those of the other models. Their ensemble average of MAE is 9.5 hours. However, this value is still larger than that (8.7 hours) of the empirical model of Kim et al. (2007). We will compare their IP shock velocities and densities with those from ACE in-situ measurements and discuss them in terms of the prediction of geomagnetic storms.Abstract (2,250 Maximum Characters): We have made a comparison of the CME-associated shock propagation based on the WSA-ENLIL model with three cone types using 29 halo CMEs from 2001 to 2002. These halo CMEs have cone model parameters as well as their associated interplanetary (IP) shocks. For this study we consider three different cone types (an asymmetric cone model, an ice-cream cone model and an elliptical cone model) to determine 3-D CME parameters (radial velocity, angular width and source location), which are the input values of the WSA-ENLIL model. The mean absolute error (MAE) of the arrival times for the asymmetric cone model is 10.6 hours, which is about 1 hour smaller than those of the other models. Their ensemble average of MAE is 9.5 hours. However, this value is still larger than that (8.7 hours) of the empirical model of Kim et al. (2007). We will compare their IP shock velocities and densities with those from ACE in-situ measurements and discuss them in terms of the prediction of geomagnetic storms.

Two-Step Forecast of Geomagnetic Storm Using Coronal Mass Ejection and Solar Wind Condition

NASA Technical Reports Server (NTRS)

Kim, R.-S.; Moon, Y.-J.; Gopalswamy, N.; Park, Y.-D.; Kim, Y.-H.

2014-01-01

To forecast geomagnetic storms, we had examined initially observed parameters of coronal mass ejections (CMEs) and introduced an empirical storm forecast model in a previous study. Now we suggest a two-step forecast considering not only CME parameters observed in the solar vicinity but also solar wind conditions near Earth to improve the forecast capability. We consider the empirical solar wind criteria derived in this study (Bz = -5 nT or Ey = 3 mV/m for t = 2 h for moderate storms with minimum Dst less than -50 nT) (i.e. Magnetic Field Magnitude, B (sub z) less than or equal to -5 nanoTeslas or duskward Electrical Field, E (sub y) greater than or equal to 3 millivolts per meter for time greater than or equal to 2 hours for moderate storms with Minimum Disturbance Storm Time, Dst less than -50 nanoTeslas) and a Dst model developed by Temerin and Li (2002, 2006) (TL [i.e. Temerin Li] model). Using 55 CME-Dst pairs during 1997 to 2003, our solar wind criteria produce slightly better forecasts for 31 storm events (90 percent) than the forecasts based on the TL model (87 percent). However, the latter produces better forecasts for 24 nonstorm events (88 percent), while the former correctly forecasts only 71 percent of them. We then performed the two-step forecast. The results are as follows: (i) for 15 events that are incorrectly forecasted using CME parameters, 12 cases (80 percent) can be properly predicted based on solar wind conditions; (ii) if we forecast a storm when both CME and solar wind conditions are satisfied (n, i.e. cap operator - the intersection set that is comprised of all the elements that are common to both), the critical success index becomes higher than that from the forecast using CME parameters alone, however, only 25 storm events (81 percent) are correctly forecasted; and (iii) if we forecast a storm when either set of these conditions is satisfied (?, i.e. cup operator - the union set that is comprised of all the elements of either or both), all geomagnetic storms are correctly forecasted.

Relationship of EUV Irradiance Coronal Dimming Slope and Depth to Coronal Mass Ejection Speed and Mass

NASA Technical Reports Server (NTRS)

Mason, James Paul; Woods, Thomas N.; Webb, David F.; Thompson, Barbara J.; Colaninno, Robin C.; Vourlidas, Angelos

2016-01-01

Extreme ultraviolet (EUV) coronal dimmings are often observed in response to solar eruptive events. These phenomena can be generated via several different physical processes. For space weather, the most important of these is the temporary void left behind by a coronal mass ejection (CME). Massive, fast CMEs tend to leave behind a darker void that also usually corresponds to minimum irradiance for the cooler coronal emissions. If the dimming is associated with a solar are, as is often the case, the are component of the irradiance light curve in the cooler coronal emission can be isolated and removed using simultaneous measurements of warmer coronal lines. We apply this technique to 37dimming events identified during two separate two-week periods in 2011, plus an event on 2010 August 7 analyzed in a previous paper, to parameterize dimming in terms of depth and slope. We provide statistics on which combination of wavelengths worked best for the flare-removal method, describe the fitting methods applied to the dimming light curves, and compare the dimming parameters with corresponding CME parameters of mass and speed. The best linear relationships found are nu(sub CME) [km/s] approx. equals 2.36 x 10 6 [km/%] x s(sub dim) [%/s] m(sub CME) [g] approx. equals 2.59 x 10(exp.15 [g/%] x the square root of d(sub dim) [%].These relationships could be used for space weather operations of estimating CME mass and speed using near-real-time irradiance dimming measurements.

Judicious use of simulation technology in continuing medical education.

PubMed

Curtis, Michael T; DiazGranados, Deborah; Feldman, Moshe

2012-01-01

Use of simulation-based training is fast becoming a vital source of experiential learning in medical education. Although simulation is a common tool for undergraduate and graduate medical education curricula, the utilization of simulation in continuing medical education (CME) is still an area of growth. As more CME programs turn to simulation to address their training needs, it is important to highlight concepts of simulation technology that can help to optimize learning outcomes. This article discusses the role of fidelity in medical simulation. It provides support from a cross section of simulation training domains for determining the appropriate levels of fidelity, and it offers guidelines for creating an optimal balance of skill practice and realism for efficient training outcomes. After defining fidelity, 3 dimensions of fidelity, drawn from the human factors literature, are discussed in terms of their relevance to medical simulation. From this, research-based guidelines are provided to inform CME providers regarding the use of simulation in CME training. 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.

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

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.

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 ...

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.

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.

Variation of Magnetic Field (By , Bz) Polarity and Statistical Analysis of Solar Wind Parameters during the Magnetic Storm Period

NASA Astrophysics Data System (ADS)

Moon, Ga-Hee

2011-06-01

It is generally believed that the occurrence of a magnetic storm depends upon the solar wind conditions, particularly the southward interplanetary magnetic field (IMF) component. To understand the relationship between solar wind parameters and magnetic storms, variations in magnetic field polarity and solar wind parameters during magnetic storms are examined. A total of 156 storms during the period of 1997~2003 are used. According to the interplanetary driver, magnetic storms are divided into three types, which are coronal mass ejection (CME)-driven storms, co-rotating interaction region (CIR)-driven storms, and complicated type storms. Complicated types were not included in this study. For this purpose, the manner in which the direction change of IMF By and Bz components (in geocentric solar magnetospheric coordinate system coordinate) during the main phase is related with the development of the storm is examined. The time-integrated solar wind parameters are compared with the time-integrated disturbance storm time (Dst) index during the main phase of each magnetic storm. The time lag with the storm size is also investigated. Some results are worth noting: CME-driven storms, under steady conditions of Bz < 0, represent more than half of the storms in number. That is, it is found that the average number of storms for negative sign of IMF Bz (T1~T4) is high, at 56.4%, 53.0%, and 63.7% in each storm category, respectively. However, for the CIR-driven storms, the percentage of moderate storms is only 29.2%, while the number of intense storms is more than half (60.0%) under the Bz < 0 condition. It is found that the correlation is highest between the time-integrated IMF Bz and the time-integrated Dst index for the CME-driven storms. On the other hand, for the CIR-driven storms, a high correlation is found, with the correlation coefficient being 0.93, between time-integrated Dst index and time-integrated solar wind speed, while a low correlation, 0.51, is found between timeintegrated Bz and time-integrated Dst index. The relationship between storm size and time lag in terms of hours from Bz minimum to Dst minimum values is investigated. For the CME-driven storms, time lag of 26% of moderate storms is one hour, whereas time lag of 33% of moderate storms is two hours for the CIR-driven storms. The average values of solar wind parameters for the CME and CIR-driven storms are also examined. The average values of |Dstmin| and |Bzmin| for the CME-driven storms are higher than those of CIR-driven storms, while the average value of temperature is lower.

The Correlation Between Solar Energetic Particle Events and Coronal Mass Ejections

NASA Astrophysics Data System (ADS)

Karelitz, A. M.; Pulkkinen, A.

2012-12-01

Solar energetic particle (SEP) events are a wide scale phenomena that are not only an issue for the 2,000+ costly satellites in the sky but also have negative implications on aviation, and even ground based communication. Forecasting the magnitude and duration of strong SEP events based on preceding events that are often associated with them, such as coronal mass ejections (CMEs) and solar flares, is an important step in future operational space weather as well as research. In order to provide a model connecting SEP and CME characteristics, six specific CMEs between 8/14/2010 and 5/17/12 that met specific qualifications (i.e. earth directed), were chosen and several parameters characterizing the connections were derived. From the derived data, correlations between many of the different parameters were tested. One of the more meaningful correlations that was found is between the peak flux of >10 MeV GOES protons and the speed of the CME. A logarithmic correlation between these two entities is clearly seen with a R^2 value of 0.78 and a fit of y=2.74e.^(003x). For forecasting purposes, the times of the arrival of the SEP event with respect to the evolution of the CME was also recorded. Another possibly meaningful correlation was found between SEP duration and CME speed with R^2 value of 0.56. The identified connections were verified by adding an event that occurred on July 12, 2012. Using the model connecting SEP peak flux and CME speed as produced in this study, space weather forecasters can better predict the magnitude of the SEP event that is a result of an earth directed CME. Doing so will enable precautions to be taken on spacecraft as well as ground based entities that are vulnerable to the high-energy protons. In future work, we plan to perform

Homologous and cannibalistic coronal mass ejections from twisted magnetic flux rope simulations

NASA Astrophysics Data System (ADS)

Chatterjee, Piyali; Fan, Yuhong

We present results from magnetohydrodynamic simulations of the development of homologous sequence of coronal mass ejections (CMEs) and demonstrate their so-called cannibalistic behavior. These CMEs originate from the repeated formations and partial eruptions of kink unstable flux ropes as a result of continued emergence of a twisted flux rope across the lower boundary into a pre-existing coronal potential arcade field. Our simulation shows that a CME erupting into the open magnetic field created by a preceding CME has a higher speed. The second of the three successive CMEs in one of the simulations is cannibalistic, catching up and merging with the first into a single fast CME before exiting the domain. All the CMEs including the leading merged CME, attained speeds of about 1000 km s-1 as they exit the domain. The reformation of a twisted flux rope after each CME eruption during the sustained flux emergence can naturally explain the X-ray observations of repeated reformations of sigmoids and "sigmoid-under-cusp" configurations at a low-coronal source of homologous CMEs. We also investigate the initiation mechanism and ejecta topology of these energetic CMEs as a function of the twist parameter of the flux rope.

Mechanoregulation of clathrin-mediated endocytosis in isolated cells and developing tissues

NASA Astrophysics Data System (ADS)

Kural, Comert

Clathrin-coated assemblies bear the largest fraction of the endocytic load from the plasma membrane of eukaryotic cells. However, dynamics of clathrin-mediated endocytosis (CME) have not been established within tissues of multicellular organisms due to experimental and analytical bottlenecks in determining the lifespan of clathrin-coated structures. We found that clathrin coat growth rates obtained from fluorescence microscopy acquisitions can be utilized as reporters of CME dynamics. Growth rates can be assembled within time windows shorter than the average clathrin coat lifetime and, thereby, allow probing the changes in CME dynamics in real time. Furthermore, this novel approach is applicable to tissues as it is not prone to particle detection and tracking errors, which result in underestimation of the clathrin coat lifetimes. Exploiting these advantages, we detected spatial and temporal changes in CME dynamics within Drosophila amnioserosa tissues at different stages of embryo development. We also found that increased membrane tension impedes CME through inhibition of formation and dissolution of clathrin-coated structures. Therefore, the parameters defining clathrin coat dynamics (i.e., lifetime, formation density and growth rates) can be utilized to monitor the spatiotemporal gradients of the plasma membrane tension during cell migration and spreading.

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.

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.

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.

Predicting the Magnetic Field of Earth-impacting CMEs

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

Kay, C.; Gopalswamy, N.; Reinard, A.

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 andmore » 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.« less

On the Feasibility of a Pulsed 14 TeV C.M.E. Muon Collider in the LHC Tunnel

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

Shiltsev, Vladimir; Neuffer, D.

We discuss the technical feasibility, key machine pa-rameters and major challenges of a 14 TeV c.m.e. muon-muon collider in the LHC tunnel [1]. The luminosity of the collider is evaluated for three alternative muon sources – the PS synchrotron, one of a type developed by the US Muon Accelerator Program (MAP) and a low-emittance option based on resonant μ-pair production.

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.

Development and evaluation of a web-based breast cancer cultural competency course for primary healthcare providers.

PubMed

Palmer, Richard C; Samson, Raquel; Triantis, Maria; Mullan, Irene D

2011-08-15

To develop and evaluate a continuing medical education (CME) course aimed at improving healthcare provider knowledge about breast cancer health disparities and the importance of cross-cultural communication in provider-patient interactions about breast cancer screening. An interactive web-based CME course was developed and contained information about breast cancer disparities, the role of culture in healthcare decision making, and demonstrated a model of cross-cultural communication. A single group pre-/post-test design was used to assess knowledge changes. Data on user satisfaction was also collected. In all, 132 participants registered for the CME with 103 completing both assessments. Differences between pre-/post-test show a significant increase in knowledge (70% vs. 94%; p < .001). Ninety-five percent of participants agreed that the web based training was an appropriate tool to train healthcare providers about cultural competency and health disparities. There was an overall high level of satisfaction among all users. Users felt that learning objectives were met and the web-based format was appropriate and easy to use and suggests that web-based CME formats are an appropriate tool to teach cultural competency skills. However, more information is needed to understand how the CME impacted practice behaviors.

American College of Obstetricians and Gynecologists

MedlinePlus

... Workshops Postgraduate Courses CME Overview Full Meeting Calendar Green Journal Access the Green Journal , an official publication of ACOG: TOC and ... Resources & Publications Committee Opinions Practice Bulletins Patient ... Journal Clinical Updates Practice Management Coding Health Info ...

Interprofessional Communities of Practice in Continuing Medical Education for Promoting and Sustaining Practice Change: A Prospective Cohort Study.

PubMed

Barker, Megan; Lecce, Julia; Ivanova, Anna; Zawertailo, Laurie; Dragonetti, Rosa; Selby, Peter

2018-01-01

Standard knowledge delivery formats for CME may have limited impact on long-term practice change. A community of practice (CoP) is one tool that may enhance competencies and support practice change. This study explores the utility of an interprofessional CoP as an adjunct to a CME program in tobacco addiction treatment (Training Enhancement in Applied Counselling and Health [TEACH] Project) to promote and sustain practice change. A prospective cohort design was utilized to examine the long-term impact of the TEACH CoP on practice change. An online survey was administered to TEACH-trained practitioners to assess perceived feasibility, importance, and confidence related to course competencies, involvement in TEACH CoP activities, engagement in knowledge transfer (KT), and implementation of new programming. Chi-square tests were used to detect differences in KT and program development associated with CoP participation. Course competency scores from immediate postcourse surveys and long-term follow-up surveys were compared. No significant differences in participant characteristics were found between those who did (n = 300) and did not (n = 122) participate in the TEACH CoP. Mean self-perceived competency scores were greater immediately after course than at long-term follow-up; however, self-ratings of competency in pharmacological interventions and motivational interviewing were higher at follow-up. TEACH CoP participation was associated with significantly greater engagement in KT and implementation of new programming after training. The findings from this evaluation suggest the value of interprofessional CoPs offered posttraining as a mechanism to enhance practice. CME providers should consider offering CoPs as a component of training programs to promote and sustain practice change.

Current Sheet Evolution In The Aftermath Of A CME Event

NASA Technical Reports Server (NTRS)

Bemporad, A.; Poletto, G.; Seuss, S. T.; Schwardron, N. A.; Elliott, H. A.; Raymond, J. C.

2006-01-01

We report on SOHO UVCS observations of the coronal restructuring following a coronal mass ejection (CME) on 2002 November 26, at the time of a SOHO-Ulysses quadrature campaign. Starting about 1.5 hr after a CME in the northwest quadrant, UVCS began taking spectra at 1.7 R, covering emission from both cool and hot plasma. Observations continued, with occasional gaps, for more than 2 days. Emission in the 974.8 A 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 versus time in the current sheet and estimate its 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 the Ulysses SWICS throughout the magnetic cloud associated with the CME, although its rapid temporal variation suggests bursty, rather than smooth, reconnection in the coronal current sheet. The SOHO-Ulysses data set provided us with the unique opportunity of analyzing a current sheet structure from its lowest coronal levels out to its in situ properties. Both the remote and in situ observations are compared with predictions of theoretical CME models.

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.

Forbush Decrease Prediction Based on Remote Solar Observations

NASA Astrophysics Data System (ADS)

Dumbovic, Mateja; Vrsnak, Bojan; Calogovic, Jasa

2016-04-01

We study the relation between remote observations of coronal mass ejections (CMEs), their associated solar flares and short-term depressions in the galactic cosmic-ray flux (so called Forbush decreases). Statistical relations between Forbush decrease magnitude and several CME/flare parameters are examined. In general we find that Forbush decrease magnitude is larger for faster CMEs with larger apparent width, which is associated with stronger flares that originate close to the center of the solar disk and are (possibly) involved in a CME-CME interaction. The statistical relations are quantified and employed to forecast expected Forbush decrease magnitude range based on the selected remote solar observations of the CME and associated solar flare. Several verification measures are used to evaluate the forecast method. We find that the forecast is most reliable in predicting whether or not a CME will produce a Forbush decrease with a magnitude >3 %. The main advantage of the method is that it provides an early prediction, 1-4 days in advance. Based on the presented research, an online forecast tool was developed (Forbush Decrease Forecast Tool, FDFT) available at Hvar Observatory web page: http://oh.geof.unizg.hr/FDFT/fdft.php. We acknowledge the support of Croatian Science Foundation under the project 6212 "Solar and Stellar Variability" and of European social fond under the project "PoKRet".

[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.

Origin and Ion Charge State Evolution of Solar Wind Transients 4 - 7 August 2011

NASA Astrophysics Data System (ADS)

Rodkin, Denis; Goryaev, Farid; Pagano, Paolo; Gibb, Gordon; Slemzin, Vladimir; Shugay, Yulia; Veselovsky, Igor; Mackay, Duncan

2017-04-01

Identification of transients and their origins on the Sun is one of the most important problems of the space weather forecasting. In our work, we present a case study of the complex event consisting of several solar wind transients detected by ACE on 4 - 7 August 2011, that caused a geomagnetic storm with Dst= - 110 nT. The supposed coronal sources - three flares and coronal mass ejections (CMEs) occurred on 2 - 4 August 2011 in the active region AR 11261. To investigate the solar origins and formation of these transients, we studied kinematic and thermodynamic properties of expanding coronal structures using the SDO/AIA EUV images and the differential emission measure (DEM) diagnostics. The Helioseismic and Magnetic Imager (HMI) magnetic field maps were used as the input data for the 3D numerical model to describe the flux rope ejection. We characterize the early phase of the flux rope ejection in the corona, where the usual three-component CME structure formed. The flux rope ejected with the speed about 200 km/s to the height of 0.25 Rsun. The kinematics of the modeled CME front well agrees with the STEREO EUV measurements. Using the results of the plasma diagnostics and MHD modeling, we calculated the ion charge ratios of carbon and oxygen as well as the mean charge state of iron ions of the 2 August 2011 CME taking into account the processes of heating, cooling, expansion, ionization and recombination of the moving plasma in the corona up to the freeze-in region. We estimated a probable heating rate of the CME plasma in the low corona by matching the calculated ion composition parameters of the CME with that measured in-situ parameters of the solar wind transients. We also consider the similarities and discrepancies between the results of the MHD simulation and the observation of the event. Our results show that analysis of the ion composition of CMEs enables to disclose a relationship between parameters of the solar wind transients and properties of their solar origins, which opens new possibilities to validate and improve the solar wind forecasting models.

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.

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.

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.

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

[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.

A novel hand-assisted laparoscopic versus conventional laparoscopic right hemicolectomy for right colon cancer: study protocol for a randomized controlled trial.

PubMed

Yang, Xuyang; Wu, Qingbin; Jin, Chengwu; He, Wanbin; Wang, Meng; Yang, Tinghan; Wei, Mingtian; Deng, Xiangbing; Meng, Wenjian; Wang, Ziqiang

2017-07-26

Although conventional laparoscopic and hand-assisted laparoscopic surgery for colorectal cancer is widely used today, there remain many technical challenges especially for right colon cancer in obese patients. Herein, we develop a novel hand-assisted laparoscopic surgery (HALS) with complete mesocolic excision (CME), D3 lymphadenectomy, and a total "no-touch" isolation technique (HALS-CME) in right hemicolectomy to overcome these issues. According to previous clinic practice, this novel procedure is not only feasible and safe but has several technical merits. However, the feasibility, short-term minimally invasive virtues, long-term oncological superiority, and potential total "no-touch" isolation technique benefits of HALS-CME should be confirmed by a prospective randomized controlled trial. This is a single-center, open-label, noninferiority, randomized controlled trial. Eligible participants will be randomly assigned to the HALS-CME group or to the laparoscopic surgery with CME, D3 lymphadenectomy, and total "no-touch" isolation technique (LAP-CME) group, or to conventional laparoscopic surgery with CME and D3 lymphadenectomy (cLAP) group at a 1:1:1 ratio using a centralized randomization list. Primary endpoints include safety, efficacy, and being oncologically clear, and 3-year disease-free, progression-free, and overall survival. Second endpoints include operative outcomes (operation time, blood loss, and incision length), pathologic evaluation (grading the plane of surgery, length of proximal and distal resection margins, distance between the tumor and the central arterial high tie, distance between the nearest bowel wall and the same high tie, area of mesentery resected, width of the chain of lymph-adipose tissue, length of the central lymph-adipose chain, number of harvested lymph nodes), and postoperative outcomes (pain intensity, postoperative inflammatory and immune responses, postoperative recovery). This trial will provide valuable clinical evidence for the feasibility, safety, and potential total "no-touch" isolation technique benefits of HALS-CME for right hemicolectomy. The hypothesis is that HALS-CME is feasible for the radical D3 resection of right colon cancer and offers short-term safety and long-term oncological superiority compared with conventional laparoscopic surgery. ClinicalTrials.gov, NCT02625272 . Registered on 8 December 2015.

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.

Testing the reliability of ice-cream cone model

NASA Astrophysics Data System (ADS)

Pan, Zonghao; Shen, Chenglong; Wang, Chuanbing; Liu, Kai; Xue, Xianghui; Wang, Yuming; Wang, Shui

2015-04-01

Coronal Mass Ejections (CME)'s properties are important to not only the physical scene itself but space-weather prediction. Several models (such as cone model, GCS model, and so on) have been raised to get rid of the projection effects within the properties observed by spacecraft. According to SOHO/ LASCO observations, we obtain the 'real' 3D parameters of all the FFHCMEs (front-side full halo Coronal Mass Ejections) within the 24th solar cycle till July 2012, by the ice-cream cone model. Considering that the method to obtain 3D parameters from the CME observations by multi-satellite and multi-angle has higher accuracy, we use the GCS model to obtain the real propagation parameters of these CMEs in 3D space and compare the results with which by ice-cream cone model. Then we could discuss the reliability of the ice-cream cone model.

Testing the reliability of ice-cream cone model

NASA Astrophysics Data System (ADS)

Pan, Z.; Shen, C.; Wang, Y.; Liu, K.

2013-12-01

Coronal Mass Ejections (CME)'s properties are important to not only the physical scene itself but spaceweather prediction. Several models(such as cone model, GCS model, and so on) have been raised to get rid of the projection effects within the properties observated by spacecraft. According to SOHO/ LASCO observations, we obtain the 'real' 3D parameters of 33 FFHCMEs (front-side full halo Coronal Mass Ejections) within the 24th solar cycle by the ice-cream cone model. Considering that the method to obtain 3D parameters from the CME observations by multi-satellite and multi-angle has higher accuracy, we use the GCS model to obtain the real propagation parameters of these CMEs in 3D space and compare the results with which by ice-cream cone model. It was demonstrated that the correlation coefficient for the speeds by using these both methods is 0.97.

Prediction of SEP Peak Proton Intensity Based on CME Speed, Direction and Observations of Associated Solar Phenomena

NASA Astrophysics Data System (ADS)

Richardson, I. G.; Mays, M. L.; Thompson, B. J.; Kwon, R.; Frechette, B. P.

2017-12-01

We assess whether a formula obtained by Richardson et al. (Solar Phys., 289, 3059, 2014; DOI 10.1007/s11207-014-0524-8) relating the intensity of 14-24 MeV protons in a solar energetic particle event at 1 AU to the solar event location and the speed of the associated coronal mass ejection (CME), may be used to "predict" the intensity of a solar energetic particle event. Starting with a subset of several hundred CMEs in the CCMC/SWRC DONKI real-time database (http://kauai.ccmc.gsfc.nasa.gov/DONKI/) selected without consideration of whether they were associated with SEP events, we first use the CME speed and direction to predict the proton intensity at Earth or the STEREO spacecraft using this formula. Since most of these CMEs were not in fact associated with SEP events, many "false alarms" result. We then examine whether considering other phenomena which may accompany the CMEs, such as the X-ray flare intensity and the properties of type II and type III radio emissions, may help to reduce the false alarm rate. We also use CME parameters calculated from an ellipsoidal shell fit to multi-spacecraft CME shock observations for a smaller number of events to predict the SEP intensity. We calculate skill scores for each case and assess whether the Richardson et al. (2014) formula, using additional observations to reduce the false alarm rate, has any potential as a SEP prediction tool, assuming that the required observations could be acquired sufficiently rapidly following the onset of the related solar event/CME.

Contents of a core library in continuing medical education: a Delphi study.

PubMed

Olson, Curtis A; Tooman, Tricia R; Leist, James C

2005-01-01

In developing their professional competence, those who are interested in the practice of continuing medical education (CME) should recognize the knowledge base that defines their field. This study systematically identifies and organizes a list of books and journals comprising a core library (100 books/15 journals) for CME professionals. The Delphi method was applied to elicit and combine the judgments of a fifty member panel considered knowledgeable about the CME field. The panelists participated in three iterations of the survey to first identify and then rank order nominated works. Separate ranked lists were created for books and journals. Forty-four participants completed the study (88% response rate). 268 books and 34 journals were identified. Mean ratings ranged from 4.78 (high) to 1.50 (low). The results of the study reflect the panel's judgment. The list is not definitive; instead, it describes what a select group of individuals knowledgeable about the CME field considered important. The list should therefore be seen as a general guide and a resource to facilitate decision-making, not as a prescription for creating a library.

Effects of a signature on rates of change: a randomized controlled trial involving continuing education and the commitment-to-change model.

PubMed

Mazmanian, P E; Johnson, R E; Zhang, A; Boothby, J; Yeatts, E J

2001-06-01

Physicians frequently are asked to sign commitments to change practice, based upon their involvement in continuing medical education (CME) activities. Although use of the commitment-to-change model is increasingly widespread in CME, the effect of signing such commitments on rates of change is not well understood. Immediately after a CME session, 110 physicians were asked to specify a change they intended to make in practice and to designate a level of commitment to change. To determine the effects of a signature on rates of change, physicians were randomly assigned to control (signature) and experimental (non-signature) groups. Follow-up surveys were conducted at two and three months to determine rates of change. In all, 88 physicians completed the first questionnaire, and 64 of them completed the follow-up. Consistent with prior studies involving the commitment-to-change model, those expressing an intention to change were significantly more likely to change on follow-up (p =.035). There was no significant difference between signature and non-signature groups (p =.99), regardless of age or gender. Signatures appear unimportant to assuring compliance with commitments to change used in CME conferences. A physician's behavior can be expected to change if the specified change is consistent with the physician's beliefs and sense of what is important. The relative influences of components of the commitment-to-change model require further study to determine more clearly their roles in causation and measurement.

