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…

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.

Continuing Medical Education, Perspectives, Problems, Prognosis.

ERIC Educational Resources Information Center

Richards, Robert K.

Predicting that continuing medical education (CME) will be mandatory for doctors within five years, this book traces CME's historical antecedents, analyzes the forces arrayed for and against it, and offers guidelines for its realistic use in a broad program of improving health care. An examination is made of: the evolution of undergraduate and…

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.

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

PubMed

Olson, Curtis A; Tooman, Tricia R

2012-08-01

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

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

ERIC Educational Resources Information Center

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

2011-01-01

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

Organizational Change in Management of Hepatitis C: Evaluation of a CME Program

ERIC Educational Resources Information Center

Garrard, Judith; Choudary, Veena; Groom, Holly; Dieperink, Eric; Willenbring, Mark L.; Durfee, Janet M.; Ho, Samuel B.

2006-01-01

Introduction: Effective treatment regimens exist for the hepatitis C virus (HCV); however, clinicians are often resistant to evaluation or treatment of patients with alcohol or substance abuse problems. We describe a continuing medical education (CME) program for clinicians in a nationwide health care system, with emphasis on current treatment…

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.

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

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.

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

PubMed

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

2011-01-01

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

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

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

PubMed

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

2011-01-01

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

The Integrated Joslin Performance Improvement/CME Program: A New Paradigm for Better Diabetes Care

ERIC Educational Resources Information Center

Brown, Julie A.; Beaser, Richard S.; Neighbours, James; Shuman, Jill

2011-01-01

Ongoing continuing medical education is an essential component of life-long learning and can have a positive influence on patient outcomes. However, some evidence suggests that continuing medical education has not fulfilled its potential as a performance improvement (PI) tool, in part due to a paradigm of CME that has focused on the quantity of…

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.

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.

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.

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

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.

Workplace injury management: using new technology to deliver and evaluate physician continuing medical education.

PubMed

Karlinsky, Harry; Dunn, Celina; Clifford, Bill; Atkins, Jim; Pachev, George; Cunningham, Ken; Fenrich, Peter; Bayani, Yassaman

2006-12-01

Physicians typically receive little continuing medical education (CME) about their role in workplace injury management as well as on workplace injuries and disease. Although new technologies may help educate physicians in these areas, careful evaluation is required, given the understudied nature of these interventions. The objective of this study is to evaluate two promising new technologies to deliver CME (online learning and videoconferencing) and to compare the effectiveness of these delivery methods to traditional CME interventions (large urban traditional conference lectures and small group local face-to-face outreach) in their impact on physician knowledge related to workplace injury management. This study utilized a prospective, controlled evaluation of two educational programs for BC physicians: 1) The Diagnosis and Management of Lateral Epicondylitis; and 2) Is Return-to-Work Good Medicine? Each educational module was delivered in each of four ways (Outreach Visit, Videoconference Session, Conference Lecture, Online) and physicians self-selected their participation--both in terms of topic and delivery method. Questionnaires related to knowledge as well as learner attitude and satisfaction were administered prior (pre-test) and following (post-test) all educational sessions. 581 physician encounters occurred as a result of the educational interventions and a significant percentage of the physicians participated in the research per se (i.e. there were 358 completed sets of pre-test and post-test 'Knowledge' questionnaires). Overall the results showed that the developed training programs increased physicians' knowledge of both Lateral Epicondylitis and the physician's role in Return-To-Work planning as reflected in improved post-test performance when compared to pre-test scores. Furthermore, videoconferencing and online training were at least as effective as conference lectures and instructor-led small group outreach sessions in their impact on physician knowledge. Use of effective videoconferencing and online learning activities will increase physician access to quality CME related to workplace injury management and will overcome access barriers intrinsic to types of CME interventions based on instructor-student face-to-face interactions.

Study of relation of continuing medical education to quality of family physicians' care.

PubMed

Dunn, E V; Bass, M J; Williams, J I; Borgiel, A E; MacDonald, P; Spasoff, R A

1988-10-01

A random sample of 120 physicians in Ontario was studied to assess quality of care in primary care and test an hypothesis that quality of care was related to continuing medical education (CME) activities. The quality-of-care scores were obtained by an in-office audit of a random selection of charts. The scores were global scores for charting, prevention, the use of 13 classes of drugs, and care of a two-year period for 182 different diagnoses. There were no relationships between global quality-of-care scores based on these randomly chosen charts and either the type or quantity of the physicians' CME activities. These activities were reading journals, attending rounds, attending scientific conferences, having informal consultations, using audio and video cassettes, and engaging in self-assessment. The implications of these findings are significant for future research in CME and for planners of present CME programs.

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.

Blood Basics

MedlinePlus

... CME) and recertification Educational Programs Programs to enhance knowledge, research, and expertise Advocacy In This Section Action ... Pacific Latin America Meeting on Hematologic Malignancies Gain knowledge, through “How I Treat” presentations, that can help ...

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

ERIC Educational Resources Information Center

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

2003-01-01

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

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.

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

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

PubMed

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

2011-12-01

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

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

PubMed

Dow, Jamie; Jacques, André

2012-01-01

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

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…

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.

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

PubMed

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

2010-01-01

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

The Impact of Financial Disclosure on Attendee Assessment of Objectivity in Continuing Medical Education Programs in Psychiatry: A Randomized, Controlled Trial.

PubMed

Jibson, Michael D; Cobourn, Lisa A; Seibert, Jennifer K

2016-04-01

The purpose of financial conflict of interest disclosures by speakers at continuing medical education (CME) programs is to assist attendees in their assessment of the objectivity of the information presented. This empirical study was undertaken to determine what level of disclosure is optimal to achieve this goal. Attendees at five CME programs were randomly assigned to receive either a standard financial disclosure, an intermediate level that included whether speakers received more or less than 5% of their income from each company they disclosed, or a high level of disclosure that included the percent of their income derived from each company. A total of 169 attendees (85.4% response rate) completed a questionnaire regarding the objectivity of the CME presentation they attended. Attendees receiving the highest level of disclosure came significantly closer to the ratings of speaker bias made by peer reviewers than did attendees receiving medium or low levels of disclosure (p = 0.03; effect size 0.31). Among the minority of attendees who received the highest level of disclosure but whose assessment of bias differed from that of peer reviewers, however, there was a tendency to underestimate bias (5.9 vs 31.4%; p < 0.0001). The major limitation of this study was an overall low level of bias in the presentations, making it difficult to generalize these findings to less objective programs. The study did not address whether the process of disclosure had an impact on speakers' behavior. This study provides mixed support for higher levels of financial disclosure than are currently required for CME programs.

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

PubMed

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

2017-04-03

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

Physician preferences for accredited online continuing medical education.

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.

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…

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.

In Search of Coherence: A View from the Accreditation Council for Graduate Medical Education

ERIC Educational Resources Information Center

Leach, David C.

2005-01-01

The Conjoint Committee on Continuing Medical Education has developed a position paper, a set of recommendations, and next steps in the reform of continuing medical education (CME). The Accreditation Council for Graduate Medical Education (ACGME) sets standards for and accredits residency programs in graduate medical education and is not directly…

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.

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