Influence of the turbulent motion on the chiral magnetic effect in the early universe

NASA Astrophysics Data System (ADS)

Dvornikov, Maxim; Semikoz, Victor B.

2017-02-01

We study the magnetohydrodynamics of relativistic plasmas accounting for the chiral magnetic effect (CME). To take into account the evolution of the plasma velocity, obeying the Navier-Stokes equation, we approximate it by the Lorentz force accompanied by the phenomenological drag time parameter. On the basis of this ansatz, we obtain the contributions of both the turbulence effects, resulting from the dynamo term, and the magnetic field instability, caused by the CME, to the evolution of the magnetic field governed by the modified Faraday equation. In this way, we explore the evolution of the magnetic field energy and the magnetic helicity density spectra in the early Universe plasma. We find that the right-left electron asymmetry is enhanced by the turbulent plasma motion in a strong seed magnetic field compared to the pure CME case studied earlier for the hot Universe plasma in the same broken phase.

Transient Mass-loss Analysis of Solar Observations Using Stellar Methods

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

Crosley, M. K.; Norman, C.; Osten, R. A.

Low-frequency dynamic spectra of radio bursts from nearby stars offer the best chance to directly detect the stellar signature of transient mass loss on low-mass stars. Crosley et al. (2016) proposes a multi-wavelength methodology to determine coronal mass ejection (CME) parameters, such as speed, mass, and kinetic energy. We test the validity and accuracy of the results derived from the methodology by using Geostationary Operational Environmental Satellite X-ray observations and Bruny Island Radio Spectrometer radio observations. These are analogous observations to those that would be found in the stellar studies. Derived results from these observations are compared to direct whitemore » light measurements of the Large Angle and Spectrometric Coronagraph. We find that, when a pre-event temperature can be determined, the accuracy of CME speeds are within a few hundred km s{sup −1}, and are reliable when specific criteria has been met. CME mass and kinetic energies are only useful in determining the approximate order of magnitude measurements when considering the large errors associated to them. These results will be directly applicable to the interpretation of any detected stellar events and the derivation of stellar CME properties.« less

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.

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.

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...

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)

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 ...

Networked Learning and Network Science: Potential Applications to Health Professionals' Continuing Education and Development.

PubMed

Margolis, Alvaro; Parboosingh, John

2015-01-01

Prior interpersonal relationships and interactivity among members of professional associations may impact the learning process in continuing medical education (CME). On the other hand, CME programs that encourage interactivity between participants may impact structures and behaviors in these professional associations. With the advent of information and communication technologies, new communication spaces have emerged that have the potential to enhance networked learning in national and international professional associations and increase the effectiveness of CME for health professionals. In this article, network science, based on the application of network theory and other theories, is proposed as an approach to better understand the contribution networking and interactivity between health professionals in professional communities make to their learning and adoption of new practices over time. © 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.

The Triggering of Large-Scale Waves by CME Initiation

NASA Astrophysics Data System (ADS)

Forbes, Terry

Studies of the large-scale waves generated at the onset of a coronal mass ejection (CME) can provide important information about the processes in the corona that trigger and drive CMEs. The size of the region where the waves originate can indicate the location of the magnetic forces that drive the CME outward, and the rate at which compressive waves steepen into shocks can provide a measure of how the driving forces develop in time. However, in practice it is difficult to separate the effects of wave formation from wave propagation. The problem is particularly acute for the corona because of the multiplicity of wave modes (e.g. slow versus fast MHD waves) and the highly nonuniform structure of the solar atmosphere. At the present time large-scale numerical simulations provide the best hope for deconvolving wave propagation and formation effects from one another.

Atypical Moles

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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.

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.

[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.

Development, modelling, and pilot testing of a complex intervention to support end-of-life care provided by Danish general practitioners.

PubMed

Winthereik, Anna Kirstine; Neergaard, Mette Asbjoern; Jensen, Anders Bonde; Vedsted, Peter

2018-06-20

Most patients in end-of-life with life-threatening diseases prefer to be cared for and die at home. Nevertheless, the majority die in hospitals. GPs have a pivotal role in providing end-of-life care at patients' home, and their involvement in the palliative trajectory enhances the patient's possibility to stay at home. The aim of this study was to develop and pilot-test an intervention consisting of continuing medical education (CME) and electronic decision support (EDS) to support end-of-life care in general practice. We developed an intervention in line with the first phases of the guidelines for complex interventions drawn up by the Medical Research Council. Phase 1 involved the development of the intervention including identification of key barriers to provision of end-of-life care for GPs and of facilitators of change. Furthermore the actual modelling of two components: CME meeting and EDS. Phase 2 focused on pilot-testing and intervention assessment by process evaluation. In phase 1 lack of identification of patients at the end of life and limited palliative knowledge among GPs were identified as barriers. The CME meeting and the EDS were developed. The CME meeting was a four-hour educational meeting performed by GPs and specialists in palliative care. The EDS consisted of two parts: a pop-up window for each patient with palliative needs and a list of all patients with palliative needs in the practice. The pilot testing in phase 2 showed that the CME meeting was performed as intended and 120 (14%) of the GPs in the region attended. The EDS was integrated in existing electronic records but was shut down early for external reasons; 50 (5%) GPs signed up. The pilot-testing demonstrated a need to strengthen the implementation as attending rate was low in the current set-up. We developed a complex intervention to support GPs in providing end-of-life care. The pilot-test showed general acceptance of the CME meetings. The EDS was shut down early and needs further evaluation before examining the whole intervention in a larger study, where evaluation could be based on patient-related outcomes and impact on end-of-life care. Clinicaltrials.gov ( NCT02050256 ) January 30, 2014.

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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

Performance assessment. Family physicians in Montreal meet the mark!

PubMed Central

Goulet, François; Jacques, André; Gagnon, Robert; Bourbeau, Denis; Laberge, Denis; Melanson, Jacques; Ménard, Claude; Racette, Pierre; Rivest, Raymond

2002-01-01

OBJECTIVE: To assess the clinical performance of a representative non-volunteer sample of family physicians in metropolitan Montreal, Que. DESIGN: Assessment of clinical performance was based on inspection visits to offices, peer review of medical records, and chart-stimulated recall interviews. The procedure was the one usually followed by the Professional Inspection Committee of the Collège des médecins du Québec. SETTING: Family physicians' practices in metropolitan Montreal. PARTICIPANTS: One hundred randomly selected family physicians. INTERVENTIONS: For each physician, 30 randomly chosen patient charts with data on three to five previous visits were reviewed using explicit criteria and a standard scale using global scores from 1 to 5 (unacceptable to excellent). MAIN OUTCOME MEASURES: Scores were assigned for office practices; record keeping; number of continuing medical education (CME) activities; and quality of clinical performance assessed in terms of investigation plan, diagnostic accuracy, treatment plan, and relevance of care. RESULTS: Overall performance was judged to be good to excellent for 98% of physicians in their private practices; for 90% of physicians concerning CME activities; for 94% of physicians concerning their clinical performance in terms of quality of care; and for 75% of physicians as to record keeping. There was a link between record keeping and quality of care as well as between the number of CME activities and quality of care. CONCLUSION: The overall clinical performance of family physicians in the greater Montreal region is excellent. PMID:12228963

Testing ElEvoHI on a multi-point in situ detected Coronal Mass Ejection

NASA Astrophysics Data System (ADS)

Amerstorfer, Tanja; Möstl, Christian; Hess, Phillip; Mays, M. Leila; Temmer, Manuela

2017-04-01

The Solar TErrestrial RElations Observatory (STEREO) has provided us a deep insight into the interplanetary propagation of coronal mass ejections (CMEs). Especially the wide-angle heliospheric imagers (HI) enabled the development of a multitude of methods for analyzing the evolution of CMEs through interplanetary (IP) space. Methods able to forecast arrival times and speeds at Earth (or other targets) use the advantage of following a CME's path of propagation up to 1 AU. However, these methods were not able to reduce today's errors in arrival time forecasts to less than ±6 hours, arrival speeds are mostly overestimated by some 100 km s-1. One reason for that is the assumption of constant propagation speed, which is clearly incorrect for most CMEs—especially for those being faster than the ambient solar wind. ElEvoHI, the Ellipse Evolution model (ElEvo) based on HI observations, is a new prediction tool, which uses the benefits of different methods and observations. It provides the possibility to adjust the CME frontal shape (angular width, ellipse aspect ratio) and the direction of motion for each CME event individually. This information can be gained from Graduated Cylindrical Shell (GCS) flux-rope fitting within coronagraph images. Using the Ellipse Conversion (ElCon) method, the observed HI elongation angle is converted into a unit of distance, which reveals the kinematics of the event. After fitting the time-distance profile of the CME using the drag-based equation of motion, where real-time in situ solar wind speed from 1 AU is used as additional input, we receive all input parameters needed to run a forecast using the ElEvo model and to predict arrival times and speeds at any target of interest in IP space. Here, we present a test on a slow CME event of 3 November 2010, in situ detected by the lined-up spacecraft MESSENGER and STEREO Behind. We gain the shape of the CME front from a cut of the 3D GCS CME shape with the ecliptic plane, resulting in an almost ideal ElEvoHI forecast of arrival time and speed at 1 AU.

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

Investigating the two-moment characterisation of subcellular biochemical networks.

PubMed

Ullah, Mukhtar; Wolkenhauer, Olaf

2009-10-07

While ordinary differential equations (ODEs) form the conceptual framework for modelling many cellular processes, specific situations demand stochastic models to capture the influence of noise. The most common formulation of stochastic models for biochemical networks is the chemical master equation (CME). While stochastic simulations are a practical way to realise the CME, analytical approximations offer more insight into the influence of noise. Towards that end, the two-moment approximation (2MA) is a promising addition to the established analytical approaches including the chemical Langevin equation (CLE) and the related linear noise approximation (LNA). The 2MA approach directly tracks the mean and (co)variance which are coupled in general. This coupling is not obvious in CME and CLE and ignored by LNA and conventional ODE models. We extend previous derivations of 2MA by allowing (a) non-elementary reactions and (b) relative concentrations. Often, several elementary reactions are approximated by a single step. Furthermore, practical situations often require the use of relative concentrations. We investigate the applicability of the 2MA approach to the well-established fission yeast cell cycle model. Our analytical model reproduces the clustering of cycle times observed in experiments. This is explained through multiple resettings of M-phase promoting factor (MPF), caused by the coupling between mean and (co)variance, near the G2/M transition.

Preventive intervention in diabetes: a new model for continuing medical education.

PubMed

Beaser, Richard S; Brown, Julie A

2013-04-01

Competence and skills in overcoming clinical inertia for diabetes treatment, and actually supporting and assisting the patient through adherence and compliance (as opposed to just reiterating what they "should" be doing and then assigning them the blame if they fail) is a key component to success in addressing diabetes, and to date it is a component that has received little formal attention. To improve and systematize diabetes care, it is critical to move beyond the "traditional" continuing medical education (CME) model of imparting knowledge as the entirety of the educational effort, and move toward a focus on Performance Improvement CME. This new approach does not just teach new information but also provides support for improvements where needed most within practice systems based on targeted data-based on self-assessments for the entire system of care. Joslin data conclude that this new approach will benefit support, clinical, and office teams as well as the specialist. In short, the Performance Improvement CME structure reflects the needed components of the successful practice today, particularly for chronic conditions such as diabetes, including the focus on interdisciplinary team care and on quality improvement, which is becoming more and more aligned with reimbursement schemes, public and private, in the U.S. Copyright © 2013 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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

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/.

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.

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.

Connecting white light to in situ observations of 22 coronal mass ejections from the Sun to 1 AU

NASA Astrophysics Data System (ADS)

Moestl, C.; Amla, K.; Farrugia, C. J.; Hall, J. R.; Liewer, P. C.; De Jong, E.; Colaninno, R. C.; Vourlidas, A.; Veronig, A. M.; Rollett, T.; Temmer, M.; Peinhart, V.; Davies, J.; Lugaz, N.; Liu, Y. D.; McEnulty, T.; Luhmann, J. G.; Galvin, A. B.

2013-12-01

We study the feasibility of using a Heliospheric Imager (HI) instrument, such as STEREO/HI, for unambiguously connecting remote images to in situ observations of coronal mass ejection (CMEs). Our goal is to develop and test methods to predict CME parameters from heliospheric images, but our dataset can actually be used to benchmark any ICME propagation model. The results are of interest concerning future missions such as Solar Orbiter, or a dedicated space weather mission at the Sun-Earth L5 point (e.g. EASCO mission concept). We compare the predictions for speed and arrival time for 22 CME events (between 2008-2012), each observed remotely by one STEREO spacecraft, to the interplanetary coronal mass ejection (ICME) speed and arrival time observed at in situ observatories (STEREO PLASTIC/IMPACT, Wind SWE/MFI). We use forward modeling for STEREO-COR2, and geometrical models for STEREO-HII, assuming different CME front shapes (Fixed-Phi, Harmonic Mean, Self-similar expansion), and fit them to the CME time-elongation functions with the SolarSoft SATPLOT tool, assuming constant CME speed and direction. The arrival times derived from imaging match the in situ ones +/- 8 hours, and speeds are consistent within +/-300 km/s, including CME apex/flank effects. We find no preference in the predictive capability for any of the 3 geometries used on the full dataset, consisting of front- and backsided, slow and fast CMEs (up to 2700 km/s). We search for new empirical relations between the predicted and observed speeds and arrival times, enhancing the HI predictive capabilities. Additionally, for very fast and back-sided CMEs, strong differences between the results of the HI models arise, consistent with theoretical expectations by Lugaz and Kintner (2013, Solar Physics). This work has received funding from the European Commission FP7 Project COMESEP (263252).

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.

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.

Effect of 2 Bleaching Agents with a Content of High Concentrated Hydrogen Peroxide on Stained 2 CAD/CAM Blocks and a Nanohybrid Composite Resin: An AFM Evaluation

PubMed Central

Cengiz, Esra

2017-01-01

The aim of this study was to evaluate color stability of 3 restorative materials, discoloration ability of different solutions, efficacy of 2 office bleaching agents, and surface roughness and topography. Sixty specimens for Clearfil Majesty Esthetic (CME), Lava Ultimate (LU), and Vita Enamic (VE) were prepared. They were immersed into 3 staining solutions for 2 weeks and then they were bleached. According to the measured L⁎, a⁎, and b⁎ parameters described by CIELAB system, color changes (ΔE00), translucency parameters (TP), whiteness index values (W⁎), and changes in closeness to pure white (ΔW⁎) were calculated. Then 3 specimens from each group were scanned with an atomic force microscope for surface analysis. After staining, CME groups and control groups of LU and VE showed clinically acceptable color changes (ΔE00 < 1,8). After bleaching, while a reverse effect on color was observed, VE showed the furthest color values to pure white. There was no statistically significant difference between whiteness index values of LU and CME. LU was the most translucent material during the study and TP values of materials showed minimal differences. Most of the VE groups and a control group of LU showed surface roughness (Ra) values higher than critical value for biofilm accumulation (0,2 μm). PMID:28804719

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;

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

Data-driven Simulations of Magnetic Connectivity in Behind-the-Limb Gamma-ray Flares and Associated Coronal Mass Ejections

NASA Astrophysics Data System (ADS)

Jin, M.; Petrosian, V.; Liu, W.; Nitta, N.; Omodei, N.; Rubio da Costa, F.; Effenberger, F.; Li, G.; Pesce-Rollins, M.

2017-12-01

Recent Fermi detection of high-energy gamma-ray emission from the behind-the-limb (BTL) solar flares pose a puzzle on the particle acceleration and transport mechanisms in such events. Due to the large separation between the flare site and the location of gamma-ray emission, it is believed that the associated coronal mass ejections (CMEs) play an important role in accelerating and subsequently transporting particles back to the Sun to produce obseved gamma-rays. We explore this scenario by simulating the CME associated with a well-observed flare on 2014 September 1 about 40 degrees behind the east solar limb and by comparing the simulation and observational results. We utilize a data-driven global magnetohydrodynamics model (AWSoM: Alfven-wave Solar Model) to track the dynamical evolution of the global magnetic field during the event and investigate the magnetic connectivity between the CME/CME-driven shock and the Fermi emission region. Moreover, we derive the time-varying shock parameters (e.g., compression ratio, Alfven Mach number, and ThetaBN) over the area that is magnetically connected to the visible solar disk where Fermi gamma-ray emission originates. Our simulation shows that the visible solar disk develops connections both to the flare site and to the CME-driven shock during the eruption, which indicate that the CME's interaction with the global solar corona is critical for understanding such Fermi BTL events and gamma-ray flares in general. We discuss the causes and implications of Fermi BTL events, in the framework of a potential shift of paradigm on particle acceleration in solar flares/CMEs.

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

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.

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

Enhancing practice improvement by facilitating practitioner interactivity: new roles for providers of continuing medical education.

PubMed

Parboosingh, I John; Reed, Virginia A; Caldwell Palmer, James; Bernstein, Henry H

2011-01-01

Research into networking and interactivity among practitioners is providing new information that has the potential to enhance the effectiveness of practice improvement initiatives. This commentary reviews the evidence that practitioner interactivity can facilitate emergent learning and behavior change that lead to practice improvements. Insights from learning theories provide a framework for understanding emergent learning as the product of interactions between individuals in trusted relationships, such as occurs in communities of practice. This framework helps explain why some groups respond more favorably to improvement initiatives than others. Failure to take advantage of practitioner interactivity may explain in part the disappointingly low mean rates of practice improvement reported in studies of the effectiveness of practice improvement projects. Examples of improvement models in primary care settings that explicitly use relationship building and facilitation techniques to enhance practitioner interactivity are provided. Ingredients of a curriculum to teach relationship building in communities of practice and facilitation skills to enhance learning in small group education sessions are explored. Sufficient evidence exists to support the roles of relationships and interactivity in practice improvement initiatives such that we recommend the development of training programs to teach these skills to CME providers. 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.

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.

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.

Do general practitioners' risk-taking propensities and learning styles influence their continuing medical education preferences?

PubMed

Robinson, Geoffrey

2002-01-01

US studies have shown that a clinician's risk-taking propensity significantly predicts clinical behaviour. Other US studies examining relationships between family practice doctors' preferences for CME and their Kolb learning style have described conflicting findings. The aim of the present study was to investigate GPs' learning styles, risk-taking propensities and CME preferences, and to explore links between them. A descriptive confidential cross-sectional postal questionnaire survey of the 304 general practitioner principals within Portsmouth and South East Hampshire Health Authority was conducted. Two hundred and seventy-four GPs returned questionnaires, a response rate of 90.1%. The Kolb learning style types were assimilators 43.8% (predominant learning abilities watching and thinking), divergers 21.1% (feeling and watching), convergers 18.3% (doing and thinking), and accommodators 16.8% (doing and feeling). The Pearson risk-taking propensities were 65.8% risk neutral, 19.4% risk seeking and 14.8% risk averse. Risk-seeking GPs were significantly more likely to be accommodators or convergers than divergers or assimilators (p = 0.006). Majorities of 54.9% stated that the present PGEA system works well, 85% welcomed feedback from their peers, and 76.8% stated that learning should be an activity for all the practice team. Further majorities would welcome help to decide their learning needs (63.8%) and are looking to judge CME effectiveness by changes in GP performance or patient care (54.8%). Further significant correlations and cross-tabulations were found between learning style and risk-taking and CME attitudes, experiences and preferences. It is concluded that risk seekers and accommodators (doing and feeling) prefer feedback, interaction and practical hands-on learning, and assimilators (watching and thinking) and the risk averse tend towards lectures, theoretical learning formats and less interactive activities. Sharing feelings in groups may be difficult for the risk averse and assimilators. The success of a combined educational strategy will depend on an inclusive philosophy, both recognizing and engaging the wide range of differences in learning style and risk taking for all the individuals who make up learning teams.

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.

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.

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.

Auto-detection of Halo CME Parameters as the Initial Condition of Solar Wind Propagation

NASA Astrophysics Data System (ADS)

Choi, Kyu-Cheol; Park, Mi-Young; Kim, Jae-Hun

2017-12-01

Halo coronal mass ejections (CMEs) originating from solar activities give rise to geomagnetic storms when they reach the Earth. Variations in the geomagnetic field during a geomagnetic storm can damage satellites, communication systems, electrical power grids, and power systems, and induce currents. Therefore, automated techniques for detecting and analyzing halo CMEs have been eliciting increasing attention for the monitoring and prediction of the space weather environment. In this study, we developed an algorithm to sense and detect halo CMEs using large angle and spectrometric coronagraph (LASCO) C3 coronagraph images from the solar and heliospheric observatory (SOHO) satellite. In addition, we developed an image processing technique to derive the morphological and dynamical characteristics of halo CMEs, namely, the source location, width, actual CME speed, and arrival time at a 21.5 solar radius. The proposed halo CME automatic analysis model was validated using a model of the past three halo CME events. As a result, a solar event that occurred at 03:38 UT on Mar. 23, 2014 was predicted to arrive at Earth at 23:00 UT on Mar. 25, whereas the actual arrival time was at 04:30 UT on Mar. 26, which is a difference of 5 hr and 30 min. In addition, a solar event that occurred at 12:55 UT on Apr. 18, 2014 was estimated to arrive at Earth at 16:00 UT on Apr. 20, which is 4 hr ahead of the actual arrival time of 20:00 UT on the same day. However, the estimation error was reduced significantly compared to the ENLIL model. As a further study, the model will be applied to many more events for validation and testing, and after such tests are completed, on-line service will be provided at the Korean Space Weather Center to detect halo CMEs and derive the model parameters.

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…

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.

PREDICTING CME EJECTA AND SHEATH FRONT ARRIVAL AT L1 WITH A DATA-CONSTRAINED PHYSICAL MODEL

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

Hess, Phillip; Zhang, Jie, E-mail: phess4@gmu.edu

2015-10-20

We present a method for predicting the arrival of a coronal mass ejection (CME) flux rope in situ, as well as the sheath of solar wind plasma accumulated ahead of the driver. For faster CMEs, the front of this sheath will be a shock. The method is based upon geometrical separate measurement of the CME ejecta and sheath. These measurements are used to constrain a drag-based model, improved by including both a height dependence and accurate de-projected velocities. We also constrain the geometry of the model to determine the error introduced as a function of the deviation of the CMEmore » nose from the Sun–Earth line. The CME standoff-distance in the heliosphere fit is also calculated, fit, and combined with the ejecta model to determine sheath arrival. Combining these factors allows us to create predictions for both fronts at the L1 point and compare them against observations. We demonstrate an ability to predict the sheath arrival with an average error of under 3.5 hr, with an rms error of about 1.58 hr. For the ejecta the error is less than 1.5 hr, with an rms error within 0.76 hr. We also discuss the physical implications of our model for CME expansion and density evolution. We show the power of our method with ideal data and demonstrate the practical implications of having a permanent L5 observer with space weather forecasting capabilities, while also discussing the limitations of the method that will have to be addressed in order to create a real-time forecasting tool.« less

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.

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.

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...

Mining reflective continuing medical education data for family physician learning needs.

PubMed

Lewis, Denice Colleen; Pluye, Pierre; Rodriguez, Charo; Grad, Roland

2016-04-06

A mixed methods research (sequential explanatory design) studied the potential of mining the data from the consumers of continuing medical education (CME) programs, for the developers of CME programs. The quantitative data generated by family physicians, through applying the information assessment method to CME content, was presented to key informants from the CME planning community through a qualitative description study.The data were revealed to have many potential applications including supporting the creation of CME content, CME program planning and personal learning portfolios.

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

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

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.

Neutralized solar energetic particles in the inner heliosphere: a parameter study

NASA Astrophysics Data System (ADS)

Wang, Xiao-Dong; Klecker, Berndt; Futaana, Yoshifumi; Cipriani, Fabrice; Barabash, Stas; Wieser, Martin

2016-04-01

The large fluxes of solar energetic particles (SEPs) in Gradual Events, dominated by protons, are believed to be produced by the acceleration of shocks driven by coronal mass ejections (CMEs). As SEPs propagate in the lower corona, there is a chance for them to be neutralized via the charge exchange and/or recombination processes and become energetic neutral atoms (ENAs). These ENAs retain the velocity of their parent SEPs and propagate in straight lines without the influence of the interplanetary magnetic field, and therefore might potentially serve as a new window to observe the particle acceleration processes in the solar corona. STEREO/Low Energy Telescope reported the first probable observation of hydrogen ENAs between 1.6 MeV - 5 MeV from the Sun prior to an X-class flare/CME [Mewaldt et al., 2009]. While such observations were somehow controversial, Wang et al. [2014] simulated the neutralization of solar energetic protons in the corona lower than 40 RS, and the result agreed with the STEREO observation. In this work, we further developed a production model of the ENA near the sun together with a transport model toward the inner planets, and explore the dependences of the ENA characteristics against the model parameters. These parameters include the angular width of the CME, its propagation direction with respect to the Sun-observer line, the propagation speed, the particle density in the corona, the abundances of O6+ and C4+, and the reaction rate of electron impact ionization in the loss of ENAs, and the heliospheric distance of the observer. The calculated ENA flux shows that at lower energy the expected ENA flux depends most sensitively on the CME apex angle and the CME propagation direction. At higher energy the dependence on the coronal density is more prominent. References Mewaldt, R. A., R. A. Leske, E. C. Stone, A. F. Barghouty, A. W. Labrador, C. M. S. Cohen, A. C. Cummings, A. J. Davis, T. T. von Rosenvinge, and M. E. Wiedenbeck (2009), STEREO Observations of Energetic Neutral Hydrogen Atoms During the 2006 December 5 Solar Flare, Astrophys. J. Lett., 693(1), L11. Wang, L., G. Li, A. Y. Shih, R. P. Lin, and R. F. Wimmer-Schweingruber (2014), Simulation of Energetic Neutral Atoms from Solar Energetic Particles, Astrophys. J. Lett., 793(2), L37.

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.

An application of the Krylov-FSP-SSA method to parameter fitting with maximum likelihood

NASA Astrophysics Data System (ADS)

Dinh, Khanh N.; Sidje, Roger B.

2017-12-01

Monte Carlo methods such as the stochastic simulation algorithm (SSA) have traditionally been employed in gene regulation problems. However, there has been increasing interest to directly obtain the probability distribution of the molecules involved by solving the chemical master equation (CME). This requires addressing the curse of dimensionality that is inherent in most gene regulation problems. The finite state projection (FSP) seeks to address the challenge and there have been variants that further reduce the size of the projection or that accelerate the resulting matrix exponential. The Krylov-FSP-SSA variant has proved numerically efficient by combining, on one hand, the SSA to adaptively drive the FSP, and on the other hand, adaptive Krylov techniques to evaluate the matrix exponential. Here we apply this Krylov-FSP-SSA to a mutual inhibitory gene network synthetically engineered in Saccharomyces cerevisiae, in which bimodality arises. We show numerically that the approach can efficiently approximate the transient probability distribution, and this has important implications for parameter fitting, where the CME has to be solved for many different parameter sets. The fitting scheme amounts to an optimization problem of finding the parameter set so that the transient probability distributions fit the observations with maximum likelihood. We compare five optimization schemes for this difficult problem, thereby providing further insights into this approach of parameter estimation that is often applied to models in systems biology where there is a need to calibrate free parameters. Work supported by NSF grant DMS-1320849.

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…

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.

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

Effect of removing the common mode errors on linear regression analysis of noise amplitudes in position time series of a regional GPS network & a case study of GPS stations in Southern California

NASA Astrophysics Data System (ADS)

Jiang, Weiping; Ma, Jun; Li, Zhao; Zhou, Xiaohui; Zhou, Boye

2018-05-01

The analysis of the correlations between the noise in different components of GPS stations has positive significance to those trying to obtain more accurate uncertainty of velocity with respect to station motion. Previous research into noise in GPS position time series focused mainly on single component evaluation, which affects the acquisition of precise station positions, the velocity field, and its uncertainty. In this study, before and after removing the common-mode error (CME), we performed one-dimensional linear regression analysis of the noise amplitude vectors in different components of 126 GPS stations with a combination of white noise, flicker noise, and random walking noise in Southern California. The results show that, on the one hand, there are above-moderate degrees of correlation between the white noise amplitude vectors in all components of the stations before and after removal of the CME, while the correlations between flicker noise amplitude vectors in horizontal and vertical components are enhanced from un-correlated to moderately correlated by removing the CME. On the other hand, the significance tests show that, all of the obtained linear regression equations, which represent a unique function of the noise amplitude in any two components, are of practical value after removing the CME. According to the noise amplitude estimates in two components and the linear regression equations, more accurate noise amplitudes can be acquired in the two components.

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.

Modelling Solar Energetic Particle Events Using the iPATH Model

NASA Astrophysics Data System (ADS)

Li, G.; Hu, J.; Ao, X.; Zank, G. P.; Verkhoglyadova, O. P.

2016-12-01

Solar Energetic Particles (SEPs) is the No. 1 space weather hazard. Understanding how particles are energized and propagated in these events is of practical concerns to the manned space missions. In particular, both the radial evolution and the longitudinal extent of a gradual solarenergetic particle (SEP) event are central topics for space weather forecasting. In this talk, I discuss the improved Particle Acceleration and Transport in the Heliosphere (iPATH) model. The iPATH model consists of three parts: (1) an updated ZEUS3D V3.5 MHD module that models thebackground solar wind and the initiation of a CME in a 2D domain; (2) an updated shock acceleration module where we investigate particle acceleration at different longitudinal locations along the surface of a CME-driven shock. Accelerated particle spectrum are obtained at the shock under the diffusive shock acceleration mechanism. Shock parameters and particle distributions are recorded and used as inputs for the later part. (3) an updated transport module where we follow the transport of accelerated particles from the shock to any destinations (Earth and/or Mars, e.g.) using a Monte-Carlo method. Both pitch angle scattering due to MHD turbulence and perpendicular diffusion across magnetic field are included. Our iPATH model is therefore intrinsically 2D in nature. The model is capable of generating time intensity profiles and instantaneous particle spectra atvarious locations and can greatly improve our current space weather forecasting capability.

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

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)

Modeling AWSoM CMEs with EEGGL: A New Approach for Space Weather Forecasting

NASA Astrophysics Data System (ADS)

Jin, M.; Manchester, W.; van der Holst, B.; Sokolov, I.; Toth, G.; Vourlidas, A.; de Koning, C. A.; Gombosi, T. I.

2015-12-01

The major source of destructive space weather is coronal mass ejections (CMEs). However, our understanding of CMEs and their propagation in the heliosphere is limited by the insufficient observations. Therefore, the development of first-principals numerical models plays a vital role in both theoretical investigation and providing space weather forecasts. Here, we present results of the simulation of CME propagation from the Sun to 1AU by combining the analytical Gibson & Low (GL) flux rope model with the state-of-art solar wind model AWSoM. We also provide an approach for transferring this research model to a space weather forecasting tool by demonstrating how the free parameters of the GL flux rope can be prescribed based on remote observations via the new Eruptive Event Generator by Gibson-Low (EEGGL) toolkit. This capability allows us to predict the long-term evolution of the CME in interplanetary space. We perform proof-of-concept case studies to show the capability of the model to capture physical processes that determine CME evolution while also reproducing many observed features both in the corona and at 1 AU. We discuss the potential and limitations of this model as a future space weather forecasting tool.

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.

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.

Origin and Ion Charge State Evolution of Solar Wind Transients during 4 - 7 August 2011

NASA Astrophysics Data System (ADS)

Rodkin, D.; Goryaev, F.; Pagano, P.; Gibb, G.; Slemzin, V.; Shugay, Y.; Veselovsky, I.; Mackay, D. H.

2017-07-01

We present a study of the complex event consisting of several solar wind transients detected by the Advanced Composition Explorer (ACE) on 4 - 7 August 2011, which caused a geomagnetic storm with Dst=-110 nT. The supposed coronal sources, three flares and coronal mass ejections (CMEs), occurred on 2 - 4 August 2011 in active region (AR) 11261. To investigate the solar origin and formation of these transients, we study the kinematic and thermodynamic properties of the expanding coronal structures using the Solar Dynamics Observatory/Atmospheric Imaging Assembly (SDO/AIA) EUV images and differential emission measure (DEM) diagnostics. The Helioseismic and Magnetic Imager (HMI) magnetic field maps were used as the input data for the 3D magnetohydrodynamic (MHD) model to describe the flux rope ejection (Pagano, Mackay, and Poedts, 2013b). We characterize the early phase of the flux rope ejection in the corona, where the usual three-component CME structure formed. The flux rope was ejected with a speed of about 200 km s^{-1} to the height of 0.25 R_{⊙}. The kinematics of the modeled CME front agrees well with the Solar Terrestrial Relations Observatory (STEREO) EUV measurements. Using the results of the plasma diagnostics and MHD modeling, we calculate the ion charge ratios of carbon and oxygen as well as the mean charge state of iron ions of the 2 August 2011 CME, taking into account the processes of heating, cooling, expansion, ionization, and recombination of the moving plasma in the corona up to the frozen-in region. We estimate a probable heating rate of the CME plasma in the low corona by matching the calculated ion composition parameters of the CME with those measured in situ for the solar wind transients. We also consider the similarities and discrepancies between the results of the MHD simulation and the observations.

Quantifying the chiral magnetic effect from anomalous-viscous fluid dynamics

NASA Astrophysics Data System (ADS)

Jiang, Yin; Shi, Shuzhe; Yin, Yi; Liao, Jinfeng

2018-01-01

The Chiral Magnetic Effect (CME) is a macroscopic manifestation of fundamental chiral anomaly in a many-body system of chiral fermions, and emerges as an anomalous transport current in the fluid dynamics framework. Experimental observation of the CME is of great interest and has been reported in Dirac and Weyl semimetals. Significant efforts have also been made to look for the CME in heavy ion collisions. Critically needed for such a search is the theoretical prediction for the CME signal. In this paper we report a first quantitative modeling framework, Anomalous Viscous Fluid Dynamics (AVFD), which computes the evolution of fermion currents on top of realistic bulk evolution in heavy ion collisions and simultaneously accounts for both anomalous and normal viscous transport effects. AVFD allows a quantitative understanding of the generation and evolution of CME-induced charge separation during the hydrodynamic stage, as well as its dependence on theoretical ingredients. With reasonable estimates of key parameters, the AVFD simulations provide the first phenomenologically successful explanation of the measured signal in 200 AGeV AuAu collisions. This material is based upon work supported by the U.S. Department of Energy, Office of Science, Office of Nuclear Physics, within the framework of the Beam Energy Scan Theory (BEST) Topical Collaboration. The work is also supported in part by the National Science Foundation under Grant No. PHY-1352368 (SS and JL), by the National Science Foundation of China under Grant No. 11735007 (JL) and by the U.S. Department of Energy under grant Contract Number No. DE- SC0012704 (BNL)/DE-SC0011090 (MIT) (YY). JL is grateful to the Institute for Nuclear Theory for hospitality during the INT-16-3 Program. The computation of this research was performed on IU’s Big Red II cluster, supported in part by Lilly Endowment, Inc. (through its support for the Indiana University Pervasive Technology Institute) and in part by the Indiana METACyt Initiative.

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…

Using Heliospheric Imaging for Storm Forecasting - SMEI CME Observations as a Tool for Operational Forecasting at AFWA

NASA Astrophysics Data System (ADS)

Webb, D. F.; Johnston, J. C.; Fry, C. D.; Kuchar, T. A.

2008-12-01

Observations of coronal mass ejections (CMEs) from heliospheric imagers such as the Solar Mass Ejection Imager (SMEI) can lead to significant improvements in operational space weather forecasting. We are working with the Air Force Weather Agency (AFWA) to ingest SMEI all-sky imagery with appropriate tools to help forecasters improve their operational space weather forecasts. We describe two approaches: 1) Near- real time analysis of propagating CMEs from SMEI images alone combined with near-Sun observations of CME onsets and, 2) Using these calculations of speed as a mid-course correction to the HAFv2 solar wind model forecasts. HAFv2 became operational at AFWA in late 2006. The objective is to determine a set of practical procedures that the duty forecaster can use to update or correct a solar wind forecast using heliospheric imager data. SMEI observations can be used inclusively to make storm forecasts, as recently discussed in Webb et al. (Space Weather, in press, 2008). We have developed a point-and-click analysis tool for use with SMEI images and are working with AFWA to ensure that timely SMEI images are available for analyses. When a frontside solar eruption occurs, especially if within about 45 deg. of Sun center, a forecaster checks for an associated CME observed by a coronagraph within an appropriate time window. If found, especially if the CME is a halo type, the forecaster checks SMEI observations about a day later, depending on the apparent initial CME speed, for possibly associated CMEs. If one is found, then the leading edge is measured over several successive frames and an elongation-time plot constructed. A minimum of three data points, i.e., over 3-4 orbits or about 6 hours, are necessary for such a plot. Using the solar source location and onset time of the CME from, e.g., SOHO observations, and assuming radial propagation, a distance-time relation is calculated and extrapolated to the 1 AU distance. As shown by Webb et al., the storm onset time is then expected to be about 3 hours after this 1 AU arrival time (AT). The prediction program is updated as more SMEI data become available. Currently when an appropriate solar event occurs, AFWA routinely runs the HAFv2 model to make a forecast of the shock and ejecta arrival times at Earth. SMEI data can be used to improve this prediction. The HAFv2 model can produce synthetic sky maps of predicted CME brightness for comparison with SMEI images. The forecaster uses SMEI imagery to observe and track the CME. The forecaster then measures the CME location and speed using the SMEI imagery and the HAFv2 synthetic sky maps. After comparing the SMEI and HAFv2 results, the forecaster can adjust a key input to HAFv2, such as the initial speed of the disturbance at the Sun or the mid-course speed. The forecaster then iteratively runs HAFv2 until the observed and forecast sky maps match. The final HAFv2 solution becomes the new forecast. When the CME/shock arrives at (or does not reach) Earth, the forecaster verifies the forecast and updates the forecast skill statistics. Eventually, we plan to develop a more automated version of this procedure.

Precepting the medical assistant practicum: expectations and rewards: an evaluation of preceptors' opinions.

PubMed

Wilson, Adam B; Fegan, Frank; Romence, Blase; Uhe, Kendra; Dionne, Barbara

2011-01-01

This study investigated the opinions of preceptors on select topics relevant to the benefits and rewards of precepting medical assisting (MA) students. A 35-item questionnaire was distributed to volunteer MA preceptors over the course of 1 year. Survey items prompted participants for information concerning background and previous experiences with MA students, as well as gathered opinions on the benefits, issues, and rewards of preceptorships. Of the preceptors who gave evidence of their credentials, 98.43% were either practicing certified medical assistants (CMA-AAMA) or nurses. Respectively, 80.85% of CMAs and 80.00% of nurses felt that students provided the office with extra help and placed no financial burden on the practice. Approximately 44% ranked free continuing medical education (CME) credits as the most important reward. Written responses identified thank-you notes as an important demonstration of service, acknowledgment, and appreciation. MA preceptors consider students a beneficial aspect of their practice because they lighten strenuous workloads and stimulate preceptors to remain current in their professional fields. Noncompensated MA preceptors value both extrinsic (e.g., free CME credits) and intrinsic rewards (e.g., feedback and thank-you cards) and suggested that intrinsic rewards were of greater value.

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.

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.

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…

The symmetry and mass of halo Coronal Mass Ejections (CMEs) as quantitative predictors for severe space weather at Earth.

NASA Astrophysics Data System (ADS)

Fuselier, S.; Allegrini, F.; Bzowski, M.; Dayeh, M. A.; Desai, M. I.; Funsten, H. O.; Galli, A.; Heirtzler, D.; Janzen, P. H.; Kubiak, M. A.; Kucharek, H.; Lewis, W. S.; Livadiotis, G.; McComas, D. J.; Moebius, E.; Petrinec, S. M.; Quinn, M. S.; Schwadron, N.; Sokol, J. M.; Trattner, K. J.

2014-12-01

The Bureau of Meteorology's Space Weather Service operates an alert service for severe space weather events. The service relies on a statistical model which ingests observations of M and X class solar flares at or shortly after the time of the flare to predict the occurrence and severity of terrestrial impacts with a lead time of 1 to 4 days. This model has been operational since 2012 and caters to the needs of critical infrastructure groups in the Australian region. This paper reports on improvements to the forecast model by including SOHO LASCO coronagraph observations of Coronal Mass Ejections (CMEs). The coronagraphs are analysed to determine the Earthward direction parameter and the integrated intensity as a measure of the CME mass. Both of these parameters can help to predict whether a CME will be geo-effective. This work aims to increase the accuracy of the model predictions and lower the rate of false positives, as well as providing an estimate of the expected level of geomagnetic storm intensity.

The symmetry and mass of halo Coronal Mass Ejections (CMEs) as quantitative predictors for severe space weather at Earth.

NASA Astrophysics Data System (ADS)

Freeland, L. E.; Terkildsen, M. B.

2015-12-01

The Bureau of Meteorology's Space Weather Service operates an alert service for severe space weather events. The service relies on a statistical model which ingests observations of M and X class solar flares at or shortly after the time of the flare to predict the occurrence and severity of terrestrial impacts with a lead time of 1 to 4 days. This model has been operational since 2012 and caters to the needs of critical infrastructure groups in the Australian region. This paper reports on improvements to the forecast model by including SOHO LASCO coronagraph observations of Coronal Mass Ejections (CMEs). The coronagraphs are analysed to determine the Earthward direction parameter and the integrated intensity as a measure of the CME mass. Both of these parameters can help to predict whether a CME will be geo-effective. This work aims to increase the accuracy of the model predictions and lower the rate of false positives, as well as providing an estimate of the expected level of geomagnetic storm intensity.

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 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

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.

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.

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.

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…

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.

Blended learning in CME: the perception of GP trainers.

PubMed

Te Pas, E; Meinema, J G; Visser, M R M; van Dijk, N

2016-05-01

Blended learning (the combination of electronic methods with traditional teaching methods) has the potential to combine the best of traditional education with the best of computer-mediated training. We chose to develop such an intervention for GP trainers who were undertaking a Continuing Medical Education (CME) course in evidence-based medicine (EBM). This study reports on our experience and investigated the factors influencing the perception on usefulness and logistics of blended learning for learners in CME. In total, 170 GP trainers participated in the intervention. We used questionnaires, observations during the four face-to-face meetings and evaluations in the e-course over one year. Additionally we organised focus groups to gain insight in some of the outcomes of the questionnaires and interpretations of the observations. The GP trainers found the design and the educational method (e-course in combination with meetings) attractive, instructive and complementary. Factors influencing their learning were (1) educational design, (2) educational method, (3) topic of the intervention, (4) time (planning), (5) time (intervention), (6) learning style, (7) technical issues, (8) preconditions and (9) level of difficulty. A close link between daily practice and the educational intervention was considered an important precondition for the success of the intervention in this group of learners. GP trainers were positive about blended learning: they found e-learning a useful way to gain knowledge and the meetings a pleasant way of transferring the knowledge into practice. Although some preconditions should be taken into consideration during its development and implementation, they would participate in similarly designed learning in the future.

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.

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

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.

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

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.

The Health Impacts of Climate Change: A Continuing Medical Education Needs Assessment Framework.

PubMed

Valois, Pierre; Blouin, Patrick; Ouellet, Claudine; Renaud, Jean-Sébastien; Bélanger, Diane; Gosselin, Pierre

2016-01-01

As the health consequences of climate change (CC) will likely become more manifest in the future, family physicians have to be knowledgeable about these impacts and the ways in which they can affect their patients. The main aim of this study was to propose a competency framework and questionnaire used to conduct a needs analysis to identify and prioritize family physicians' real educational needs regarding the health impacts of CC. A mixed method combining a qualitative interview and a quantitative online questionnaire was used (n = 24 physicians). The interview assessed key beliefs related to participating in an online continuing medical education (eCME) activity on the health impacts of climate change, and the perception of the key factors or conditions required to ensure the family physicians' satisfaction with this eCME activity. The questionnaire assessed the current and desired levels of competency on five general training themes: general knowledge about CC; heat-related illnesses; CC, extreme weather events and modification of vector-borne and zoonotic diseases; CC, extreme weather events and modification of water-borne diseases; and mental health impacts of natural disasters. Results revealed the need for improved medical education on climate change and health. Results also add to the literature by showing that a 3-hour eCME activity covering these topics would be useful and would allow family physicians to use this knowledge in their daily practice, notably through prevention and counseling. Introducing a CME needs assessment framework and a generic instrument that reflects family physicians' needs regarding the health impacts of CC has the added advantage of standardizing the assessment procedure.

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.

Leveraging Social Media to Promote Evidence-Based Continuing Medical Education.

PubMed

Flynn, Simone; Hebert, Paul; Korenstein, Deborah; Ryan, Mark; Jordan, William B; Keyhani, Salomeh

2017-01-01

New dissemination methods are needed to engage physicians in evidence-based continuing medical education (CME). To examine the effectiveness of social media in engaging physicians in non-industry-sponsored CME. We tested the effect of different media platforms (e-mail, Facebook, paid Facebook and Twitter), CME topics, and different "hooks" (e.g., Q&A, clinical pearl and best evidence) on driving clicks to a landing site featuring non-industry sponsored CME. We modelled the effects of social media platform, CME topic, and hook using negative binomial regression on clicks to a single landing site. We used clicks to landing site adjusted for exposure and message number to calculate rate ratios. To understand how physicians interact with CME content on social media, we also conducted interviews with 10 physicians. The National Physicians Alliance (NPA) membership. NPA e-mail recipients, Facebook followers and friends, and Twitter followers. Clicks to the NPA's CME landing site. On average, 4,544 recipients received each message. Messages generated a total of 592 clicks to the landing site, for a rate of 5.4 clicks per 1000 recipients exposed. There were 5.4 clicks from e-mail, 11.9 clicks from Facebook, 5.5 clicks from paid Facebook, and 6.9 clicks from Twitter to the landing site for 1000 physicians exposed to each of 4 selected CME modules. A Facebook post generated 2.3x as many clicks to the landing site as did an e-mail after controlling for participant exposure, hook type and CME topic (p<0.001). Twitter posts (p = 0.13) and paid Facebook posts (p = 0.06) were not statistically different from e-mail in generating clicks to the landing site. Use of different hooks to engage physicians had no impact on clicks to the landing site. Interviews with physicians suggested that social media might not be a preferred vehicle for disseminating CME. Social media has a modest impact on driving traffic to evidence-based CME options. Facebook had a superior effect on driving physician web traffic to evidence-based CME compared to other social media platforms and email.

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.

Leveraging Social Media to Promote Evidence-Based Continuing Medical Education

PubMed Central

Flynn, Simone; Hebert, Paul; Korenstein, Deborah; Ryan, Mark; Jordan, William B.

2017-01-01

Importance New dissemination methods are needed to engage physicians in evidence-based continuing medical education (CME). Objective To examine the effectiveness of social media in engaging physicians in non-industry-sponsored CME. Design We tested the effect of different media platforms (e-mail, Facebook, paid Facebook and Twitter), CME topics, and different “hooks” (e.g., Q&A, clinical pearl and best evidence) on driving clicks to a landing site featuring non-industry sponsored CME. We modelled the effects of social media platform, CME topic, and hook using negative binomial regression on clicks to a single landing site. We used clicks to landing site adjusted for exposure and message number to calculate rate ratios. To understand how physicians interact with CME content on social media, we also conducted interviews with 10 physicians. Setting The National Physicians Alliance (NPA) membership. Participants NPA e-mail recipients, Facebook followers and friends, and Twitter followers. Main Outcomes and Measures Clicks to the NPA’s CME landing site. Results On average, 4,544 recipients received each message. Messages generated a total of 592 clicks to the landing site, for a rate of 5.4 clicks per 1000 recipients exposed. There were 5.4 clicks from e-mail, 11.9 clicks from Facebook, 5.5 clicks from paid Facebook, and 6.9 clicks from Twitter to the landing site for 1000 physicians exposed to each of 4 selected CME modules. A Facebook post generated 2.3x as many clicks to the landing site as did an e-mail after controlling for participant exposure, hook type and CME topic (p<0.001). Twitter posts (p = 0.13) and paid Facebook posts (p = 0.06) were not statistically different from e-mail in generating clicks to the landing site. Use of different hooks to engage physicians had no impact on clicks to the landing site. Interviews with physicians suggested that social media might not be a preferred vehicle for disseminating CME. Conclusions Social media has a modest impact on driving traffic to evidence-based CME options. Facebook had a superior effect on driving physician web traffic to evidence-based CME compared to other social media platforms and email. PMID:28060854

78 FR 31890 - Antidisruptive Practices Authority

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-28

... trade when the settlement price is determined under the rules of that registered entity.\\14\\ \\13\\ Id...) does not require a pattern of activity, even a single instance of trading activity can be disruptive of... post hoc analysis which labels a trade or a series of trades ``disruptive.' ''). \\61\\ See, e.g., CME at...

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,…

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…

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.

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)

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

A model on CME/Flare initiation: Loss of Equilibrium caused by mass loss of quiescent prominences

NASA Astrophysics Data System (ADS)

Miley, George; Chon Nam, Sok; Kim, Mun Song; Kim, Jik Su

2015-08-01

Coronal Mass Ejections (CMEs) model should give an answer to enough energy storage for giant bulk plasma into interplanetary space to escape against the sun’s gravitation and its explosive eruption. Advocates of ‘Mass Loading’ model (e.g. Low, B. 1996, SP, 167, 217) suggested a simple mechanism of CME initiation, the loss of mass from a prominence anchoring magnetic flux rope, but they did not associate the mass loss with the loss of equilibrium. The catastrophic loss of equilibrium model is considered as to be a prospective CME/Flare model to explain sudden eruption of magnetic flux systems. Isenberg, P. A., et al (1993, ApJ, 417, 368)developed ideal magnetohydrodynamic theory of the magnetic flux rope to show occurrence of catastrophic loss of equilibrium according to increasing magnetic flux transported into corona.We begin with extending their study including gravity on prominence’s material to obtain equilibrium curves in case of given mass parameters, which are the strengths of the gravitational force compared with the characteristic magnetic force. Furthermore, we study quasi-static evolution of the system including massive prominence flux rope and current sheet below it to obtain equilibrium curves of prominence’s height according to decreasing mass parameter in a properly fixed magnetic environment. The curves show equilibrium loss behaviors to imply that mass loss result in equilibrium loss. Released fractions of magnetic energy are greater than corresponding zero-mass case. This eruption mechanism is expected to be able to apply to the eruptions of quiescent prominences, which is located in relatively weak magnetic environment with 105 km of scale length and 10G of photospheric magnetic field.

The density compression ratio of shock fronts associated with coronal mass ejections

NASA Astrophysics Data System (ADS)

Kwon, Ryun-Young; Vourlidas, Angelos

2018-02-01

We present a new method to extract the three-dimensional electron density profile and density compression ratio of shock fronts associated with coronal mass ejections (CMEs) observed in white light coronagraph images. We demonstrate the method with two examples of fast halo CMEs (˜2000 km s-1) observed on 2011 March 7 and 2014 February 25. Our method uses the ellipsoid model to derive the three-dimensional geometry and kinematics of the fronts. The density profiles of the sheaths are modeled with double-Gaussian functions with four free parameters, and the electrons are distributed within thin shells behind the front. The modeled densities are integrated along the lines of sight to be compared with the observed brightness in COR2-A, and a χ2 approach is used to obtain the optimal parameters for the Gaussian profiles. The upstream densities are obtained from both the inversion of the brightness in a pre-event image and an empirical model. Then the density ratio and Alfvénic Mach number are derived. We find that the density compression peaks around the CME nose, and decreases at larger position angles. The behavior is consistent with a driven shock at the nose and a freely propagating shock wave at the CME flanks. Interestingly, we find that the supercritical region extends over a large area of the shock and lasts longer (several tens of minutes) than past reports. It follows that CME shocks are capable of accelerating energetic particles in the corona over extended spatial and temporal scales and are likely responsible for the wide longitudinal distribution of these particles in the inner heliosphere. Our results also demonstrate the power of multi-viewpoint coronagraphic observations and forward modeling in remotely deriving key shock properties in an otherwise inaccessible regime.

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

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.

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

Lung assist devices influence cardio-energetic parameters: Numerical simulation study.

PubMed

De Lazzari, C; Quatember, B; Recheis, W; Mayr, M; Demertzis, S; Allasia, G; De Rossi, A; Cavoretto, R; Venturino, E; Genuini, I

2015-08-01

We aim at an analysis of the effects mechanical ventilators (MVs) and thoracic artificial lungs (TALs) will have on the cardiovascular system, especially on important quantities, such as left and right ventricular external work (EW), pressure-volume area (PVA) and cardiac mechanical efficiency (CME). Our analyses are based on simulation studies which were carried out by using our CARDIOSIM(©) software simulator. At first, we carried out simulation studies of patients undergoing mechanical ventilation (MV) without a thoracic artificial lung (TAL). Subsequently, we conducted simulation studies of patients who had been provided with a TAL, but did not undergo MV. We aimed at describing the patient's physiological characteristics and their variations with time, such as EW, PVA, CME, cardiac output (CO) and mean pulmonary arterial/venous pressure (PAP/PVP). We were starting with a simulation run under well-defined initial conditions which was followed by simulation runs for a wide range of mean intrathoracic pressure settings. Our simulations of MV without TAL showed that for mean intrathoracic pressure settings from negative (-4 mmHg) to positive (+5 mmHg) values, the left and right ventricular EW and PVA, right ventricular CME and CO decreased, whereas left ventricular CME and the PAP increased. The simulation studies of patients with a TAL, comprised all the usual TAL arrangements, viz. configurations "in series" and in parallel with the natural lung and, moreover, hybrid configurations. The main objective of the simulation studies was, as before, the assessment of the hemodynamic response to the application of a TAL. We could for instance show that, in case of an "in series" configuration, a reduction (an increase) in left (right) ventricular EW and PVA values occurred, whereas the best performance in terms of CO can be achieved in the case of an in parallel configuration.

Speed of CMEs and the Magnetic Non-Potentiality of Their Source ARs

NASA Technical Reports Server (NTRS)

Tiwari, Sanjiv K.; Falconer, David A.; Moore, Ronald L.; Venkatakrishnan, P.

2014-01-01

Most fast coronal mass ejections (CMEs) originate from solar active regions (ARs). Non-potentiality of ARs is expected to determine the speed and size of CMEs in the outer corona. Several other unexplored parameters might be important as well. To find out the correlation between the initial speed of CMEs and the non-potentiality of source ARs, we associated over a hundred of CMEs with source ARs via their co-produced flares. The speed of the CMEs are collected from the SOHO LASCO CME catalog. We have used vector magnetograms obtained mainly with HMI/SDO, also with Hinode (SOT/SP) when available within an hour of a CME occurrence, to evaluate various magnetic non-potentiality parameters, e.g. magnetic free-energy proxies, computed magnetic free energy, twist, shear angle, signed shear angle etc. We have also included several other parameters e.g. total unsigned flux, net current, magnetic area of ARs, area of sunspots, to investigate their correlation, if any, with the initial speeds of CMEs. Our preliminary results show that the ARs with larger non-potentiality and area mostly produce fast CMEs but they can also produce slower ones. The ARs with lesser non-potentiality and area generally produce only slower CMEs, however, there are a few exceptions. The total unsigned flux correlate with the non-potentiality parameters and area of ARs but some ARs with large unsigned flux are also found to be least non-potential. A more detailed analysis is underway.

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.

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

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.

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.

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.

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.

Establishing midwifery in low-resource settings: guidance from a mixed-methods evaluation of the Afghanistan midwifery education program.

PubMed

Zainullah, Partamin; Ansari, Nasratullah; Yari, Khalid; Azimi, Mahmood; Turkmani, Sabera; Azfar, Pashtoon; LeFevre, Amnesty; Mungia, Jaime; Gubin, Rehana; Kim, Young-Mi; Bartlett, Linda

2014-10-01

The shortage of skilled birth attendants has been a key factor in the high maternal and newborn mortality in Afghanistan. Efforts to strengthen pre-service midwifery education in Afghanistan have increased the number of midwives from 467 in 2002 to 2954 in 2010. We analyzed the costs and graduate performance outcomes of the two types of pre-service midwifery education programs in Afghanistan that were either established or strengthened between 2002 and 2010 to guide future program implementation and share lessons learned. We performed a mixed-methods evaluation of selected midwifery schools between June 2008 and November 2010. This paper focuses on the evaluation's quantitative methods, which included (a) an assessment of a sample of midwifery school graduates (n=138) to measure their competencies in six clinical skills; (b) prospective documentation of the actual clinical practices of a subsample of these graduates (n=26); and (c) a costing analysis to estimate the resources required to educate students enrolled in these programs. For the clinical competency assessment and clinical practices components, two Institutes for Health Sciences (IHS) schools and six Community Midwifery Education (CME) schools; for the costing analysis, a different set of nine schools (two IHS, seven CME), all of which were funded by the US Agency for International Development. Midwives who had graduated from either IHS or CME schools. CME graduates (n=101) achieved an overall mean competency score of 63.2% (59.9-66.6%) on the clinical competency assessment compared to 57.3% (49.9-64.7%) for IHS graduates (n=37). Reproductive health activities accounted for 76% of midwives' time over an average of three months. Approximately 1% of childbirths required referral or resulted in maternal death. On the basis of known costs for the programs, the estimated cost of graduating a class with 25 students averaged US$298,939, or US$10,784 per graduate. The pre-service midwifery education experience of Afghanistan can serve as a model to rapidly increase the number of skilled birth attendants. In such settings, it is important to ensure the provision of continued practice opportunities and refresher trainings after graduation to aid skill retention, a co-operative and supportive work environment that will use midwives for the reproductive health skills for which they were trained, and selection mechanisms that can identify the most promising students and post-graduation deployment options to maximise the return on the substantial educational investment. © 2013 Published by Elsevier Ltd.

The uniqueness of the solution of cone-like inversion models for halo CMEs

NASA Astrophysics Data System (ADS)

Zhao, X. P.

2006-12-01

Most of elliptic halo CMEs are believed to be formed by the Thompson scattering of the photospheric light by the 3-D cone-like shell of the CME plasma. To obtain the real propagation direction and angular width of the halo CMEs, such cone-like inversion models as the circular cone, the elliptic cone and the ice-cream cone models have been suggested recently. Because the number of given parameters that are used to characterize 2-D elliptic halo CMEs observed by one spacecraft are less than the number of unknown parameters that are used to characterize the 3-D elliptic cone model, the solution of the elliptic cone model is not unique. Since it is difficult to determine whether or not an observed halo CME is formed by an circular cone or elliptic cone shell, the solution of circular cone model may often be not unique too. To fix the problem of the uniqueness of the solution of various 3-D cone-like inversion models, this work tries to develop the algorithm for using the data from multi-spacecraft, such as the STEREO A and B, and the Solar Sentinels.

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

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.

Asking About Pets Enhances Patient Communication and Care: A Pilot Study.

PubMed

Hodgson, Kate; Darling, Marcia; Freeman, Douglas; Monavvari, Alan

2017-01-01

This research explored whether asking patients about their pets would enable better environmental/social history taking, and improve patient communication/care. Primary health care providers (PHPs) were surveyed about prevalence of patients living with pets, the health impact of pets, and influences on patient communication. Following an educational intervention, they committed to asking patients about their pets. A follow-up survey was conducted electronically. PHPs were recruited at a continuing medical education (CME) conference and at CME workshops. All 225 participants were PHPs. At the conference, participants were educated one-on-one about the clinical relevance of pets in the family. CME sessions were large or small group teaching. Baseline and final surveys measured awareness of pets in patients' families, assessment of determinants of health, impact on rapport with patients, and patient care. A sign test assessed difference in scores using repeated-measures analysis. Binomial outcomes were assessed using Fisher's exact test. Comments were themed. Ninety-four PHPs (42%) completed the study. Pet-related discussions opened communication with patients. Two-thirds of participants identified positive effects on practice and on relationships with patients. PHPs were able to leverage the health benefits of pets (zooeyia) and mitigate zoonotic risk. Asking patients about pets in the family reveals clinically relevant information, improves communication, and strengthens the therapeutic alliance.

Asking About Pets Enhances Patient Communication and Care: A Pilot Study

PubMed Central

Hodgson, Kate; Darling, Marcia; Freeman, Douglas; Monavvari, Alan

2017-01-01

This research explored whether asking patients about their pets would enable better environmental/social history taking, and improve patient communication/care. Primary health care providers (PHPs) were surveyed about prevalence of patients living with pets, the health impact of pets, and influences on patient communication. Following an educational intervention, they committed to asking patients about their pets. A follow-up survey was conducted electronically. PHPs were recruited at a continuing medical education (CME) conference and at CME workshops. All 225 participants were PHPs. At the conference, participants were educated one-on-one about the clinical relevance of pets in the family. CME sessions were large or small group teaching. Baseline and final surveys measured awareness of pets in patients’ families, assessment of determinants of health, impact on rapport with patients, and patient care. A sign test assessed difference in scores using repeated-measures analysis. Binomial outcomes were assessed using Fisher’s exact test. Comments were themed. Ninety-four PHPs (42%) completed the study. Pet-related discussions opened communication with patients. Two-thirds of participants identified positive effects on practice and on relationships with patients. PHPs were able to leverage the health benefits of pets (zooeyia) and mitigate zoonotic risk. Asking patients about pets in the family reveals clinically relevant information, improves communication, and strengthens the therapeutic alliance. PMID:28984509

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,…

Didactic and Technical Considerations When Developing e-Learning and CME

ERIC Educational Resources Information Center

te Pas, Ellen; Wieringa-de Waard, Margreet; Blok, Bernadette Snijders; Pouw, Henny; van Dijk, Nynke

2016-01-01

Several usability issues were encountered during the design of a blended e-learning program for a course in evidence-based medicine for general practice trainers. The program was developed in four steps. We focused in this article on step 2 and 3. Step 2 focused on which educational principles to apply, that is, which learning theories,…

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…

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.

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.

Measuring Participants' Attitudes Toward Mobile Device Conference Applications in Continuing Medical Education: Validation of an Instrument.

PubMed

Wittich, Christopher M; Wang, Amy T; Fiala, Justin A; Mauck, Karen F; Mandrekar, Jayawant N; Ratelle, John T; Beckman, Thomas J

2016-01-01

Mobile device applications (apps) may enhance live CME courses. We aimed to (1) validate a measure of participant attitudes toward using a conference app and (2) determine associations between participant characteristics and attitudes toward CME apps with conference app usage. We conducted a cross-sectional validation study of participants at the Mayo Clinic Selected Topics in Internal Medicine Course. A conference app was developed that included presentation slides, note-taking features, search functions, social networking with other attendees, and access to presenter information. The CME app attitudes survey instrument (CMEAPP-10) was designed to determine participant attitudes toward conference apps. Of the 602 participants, 498 (82.7%) returned surveys. Factor analysis revealed a two-dimensional model for CMEAPP-10 scores (Cronbach α, 0.97). Mean (SD) CMEAPP-10 scores (maximum possible score of five) were higher for women than for men (4.06 [0.91] versus 3.85 [0.92]; P = .04). CMEAPP-10 scores (mean [SD]) were significantly associated (P = .02) with previous app usage as follows: less than once per month, 3.73 (1.05); monthly, 3.41 (1.16); weekly, 4.03 (0.69); and daily or more, 4.06 (0.89). Scores were unrelated to participant age, specialty, practice characteristics, or previous app use. This is the first validated measure of attitudes toward CME apps among course participants. App usage was higher among younger participants who had previously used educational or professional apps. Additionally, attitudes were more favorable among women and those who had previously used apps. These findings have important implications regarding efforts to engage participants with portable and accessible technology.

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

Development of a full ice-cream cone model for halo CME structures

NASA Astrophysics Data System (ADS)

Na, Hyeonock; Moon, Yong-Jae

2015-04-01

The determination of three dimensional parameters (e.g., radial speed, angular width, source location) of Coronal Mass Ejections (CMEs) is very important for space weather forecast. To estimate these parameters, several cone models based on a flat cone or a shallow ice-cream cone with spherical front have been suggested. In this study, we investigate which cone model is proper for halo CME morphology using 33 CMEs which are identified as halo CMEs by one spacecraft (SOHO or STEREO-A or B) and as limb CMEs by the other ones. From geometrical parameters of these CMEs such as their front curvature, we find that near full ice-cream cone CMEs (28 events) are dominant over shallow ice-cream cone CMEs (5 events). So we develop a new full ice-cream cone model by assuming that a full ice-cream cone consists of many flat cones with different heights and angular widths. This model is carried out by the following steps: (1) construct a cone for given height and angular width, (2) project the cone onto the sky plane, (3) select points comprising the outer boundary, (4) minimize the difference between the estimated projection points with the observed ones. We apply this model to several halo CMEs and compare the results with those from other methods such as a Graduated Cylindrical Shell model and a geometrical triangulation method.

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.

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

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.

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.

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).

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.

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

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…

Influence of physician factors on the effectiveness of a continuing medical education intervention.

PubMed

Flores, Sergio; Reyes, Hortensia; Perez-Cuevas, Ricardo

2006-01-01

Continuing medical education (CME) is essential for improving the quality of care in primary health care settings. This study's objective was to determine how the characteristics of family physicians influenced the effectiveness of a multifaceted CME intervention to improve the management of acute respiratory infection (ARI) or type 2 diabetes (DM2). A secondary analysis was conducted based on data from 121 family physicians, who participated in the educational intervention study. The outcome variable was positive change in physician's performance for treatment of ARI or DM2. The exposure variable was multifaceted CME intervention. Independent variables were professional physicians and organizational characteristics. Analysis included log binomial regression modeling. Factors influencing positive change included, for ARI, participation in the CME intervention and medical director interested in that condition and for DM2, participation in the CME intervention, medical director interested in DM2, and being a teacher. Physicians' characteristics and organizational environment influence the effectiveness of educational intervention and are therefore relevant to the implementation of CME strategies.

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.

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.

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.

SOHO Observations of a Coronal Mass Ejection

NASA Astrophysics Data System (ADS)

Akmal, Arya; Raymond, John C.; Vourlidas, Angelos; Thompson, Barbara; Ciaravella, A.; Ko, Y.-K.; Uzzo, M.; Wu, R.

2001-06-01

We describe a coronal mass ejection (CME) observed on 1999 April 23 by the Ultraviolet Coronagraph Spectrometer (UVCS), the Extreme-Ultraviolet Imaging Telescope (EIT), and the Large-Angle and Spectrometric Coronagraphs (LASCO) aboard the Solar and Heliospheric Observatory (SOHO). In addition to the O VI and C III lines typical of UVCS spectra of CMEs, this 480 km s-1 CME exhibits the forbidden and intercombination lines of O V at λλ1213.8 and 1218.4. The relative intensities of the O V lines represent an accurate electron density diagnostic not generally available at 3.5 Rsolar. By combining the density with the column density derived from LASCO, we obtain the emission measure of the ejected gas. With the help of models of the temperature and time-dependent ionization state of the expanding gas, we determine a range of heating rates required to account for the UV emission lines. The total thermal energy deposited as the gas travels to 3.5 Rsolar is comparable to the kinetic and gravitational potential energies. We note a core of colder material radiating in C III, surrounded by hotter material radiating in the O V and O VI lines. This concentration of the coolest material into small regions may be a common feature of CMEs. This event thus represents a unique opportunity to describe the morphology of a CME, and to characterize its plasma parameters.

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.

Translational Health: The Next Generation of Medicine

DTIC Science & Technology

2006-09-01

service. He was the Chief of Minimally Invasive Surgery and Bariatric Surgery when he retired. Here at Windber Medical Center, he continues to...uniquely demonstrate biological diversity in action. Minimally Invasive Surgery (CME) Kim Marley, MD, FACS Windber Medical Center 600...results of MIS procedures Biography Dr. Marley has been in the practice of General and Advanced Laparoscopic Surgery since 1992. He retired from

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…

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...

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.

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.

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.

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.

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.

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.

Today´s medical self and the other: Challenges and evolving solutions for enhanced humanization and quality of care

PubMed Central

Quintana-Vargas, Silvia; Ruddick, William; Castro-Santana, Anaclara; Islas-Andrade, Sergio; Altamirano-Bustamante, Nelly F.

2017-01-01

Background Recent scientific developments, along with growing awareness of cultural and social diversity, have led to a continuously growing range of available treatment options; however, such developments occasionally lead to an undesirable imbalance between science, technology and humanism in clinical practice. This study explores the understanding and practice of values and value clusters in real-life clinical settings, as well as their role in the humanization of medicine and its institutions. The research focuses on the values of clinical practice as a means of finding ways to enhance the pairing of Evidence-Based Medicine (EBM) with Values-based Medicine (VBM) in daily practice. Methods and findings The views and representations of clinical practice in 15 pre-CME and 15 post-CME interviews were obtained from a random sampling of active healthcare professionals. These views were then identified and qualitatively analyzed using a three-step hermeneutical approach. A clinical values space was identified in which ethical and epistemic values emerge, grow and develop within the biomedical, ethical, and socio-economic dimensions of everyday health care. Three main values—as well as the dynamic clusters and networks that they tend to form—were recognized: healthcare personnel-patient relationships, empathy, and respect. An examination of the interviews suggested that an adequate conceptualization of values leads to the formation of a wider axiological system. The role of clinician-as-consociate emerged as an ideal for achieving medical excellence. Conclusions By showing the intricate clusters and networks into which values are interwoven, our analysis suggests methods for fine-tuning educational interventions so they can lead to demonstrable changes in attitudes and practices. PMID:28759585

Today´s medical self and the other: Challenges and evolving solutions for enhanced humanization and quality of care.

PubMed

Sueiras, Perla; Romano-Betech, Victoria; Vergil-Salgado, Alejandro; de Hoyos, Adalberto; Quintana-Vargas, Silvia; Ruddick, William; Castro-Santana, Anaclara; Islas-Andrade, Sergio; Altamirano-Bustamante, Nelly F; Altamirano-Bustamante, Myriam M

2017-01-01

Recent scientific developments, along with growing awareness of cultural and social diversity, have led to a continuously growing range of available treatment options; however, such developments occasionally lead to an undesirable imbalance between science, technology and humanism in clinical practice. This study explores the understanding and practice of values and value clusters in real-life clinical settings, as well as their role in the humanization of medicine and its institutions. The research focuses on the values of clinical practice as a means of finding ways to enhance the pairing of Evidence-Based Medicine (EBM) with Values-based Medicine (VBM) in daily practice. The views and representations of clinical practice in 15 pre-CME and 15 post-CME interviews were obtained from a random sampling of active healthcare professionals. These views were then identified and qualitatively analyzed using a three-step hermeneutical approach. A clinical values space was identified in which ethical and epistemic values emerge, grow and develop within the biomedical, ethical, and socio-economic dimensions of everyday health care. Three main values-as well as the dynamic clusters and networks that they tend to form-were recognized: healthcare personnel-patient relationships, empathy, and respect. An examination of the interviews suggested that an adequate conceptualization of values leads to the formation of a wider axiological system. The role of clinician-as-consociate emerged as an ideal for achieving medical excellence. By showing the intricate clusters and networks into which values are interwoven, our analysis suggests methods for fine-tuning educational interventions so they can lead to demonstrable changes in attitudes and practices.

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.

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

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.

Project ECHO: A Telementoring Network Model for Continuing Professional Development.

PubMed

Arora, Sanjeev; Kalishman, Summers G; Thornton, Karla A; Komaromy, Miriam S; Katzman, Joanna G; Struminger, Bruce B; Rayburn, William F

2017-01-01

A major challenge with current systems of CME is the inability to translate the explosive growth in health care knowledge into daily practice. Project ECHO (Extension for Community Healthcare Outcomes) is a telementoring network designed for continuing professional development (CPD) and improving patient outcomes. The purpose of this article was to describe how the model has complied with recommendations from several authoritative reports about redesigning and enhancing CPD. This model links primary care clinicians through a knowledge network with an interprofessional team of specialists from an academic medical center who provide telementoring and ongoing education enabling community clinicians to treat patients with a variety of complex conditions. Knowledge and skills are shared during weekly condition-specific videoconferences. The model exemplifies learning as described in the seven levels of CPD by Moore (participation, satisfaction, learning, competence, performance, patient, and community health). The model is also aligned with recommendations from four national reports intended to redesign knowledge transfer in improving health care. Efforts in learning sessions focus on information that is relevant to practice, focus on evidence, education methodology, tailoring of recommendations to individual needs and community resources, and interprofessionalism. Project ECHO serves as a telementoring network model of CPD that aligns with current best practice recommendations for CME. This transformative initiative has the potential to serve as a leading model for larger scale CPD, nationally and globally, to enhance access to care, improve quality, and reduce cost.

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.

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.

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.

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

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.

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.

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

Medical journals of Nigeria, quo vadis?

PubMed

Eke, N; Nkanginieme, K E O

2002-01-01

The Nigerian health sector is beset with an underdeveloped Continuing Medical Education (CME) programme, a scarcity of reading materials and the lack of a reading culture. Recent issues of available journals were obtained and read to identify data such as: the ownership and base, presence of mission statement, print quality, administrative and editorial matters, abstract format, CME value of articles, advertisements, subscription information and communication channels and practice. The availability of the journals in the libraries of the three 'first generation' teaching hospitals and accessibility through the Medline were ascertained. Twenty-eight current journals were obtained. Lagos has the highest number of editorial bases. Fifteen journals belong to national medical associations, 2 to regions and 11 to institutions. The journal title was considered appropriate in 13, cover design was good in 15, paper quality was good in 20 and legibility was good in 11 journals. Poor editing was manifested by bad grammar, spelling and punctuation. Six journals contained review articles of good CME value. Eight journals had a full compliment of communication facilities. The existence of a functional independent administrative office or staff was indicated in 7 journals. No journal indicated the dates of submission and acceptance of articles. Twenty-one journals were on the shelf of the library of ABUTH, Zaria. Two journals are accessible through the Medline and another is on-line. Adequate funding and improved management will effectively address most of the problems identified.

[The standardized practice of laparoscopic-assisted radical right hemicolectomy in order to achieve complete mesocolic excision].

PubMed

Li, Bing-gen; Nie, Xiang-yang; He, Yong-zhong; Xie, Hui-hua; Yu, Guo-zhong; Du, Han-peng; Kong, Fan-dong; Gong, Du-hui; Lin, Wei-bin; Wu, Ming-jian

2012-03-01

To explore the feasibility of laparoscopic-assisted radical right hemicolectomy with the outcome being a complete mesocolic excision (CME). Between February 2010 and June 2011, we performed the standardized surgery of laparoscopic-assisted radical right hemicolectomy with an aim of CME on 14 patients. There were 10 males and 4 females, with an average age of 57 years (range 36 to 74 years). All the pathologic results in 14 cases were primary colonic adenocarcinoma. The TNM stages were distributed as follows: 2 in II A, 3 in II B, 3 in III A, 5 in III B and 1 in III C. Surgery was successfully performed for all patients without open conversion. The average operation time was (178 ± 37) minutes (range 127 to 221 minutes), average intraoperative blood loss was (67 ± 23) ml (range 30 to 110 ml), while the average number of lymph node harvest was 21 ± 7 (range 14 to 31), and the postoperative hospital stay was (10.0 ± 2.2) days (range 7 to 15 days). Minor complications occured in 2 patients. Major complications and post-operative mortality were not observed. All the patients were followed up for 3 to 19 months, no tumor recurrence or metastasis was identified. The standardized surgery of laparoscopic-assisted radical right hemicolectomy with the final outcome of CME is safe and feasible.

Solar Eruptive Flares: from Physical Understanding to Probabilistic Forecasting

NASA Astrophysics Data System (ADS)

Georgoulis, M. K.

2013-12-01

We describe a new, emerging physical picture of the triggering of major solar eruptions. First, we discuss and aim to interpret the single distinguishing feature of tight, shear-ridden magnetic polarity inversion lines (PILs) in solar active regions, where most of these eruptions occur. Then we analyze the repercussions of this feature, that acts to form increasingly helical pre-eruption structures. Eruptions, with the CME progenitor preceding the flare, tend to release parts of the accumulated magnetic free energy and helicity that are always much smaller than the respective budgets of the source active region. These eruption-related decreases, however, are not optimal for eruption forecasting - this role is claimed by physically intuitive proxy parameters that could show increased pre-eruption sensitivity at time scales practical for prediction. Concluding, we show how reconciling this new information - jointly enabled by the exceptional resolution and quality of Hinode and cadence of SDO data - can lead to advances in understanding that outline the current state-of-the-art of our eruption-forecasting capability.

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

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.

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.

On the deficit problem of mass and energy of solar coronal mass ejections connected with interplanetary shocks

NASA Technical Reports Server (NTRS)

Ivanchuk, V. I.; Pishkalo, N. I.

1995-01-01

Mean values of a number of parameters of the most powerful coronal mass ejections (CMEs) and interplanetary shocks generated by these ejections are estimated using an analysis of data obtained by the cosmic coronagraphs and spacecrafts, and geomagnetic storm measurements. It was payed attention that the shock mass and mechanical energy, averaging 5 x 10(exp 16) grm and 2 x 10(exp 32) erg respectively, are nearly 10 times larger than corresponding parameters of the ejections. So, the CME energy deficit problem seems to exist really. To solve this problem one can make an assumption that the process of the mass and energy growth of CMEs during their propagation out of the Sun observed in the solar corona is continued in supercorona too up to distances of 10-30 solar radii. This assumption is confirmed by the data analysis of five events observed using zodiacal light photometers of the HELIOS- I and HELIOS-2 spacecrafts. The mass growth rate is estimated to be equal to (1-7) x 10(exp 11) grm/sec. It is concluded that the CME contribution to mass and energy flows in the solar winds probably, is larger enough than the value of 3-5% adopted usually.

Macular edema after uncomplicated cataract surgery: a role for phacoemulsification energy and vitreoretinal interface status?

PubMed

Anastasilakis, Konstantinos; Mourgela, Anna; Symeonidis, Chrysanthos; Dimitrakos, Stavros A; Ekonomidis, Panayiotis; Tsinopoulos, Ioannis

2015-01-01

To study postoperative macular thickness fluctuations measured by spectral-domain optical coherence tomography (SD-OCT) and to investigate a potential correlation among macular edema (ME) incidence, cumulative dissipated energy (CDE) released during phacoemulsification, and vitreoretinal interface status. This is a prospective, cross-sectional study of 106 cataract patients with no macular disorder who underwent phacoemulsification. Best-corrected visual acuity measurement, slit-lamp examination, OCT scans were performed preoperatively and 30 and 90 days postoperatively. The intraoperative parameters measured were CDE and total phacoemulsification time. The SD-OCT parameters assessed were central subfield thickness (CST), cube average thickness (CAT), cube macular volume, vitreoretinal interface status, and presence of cystoid or diffuse ME. Four patients (3.8%) developed subclinical ME. Regarding ME, there was no significant difference between patients with presence or absence of posterior vitreous detachment (chi-square, p = 0.57), although 75% of ME cases were observed in patients with attached posterior vitreous. With regard to comparison between eyes with and without subclinical CME incidence, CDE (p = 0.05), phacoemulsification time (p = 0.001), CST at month 1 (p = 0.002), cube macular volume at month 1 (p = 0.039), and CAT at month 1 (p = 0.050) were significantly higher in the subclinical CME group. This study provides evidence that OCT macular thickness parameters increase significantly at first and third month postoperatively and that the incidence of pseudophakic ME can be affected by CDE.

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…

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…

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.

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.

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.

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

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.

Scientific goals of the Cooperative Multiscale Experiment (CME)

NASA Technical Reports Server (NTRS)

Cotton, William

1993-01-01

Mesoscale Convective Systems (MCS) form the focus of CME. Recent developments in global climate models, the urgent need to improve the representation of the physics of convection, radiation, the boundary layer, and orography, and the surge of interest in coupling hydrologic, chemistry, and atmospheric models of various scales, have emphasized the need for a broad interdisciplinary and multi-scale approach to understanding and predicting MCS's and their interactions with processes at other scales. The role of mesoscale systems in the large-scale atmospheric circulation, the representation of organized convection and other mesoscale flux sources in terms of bulk properties, and the mutually consistent treatment of water vapor, clouds, radiation, and precipitation, are all key scientific issues concerning which CME will seek to increase understanding. The manner in which convective, mesoscale, and larger scale processes interact to produce and organize MCS's, the moisture cycling properties of MCS's, and the use of coupled cloud/mesoscale models to better understand these processes, are also major objectives of CME. Particular emphasis will be placed on the multi-scale role of MCS's in the hydrological cycle and in the production and transport of chemical trace constituents. The scientific goals of the CME consist of the following: understand how the large and small scales of motion influence the location, structure, intensity, and life cycles of MCS's; understand processes and conditions that determine the relative roles of balanced (slow manifold) and unbalanced (fast manifold) circulations in the dynamics of MCS's throughout their life cycles; assess the predictability of MCS's and improve the quantitative forecasting of precipitation and severe weather events; quantify the upscale feedback of MCS's to the large-scale environment and determine interrelationships between MCS occurrence and variations in the large-scale flow and surface forcing; provide a data base for initialization and verification of coupled regional, mesoscale/hydrologic, mesoscale/chemistry, and prototype mesoscale/cloud-resolving models for prediction of severe weather, ceilings, and visibility; provide a data base for initialization and validation of cloud-resolving models, and for assisting in the fabrication, calibration, and testing of cloud and MCS parameterization schemes; and provide a data base for validation of four dimensional data assimilation schemes and algorithms for retrieving cloud and state parameters from remote sensing instrumentation.

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

Giant self-biased converse magnetoelectric effect in multiferroic heterostructure with single-phase magnetostrictive materials

NASA Astrophysics Data System (ADS)

Zhang, Jitao; Li, Ping; Wen, Yumei; He, Wei; Yang, Aichao; Wang, Decai; Yang, Chao; Lu, Caijiang

2014-10-01

Giant self-biased converse magnetoelectric (CME) effects with obvious hysteretic behaviors are systematically investigated in two-phase SmFe2/PZT [Pb(Zr1-x, Tix)O3] multiferroic laminates at room temperature. Taking advantage of the huge anisotropic field of SmFe2 plate, large remnant CME coupling is provoked by this field instead of permanent magnets to bias the laminate. Consequently, bitable magnetization status switching is realized through a smaller ac voltage far below the electric coercive field in the absence of magnetic bias field. Experiments demonstrate that a large remnant CME coefficient (αCME) of 0.007 mG/V is achieved, exhibiting ˜50 times higher CME coefficient than the previous laminate composite multi-phase magnetostrictive plates. These results provide promising applications for realization of high-density magnetoelectric random access memories (MERAMs) devices with lower energy consumption.

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).

Explicit calculation of the two-loop corrections to the chiral magnetic effect with the NJL model

NASA Astrophysics Data System (ADS)

Chu, Kit-fai; Huang, Peng-hui; Liu, Hui

2018-05-01

The chiral magnetic effect (CME) is usually believed to not receive higher-order corrections due to the nonrenormalization of the AVV triangle diagram in the framework of quantum field theory. However, the CME-relevant triangle, which is obtained by expanding the current-current correlation, requires zero momentum on the axial vertex and is not equivalent to the general AVV triangle when taking the zero-momentum limit owing to the infrared problem on the axial vertex. Therefore, it is still significant to check if there exists perturbative higher-order corrections to the current-current correlation. In this paper, we explicitly calculate the two-loop corrections of CME within the Nambu-Jona-Lasinio model with a Chern-Simons term, which ensures a consistent μ5 . The result shows the two-loop corrections to the CME conductivity are zero, which confirms the nonrenomalization of CME conductivity.

Adaptively biased sequential importance sampling for rare events in reaction networks with comparison to exact solutions from finite buffer dCME method

PubMed Central

Cao, Youfang; Liang, Jie

2013-01-01

Critical events that occur rarely in biological processes are of great importance, but are challenging to study using Monte Carlo simulation. By introducing biases to reaction selection and reaction rates, weighted stochastic simulation algorithms based on importance sampling allow rare events to be sampled more effectively. However, existing methods do not address the important issue of barrier crossing, which often arises from multistable networks and systems with complex probability landscape. In addition, the proliferation of parameters and the associated computing cost pose significant problems. Here we introduce a general theoretical framework for obtaining optimized biases in sampling individual reactions for estimating probabilities of rare events. We further describe a practical algorithm called adaptively biased sequential importance sampling (ABSIS) method for efficient probability estimation. By adopting a look-ahead strategy and by enumerating short paths from the current state, we estimate the reaction-specific and state-specific forward and backward moving probabilities of the system, which are then used to bias reaction selections. The ABSIS algorithm can automatically detect barrier-crossing regions, and can adjust bias adaptively at different steps of the sampling process, with bias determined by the outcome of exhaustively generated short paths. In addition, there are only two bias parameters to be determined, regardless of the number of the reactions and the complexity of the network. We have applied the ABSIS method to four biochemical networks: the birth-death process, the reversible isomerization, the bistable Schlögl model, and the enzymatic futile cycle model. For comparison, we have also applied the finite buffer discrete chemical master equation (dCME) method recently developed to obtain exact numerical solutions of the underlying discrete chemical master equations of these problems. This allows us to assess sampling results objectively by comparing simulation results with true answers. Overall, ABSIS can accurately and efficiently estimate rare event probabilities for all examples, often with smaller variance than other importance sampling algorithms. The ABSIS method is general and can be applied to study rare events of other stochastic networks with complex probability landscape. PMID:23862966

Adaptively biased sequential importance sampling for rare events in reaction networks with comparison to exact solutions from finite buffer dCME method

NASA Astrophysics Data System (ADS)

Cao, Youfang; Liang, Jie

2013-07-01

Critical events that occur rarely in biological processes are of great importance, but are challenging to study using Monte Carlo simulation. By introducing biases to reaction selection and reaction rates, weighted stochastic simulation algorithms based on importance sampling allow rare events to be sampled more effectively. However, existing methods do not address the important issue of barrier crossing, which often arises from multistable networks and systems with complex probability landscape. In addition, the proliferation of parameters and the associated computing cost pose significant problems. Here we introduce a general theoretical framework for obtaining optimized biases in sampling individual reactions for estimating probabilities of rare events. We further describe a practical algorithm called adaptively biased sequential importance sampling (ABSIS) method for efficient probability estimation. By adopting a look-ahead strategy and by enumerating short paths from the current state, we estimate the reaction-specific and state-specific forward and backward moving probabilities of the system, which are then used to bias reaction selections. The ABSIS algorithm can automatically detect barrier-crossing regions, and can adjust bias adaptively at different steps of the sampling process, with bias determined by the outcome of exhaustively generated short paths. In addition, there are only two bias parameters to be determined, regardless of the number of the reactions and the complexity of the network. We have applied the ABSIS method to four biochemical networks: the birth-death process, the reversible isomerization, the bistable Schlögl model, and the enzymatic futile cycle model. For comparison, we have also applied the finite buffer discrete chemical master equation (dCME) method recently developed to obtain exact numerical solutions of the underlying discrete chemical master equations of these problems. This allows us to assess sampling results objectively by comparing simulation results with true answers. Overall, ABSIS can accurately and efficiently estimate rare event probabilities for all examples, often with smaller variance than other importance sampling algorithms. The ABSIS method is general and can be applied to study rare events of other stochastic networks with complex probability landscape.

Adaptively biased sequential importance sampling for rare events in reaction networks with comparison to exact solutions from finite buffer dCME method.

PubMed

Cao, Youfang; Liang, Jie

2013-07-14

Critical events that occur rarely in biological processes are of great importance, but are challenging to study using Monte Carlo simulation. By introducing biases to reaction selection and reaction rates, weighted stochastic simulation algorithms based on importance sampling allow rare events to be sampled more effectively. However, existing methods do not address the important issue of barrier crossing, which often arises from multistable networks and systems with complex probability landscape. In addition, the proliferation of parameters and the associated computing cost pose significant problems. Here we introduce a general theoretical framework for obtaining optimized biases in sampling individual reactions for estimating probabilities of rare events. We further describe a practical algorithm called adaptively biased sequential importance sampling (ABSIS) method for efficient probability estimation. By adopting a look-ahead strategy and by enumerating short paths from the current state, we estimate the reaction-specific and state-specific forward and backward moving probabilities of the system, which are then used to bias reaction selections. The ABSIS algorithm can automatically detect barrier-crossing regions, and can adjust bias adaptively at different steps of the sampling process, with bias determined by the outcome of exhaustively generated short paths. In addition, there are only two bias parameters to be determined, regardless of the number of the reactions and the complexity of the network. We have applied the ABSIS method to four biochemical networks: the birth-death process, the reversible isomerization, the bistable Schlögl model, and the enzymatic futile cycle model. For comparison, we have also applied the finite buffer discrete chemical master equation (dCME) method recently developed to obtain exact numerical solutions of the underlying discrete chemical master equations of these problems. This allows us to assess sampling results objectively by comparing simulation results with true answers. Overall, ABSIS can accurately and efficiently estimate rare event probabilities for all examples, often with smaller variance than other importance sampling algorithms. The ABSIS method is general and can be applied to study rare events of other stochastic networks with complex probability landscape.

General solution of the chemical master equation and modality of marginal distributions for hierarchic first-order reaction networks.

PubMed

Reis, Matthias; Kromer, Justus A; Klipp, Edda

2018-01-20

Multimodality is a phenomenon which complicates the analysis of statistical data based exclusively on mean and variance. Here, we present criteria for multimodality in hierarchic first-order reaction networks, consisting of catalytic and splitting reactions. Those networks are characterized by independent and dependent subnetworks. First, we prove the general solvability of the Chemical Master Equation (CME) for this type of reaction network and thereby extend the class of solvable CME's. Our general solution is analytical in the sense that it allows for a detailed analysis of its statistical properties. Given Poisson/deterministic initial conditions, we then prove the independent species to be Poisson/binomially distributed, while the dependent species exhibit generalized Poisson/Khatri Type B distributions. Generalized Poisson/Khatri Type B distributions are multimodal for an appropriate choice of parameters. We illustrate our criteria for multimodality by several basic models, as well as the well-known two-stage transcription-translation network and Bateman's model from nuclear physics. For both examples, multimodality was previously not reported.

Kinematic Treatment of CME Evolution in the Solar Wind

NASA Technical Reports Server (NTRS)

Riley, Pete; Crooker, N. U.

2004-01-01

We present a kinematic study of the evolution of coronal mass ejections (CMEs) in the solar wind. Specifically, we consider the effects of: (1) spherical expansion; and (2) uniform expansion due to pressure gradients between the Interplanetary CME (ICME) and the ambient solar wind. We compare these results with an MHD model, which allows us to isolate these effects from the combined kinematic and dynamical effects, which are included in MHD models. They also provide compelling evidence that the fundamental cross section of so-called "force-free" flux ropes (or magnetic clouds) is neither circular or elliptical, but rather a convex-outward, "pancake" shape. We apply a force-free fitting to the magnetic vectors from the MHD simulation to assess how the distortion of the flux rope affects the fitting. In spite of these limitations, force-free fittings, which are straightforward to apply, do provide an important description of a number of parameters, including the radial dimension, orientation and chirality of the ICME.

Particle acceleration and transport at a 2D CME-driven shock using the HAFv3 and PATH Code

NASA Astrophysics Data System (ADS)

Li, G.; Ao, X.; Fry, C. D.; Verkhoglyadova, O. P.; Zank, G. P.

2012-12-01

We study particle acceleration at a 2D CME-driven shock and the subsequent transport in the inner heliosphere (up to 2 AU) by coupling the kinematic Hakamada-Akasofu-Fry version 3 (HAFv3) solar wind model (Hakamada and Akasofu, 1982, Fry et al. 2003) with the Particle Acceleration and Transport in the Heliosphere (PATH) model (Zank et al., 2000, Li et al., 2003, 2005, Verkhoglyadova et al. 2009). The HAFv3 provides the evolution of a two-dimensional shock geometry and other plasma parameters, which are fed into the PATH model to investigate the effect of a varying shock geometry on particle acceleration and transport. The transport module of the PATH model is parallelized and utilizes the state-of-the-art GPU computation technique to achieve a rapid physics-based numerical description of the interplanetary energetic particles. Together with a fast execution of the HAFv3 model, the coupled code gives us a possibility to nowcast/forecast the interplanetary radiation environment.

Perceptions of Continuing Medical Education, Professional Development, and Organizational Support in the United Arab Emirates

ERIC Educational Resources Information Center

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

2010-01-01

Introduction: 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). Methods: A 6-part questionnaire focused on the following areas of CME: the workshop leaders/trainers, the training…

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.

Why a geoeffective CME was missed by SOHO LASCO?

NASA Astrophysics Data System (ADS)

Chi, Y.; Zhang, J.; Shen, C.; Hess, P.; Feng, L.; Wang, Y.; Mishra, W.

2017-12-01

During 2011 May 25, two Earth directed coronal mass ejections (CMEs) were recorded by STEREO COR2 as limb CMEs, when the separation between twin STEREO spacecraft and Earth was approximately 90°. At the same time, SOHO LASCO did not record corresponding halo or partial halo CME. These CMEs provided an opportunity to study why SOHO LASCO may miss Earth direction CME. According to GCS model, we find the two CMEs both have small half angle and aspect ratio. Most part of CMEs are behind the occulter of SOHO LASCO C2. We also estimated the two CMEs' mass and find the both CMEs' mass is small. The expected CME brightness according to the CME's mass is in the same order of the noise of SOHO LASCO. In the HI1 Fov, We have found evidence of interaction between the two CMEs. Combining with the WIND in situ observations, we find the CMEs are adjacent to each other. The duration of the two flux rope structure are 7 and 6.6 hours, respectively. This may provide an evidence that small flux structure without corresponding CME is also the solar erupted structure.

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.

The Formation and Early Evolution of a CME and the Associated Shock on 2014 January 8

NASA Astrophysics Data System (ADS)

Wan, Linfeng; Cheng, Xin; Shi, Tong; Su, Wei; Ding, Mingde

2017-08-01

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 AIA on board \\textit{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. 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 (HXR) 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 $\\sim$600 km s$^{-1}$, the EUV wave starts to evolve into a shock wave, which is evidenced by the appearance of a type II radio burst. Interestingly, we also notice an unusual solar radio signal at $\\sim$4 GHz that is similar to the pattern of a type II radio burst but drifts to higher frequencies at a rate of $\\sim$0.3 MHz per second during about 7 minutes. Its derived density is $\\sim$5$\\times$10$^{10}$ cm$^{-3}$ and increases slowly with time. Joint imaging observations of HXR and EUV help to locate the loop-top region and calculate its thermal proprieties, including slowly increasing densities ($\\sim$5$\\times$10$^{10}$ cm$^{-3}$) and temperatures ($\\sim$14 MK). The similar results obtained from two different ways above imply the possibility of this scenario: plasma blobs that are ejected along the current sheet via magnetic reconnection collide with underlying flare loops that are undergoing chromospheric evaporation. 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 $\\sim$2 MK, while that in the CME core region and the flare region has a much higher temperature of $\\ge$8 MK.

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.

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.

Relationship among practice change, motivation, and self-efficacy.

PubMed

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

2014-01-01

The relationship between an individual's sense of self-efficacy, motivation to change, and the implementation of improvement programs has been reported. This research reports the relationship among self-efficacy, motivation to change, and intent to implement continuing medical education (CME) activity learnings. The measure of individual sense of self-efficacy was a 4-item scale. The measure of motivation was a 4-item scale following on the work of Johnson, et al. The self-efficacy scale has been confirmed for structure, and together the 2 scales provide indicators of 3 underlying variables-2 self-efficacy constructs and a motivation variable. In addition, a global intent to implement measure was collected. Preliminary analysis demonstrates a significant relationship between a self-efficacy construct, the motivation to change construct, and global intent to change. Specifically, the sense of efficacy in effecting change in the practice environment is predictive of a high level of motivation to change, which, in turn, is predictive of formation of an intent to change practice patterns. Further inspection of the motivation to change construct suggests that it mediates the self-efficacy constructs' effect on intent. This is consistent with an earlier report on the relationship among self-efficacy, barriers to change, and stated intent. This new finding suggests that the proximal construct motivation completely masks an important underlying causal relationship that appears to contribute to practice change following CME: self-efficacy. A focus on the participants' sense of self-agency may provide a path to practice change. © 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.

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.

The PTEN/Akt Signaling Pathway Mediates Myocardial Apoptosis in Swine After Coronary Microembolization.

PubMed

Wang, Jiangyou; Chen, Han; Su, Qiang; Zhou, You; Liu, Tao; Li, Lang

2016-09-01

Phosphatase and the tensin homolog deleted on chromosome ten (PTEN) has been recognized as a promoter of apoptosis in various tissues and has been shown to be upregulated in circumstances of coronary microembolization (CME). We hypothesized that the upregulation of PTEN correlates with CME-induced myocardial apoptosis. Swine CME was induced by an intracoronary injection of inert plastic microspheres (diameter of 42 μm) into the left anterior descending coronary, with or without pretreatment of the PTEN small-interfering RNA (siRNA). Echocardiological measurements, a pathological examination, Terminal-deoxynucleoitidyl Transferase Mediated Nick End Labeling (TUNEL) staining, and Western blotting, were performed to assess their functional, morphological, and molecular effects in CME. PTEN was aberrantly upregulated in cardiomyocytes following CME. Downregulation of PTEN in vivo via siRNA was associated with improved cardiac function and attenuated myocardial apoptosis; concomitantly inhibited the expression of key proapoptotic proteins, such as phosphorylated Bad (p-Bad); cleaved caspase-3; and enhanced the expression of key antiapoptotic proteins, such as phosphorylated protein kinase B (p-Akt). However, there was no difference in the Akt-regulated downstream protein IκB kinases (IKKα, IKKβ, and IKKγ) among the sham, CME, and control siRNA groups. This study demonstrates, for the first time, that the PTEN/Akt signaling pathway contributes to cardiomyocyte apoptosis. The data generated from this study provide a rationale for the development of PTEN-based therapeutic strategies for CME-induced myocardial injury. © The Author(s) 2016.

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.

Prevalence of macular abnormalities assessed by optical coherence tomography in patients with Usher syndrome.

PubMed

Testa, Francesco; Melillo, Paolo; Rossi, Settimio; Marcelli, Vincenzo; de Benedictis, Antonella; Colucci, Raffaella; Gallo, Beatrice; Brunetti-Pierri, Raffaella; Donati, Simone; Azzolini, Claudio; Marciano, Elio; Simonelli, Francesca

2018-01-01

To investigate the prevalence of macular abnormalities in patients affected by Usher syndrome (USH), by comparing the clinical findings between two types (i.e., USH1 and USH2). A retrospective study was performed by reviewing optical coherence tomography (OCT) in 134 USH patients to determine the presence of macular abnormalities, including cystoid macular edema (CME), epiretinal membrane (ERM), vitreo-macular traction syndrome (VMT), and macular hole (MH). Macular abnormalities were observed in 126/268 (47.0%) examined eyes. The most frequent abnormality was ERM observed in 51 eyes (19%), followed by CME observed in 42 eyes (15.7%). Moreover, CME was significantly (p < 0.05) associated with younger age (CME: 30.1 ± 11.1 years; without CME: 36.9 ± 14.9 years), whereas VMT and full thickness MH were associated with older age (p < 0.05). Moreover, a significantly (p < 0.05) decreased best-corrected visual acuity was associated with MH compared to eyes without MH. Finally, CME was more frequent in USH1 compared to USH2. Our study, for the first time in the literature, showed the distribution of all macular abnormalities assessed by SD-OCT in a large USH cohort, comparing USH1 and USH2 patients. We observed that ocular abnormalities are highly prevalent in USH patients compared to general population, with ERM and CME being the most common alterations. Based on these findings, OCT screening in USH patients is recommended for early detection of macular changes and early treatment.

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.

Global MHD Simulation of the Coronal Mass Ejection on 2011 March 7: from Chromosphere to 1 AU

NASA Astrophysics Data System (ADS)

Jin, M.; Manchester, W.; van der Holst, B.; Oran, R.; Sokolov, I.; Toth, G.; Vourlidas, A.; Liu, Y.; Sun, X.; Gombosi, T. I.

2013-12-01

In this study, we present magnetohydrodynamics simulation results of a fast CME event that occurred on 2011 March 7 by using the newly developed Alfven Wave Solar Model (AWSoM) in Space Weather Modeling Framework (SWMF). The background solar wind is driven by Alfven-wave pressure and heated by Alfven-wave dissipation in which we have incorporated balanced turbulence at the top of the closed field lines. The magnetic field of the inner boundary is specified with a synoptic magnetogram from SDO/HMI. In order to produce the physically correct CME structures and CME-driven shocks, the electron and proton temperatures are separated so that the electron heat conduction is explicitly treated in conjunction with proton shock heating. Also, collisionless heat conduction is implemented for getting the correct electron temperature at 1 AU. We initiate the CME by using the Gibson-Low flux rope model and simulate the CME propagation to 1 AU. A comprehensive validation study is performed using remote as well as in-situ observations from SOHO, STEREOA/B, ACE, and WIND. Our result shows that the new model can reproduce most of the observed features and the arrival time of the CME is correctly estimated, which suggests the forecasting capability of the new model. We also examine the simulated CME-driven shock structures that are important for modeling the associated solar energetic event (SEP) with diffusive shock acceleration.

Revised Tijeras Arroyo Groundwater Current Conceptual Model and Corrective Measures Evaluation Report - February 2018.

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

Copland, John R.

The U.S. Department of Energy (DOE) and the management and operating (M&O) contractor for Sandia National Laboratories beginning on May 1, 2017, National Technology & Engineering Solutions of Sandia, LLC (NTESS), hereinafter collectively referred to as DOE/NTESS, prepared this Revised Tijeras Arroyo Groundwater Current Conceptual Model (CCM) and Corrective Measures Evaluation (CME) Report , referred to as the Revised CCM/CME Report, to meet requirements under the Sandia National Laboratories-New Mexico (SNL/NM) Compliance Order on Consent (Consent Order). The Consent Order became effective on April 29, 2004. The Consent Order identifies the Tijeras Arroyo Groundwater (TAG) Area of Concern (AOC) asmore » an area of groundwater contamination requiring further characterization and corrective action. In November 2004, New Mexico Environment Department (NMED) approved the July 2004 CME Work Plan. In April 2005, DOE and the SNL M&O contractor at the time, Sandia Corporation (Sandia), hereinafter collectively referred to as DOE/Sandia, submitted a CME Report, but NMED did not finalize review of that document. In December 2016, DOE/Sandia submitted a combined and updated CCM/CME Report. NMED issued a disapproval letter in May 2017 that included comments on the December 2016 CCM/CME Report. In August 2017, NMED and DOE/NTESS staff held a meeting to discuss and clarify outstanding issues. This Revised CCM/CME Report addresses (1) the issues presented in the NMED May 2017 disapproval letter and (2) findings from the August 2017 meeting.« less

Relationship between the start times of flares and CMEs to the time of potential radiation hazards

NASA Astrophysics Data System (ADS)

Kang, G.; Zheng, Y.; Kuznetsova, M. M.

2013-12-01

Solar flares, short-term outbursts of energy of the Sun, and coronal mass ejections (CME), massive bursts of solar matter, are two solar phenomena that are known to increase solar energetic particles in space. Increased solar energetic particles cause immense radiation that poses a serious threat to astronauts in space, radio communication signals, and passengers on high-latitude flights on the Earth. The relationship between the start times of flares and CMEs to the time of potential radiation hazards was investigated to determine how much warning time is available. Additionally, this project compared the difference between these relationships for four energy levels of solar energetic particles: proton flux exceeding 10 MeV, 30 MeV, 50 MeV and 100 MeV. This project gathered data of 22 recent SEP events between 2010 and 2012 and the parameters of associated CMEs and flares. Through the use of IDL (Interactive Data Language) programming, thorough analysis was conducted, including 2-sample t-tests and Kruskal-Wallis tests for 2 or more samples. The average lead time to warn humans of possible radiation hazard from the detection of a flare and a CME occurrence was found to be around 12 to 20 hours. The lead time was the greatest for the lowest energy level, though the differences in energy levels and that between the lead times for CME and flares were found to be statistically insignificant with p-values exceeding the alpha value of 0.20.

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.

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.

Development of a Full Ice-cream Cone Model for Halo Coronal Mass Ejections

NASA Astrophysics Data System (ADS)

Na, Hyeonock; Moon, Y.-J.; Lee, Harim

2017-04-01

It is essential to determine three-dimensional parameters (e.g., radial speed, angular width, and source location) of coronal mass ejections (CMEs) for the space weather forecast. In this study, we investigate which cone type represents a halo CME morphology using 29 CMEs (12 Solar and Heliospheric Observatory (SOHO)/Large Angle and Spectrometric Coronagraph (LASCO) halo CMEs and 17 Solar Terrestrial Relations Observatory (STEREO)/Sun-Earth Connection Coronal and Heliospheric Investigation COR2 halo CMEs) from 2010 December to 2011 June. These CMEs are identified as halo CMEs by one spacecraft (SOHO or one of STEREO A and B) and limb ones by the other spacecraft (One of STEREO A and B or SOHO). From cone shape parameters of these CMEs, such as their front curvature, we find that the CME observational structures are much closer to a full ice-cream cone type than a shallow ice-cream cone type. Thus, 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 to estimate the three-dimensional parameters of the halo CMEs. This model is constructed by carrying out the following steps: (1) construct a cone for a given height and angular width, (2) project the cone onto the sky plane, (3) select points comprising the outer boundary, and (4) minimize the difference between the estimated projection speeds with the observed ones. 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).

Development of a Full Ice-cream Cone Model for Halo Coronal Mass Ejections

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

Na, Hyeonock; Moon, Y.-J.; Lee, Harim, E-mail: nho0512@khu.ac.kr, E-mail: moonyj@khu.ac.kr

It is essential to determine three-dimensional parameters (e.g., radial speed, angular width, and source location) of coronal mass ejections (CMEs) for the space weather forecast. In this study, we investigate which cone type represents a halo CME morphology using 29 CMEs (12 Solar and Heliospheric Observatory (SOHO) /Large Angle and Spectrometric Coronagraph (LASCO) halo CMEs and 17 Solar Terrestrial Relations Observatory ( STEREO )/Sun–Earth Connection Coronal and Heliospheric Investigation COR2 halo CMEs) from 2010 December to 2011 June. These CMEs are identified as halo CMEs by one spacecraft ( SOHO or one of STEREO A and B ) and limbmore » ones by the other spacecraft (One of STEREO A and B or SOHO ). From cone shape parameters of these CMEs, such as their front curvature, we find that the CME observational structures are much closer to a full ice-cream cone type than a shallow ice-cream cone type. Thus, 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 to estimate the three-dimensional parameters of the halo CMEs. This model is constructed by carrying out the following steps: (1) construct a cone for a given height and angular width, (2) project the cone onto the sky plane, (3) select points comprising the outer boundary, and (4) minimize the difference between the estimated projection speeds with the observed ones. 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).« less

Prospective Out-of-ecliptic White-light Imaging of Coronal Mass Ejections Traveling through the Corona and Heliosphere

NASA Astrophysics Data System (ADS)

Xiong, Ming; Davies, Jackie A.; Harrison, Richard A.; Zhou, Yufen; Feng, Xueshang; Xia, Lidong; Li, Bo; Liu, Ying D.; Hayashi, Keiji; Li, Huichao; Yang, Liping

2018-01-01

The in-flight performance of the Coriolis/SMEI and STEREO/HI instruments substantiates the high-technology readiness level of white-light (WL) imaging of coronal mass ejections (CMEs) in the inner heliosphere. The WL intensity of a propagating CME is jointly determined by its evolving mass distribution and the fixed Thomson-scattering geometry. From their in-ecliptic viewpoints, SMEI and HI, the only heliospheric imagers that have been flown to date, integrate the longitudinal dimension of CMEs. In this paper, using forward magnetohydrodynamic modeling, we synthesize the WL radiance pattern of a typical halo CME viewed from an out-of-ecliptic (OOE) vantage point. The major anatomical elements of the CME identified in WL imagery are a leading sheath and a trailing ejecta; the ejecta-driven sheath is the brightest feature of the CME. The sheath, a three-dimensional (3D) dome-like density structure, occupies a wide angular extent ahead of the ejecta itself. The 2D radiance pattern of the sheath depends critically on viewpoint. For a CME modeled under solar minimum conditions, the WL radiance pattern of the sheath is generally a quasi-straight band when viewed from an in-ecliptic viewpoint and a semicircular arc from an OOE viewpoint. The dependence of the radiance pattern of the ejecta-driven sheath on viewpoint is attributed to the bimodal nature of the 3D background solar wind flow. Our forward-modeling results suggest that OOE imaging in WL radiance can enable (1) a near-ecliptic CME to be continuously tracked from its coronal initiation, (2) the longitudinal span of the CME to be readily charted, and (3) the transporting speed of the CME to be reliably determined. Additional WL polarization measurements can significantly limit the ambiguity of localizing CMEs. We assert that a panoramic OOE view in WL would be highly beneficial in revealing CME morphology and kinematics in the hitherto-unresolved longitudinal dimension and hence for monitoring the propagation and evolution of near-ecliptic CMEs for space weather operations.

On Flare-CME Characteristics from Sun to Earth Combining Remote-Sensing Image Data with In Situ Measurements Supported by Modeling

NASA Astrophysics Data System (ADS)

Temmer, Manuela; Thalmann, Julia K.; Dissauer, Karin; Veronig, Astrid M.; Tschernitz, Johannes; Hinterreiter, Jürgen; Rodriguez, Luciano

2017-07-01

We analyze the well-observed flare and coronal mass ejection (CME) from 1 October 2011 (SOL2011-10-01T09:18) covering the complete chain of effects - from Sun to Earth - to better understand the dynamic evolution of the CME and its embedded magnetic field. We study in detail the solar surface and atmosphere associated with the flare and CME using the Solar Dynamics Observatory (SDO) and ground-based instruments. We also track the CME signature off-limb with combined extreme ultraviolet (EUV) and white-light data from the Solar Terrestrial Relations Observatory (STEREO). By applying the graduated cylindrical shell (GCS) reconstruction method and total mass to stereoscopic STEREO-SOHO ( Solar and Heliospheric Observatory) coronagraph data, we track the temporal and spatial evolution of the CME in the 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 magnetic cloud (MC) from in situ measurements from 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 find that the magnetic helicity and axial magnetic flux are lower in the interplanetary space by ˜ 50% and 75%, respectively, possibly indicating an erosion process. A CME mass increase of 10% is observed over a range of {˜} 4 - 20 R_{⊙}. 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.

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.

Intranasal mucoadhesive microemulsions of clonazepam: preliminary studies on brain targeting.

PubMed

Vyas, Tushar K; Babbar, A K; Sharma, R K; Singh, Shashi; Misra, Ambikanandan

2006-03-01

The aim of this investigation was to prepare clonazepam microemulsions (CME) for rapid drug delivery to the brain to treat acute status epileptic patients and to characterize and evaluate the performance of CME in vitro and in vivo in rats. The CME were prepared by the titration method and were characterized for globule size and size distribution, zeta potential, and drug content. CME was radiolabeled with (99m)Tc (technetium) and biodistribution of drug in the brain was studied in Swiss albino rats after intranasal and intravenous administrations. Brain scintigraphy imaging in rabbits was also performed to ascertain the uptake of the drug into the brain. Pre and postCME formulation treated human nasal mucosa was subjected to transmission electron microscopy to investigate the mechanism of drug uptake across the nasal mucosa. CME were transparent and stable with mean globule size of 15 +/- 10 nm and zeta potential of -30 mV to -40 mV. (99m)Tc-labeled clonazepam solution ((99m)Tc CS)/ clonazepam microemulsion (CME)/clonazepam mucoadhesive microemulsion (CMME) were found to be stable and suitable for in vivo studies. Brain/blood uptake ratios at 0.50 hour (h) following intranasal CMME, CME, clonazepam solution (CS), and intravenous CME administrations were found to be 0.67, 0.50, 0.48, and 0.13, respectively indicating more effective targeting with intranasal administration and best targeting of the brain with intranasal CMME. Brain/blood ratio at all sampling points up to 8 h following intranasal administration of CMME compared to intravenous was found to be twofold higher indicating larger extent of distribution of the drug in brain. Rabbit brain scintigraphy also showed higher intranasal uptake of the drug into the brain. Transmission electron microscopy revealed significant accretion of CMME within interstitial spaces and paracellular mode of transport due to stretching of the tight junctions present in the nasal mucosa. This investigation demonstrates a more rapid and larger extent of transport of clonazepam into the rat brain with intranasal CMME, which may prove useful in treating acute status epileptics. Copyright 2006 Wiley-Liss, Inc. and the American Pharmacists Association.

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.

Understanding the evolution and propagation of coronal mass ejections and associated plasma sheaths in interplanetary space

NASA Astrophysics Data System (ADS)

Hess, Phillip

A Coronal Mass Ejection (CME) is an eruption of magnetized plasma from the Coronaof the Sun. Understanding the physical process of CMEs is a fundamental challenge in solarphysics, and is also of increasing importance for our technological society. CMEs are knownthe main driver of space weather that has adverse effects on satellites, power grids, com-munication and navigation systems and astronauts. Understanding and predicting CMEs is still in the early stage of research. In this dissertation, improved observational methods and advanced theoretical analysis are used to study CMEs. Unlike many studies in the past that treat CMEs as a single object, this study divides aCME into two separate components: the ejecta from the corona and the sheath region thatis the ambient plasma compressed by the shock/wave running ahead of the ejecta; bothstructures are geo-effective but evolve differently. Stereoscopic observations from multiplespacecraft, including STEREO and SOHO, are combined to provide a three-dimensionalgeometric reconstruction of the structures studied. True distances and velocities of CMEs are accurately determined, free of projection effects, and with continuous tracking from the low corona to 1 AU.To understand the kinematic evolution of CMEs, an advanced drag-based model (DBM) is proposed, with several improvements to the original DBM model. The new model varies the drag parameter with distance; the variation is constrained by thenecessary conservation of physical parameters. Second, the deviation of CME-nose from the Sun-Earth-line is taken into account. Third, the geometric correction of the shape of the ejecta front is considered, based on the assumption that the true front is a flattened croissant-shaped flux rope front. These improvements of the DBM model provide a framework for using measurement data to make accurate prediction of the arrival times of CME ejecta and sheaths. Using a set of seven events to test the model, it is found that the evolution of the ejecta front can be accurately predicted, with a slightly poorer performance on the sheath front. To improve the sheath prediction, the standoff-distance between the ejecta and the sheath front is used to model the evolution. The predicted arrivals of both the sheath and ejecta fronts at Earth are determined to within an average 3.5 hours and 1.5 hours of observed arrivals,respectively. These prediction errors show a significant improvement over predictions made by other researches. The results of this dissertation study demonstrate that accurate space weather prediction is possible, and also reveals what observations are needed in the future for realistic operational space weather prediction.

Post-Fisherian Experimentation: From Physical to Virtual

DOE PAGES

Jeff Wu, C. F.

2014-04-24

Fisher's pioneering work in design of experiments has inspired further work with broader applications, especially in industrial experimentation. Three topics in physical experiments are discussed: principles of effect hierarchy, sparsity, and heredity for factorial designs, a new method called CME for de-aliasing aliased effects, and robust parameter design. The recent emergence of virtual experiments on a computer is reviewed. Here, some major challenges in computer experiments, which must go beyond Fisherian principles, are outlined.

A new view of solar coronal mass ejections with the Heliophysics System Observatory (Arne Richter Award for Outstanding Young Scientists Lecture)

NASA Astrophysics Data System (ADS)

Moestl, Christian

2016-04-01

Solar coronal mass ejections (CMEs) play a pivotal role in solar, heliospheric and planetary physics because they lead to connections of plasma phenomena from the Sun to the planets throughout the solar system. CMEs drive the strongest geomagnetic storms, fill the heliosphere with energetic particles, illuminate planetary skies with aurorae, modulate cosmic rays on planetary surfaces, and lead to erosion of planetary atmospheres over long time scales. Thus, even for studying the detection of life on exoplanets, the role of possible stellar CMEs should not be neglected. However, besides the simple fascination of studying the biggest explosions in the solar system, they are of increasingly high practical significance concerning risk mitigation of natural desasters and the protection of our common wealth. As the impact of a "super-CME", a rare but possible event, may affect the entire planet Earth, coordinated international efforts for their fundamental understanding, as well as building dedicated space weather missions for daily forecasts is necessary. There is a chance of a CME on the order of a Carrington event, with a minimum Dst of about -1000 nT, impacting Earth once every 100 years - or a 10% chance in a given solar cycle. An impact of such a super-CME is expected to cause e.g. wide-spread electricity blackouts and satellite failures. In the last 10 years, the field has made major advantages in understanding how CMEs evolve from the Sun to the planets. Because of the extension of CMEs on the order of 60-100 degree heliospheric longitude and radial sizes around 0.1-0.2 AU, multipoint imaging and in situ observations are inevitably necessary to understand basic CME physics. To this end, I will show data, as provided by the Heliophysics System Observatory (HSO), and their interpretation with various modeling effors. The HSO can be understood as a web of sensors placed throughout the heliosphere, consisting of spacecraft such as STEREO, Wind, ACE, Venus Express and MESSENGER. They provide, mainly with their magnetometers, multipoint in situ observations of CMEs. The STEREO mission plays a key role, as it has provided for the first time data of heliospheric imagers far away from the Sun-Earth line. This data set now covers almost a full solar cycle, bridging the observational gap between the Sun and the terrestrial planets. This means that we are now entering a new era where big catalogues of solar and heliospheric events are routinely available. I further focus on unsolved problems in the field, such as finding connections between coronagraph, heliospheric imaging and in situ CME detections, and understanding the global shape of the CME shock and magnetic flux rope. The biggest problem concerns the prediction of the CME core magnetic field, and in particular its Bz profile, which is the main reason why space weather prediction is still quite inaccurate. Finally, the upcoming missions Solar Orbiter and Solar Probe Plus are bound to disruptively transform the field in the upcoming years with out-of-ecliptic heliospheric imaging and in situ observations of the Sun's corona.

Pulmonary Rehabilitation: Improvement with Movement.

PubMed

Rajagopal, Anita; Casaburi, Richard

2016-01-15

This article serves as a CME- available, enduring material summary of the following COPD9 USA presentations: - "Lessons Learned from Pulmonary Education Program and On Track with COPD Ongoing Health Management." Presenter : Scott Cerreta, BS, RRT - "Cultivating Memorial Funds for Pulmonary Rehabilitation" Presenter : Valerie McLeod, RRT - "Strategies for Success: Maintenance Program Best Practices" Presenter : David Vines, MHS, RRT - "Strategies for Success-Maximizing Participation and Completion Rates," Presenter : Trina M. Limberg, BS, RRT.

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.

Continuing Medical Education Speakers with High Evaluation Scores Use more Image-based Slides.

PubMed

Ferguson, Ian; Phillips, Andrew W; Lin, Michelle

2017-01-01

Although continuing medical education (CME) presentations are common across health professions, it is unknown whether slide design is independently associated with audience evaluations of the speaker. Based on the conceptual framework of Mayer's theory of multimedia learning, this study aimed to determine whether image use and text density in presentation slides are associated with overall speaker evaluations. This retrospective analysis of six sequential CME conferences (two annual emergency medicine conferences over a three-year period) used a mixed linear regression model to assess whether post-conference speaker evaluations were associated with image fraction (percentage of image-based slides per presentation) and text density (number of words per slide). A total of 105 unique lectures were given by 49 faculty members, and 1,222 evaluations (70.1% response rate) were available for analysis. On average, 47.4% (SD=25.36) of slides had at least one educationally-relevant image (image fraction). Image fraction significantly predicted overall higher evaluation scores [F(1, 100.676)=6.158, p=0.015] in the mixed linear regression model. The mean (SD) text density was 25.61 (8.14) words/slide but was not a significant predictor [F(1, 86.293)=0.55, p=0.815]. Of note, the individual speaker [χ 2 (1)=2.952, p=0.003] and speaker seniority [F(3, 59.713)=4.083, p=0.011] significantly predicted higher scores. This is the first published study to date assessing the linkage between slide design and CME speaker evaluations by an audience of practicing clinicians. The incorporation of images was associated with higher evaluation scores, in alignment with Mayer's theory of multimedia learning. Contrary to this theory, however, text density showed no significant association, suggesting that these scores may be multifactorial. Professional development efforts should focus on teaching best practices in both slide design and presentation skills.

Image Gallery

MedlinePlus

... Ultrasound Pediatric Ultrasound Point-of-Care Ultrasound Sonography Therapeutic Ultrasound Ultrasound in Global Health Ultrasound in Medical Education CME Center CME Tracker Annual Convention Journal Tests ...

A CME-Driven Solar Wind Disturbance Observed at both Low and High Heliographic Latitudes

NASA Technical Reports Server (NTRS)

Gosling, J. T.; McComas, D. J.; Phillips, J. L.; Pizzo, V. J.; Goldstein, B. E.; Forsyth, R. J.; Lepping, R. P.

1995-01-01

A solar wind disturbance produced by a fast coronal mass ejection, CME, that departed from the Sun on February 20, 1994 was observed in the ecliptic plane at 1 AU by IMP 8 and at high heliographic latitudes at 3.53 AU by Ulysses. In the ecliptic the disturbance included a strong forward shock but no reverse shock, while at high latitudes the disturbance was bounded by a relatively weak forward-reverse shock pair. It is clear that the disturbance in the ecliptic plane was driven primarily by the relative speed between the CME and a slower ambient solar wind ahead, whereas at higher latitudes the disturbance was driven by expansion of the CME. The combined IMP 8 and Ulysses observations thus provide a graphic illustration of how a single fast CME can produce very different types of solar wind disturbances at low and high heliographic latitudes. Simple numerical simulations help explain observed differences at the two spacecraft.

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.;

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

NASA Sun Earth

NASA Image and Video Library

2017-12-08

CME blast and subsequent impact at Earth -- This illustration shows a CME blasting off the Sun’s surface in the direction of Ea CME blast and subsequent impact at Earth -- This illustration shows a CME blasting off the Sun’s surface in the direction of Earth. This left portion is composed of an EIT 304 image superimposed on a LASCO C2 coronagraph. Two to four days later, the CME cloud is shown striking and beginning to be mostly deflected around the Earth’s magnetosphere. The blue paths emanating from the Earth’s poles represent some of its magnetic field lines. The magnetic cloud of plasma can extend to 30 million miles wide by the time it reaches earth. These storms, which occur frequently, can disrupt communications and navigational equipment, damage satellites, and even cause blackouts. (Objects in the illustration are not drawn to scale.) Credit: NASA/GSFC/SOHO/ESA To learn more go to the SOHO website: sohowww.nascom.nasa.gov/home.html To learn more about NASA's Sun Earth Day go here: sunearthday.nasa.gov/2010/index.php

Structures and transport dynamics of a Campylobacter jejuni multidrug efflux pump

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

Su, Chih-Chia; Yin, Linxiang; Kumar, Nitin

2017-08-01

Resistance-nodulation-cell division efflux pumps are integral membrane proteins that catalyze the export of substrates across cell membranes. Within the hydrophobe-amphiphile efflux subfamily, these resistance-nodulation-cell division proteins largely form trimeric efflux pumps. The drug efflux process has been proposed to entail a synchronized motion between subunits of the trimer to advance the transport cycle, leading to the extrusion of drug molecules. Here we use X-ray crystallography and single-molecule fluorescence resonance energy transfer imaging to elucidate the structures and functional dynamics of the Campylobacter jejuni CmeB multidrug efflux pump. We find that the CmeB trimer displays a very unique conformation. A directmore » observation of transport dynamics in individual CmeB trimers embedded in membrane vesicles indicates that each CmeB subunit undergoes conformational transitions uncoordinated and independent of each other. On the basis of our findings and analyses, we propose a model for transport mechanism where CmeB protomers function independently within the trimer.« less

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.

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

3D Reconnection and SEP Considerations in the CME-Flare Problem

NASA Astrophysics Data System (ADS)

Moschou, S. P.; Cohen, O.; Drake, J. J.; Sokolov, I.; Borovikov, D.; Alvarado Gomez, J. D.; Garraffo, C.

2017-12-01

Reconnection is known to play a major role in particle acceleration in both solar and astrophysical regimes, yet little is known about its connection with the global scales and its comparative contribution in the generation of SEPs with respect to other acceleration mechanisms, such as the shock at a fast CME front, in the presence of a global structure such as a CME. Coupling efforts, combining both particle and global scales, are necessary to answer questions about the fundamentals of the energetic processes evolved. We present such a coupling modeling effort that looks into particle acceleration through reconnection in a self-consistent CME-flare model in both particle and fluid regimes. Of special interest is the supra-thermal component of the acceleration due to the reconnection that will at a later time interact colliding with the solar atmospheric material of the more dense chromospheric layer and radiate in hard X- and γ-rays for super-thermal electrons and protons respectively. Two cutting edge computational codes are used to capture the global CME and flare dynamics, specifically a two fluid MHD code and a 3D PIC code for the flare scales. Finally, we are connecting the simulations with current observations in different wavelengths in an effort to shed light to the unified CME-flare picture.

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.

ARE HALO-LIKE SOLAR CORONAL MASS EJECTIONS MERELY A MATTER OF GEOMETRIC PROJECTION EFFECTS?

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

Kwon, Ryun-Young; Zhang, Jie; Vourlidas, Angelos, E-mail: ryunyoung.kwon@gmail.com

2015-02-01

We investigated the physical nature of halo coronal mass ejections (CMEs) based on the stereoscopic observations from the two STEREO spacecraft, Ahead and Behind (hereafter A and B), and the SOHO spacecraft. Sixty-two halo CMEs occurred as observed by SOHO LASCO C2 for the three-year period from 2010 to 2012 during which the separation angles between SOHO and STEREO were nearly 90°. In such quadrature configuration, the coronagraphs of STEREO, COR2-A and -B, showed the side view of those halo CMEs seen by C2. It has been widely believed that the halo appearance of a CME is caused by themore » geometric projection effect, i.e., a CME moves along the Sun-observer line. In other words, it would appear as a non-halo CME if viewed from the side. However, to our surprise, we found that 41 out of 62 events (66%) were observed as halo CMEs by all coronagraphs. This result suggests that a halo CME is not just a matter of the propagating direction. In addition, we show that a CME propagating normal to the line of sight can be observed as a halo CME due to the associated fast magnetosonic wave or shock front. We conclude that the apparent width of CMEs, especially halos or partial halos is driven by the existence and the extent of the associated waves or shocks and does not represent an accurate measure of the CME ejecta size. This effect needs to be taken into careful consideration in space weather predictions and modeling efforts.« less

Coronal Mass Ejections and Dimmings: A Comparative Study using MHD Simulations and SDO Observations

NASA Astrophysics Data System (ADS)

Jin, M.; Cheung, C. M. M.; DeRosa, M. L.; Nitta, N.; Schrijver, K.

2017-12-01

Solar coronal dimmings have been observed extensively in the past two decades. Due to their close association with coronal mass ejections (CMEs), there is a critical need to improve our understanding of the physical processes that cause dimmings and determine their relationship with CMEs. In this study, we investigate coronal dimmings by combining simulation and observational efforts. By utilizing a data-driven global magnetohydrodynamics model (AWSoM: Alfven-wave Solar Model), we simulate coronal dimmings resulting from different CME energetics and flux rope configurations. We synthesize the emissions of different EUV spectral bands/lines and compare with SDO/AIA and EVE observations. A detailed analysis of simulation and observation data suggests that although the transient dimming / brightening patterns could relate to plasma heating processes (either by adiabatic compression or reconnection), the long-lasting "core" and "remote" (also known as "secondary") dimmings both originate from regions with open/quasi-open fields and are caused by mass loss process. The mass loss in the remote dimming region is induced by CME-driven shock. Using metrics such as dimming depth, dimming slope, and recovery time, we investigate the relationship between dimmings and CME properties (e.g., CME mass, CME speed) in the simulation. Our result suggests that coronal dimmings encode important information about CME energetics, CME-driven shock properties, and magnetic configuration of erupting flux ropes. We also discuss how our knowledge about solar coronal dimmings could be extended to the study of stellar CMEs, which may prove important for exoplanet atmospheres and habitability but which are currently not observable.

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.

ON A CORONAL BLOWOUT JET: THE FIRST OBSERVATION OF A SIMULTANEOUSLY PRODUCED BUBBLE-LIKE CME AND A JET-LIKE CME IN A SOLAR EVENT

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

Shen Yuandeng; Liu Yu; Su Jiangtao

2012-02-01

The coronal blowout jet is a peculiar category among various jet phenomena, in which the sheared base arch, often carrying a small filament, experiences a miniature version of blowout eruption that produces large-scale coronal mass ejection (CME). In this paper, we report such a coronal blowout jet with high-resolution multi-wavelength and multi-angle observations taken from Solar Dynamics Observatory, Solar Terrestrial Relations Observatory, and Big Bear Solar Observatory. For the first time, we find that simultaneous bubble-like and jet-like CMEs were dynamically related to the blowout jet that showed cool and hot components next to each other. Our observational results indicatemore » that (1) the cool component resulted from the eruption of the filament contained within the jet's base arch, and it further caused the bubble-like CME; (2) the jet-like CME was associated with the hot component, which was the outward moving heated plasma generated by the reconnection of the base arch and its ambient open field lines. On the other hand, bifurcation of the jet's cool component was also observed, which resulted from the uncoupling of the erupting filament's two legs that were highly twisted at the very beginning. Based on these results, we propose a model to interpret the coronal blowout jet, in which the external reconnection not only produces the jet-like CME, but also leads to the rising of the filament. Subsequently, internal reconnection starts underneath the rising filament and thereby causes the bubble-like CME.« less

Complete mesocolic excision and extended (D3) lymphadenectomy for colonic cancer: is it worth that extra effort? A review of the literature.

PubMed

Emmanuel, Andrew; Haji, Amyn

2016-04-01

Recent interest in complete mesocolic excision (CME) with central vascular ligation (CVL) or extended (D3) lymphadenectomy (EL) for curative resection of colon cancer has been driven by published series from experienced practitioners showing excellent survival outcomes and low recurrence rates. In this article, we attempt to clarify the role of CME or EL in modern colorectal surgery. A narrative review of the evidence for CME and EL in the curative treatment of colon cancer. The principal of CME surgery, similar to total mesorectal excision (TME) for rectal cancer, is the removal of all lymphatic, vascular, and neural tissue in the drainage area of the tumour in a complete mesocolic envelope with intact mesentery, peritoneum and encasing fascia. Extended (D3) lymphadenectomy (EL) is based on similar principles. Sound anatomical and oncological arguments are made to support the principles of removing the tumor contained within an intact mesocolic facial envelope together with an extended lymph node harvest. Excellent oncological outcomes with minimal morbidity and mortality have been reported. This has led to calls for the standardisation of surgery for colon cancer using CME. However, there is conflicting evidence regarding the prognostic benefit of greater lymph node harvests and the evidence for an oncological benefit of CME is limited by methodology flaws and several potential confounding factors. Although there is a reasonable anatomical and oncological basis for these techniques, there are no randomised controlled trials from which to draw confident conclusions and there is insufficient consistent high quality evidence to recommend widespread adoption of CME.

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

Attendees' perceptions of commercial influence in noncommercially funded CME programs.

PubMed

Goldfarb, Elizabeth; Baer, Lee; Fromson, John A; Gorrindo, Tristan; Iodice, Kristin E; Birnbaum, Robert J

2012-01-01

The controversy surrounding commercial support for continuing medical education (CME) programs has led to policy changes, but data show no significant difference in perceived bias between commercial and noncommercial CME. Indeed, what attendees perceive as commercial influence is not fully understood. We sought to clarify what sources contribute to attendees' perceptions of commercial influence in non-industry-supported CME programs, and how attendees perceive that this influence manifests itself on both speaker and program levels. Evaluation forms were received from 1 544 attendees at 14 live noncommercially supported CME programs in 2006, 2007, and 2010. Attendees rated perceived commercial influence for each lecture and the entire program. Using open-ended and "check all that apply'' questions, participants specified perceived sources and manifestations of commercial influence. Attendees rating individual lectures but not the entire program as commercially influenced accounted for 59.9% of those who identified bias. The most frequently endorsed source of commercial influence was individual speakers' funding, and the most listed manifestations were speakers' mentions of pharmaceuticals and expressions of personal opinions. Rating the entire program commercially influenced correlated with whether attendees considered the funding of referenced research a source of influence. CME attendees consider a broad spectrum of factors when reporting commercial influence. Evaluation forms should include bias questions per lecture as well as items to clarify perceived sources and manifestations of commercial influence. 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.

IMPULSIVE ACCELERATION OF CORONAL MASS EJECTIONS. II. RELATION TO SOFT X-RAY FLARES AND FILAMENT ERUPTIONS

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

Bein, B. M.; Berkebile-Stoiser, S.; Veronig, A. M.

2012-08-10

Using high time cadence images from the STEREO EUVI, COR1, and COR2 instruments, we derived detailed kinematics of the main acceleration stage for a sample of 95 coronal mass ejections (CMEs) in comparison with associated flares and filament eruptions. We found that CMEs associated with flares reveal on average significantly higher peak accelerations and lower acceleration phase durations, initiation heights, and heights, at which they reach their peak velocities and peak accelerations. This means that CMEs that are associated with flares are characterized by higher and more impulsive accelerations and originate from lower in the corona where the magnetic fieldmore » is stronger. For CMEs that are associated with filament eruptions we found only for the CME peak acceleration significantly lower values than for events that were not associated with filament eruptions. The flare rise time was found to be positively correlated with the CME acceleration duration and negatively correlated with the CME peak acceleration. For the majority of the events the CME acceleration starts before the flare onset (for 75% of the events) and the CME acceleration ends after the soft X-ray (SXR) peak time (for 77% of the events). In {approx}60% of the events, the time difference between the peak time of the flare SXR flux derivative and the peak time of the CME acceleration is smaller than {+-}5 minutes, which hints at a feedback relationship between the CME acceleration and the energy release in the associated flare due to magnetic reconnection.« 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

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.

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.

ESTIMATING THE HEIGHT OF CMEs ASSOCIATED WITH A MAJOR SEP EVENT AT THE ONSET OF THE METRIC TYPE II RADIO BURST DURING SOLAR CYCLES 23 AND 24

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

Mäkelä, P.; Akiyama, S.; Xie, H.

2015-06-10

We studied the coronal mass ejection (CME) height at the onset of 59 metric type II radio bursts associated with major solar energetic particle (SEP) events, excluding ground level enhancements (GLEs), during solar cycles 23 and 24. We calculated CME heights using a simple flare-onset method used by Gopalswamy et al. to estimate CME heights at the metric type II onset for cycle 23 GLEs. We found the mean CME height for non-GLE events (1.72 R{sub ☉}) to be ∼12% greater than that (1.53 R{sub ☉}) for cycle 23 GLEs. The difference could be caused by more impulsive acceleration ofmore » the GLE-associated CMEs. For cycle 24 non-GLE events, we compared the CME heights obtained using the flare-onset method and the three-dimensional spherical-shock fitting method and found the correlation to be good (CC = 0.68). We found the mean CME height for cycle 23 non-GLE events (1.79 R{sub ☉}) to be greater than that for cycle 24 non-GLE events (1.58 R{sub ☉}), but statistical tests do not definitely reject the possibility of coincidence. We suggest that the lower formation height of the shocks during cycle 24 indicates a change in the Alfvén speed profile because solar magnetic fields are weaker and plasma density levels are closer to the surface than usual during cycle 24. We also found that complex type III bursts showing diminution of type III emission in the 7–14 MHz frequency range are more likely associated with events with a CME height at the type II onset above 2 R{sub ☉}, supporting suggestions that the CME/shock structure causes the feature.« less

Interplanetary Propagation Behavior of the Fast Coronal Mass Ejection on 23 July 2012

NASA Astrophysics Data System (ADS)

Temmer, M.; Nitta, N. V.

2015-03-01

The fast coronal mass ejection (CME) on 23 July 2012 caused attention because of its extremely short transit time from the Sun to 1 AU, which was shorter than 21 h. In situ data from STEREO-A revealed the arrival of a fast forward shock with a speed of more than 2200 km s-1 followed by a magnetic structure moving with almost 1900 km s-1. We investigate the propagation behavior of the CME shock and magnetic structure with the aim to reproduce the short transit time and high impact speed as derived from in situ data. We carefully measured the 3D kinematics of the CME using the graduated cylindrical shell model and obtained a maximum speed of 2580±280 km s-1 for the CME shock and 2270±420 km s-1 for its magnetic structure. Based on the 3D kinematics, the drag-based model (DBM) reproduces the observational data reasonably well. To successfully simulate the CME shock, the ambient flow speed needs to have an average value close to the slow solar wind speed (450 km s-1), and the initial shock speed at a distance of 30 R ⊙ should not exceed ≈ 2300 km s-1, otherwise it would arrive much too early at STEREO-A. The model results indicate that an extremely small aerodynamic drag force is exerted on the shock, smaller by one order of magnitude than average. As a consequence, the CME hardly decelerates in interplanetary space and maintains its high initial speed. The low aerodynamic drag can only be reproduced when the density of the ambient solar wind flow, in which the fast CME propagates, is decreased to ρ sw=1 - 2 cm-3 at the distance of 1 AU. This result is consistent with the preconditioning of interplanetary space by a previous CME.

Macular autofluorescence in eyes with cystoid macula edema, detected with 488 nm-excitation but not with 580 nm-excitation.

PubMed

Bessho, Kenichiro; Gomi, Fumi; Harino, Seiyo; Sawa, Miki; Sayanagi, Kaori; Tsujikawa, Motokazu; Tano, Yasuo

2009-06-01

Fundus autofluorescence (AF) derives from lipofuscin in the retinal pigment epithelium (RPE). Because lipofuscin is a by-product of phagocytosis of photoreceptors by RPE, AF imaging is expected to describe some functional aspect of the retina. In this study we report distribution of AF in patients showing macular edema. Three eyes with diabetic macular edema (DME) and 11 with retinal vein occlusion (RVO), associated with macular edema (ME) were examined. ME was determined by standard fundus examination, fluorescein angiography (FA) and optical coherence tomography (OCT). AF was recorded using a Heidelberg confocal scanning laser ophthalmoscope (cSLO) with 488 nm laser exciter (488 nm-AF), and a conventional Topcon fundus camera with halogen lamp exciter and 580 nm band-pass filter (580 nm-AF). Color fundus picture, FA image and these two AF images were analyzed by superimposing all images. All subjects presented cystoid macular edema (CME) with petaloid pattern hyperfluorescence in FA. In 488 nm-AF, all eyes (100%) showed macular autofluorescence of a similar shape to that of the CME in FA. In contrast, in 580 nm-AF only one eye (7%) presented this corresponding petaloid-shaped autofluorescence. In all cases, peripheral retinal edemas did not show autofluorescence corresponding to the leakage in FA. In eyes with CME, analogous hyperautofluorescence to the CME was always observed in 488 nm-AF, while it was rarely observed in 580 nm-AF. Moreover, this CME hyperautofluorescence was only seen in the macular area. We hypothesize that autofluorescence from CME may be considered as a "pseudo" or "relative" autofluorescence, due to macular stretching following CME that may result in lateral displacement of macular pigments (MPs) and subsequent reduction of MPs density, as MPs block 488 nm-AF more intensely than 580 nm-AF. Although this phenomenon may not directly indicate change of RPE function, it may be used as a method to assess or track CME non-invasively.

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.

THE FORMATION AND EARLY EVOLUTION OF A CORONAL MASS EJECTION AND ITS ASSOCIATED SHOCK WAVE ON 2014 JANUARY 8

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

Wan Linfeng; Cheng, Xin; Shi, Tong

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 CMEmore » 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{sup −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 {sub 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.« less

SCEC Earthquake System Science Using High Performance Computing

NASA Astrophysics Data System (ADS)

Maechling, P. J.; Jordan, T. H.; Archuleta, R.; Beroza, G.; Bielak, J.; Chen, P.; Cui, Y.; Day, S.; Deelman, E.; Graves, R. W.; Minster, J. B.; Olsen, K. B.

2008-12-01

The SCEC Community Modeling Environment (SCEC/CME) collaboration performs basic scientific research using high performance computing with the goal of developing a predictive understanding of earthquake processes and seismic hazards in California. SCEC/CME research areas including dynamic rupture modeling, wave propagation modeling, probabilistic seismic hazard analysis (PSHA), and full 3D tomography. SCEC/CME computational capabilities are organized around the development and application of robust, re- usable, well-validated simulation systems we call computational platforms. The SCEC earthquake system science research program includes a wide range of numerical modeling efforts and we continue to extend our numerical modeling codes to include more realistic physics and to run at higher and higher resolution. During this year, the SCEC/USGS OpenSHA PSHA computational platform was used to calculate PSHA hazard curves and hazard maps using the new UCERF2.0 ERF and new 2008 attenuation relationships. Three SCEC/CME modeling groups ran 1Hz ShakeOut simulations using different codes and computer systems and carefully compared the results. The DynaShake Platform was used to calculate several dynamic rupture-based source descriptions equivalent in magnitude and final surface slip to the ShakeOut 1.2 kinematic source description. A SCEC/CME modeler produced 10Hz synthetic seismograms for the ShakeOut 1.2 scenario rupture by combining 1Hz deterministic simulation results with 10Hz stochastic seismograms. SCEC/CME modelers ran an ensemble of seven ShakeOut-D simulations to investigate the variability of ground motions produced by dynamic rupture-based source descriptions. The CyberShake Platform was used to calculate more than 15 new probabilistic seismic hazard analysis (PSHA) hazard curves using full 3D waveform modeling and the new UCERF2.0 ERF. The SCEC/CME group has also produced significant computer science results this year. Large-scale SCEC/CME high performance codes were run on NSF TeraGrid sites including simulations that use the full PSC Big Ben supercomputer (4096 cores) and simulations that ran on more than 10K cores at TACC Ranger. The SCEC/CME group used scientific workflow tools and grid-computing to run more than 1.5 million jobs at NCSA for the CyberShake project. Visualizations produced by a SCEC/CME researcher of the 10Hz ShakeOut 1.2 scenario simulation data were used by USGS in ShakeOut publications and public outreach efforts. OpenSHA was ported onto an NSF supercomputer and was used to produce very high resolution hazard PSHA maps that contained more than 1.6 million hazard curves.

American Institute of Ultrasound in Medicine

MedlinePlus

... Ultrasound Pediatric Ultrasound Point-of-Care Ultrasound Sonography Therapeutic Ultrasound Ultrasound in Global Health Ultrasound in Medical Education CME Center CME Tracker Annual Convention Journal Tests ...

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

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.

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

MLSO Mark III K-Coronameter Observations of the CME Rate from 1989 - 1996

NASA Astrophysics Data System (ADS)

St. Cyr, O. C.; Flint, Q. A.; Xie, H.; Webb, D. F.; Burkepile, J. T.; Lecinski, A. R.; Quirk, C.; Stanger, A. L.

2015-10-01

We report here an attempt to fill the 1990 - 1995 gap in the CME rate using the Mauna Loa Solar Observatory's Mark III (Mk3) K-coronameter. The Mk3 instrument observed routinely several hours most days beginning in 1980 until it was upgraded to Mk4 in 1999. We describe the statistical properties of the CMEs detected during 1989 - 1996, and we determine a CME rate for each of those years. Since spaceborne coronagraphs have more complete duty cycles than a ground-based instrument at a single location, we compare the Mk3-derived CME rate from 1989 with the rate from the SMM C/P coronagraph, and from 1996 with the rate from the SOHO LASCO coronagraphs.

An Analytical Diffusion–Expansion Model for Forbush Decreases Caused by Flux Ropes

NASA Astrophysics Data System (ADS)

Dumbović, Mateja; Heber, Bernd; Vršnak, Bojan; Temmer, Manuela; Kirin, Anamarija

2018-06-01

We present an analytical diffusion–expansion Forbush decrease (FD) model ForbMod, which is based on the widely used approach of an initially empty, closed magnetic structure (i.e., flux rope) that fills up slowly with particles by perpendicular diffusion. The model is restricted to explaining only the depression caused by the magnetic structure of the interplanetary coronal mass ejection (ICME). We use remote CME observations and a 3D reconstruction method (the graduated cylindrical shell method) to constrain initial boundary conditions of the FD model and take into account CME evolutionary properties by incorporating flux rope expansion. Several flux rope expansion modes are considered, which can lead to different FD characteristics. In general, the model is qualitatively in agreement with observations, whereas quantitative agreement depends on the diffusion coefficient and the expansion properties (interplay of the diffusion and expansion). A case study was performed to explain the FD observed on 2014 May 30. The observed FD was fitted quite well by ForbMod for all expansion modes using only the diffusion coefficient as a free parameter, where the diffusion parameter was found to correspond to an expected range of values. Our study shows that, in general, the model is able to explain the global properties of an FD caused by a flux rope and can thus be used to help understand the underlying physics in case studies.

On the Reduced Geoeffectiveness of Solar Cycle 24: A Moderate Storm Perspective

NASA Technical Reports Server (NTRS)

Selvakumaran, R.; Veenadhari, B.; Akiyama, S.; Pandya, Megha; Gopalswamy, N,; Yashiro, S.; Kumar, Sandeep; Makela, P.; Xie, H.

2016-01-01

The moderate and intense geomagnetic storms are identified for the first 77 months of solar cycles 23 and 24. The solar sources responsible for the moderate geomagnetic storms are indentified during the same epoch for both the cycles. Solar cycle 24 has shown nearly 80% reduction in the occurrence of intense storms whereas it is only 40% in case of moderate storms when compared to previous cycle. The solar and interplanetary characteristics of the moderate storms driven by coronal mass ejection (CME) are compared for solar cycles 23 and 24 in order to see reduction in geoeffectiveness has anything to do with the occurrence of moderate storm. Though there is reduction in the occurrence of moderate storms, the Dst distribution does not show much difference. Similarly, the solar source parameters like CME speed, mass, and width did not show any significant variation in the average values as well as the distribution. The correlation between VBz and Dst is determined, and it is found to be moderate with value of 0.68 for cycle 23 and 0.61 for cycle 24. The magnetospheric energy flux parameter epsilon (epsilon) is estimated during the main phase of all moderate storms during solar cycles 23 and 24. The energy transfer decreased in solar cycle 24 when compared to cycle 23. These results are significantly different when all geomagnetic storms are taken into consideration for both the solar cycles.

America’s Achilles Heel: Defense Against High-altitude Electromagnetic Pulse-policy vs. Practice

DTIC Science & Technology

2014-12-12

Directives SCADA Supervisory Control and Data Acquisition Systems SHIELD Act Secure High-voltage Infrastructure for Electricity from Lethal Damage Act...take place, it is important to understand the effects of the components of EMP from a high-altitude nuclear detonation. The requirements for shielding ...Mass Ejection (CME). A massive, bubble-shaped burst of plasma expanding outward from the Sun’s corona, in which large amounts of superheated

Factors Affecting the Occurrence of Large Solar Energetic Particle Events

NASA Astrophysics Data System (ADS)

Gopalswamy, N.; Yashiro, S.; Akiyama, S.; Xie, H.; Makela, P. A.; Thakur, N.

2014-12-01

In order to understand the paucity of high-energy solar energetic particle (SEP) events in solar cycle 24, we examined all major eruptions (soft X-ray flare size ≥M5.0) on the front side of the Sun during the period from December 1, 2008 to January 31, 2014. There were 59 such eruptions that were associated with CMEs. When a flux rope was fitted to the white-light CMEs observed by SOHO and STEREO it was found that the CME sources were on the disk only for 55 eruptions. There were 16 large SEP events (proton intensity ≥10 pfu in the >10 MeV channel) detected by GOES and 4 by STEREO-B in association with these eruptions. When the CMEs were grouped according to their speeds (<1500 km/s and ≥ 1500 km/s) it was found that only three of the <1500 km/s CMEs (or 11%) were associated with large SEP events compared to 17 or (61%) of the ≥ 1500 km/s CMEs. This result confirms the importance of CME speed for SEP association. In fact there were ten other large SEP events with flare size

The impact of seasonal signals on spatio-temporal filtering

NASA Astrophysics Data System (ADS)

Gruszczynski, Maciej; Klos, Anna; Bogusz, Janusz

2016-04-01

Existence of Common Mode Errors (CMEs) in permanent GNSS networks contribute to spatial and temporal correlation in residual time series. Time series from permanently observing GNSS stations of distance less than 2 000 km are similarly influenced by such CME sources as: mismodelling (Earth Orientation Parameters - EOP, satellite orbits or antenna phase center variations) during the process of the reference frame realization, large-scale atmospheric and hydrospheric effects as well as small scale crust deformations. Residuals obtained as a result of detrending and deseasonalising of topocentric GNSS time series arranged epoch-by-epoch form an observation matrix independently for each component (North, East, Up). CME is treated as internal structure of the data. Assuming a uniform temporal function across the network it is possible to filter CME out using PCA (Principal Component Analysis) approach. Some of above described CME sources may be reflected as a wide range of frequencies in GPS residual time series. In order to determine an impact of seasonal signals modeling to existence of spatial correlation in network and consequently the results of CME filtration, we chose two ways of modeling. The first approach was commonly presented by previous authors, who modeled with the Least-Squares Estimation (LSE) only annual and semi-annual oscillations. In the second one the set of residuals was a result of modeling of deterministic part that included fortnightly periods plus up to 9th harmonics of Chandlerian, tropical and draconitic oscillations. Correlation coefficients for residuals in parallel with KMO (Kaiser-Meyer-Olkin) statistic and Bartlett's test of sphericity were determined. For this research we used time series expressed in ITRF2008 provided by JPL (Jet Propulsion Laboratory). GPS processing was made using GIPSY-OASIS software in a PPP (Precise Point Positioning) mode. In order to form GPS station network that meet demands of uniform spatial response to the CME we chose 18 stations located in Central Europe. Created network extends up to 1500 kilometers. The KMO statistic indicate whether a component analysis may be useful for a chosen data set. We obtained KMO statistic value of 0.87 and 0.62 for residuals of Up component after first and second approaches were applied, what means that both residuals share common errors. Bartlett's test of sphericity analysis met a requirement that in both cases there are correlations in residuals. Another important results are the eigenvalues expressed as a percentage of the total variance explained by the first few components in PCA. For North, East and Up component we obtain respectively 68%, 75%, 65% and 47%, 54%, 52% after first and second approaches were applied. The results of CME filtration using PCA approach performed on both residual time series influence directly the uncertainty of the velocity of permanent stations. In our case spatial filtering reduces the uncertainty of velocity from 0.5 to 0.8 mm for horizontal components and from 0.6 to 0.9 mm on average for Up component when annual and semi-annual signals were assumed. Nevertheless, while second approach to the deterministic part modelling was used, deterioration of velocity uncertainty was noticed only for Up component, probably due to much higher autocorrelation in the time series when comparing to horizontal components.

Single ICMEs and Complex Transient Structures in the Solar Wind in 2010 - 2011

NASA Astrophysics Data System (ADS)

Rodkin, D.; Slemzin, V.; Zhukov, A. N.; Goryaev, F.; Shugay, Y.; Veselovsky, I.

2018-05-01

We analyze the statistics, solar sources, and properties of interplanetary coronal mass ejections (ICMEs) in the solar wind. The total number of coronal mass ejections (CMEs) registered in the Coordinated Data Analysis Workshops catalog (CDAW) during the first eight years of Cycle 24 was 61% larger than in the same period of Cycle 23, but the number of X-ray flares registered by the Geostationary Operational Environmental Satellite (GOES) was 20 % smaller because the solar activity was lower. The total number of ICMEs in the given period of Cycle 24 in the Richardson and Cane list was 29% smaller than in Cycle 23, which may be explained by a noticeable number of non-classified ICME-like events in the beginning of Cycle 24. For the period January 2010 - August 2011, we identify solar sources of the ICMEs that are included in the Richardson and Cane list. The solar sources of ICME were determined from coronagraph observations of the Earth-directed CMEs, supplemented by modeling of their propagation in the heliosphere using kinematic models (a ballistic and drag-based model). A detailed analysis of the ICME solar sources in the period under study showed that in 11 cases out of 23 (48%), the observed ICME could be associated with two or more sources. For multiple-source events, the resulting solar wind disturbances can be described as complex (merged) structures that are caused by stream interactions, with properties depending on the type of the participating streams. As a reliable marker to identify interacting streams and their sources, we used the plasma ion composition because it freezes in the low corona and remains unchanged in the heliosphere. According to the ion composition signatures, we classify these cases into three types: complex ejecta originating from weak and strong CME-CME interactions, as well as merged interaction regions (MIRs) originating from the CME high-speed stream (HSS) interactions. We describe temporal profiles of the ion composition for the single-source and multi-source solar wind structures and compared them with the ICME signatures determined from the kinematic and magnetic field parameters of the solar wind. In single-source events, the ion charge state, as a rule, has a one-peak enhancement with an average duration of about one day, which is similar to the mean ICME duration of 1.12 days derived from the Richardson and Cane list. In the multi-source events, the total profile of the ion charge state consists of a sequence of enhancements that is associated with the interaction between the participating streams. On average, the total duration of the complex structures that appear as a result of the CME-CME and CME-HSS interactions as determined from their ion composition is 2.4 days, which is more than twice longer than that of the single-source events.

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.

The Solar Stormwatch CME catalogue: Results from the first space weather citizen science project

NASA Astrophysics Data System (ADS)

Barnard, L.; Scott, C.; Owens, M.; Lockwood, M.; Tucker-Hood, K.; Thomas, S.; Crothers, S.; Davies, J. A.; Harrison, R.; Lintott, C.; Simpson, R.; O'Donnell, J.; Smith, A. M.; Waterson, N.; Bamford, S.; Romeo, F.; Kukula, M.; Owens, B.; Savani, N.; Wilkinson, J.; Baeten, E.; Poeffel, L.; Harder, B.

2014-12-01

Solar Stormwatch was the first space weather citizen science project, the aim of which is to identify and track coronal mass ejections (CMEs) observed by the Heliospheric Imagers aboard the STEREO satellites. The project has now been running for approximately 4 years, with input from >16,000 citizen scientists, resulting in a data set of >38,000time-elongation profiles of CME trajectories, observed over 18 preselected position angles. We present our method for reducing this data set into a CME catalogue. The resulting catalogue consists of 144 CMEs over the period January 2007 to February 2010, of which 110 were observed by STEREO-A and 77 were observed by STEREO-B. For each CME, the time-elongation profiles generated by the citizen scientists are averaged into a consensus profile along each position angle that the event was tracked. We consider this catalogue to be unique, being at present the only citizen science-generated CME catalogue, tracking CMEs over an elongation range of 4° out to a maximum of approximately 70°. Using single spacecraft fitting techniques, we estimate the speed, direction, solar source region, and latitudinal width of each CME. This shows that at present, the Solar Stormwatch catalogue (which covers only solar minimum years) contains almost exclusively slow CMEs, with a mean speed of approximately 350 km s-1. The full catalogue is available for public access at www.met.reading.ac.uk/~spate/solarstormwatch. This includes, for each event, the unprocessed time-elongation profiles generated by Solar Stormwatch, the consensus time-elongation profiles, and a set of summary plots, as well as the estimated CME properties.

Validation of the CME Geomagnetic Forecast Alerts Under the COMESEP Alert System

NASA Astrophysics Data System (ADS)

Dumbović, Mateja; Srivastava, Nandita; Rao, Yamini K.; Vršnak, Bojan; Devos, Andy; Rodriguez, Luciano

2017-08-01

Under the European Union 7th Framework Programme (EU FP7) project Coronal Mass Ejections and Solar Energetic Particles (COMESEP, http://comesep.aeronomy.be), an automated space weather alert system has been developed to forecast solar energetic particles (SEP) and coronal mass ejection (CME) risk levels at Earth. The COMESEP alert system uses the automated detection tool called Computer Aided CME Tracking (CACTus) to detect potentially threatening CMEs, a drag-based model (DBM) to predict their arrival, and a CME geoeffectiveness tool (CGFT) to predict their geomagnetic impact. Whenever CACTus detects a halo or partial halo CME and issues an alert, the DBM calculates its arrival time at Earth and the CGFT calculates its geomagnetic risk level. The geomagnetic risk level is calculated based on an estimation of the CME arrival probability and its likely geoeffectiveness, as well as an estimate of the geomagnetic storm duration. We present the evaluation of the CME risk level forecast with the COMESEP alert system based on a study of geoeffective CMEs observed during 2014. The validation of the forecast tool is made by comparing the forecasts with observations. In addition, we test the success rate of the automatic forecasts (without human intervention) against the forecasts with human intervention using advanced versions of the DBM and CGFT (independent tools available at the Hvar Observatory website, http://oh.geof.unizg.hr). The results indicate that the success rate of the forecast in its current form is unacceptably low for a realistic operation system. Human intervention improves the forecast, but the false-alarm rate remains unacceptably high. We discuss these results and their implications for possible improvement of the COMESEP alert system.

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.

Ultrasound Microbubble Treatment Enhances Clathrin-Mediated Endocytosis and Fluid-Phase Uptake through Distinct Mechanisms.

PubMed

Fekri, Farnaz; Delos Santos, Ralph Christian; Karshafian, Raffi; Antonescu, Costin N

2016-01-01

Drug delivery to tumors is limited by several factors, including drug permeability of the target cell plasma membrane. Ultrasound in combination with microbubbles (USMB) is a promising strategy to overcome these limitations. USMB treatment elicits enhanced cellular uptake of materials such as drugs, in part as a result of sheer stress and formation of transient membrane pores. Pores formed upon USMB treatment are rapidly resealed, suggesting that other processes such as enhanced endocytosis may contribute to the enhanced material uptake by cells upon USMB treatment. How USMB regulates endocytic processes remains incompletely understood. Cells constitutively utilize several distinct mechanisms of endocytosis, including clathrin-mediated endocytosis (CME) for the internalization of receptor-bound macromolecules such as Transferrin Receptor (TfR), and distinct mechanism(s) that mediate the majority of fluid-phase endocytosis. Tracking the abundance of TfR on the cell surface and the internalization of its ligand transferrin revealed that USMB acutely enhances the rate of CME. Total internal reflection fluorescence microscopy experiments revealed that USMB treatment altered the assembly of clathrin-coated pits, the basic structural units of CME. In addition, the rate of fluid-phase endocytosis was enhanced, but with delayed onset upon USMB treatment relative to the enhancement of CME, suggesting that the two processes are distinctly regulated by USMB. Indeed, vacuolin-1 or desipramine treatment prevented the enhancement of CME but not of fluid phase endocytosis upon USMB, suggesting that lysosome exocytosis and acid sphingomyelinase, respectively, are required for the regulation of CME but not fluid phase endocytosis upon USMB treatment. These results indicate that USMB enhances both CME and fluid phase endocytosis through distinct signaling mechanisms, and suggest that strategies for potentiating the enhancement of endocytosis upon USMB treatment may improve targeted drug delivery.

Prediction of Shock Arrival Times from CME and Flare Data

NASA Technical Reports Server (NTRS)

Nunez, Marlon; Nieves-Chinchilla, Teresa; Pulkkinen, Antti

2016-01-01

This paper presents the Shock ARrival Model (SARM) for predicting shock arrival times for distances from 0.72 AU to 8.7 AU by using coronal mass ejections (CME) and flare data. SARM is an aerodynamic drag model described by a differential equation that has been calibrated with a dataset of 120 shocks observed from 1997 to 2010 by minimizing the mean absolute error (MAE), normalized to 1 AU. SARM should be used with CME data (radial, earthward or plane-of-sky speeds), and flare data (peak flux, duration, and location). In the case of 1 AU, the MAE and the median of absolute errors were 7.0 h and 5.0 h respectively, using the available CMEflare data. The best results for 1 AU (an MAE of 5.8 h) were obtained using both CME data, either radial or cone-model-estimated speeds, and flare data. For the prediction of shock arrivals at distances from 0.72 AU to 8.7 AU, the normalized MAE and the median were 7.1 h and 5.1 h respectively, using the available CMEflare data. SARM was also calibrated to be used with CME data alone or flare data alone, obtaining normalized MAE errors of 8.9 h and 8.6 h respectively for all shock events. The model verification was carried out with an additional dataset of 20 shocks observed from 2010 to 2012 with radial CME speeds to compare SARM with the empirical ESA model [Gopalswamy et al., 2005a] and the numerical MHD-based ENLIL model [Odstrcil et al., 2004]. The results show that the ENLIL's MAE was lower than the SARM's MAE, which was lower than the ESA's MAE. The SARM's best results were obtained when both flare and true CME speeds were used.

Associations between teaching effectiveness scores and characteristics of presentations in hospital medicine continuing education.

PubMed

Ratelle, John T; Wittich, Christopher M; Yu, Roger C; Newman, James S; Jenkins, Sarah M; Beckman, Thomas J

2015-09-01

There is little research regarding characteristics of effective continuing medical education (CME) presentations in hospital medicine (HM). Therefore, we sought to identify associations between validated CME teaching effectiveness scores and characteristics of CME presentations in the field of HM. This was a cross-sectional study of participants and didactic presentations from a national HM CME course in 2014. Participants provided CME teaching effectiveness (CMETE) ratings using an instrument with known validity evidence. Overall CMETE scores (5-point scale: 1 = strongly disagree; 5 = strongly agree) were averaged for each presentation, and associations between scores and presentation characteristics were determined using the Kruskal-Wallis test. The threshold for statistical significance was set at P < 0.05. A total of 277 out of 368 participants (75.3%) completed evaluations for the 32 presentations. CMETE scores (mean [standard deviation]) were significantly associated with the use of audience response (4.64 [0.16]) versus no audience response (4.49 [0.16]; P = 0.01), longer presentations (≥30 minutes: 4.67 [0.13] vs <30 minutes: 4.51 [0.18]; P = 0.02), and larger number of slides (≥50: 4.66 [0.17] vs <50: 4.55 [0.17]; P = 0.04). There were no significant associations between CMETE scores and use of clinical cases, defined goals, or summary slides. To our knowledge, this is the first study regarding associations between validated teaching effectiveness scores and characteristics of effective CME presentations in HM. Our findings, which support previous research in other fields, indicate that CME presentations may be improved by increasing interactivity through the use of audience response systems and allowing longer presentations. © 2015 Society of Hospital Medicine.

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

Military- and Sports-Related Mild Traumatic Brain Injury: Clinical Presentation, Management, and Long-Term Consequences

PubMed Central

Peskind, Elaine R.; Brody, David; Cernak, Ibolja; McKee, Ann; Ruff, Robert L.

2018-01-01

CME Background Articles are selected for credit designation based on an assessment of the educational needs of CME participants, with the purpose of providing readers with a curriculum of CME articles on a variety of topics throughout each volume. Activities are planned using a process that links identified needs with desired results. Participants may receive credit by reading the article, correctly answering at least 70% of the questions in the Posttest, and completing the Evaluation. The Posttest and Evaluation are now available online only at PSYCHIATRIST.COM (Keyword: February). CME Objective After studying the Commentary by Peskind et al, you should be able to: Screen patients who have experienced an event resulting in head injury for mild traumatic brain injury (mTBI) Treat mTBI according to the current guidelines for assessing and managing concussions and mTBI Accreditation Statement The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Credit Designation The CME Institute of Physicians Postgraduate Press, Inc., designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Note The American Academy of Physician Assistants (AAPA) accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society. Physician assistants may receive a maximum of 1 hour of Category I credit for completing this program. Date of Original Release/Review This educational activity is eligible for AMA PRA Category 1 Credit™ through February 29, 2016. The latest review of this material was January 2013. PMID:23473351

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

Applicability of the theory of planned behavior in explaining the general practitioners eLearning use in continuing medical education.

PubMed

Hadadgar, Arash; Changiz, Tahereh; Masiello, Italo; Dehghani, Zahra; Mirshahzadeh, Nahidossadat; Zary, Nabil

2016-08-22

General practitioners (GP) update their knowledge and skills by participating in continuing medical education (CME) programs either in a traditional or an e-Learning format. GPs' beliefs about electronic format of CME have been studied but without an explicit theoretical framework which makes the findings difficult to interpret. In other health disciplines, researchers used theory of planned behavior (TPB) to predict user's behavior. In this study, an instrument was developed to investigate GPs' intention to use e-Learning in CME based on TPB. The goodness of fit of TPB was measured using confirmatory factor analysis and the relationship between latent variables was assessed using structural equation modeling. A total of 148 GPs participated in the study. Most of the items in the questionnaire related well to the TPB theoretical constructs, and the model had good fitness. The perceived behavioral control and attitudinal constructs were included, and the subjective norms construct was excluded from the structural model. The developed questionnaire could explain 66 % of the GPs' intention variance. The TPB could be used as a model to construct instruments that investigate GPs' intention to participate in e-Learning programs in CME. The findings from the study will encourage CME managers and researchers to explore the developed instrument as a mean to explain and improve the GPs' intentions to use eLearning in CME.

High Spending on Maternity Care in India: What Are the Factors Explaining It?

PubMed

Goli, Srinivas; Moradhvaj; Rammohan, Anu; Shruti; Pradhan, Jalandhar

2016-01-01

High maternity-related health care spending is often cited as an important barrier in utilizing quality health care during pregnancy and childbirth. This study has two objectives: (i) to measure the levels of expenditure on total maternity care in disaggregated components such as ANCs, PNCs, and Natal care expenditure; (ii) to quantify the extent of catastrophic maternity expenditure (CME) incurred by households and identify the factors responsible for it. Data from the 71st round of the National Sample Survey (2014) was used to estimate maternity expenditure and its predictors. CME was measured as a share of consumption expenditure by different cut-offs. The two-part model was used to identify the factors associated with maternity spending and CME. The findings show that household spending on maternity care (US$ 149 in constant price) is much higher than previous estimates (US$ 50 in constant price). A significant proportion of households in India (51%) are incurring CME. Along with economic and educational status, type of health care and place of residence emerged as significant factors in explaining CME. Findings from this study assume importance in the context of an emerging demand for higher maternity entitlements and government spending on public health care in India. To reduce CME, India needs to improve the availability and accessibility of better-quality public health services and increase maternity entitlements in line with maternity expenditure identified in this study.

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

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.

What Properties of CMEs are Most Important for Space Weather?

NASA Technical Reports Server (NTRS)

Gopalswamy, Nat

2012-01-01

Severe space weather is characterized by intense particle radiation from the Sun and major geomagnetic storm caused by magnetized solar plasmas arriving at Earth. Coronal mass ejections (CMEs) are key players in both these aspects. CMEs traveling at super-Alfv nic speeds drive fast-mode MHD shocks that create the high levels of particle radiation. When a CME arrives at Earth, the CME-associated magnetic fields reconnect with Earth s magnetopause fields resulting in solar plasma entry into the magnetosphere and a geomagnetic storm depending on the magnetic structure of the CME. Particle radiation starts affecting geospace as soon as the CMEs leave the Sun and the geospace may be immersed in the radiation for several days. On the other hand, the geomagnetic storm happens only upon CME arrival at Earth. The requirements for the production of particles and magnetic storms by CMEs are different in a number of respects: solar source location, CME magnetic structure, conditions in the ambient solar wind, and shock-driving ability of CMEs. Intense shocks arriving at Earth have additional space weather effects such as sudden impulse that shrinks the magnetosphere often exposing satellites in geosynchronous orbit to the solar wind and energetic storm particle events. This paper highlights these space weather effects using CME observations space and ground based instruments during of solar cycles 23 and 24.

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

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.

Statistical Study of Interplanetary Coronal Mass Ejections with Strong Magnetic Fields

NASA Astrophysics Data System (ADS)

Murphy, Matthew E.

Coronal Mass Ejections (CMEs) with strong magnetic fields (B ) are typically associated with significant Solar Energetic Particle (SEP) events, high solar wind speed and solar flare events. Successful prediction of the arrival time of a CME at Earth is required to maximize the time available for satellite, infrastructure, and space travel programs to take protective action against the coming flux of high-energy particles. It is known that the magnetic field strength of a CME is linked to the strength of a geomagnetic storm on Earth. Unfortunately, the correlations between strong magnetic field CMEs from the entire sun (especially from the far side or non-Earth facing side of the sun) to SEP and flare events, solar source regions and other relevant solar variables are not well known. New correlation studies using an artificial intelligence engine (Eureqa) were performed to study CME events with magnetic field strength readings over 30 nanoteslas (nT) from January 2010 to October 17, 2014. This thesis presents the results of this study, validates Eureqa to obtain previously published results, and presents previously unknown functional relationships between solar source magnetic field data, CME initial speed and the CME magnetic field. These new results enable the development of more accurate CME magnetic field predictions and should help scientists develop better forecasts thereby helping to prevent damage to humanity's space and Earth assets.

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.

American Osteopathic College of Dermatology

MedlinePlus

... Board Certification Grand Rounds Resident Awards AOCD Residency Leadership Award A.P. Ulbrich Resident Research Award Daniel Koprince Award Resident Research Paper Award Surgery in the Outback CME CME Attestation ...

Simulation of Homologous and Cannibalistic Coronal Mass Ejections produced by the Emergence of a Twisted Flux Rope into the Solar Corona

NASA Astrophysics Data System (ADS)

Chatterjee, Piyali; Fan, Yuhong

2013-11-01

We report the first results of a magnetohydrodynamic simulation of the development of a homologous sequence of three coronal mass ejections (CMEs) and demonstrate their so-called cannibalistic behavior. These CMEs originate from the repeated formations and partial eruptions of kink unstable flux ropes as a result of continued emergence of a twisted flux rope across the lower boundary into a pre-existing coronal potential arcade field. The simulation shows that a CME erupting into the open magnetic field created by a preceding CME has a higher speed. The second of the three successive CMEs is cannibalistic, catching up and merging with the first into a single fast CME before exiting the domain. All the CMEs including the leading merged CME, attained speeds of about 1000 km s-1 as they exit the domain. The reformation of a twisted flux rope after each CME eruption during the sustained flux emergence can naturally explain the X-ray observations of repeated reformations of sigmoids and "sigmoid-under-cusp" configurations at a low-coronal source of homologous CMEs.

Predictions for isobaric collisions at √{sN N}=200 GeV from a multiphase transport model

NASA Astrophysics Data System (ADS)

Deng, Wei-Tian; Huang, Xu-Guang; Ma, Guo-Liang; Wang, Gang

2018-04-01

The isobaric collisions of Ru9644+Ru9644 and Zr9640+Zr9640 have recently been proposed to discern the charge separation signal of the chiral magnetic effect (CME). In this article, we employ the string melting version of a multiphase transport model to predict various charged-particle observables, including d N /d η ,pT spectra, elliptic flow (v2), and particularly possible CME signals in Ru + Ru and Zr + Zr collisions at √{sNN}=200 GeV . Two sets of the nuclear structure parametrization have been explored, and the difference between the two isobaric collisions appears to be small, in terms of d N /d η ,pT spectra, and v2 for charged particles. We mimic the CME by introducing an initial charge separation that is proportional to the magnetic field produced in the collision, and study how the final-state interactions affect the CME observables. The relative difference in the CME signal between the two isobaric collisions is found to be robust, insensitive to the final-state interactions.

Out-of-equilibrium chiral magnetic effect from chiral kinetic theory

NASA Astrophysics Data System (ADS)

Huang, Anping; Jiang, Yin; Shi, Shuzhe; Liao, Jinfeng; Zhuang, Pengfei

2018-02-01

Recently there has been significant interest in the macroscopic manifestation of chiral anomaly in many-body systems of chiral fermions. A notable example is the Chiral Magnetic Effect (CME). Enthusiastic efforts have been made to search for the CME in the quark-gluon plasma created in heavy ion collisions. A crucial challenge is that the extremely strong magnetic field in such collisions may last only for a brief moment and the CME current may have to occur at so early a stage that the quark-gluon matter is still far from thermal equilibrium. This thus requires modeling of the CME in an out-of-equilibrium setting. With the recently developed theoretical tool of chiral kinetic theory, we make a first phenomenological study of the CME-induced charge separation during the pre-thermal stage in heavy ion collisions. The effect is found to be very sensitive to the time dependence of the magnetic field and also influenced by the initial quark momentum spectrum as well as the relaxation time of the system evolution toward thermal equilibrium. Within the present approach, such pre-thermal charge separation is found to be modest.

Indocyanine green angiography findings of cystoid macular edema secondary to paclitaxel therapy.

PubMed

Nomi, Nanami; Ota, Manami; Fukumura, Miho; Nuno, Yoshihisa; Hatano, Makoto; Wakuta, Makiko; Yanai, Ryoji; Kimura, Kazuhiro

2018-03-01

To report 2 cases of paclitaxel-related maculopathy manifesting as cystoid macular edema (CME) with late petaloid hyperfluorescence on indocyanine green angiography (IA). A 74-year-old man (patient 1) undergoing paclitaxel chemotherapy for gastric and metastatic liver cancer and a 69-year-old man (patient 2) receiving paclitaxel for hypopharyngeal cancer presented with anorthopia in both eyes. Spectral domain-optical coherence tomography (SD-OCT) revealed macular edema in both eyes of each patient. Fluorescein angiography showed weak petaloid pooling around the fovea in the late phase. IA revealed CME with petaloid hyperfluorescence that matched the region of macular edema detected by SD-OCT. The CME was attenuated in the right eye but not in the left eye of patient 1 at 2 weeks after discontinuation of paclitaxel treatment, whereas it was no longer apparent in either eye at 3 months. The CME was no longer detected in either eye of patient 2 at 3 months after discontinuation of paclitaxel. These cases suggest that paclitaxel-induced CME may result from intraretinal accumulation of intracellular fluid and minimal impairment of the blood retinal barrier.

Evolution of a Coronal Mass Ejection from the Sun to Mercury, Venus, Earth and Beyond

NASA Astrophysics Data System (ADS)

Wang, Y.; Shen, C.; Liu, J.; Mengjiao, X.; Guo, J.

2017-12-01

A clear magnetic cloud was observed by Messenger at Mercury. By using coronagraph images from SOHO/LASCO and STEREO/COR and the in-situ data from Wind near the Earth, we estimated its propgation velocity and identified the possible CME candidate in the corona and its counterpart recorded by Venus Express near Venus. By applying the CME's DIPS (Deflection in InterPlanetary Space) model, we show that the CME's arrivals at the three different heliocentric distance can be well reproduced. By extending the trajectory of the CME to the orbitor of Mars, we predict the arrival of the CME at Mars, which is in agreement with a significant Forbush decrease observed by MSL. We use uniformly-twisted force-free flux rope model to fit the in-situ measurements at Mercury, Venus and the Earth to study the evolution of the magnetic flux rope, and find that both axial magnetic flux and twist significantly decreased, suggesting that a significant erosion process was on-going and might change the averaged twist of the magnetic flux rope.

Interactions of viruses in Cowpea: effects on growth and yield parameters

PubMed Central

Kareem, KT; Taiwo, MA

2007-01-01

The study was carried out to investigate the effects of inoculating three cowpea cultivars: "OLO II", "OLOYIN" and IT86D-719 with three unrelated viruses: Cowpea aphid-borne mosaic virus (CABMV), genus Potyvirus, Cowpea mottle virus (CMeV), genus Carmovirus and Southern bean mosaic virus (SBMV), genus Sobemovirus singly and in mixture on growth and yield of cultivars at 10 and 30 days after planting (DAP). Generally, the growth and yield of the buffer inoculated control plants were significantly higher than those of the virus inoculated plants. Inoculation of plants at an early age of 10 DAP resulted in more severe effect than inoculations at a later stage of 30 DAP. The average values of plant height and number of leaves produced by plants inoculated 30 DAP were higher than those produced by plants inoculated 10 DAP. Most of the plants inoculated 10 DAP died and did not produce seeds. However, " OLOYIN" cultivar was most tolerant and produced reasonable yields when infected 30 DAP. The effect of single viruses on growth and yield of cultivars showed that CABMV caused more severe effects in IT86D-719, SBMV had the greatest effect on "OLO II" while CMeV induced the greatest effect on "OLOYIN". Yield was greatly reduced in double infections involving CABMV in combination with either CMeV or SBMV in "OLOYIN" and "OLO II", however, there was complete loss in yield of IT86D-719. Triple infection led to complete yield loss in all the three cultivars. PMID:17286870

Laboratory Simulations of CME-Solar Wind Interactions Using a Coaxial Gun and Background Plasma

NASA Astrophysics Data System (ADS)

Wallace, B. H.; Zhang, Y.; Fisher, D.; Gilmore, M.

2016-12-01

Understanding and predicting solar coronal mass ejections (CMEs) is of critical importance for mitigating their disruptive behavior on ground- and space-based technologies. While predictive models of CME propagation and evolution have relied primarily on sparse in-situ data along with ground and satellite images for validation purposes, emerging laboratory efforts have shown that CME-like events can be created with parameters applicable to the solar regime that may likewise aid in predictive modeling. A modified version of the coaxial plasma gun from the Plasma Bubble Expansion Experiment (PBEX) [A. G. Lynn, Y. Zhang, S. C. Hsu, H. Li, W. Liu, M. Gilmore, and C. Watts, Bull. Amer. Phys. Soc. 52, 53 (2007)] will be used in conjunction with the Helicon-Cathode (HelCat) basic plasma science device in order to observe the magnetic characteristics of CMEs as they propagate through the solar wind. The evolution of these interactions will be analyzed using a multi-tip Langmuir probe array, a 33-position B-dot probe array, and a high speed camera. The results of this investigation will be used alongside the University of Michigan's BATS-R-US 3-D MHD numerical code, which will be used to perform simulations of the coaxial plasma gun experiment. The results of these two approaches will be compared in order to validate the capabilities of the BATS-R-US code as well as to further our understanding of magnetic reconnection and other processes that take place as CMEs propagate through the solar wind. The details of the experimental setup as well as the analytical approach are discussed.

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

Krupar, V.; Eastwood, J. P.; Kruparova, O.

Coronal mass ejections (CMEs) are large-scale eruptions of magnetized plasma that may cause severe geomagnetic storms if Earth directed. Here, we report a rare instance with comprehensive in situ and remote sensing observations of a CME combining white-light, radio, and plasma measurements from four different vantage points. For the first time, we have successfully applied a radio direction-finding technique to an interplanetary type II burst detected by two identical widely separated radio receivers. The derived locations of the type II and type III bursts are in general agreement with the white-light CME reconstruction. We find that the radio emission arisesmore » from the flanks of the CME and are most likely associated with the CME-driven shock. Our work demonstrates the complementarity between radio triangulation and 3D reconstruction techniques for space weather applications.« less

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

Predicting ICME properties at 1AU

NASA Astrophysics Data System (ADS)

Lago, A.; Braga, C. R.; Mesquita, A. L.; De Mendonça, R. R. S.

2017-12-01

Coronal mass ejections (CMEs) are among the main origins of geomagnetic disturbances. They change the properties of the near-earth interplanetary medium, enhancing some key parameters, such as the southward interplanetary magnetic field and the solar wind speed. Both quantities are known to be related to the energy transfer from the solar wind to the Earth's magnetosphere via the magnetic reconnection process. Many attempts have been made to predict the magnetic filed and the solar wind speed from coronagraph observations. However, we still have much to learn about the dynamic evolution of ICMEs as they propagate through the interplanetary space. Increased observation capability is probably needed. Among the several attempts to establish correlations between CME and ICME properties, it was found that the average CME propagation speed to 1AU is highly correlated to the ICME peak speed (Dal Lago et al, 2004). In this work, we present an extended study of such correlation, which confirms the results found in our previous study. Some suggestions on how to use this kind of results for space weather estimates are explored.

A probabilistic approach to the drag-based model

NASA Astrophysics Data System (ADS)

Napoletano, Gianluca; Forte, Roberta; Moro, Dario Del; Pietropaolo, Ermanno; Giovannelli, Luca; Berrilli, Francesco

2018-02-01

The forecast of the time of arrival (ToA) of a coronal mass ejection (CME) to Earth is of critical importance for our high-technology society and for any future manned exploration of the Solar System. As critical as the forecast accuracy is the knowledge of its precision, i.e. the error associated to the estimate. We propose a statistical approach for the computation of the ToA using the drag-based model by introducing the probability distributions, rather than exact values, as input parameters, thus allowing the evaluation of the uncertainty on the forecast. We test this approach using a set of CMEs whose transit times are known, and obtain extremely promising results: the average value of the absolute differences between measure and forecast is 9.1h, and half of these residuals are within the estimated errors. These results suggest that this approach deserves further investigation. We are working to realize a real-time implementation which ingests the outputs of automated CME tracking algorithms as inputs to create a database of events useful for a further validation of the approach.

Deflections of Fast Coronal Mass Ejections and the Properties of Associated Solar Energetic Particle Events (POSTPRINT)

DTIC Science & Technology

2012-09-20

coronal mass ejection (CME) source regions can deflect fast CMEs from their expected trajectories in space, explaining the appearance of driverless shocks...the appearance of driverless shocks at 1 AU from CMEs ejected near solar central meridian (CM). This suggests that SEP events originating in CME-driven...interplanetary CME (ICME) drivers. Most such driverless shocks occur only from CMEs near the solar limbs, but these disk-center CMEs were located adjacent to CHs

The role of the chief marketing executive in hospitals. A survey.

PubMed

Wagle, J S; Kizilbash, A H

1987-05-01

The role and support for the Chief Marketing Executive (CME) in hospitals is studies through a 97 hospital survey. The authors found that the majority of CMEs report at a high level in the organization, but their staffs are still small and their duties diverse. However, the budgets for advertising and market research are increasing. The authors anticipate the CME's role to continue evolving into a strategist as hospitals define more clearly the CME's duties and recognize marketing's contribution to the organization.

Observational Properties of Coronal Mass Ejections

DTIC Science & Technology

2006-01-01

speeds 2.5. Masses and Energies of CMEs exceeded 2000 km s-1; the fastest CME speed measured thus far was 2657 km s-1 on 4 November 2000. When compiled The...accelerated. The average deceleration of the fastest (> 900 km s-1) The CME kinetic energies can also be calculated from the CME group is -16 m s-2...OBSERVATIONAL PROPERTIES OF CORONAL MASS EJECTIONS 15 *"...... .. ’..’... ... ’...... kinetic energy is 2.4 x 1030 ergs (5.0 x 1029 ergs) [Vourlidas, 2004

The First Year of Solar-Wind Data From the GENESIS Mission

NASA Astrophysics Data System (ADS)

Wiens, R. C.; Barraclough, B. L.; Steinberg, J. T.; Reisenfeld, D. B.; Neugebauer, M.; Burnett, D. S.

2002-12-01

The GENESIS mission was launched in August, 2001, and has been in an L1 halo orbit for over a year. The primary purpose of the mission is to collect solar-wind samples that will be returned to Earth in 2004 for high-precision isotopic and elemental analyses. GENESIS uses conventional ion and electron spectrometers to record solar-wind conditions during collection, and to make real-time determinations of the solar-wind regimes to facilitate collection of separate samples of interstream (IS), coronal hole (CH), and coronal mass ejection (CME) flows. Of particular interest is the use of a bi-directional electron (BDE) index to determine the presence of CMEs. And although GENESIS lacks a magnetometer, the field vector, with sign ambiguity, is determined by the electron direction, and matches other spacecraft magnetometer data well. GENESIS in-situ data and on-board regime determinations are available on the web. The data from Fall, 2001 were characterized by numerous CME regimes (comprising 32% of the time in the 4th quarter, based on the on-board algorithm), with little CH flow (only 2%). A strong CH flow was observed every solar rotation from mid-January through late May. June was quiet, nearly all IS flow. The first and second quarters of 2002 were approximately 28% CME flow, with CH flow dropping from 18% to 6%. The discovery of unexpectedly noticeable BDE signals during CH flows at 1 AU (Steinberg et al., 2002) caused us early on to modify our regime selection algorithm to accommodate these. The on-board algorithm intentionally errs on the side of overestimating CME flows in order to keep the CH sample more pure. Comparisons have been made of various compositional parameters determined by Genesis (Barraclough et al., this meeting) and by ACE SWICS (Reisenfeld et al., this meeting) for times corresponding to the Genesis collection periods for each of the three regimes. The Genesis L1 halo orbit is ~0.8 x 0.25 million km radius, somewhat larger than the ~0.3 x 0.2 and ~0.7 x 0.2 million km orbits of ACE and SOHO, respectively, presenting excellent opportunities for multi-spacecraft observations at L1.

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.

The Relationship Between the Expansion Speed and Radial Speed of CMEs Confirmed Using Quadrature Observations of the 2011 February 15 CME

NASA Astrophysics Data System (ADS)

Gopalswamy, N.; Makela, P.; Yashiro, S.; Davila, J. M.

2012-08-01

It is difficult to measure the true speed of Earth-directed CMEs from a coronagraph along the Sun-Earth line because of the occulting disk. However, the expansion speed (the speed with which the CME appears to spread in the sky plane) can be measured by such coronagraph. In order to convert the expansion speed to radial speed (which is important for space weather applications) one can use empirical relationship between the two that assumes an average width for all CMEs. If we have the width information from quadrature observations, we can confirm the relationship between expansion and radial speeds derived by Gopalswamy et al. (2009a). The STEREO spacecraft were in qudrature with SOHO (STEREO-A ahead of Earth by 87oand STEREO-B 94obehind Earth) on 2011 February 15, when a fast Earth-directed CME occurred. The CME was observed as a halo by the Large-Angle and Spectrometric Coronagraph (LASCO) on board SOHO. The sky-plane speed was measured by SOHO/LASCO as the expansion speed, while the radial speed was measured by STEREO-A and STEREO-B. In addition, STEREO-A and STEREO-B images measured the width of the CME, which is unknown from Earth view. From the SOHO and STEREO measurements, we confirm the relationship between the expansion speed (Vexp) and radial speed (Vrad) derived previously from geometrical considerations (Gopalswamy et al. 2009a): Vrad=1/2 (1 + cot w)Vexp, where w is the half width of the CME. STEREO-B images of the CME, we found that CME had a full width of 7 6o, so w=3 8o. This gives the relation as Vrad=1.1 4 Vexp. From LASCO observations, we measured Vexp=897 km/s, so we get the radial speed as 10 2 3 km/s. Direct measurement of radial speed yields 945 km/s (STEREO-A) and 105 8 km/s (STEREO-B). These numbers are different only by 7.6 % and 3.4 % (for STEREO-A and STEREO-B, respectively) from the computed value.

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.

Aesthetic Surgery of the Buttocks Using Implants: Practice-Based Recommendations.

PubMed

Senderoff, Douglas M

2016-05-01

The demand for gluteal enhancement has increased rapidly in the past few years. In this Continuing Medical Education (CME) article, the evaluation, surgical planning, operative technique, and management of potential complications of gluteal augmentation using solid silicone implants are discussed. Practice-based recommendations are presented along with a review of the scientific literature. The intramuscular and subfascial technique is described along with a discussion of the advantages and disadvantages of each approach. Guidelines for implant selection, placement, and revisional procedures are presented along with recommendations for maximizing successful outcomes. © 2016 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

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

Education on human rights and healthcare: evidence from Serbia.

PubMed

Vranes, Aleksandra Jovic; Mikanovic, Vesna Bjegovic; Vukovic, Dejana; Djikanovic, Bosiljka; Babic, Momcilo

2015-03-01

Ensuring and enforcing human rights in patient care are important to promote health and to provide quality and appropriate healthcare services. Therefore, continued medical education (CME) is essential for healthcare professionals to utilize their sphere of influence to affect change in healthcare practice. A total of 123 participants attended three CME courses. Course topics covered: (i) the areas of human rights and healthcare, (ii) rights, obligations and responsibilities of healthcare professionals in relation to human rights and the rights of patients, (iii) healthcare of vulnerable groups and (iv) access to essential medical services. Evaluation of the CME courses involved two components: evaluation of participants' performance and the participants' evaluation of the teaching process. The participants were assessed at the beginning and end of each course. Each of the courses was evaluated by the participants through a questionnaire distributed at the end of each course. Descriptive statistics was used for data interpretation. Knowledge of the healthcare professionals improved at the end of all the three courses. The participants assessed several aspects of the courses, including the course topics, educational methods, the course methods, organization, duration and dynamics as well as the physical environment and the technical facilities of the course, and rated each very highly. Our results corroborate the importance and necessity of courses to heighten awareness of the state of current healthcare and human rights issues to increase the involvement of healthcare professionals both locally and globally. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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

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.

American Board of Obesity Medicine (ABOM)

MedlinePlus

... form below to receive more information. PARTNERS Primary Obesity CME Columbia University Institute of Human Nutrition Harvard ... Obesity Medicine Obesity Medicine Association The Obesity Society Obesity-Related CME American Society for Metabolic and Bariatric ...

Anti-Hepatozoon canis serum antibodies and gamonts in naturally-occurring canine monocytic ehrlichiosis.

PubMed

Mylonakis, Mathios E; Leontides, Leonidas; Gonen, Liat; Billinis, Charalambos; Koutinas, Alexander F; Baneth, Gad

2005-05-15

The prevalence of IgG antibodies to Hepatozoon canis and the presence of gamonts in the blood and hemolymphatic tissues were studied in dogs with canine monocytic ehrlichiosis (CME) caused by Ehrlichia canis. Both pathogens are transmitted by the tick Rhipicephalus sanguineus. Forty-five out of 69 (65.2%) dogs with CME were seropositive to H. canis by an enzyme-linked immunosorbent assay (ELISA). Intra-neutrophilic gamonts of H. canis were found in 2 out of 69 dogs (2.9%) comprising 4.5% of the seropositive dogs. The present study indicated that the prevalence of antibodies to H. canis was high among dogs with CME in an area where both infections are endemic. However, previous exposure to H. canis was not found as an important contributor to clinical or clinicopathologic abnormalities found in dogs with CME.

MLSO Mark III K-Coronameter Observations of the CME Rate from 1989-1996

NASA Technical Reports Server (NTRS)

St Cyr, O. C.; Flint, Q. A.; Xie, H.; Webb, D. F.; Burkepile, J. T.; Lecinski, A. R.; Quirk, C.; Stanger, A. L.

2015-01-01

We report here an attempt to fill the 1990-1995 gap in the CME (coronal mass ejection) rate using the Mauna Loa Solar Observatory (MLSO)'s Mark III (Mk3) K-coronameter. The Mk3 instrument observed routinely several hours most days beginning in 1980 until it was upgraded to Mk4 in 1999. We describe the statistical properties of the CMEs detected during 1989-1996, and we determine a CME rate for each of those years. Since spaceborne coronagraphs have more complete duty cycles than a ground-based instrument at a single location, we compare the Mk3-derived CME rate from 1989 with the SMM C/P (Solar Maximum Mission Coronagraph/Polarimeter) coronagraph, and from 1996 with the SOHO (Solar and Hellospheric Observatory) LASCO (Large Angle and Spectrometric COronagraph) coronagraphs.

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.

A CORONAL HOLE'S EFFECTS ON CORONAL MASS EJECTION SHOCK MORPHOLOGY IN THE INNER HELIOSPHERE

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

Wood, B. E.; Wu, C.-C.; Howard, R. A.

2012-08-10

We use STEREO imagery to study the morphology of a shock driven by a fast coronal mass ejection (CME) launched from the Sun on 2011 March 7. The source region of the CME is located just to the east of a coronal hole. The CME ejecta is deflected away from the hole, in contrast with the shock, which readily expands into the fast outflow from the coronal hole. The result is a CME with ejecta not well centered within the shock surrounding it. The shock shape inferred from the imaging is compared with in situ data at 1 AU, wheremore » the shock is observed near Earth by the Wind spacecraft, and at STEREO-A. Shock normals computed from the in situ data are consistent with the shock morphology inferred from imaging.« less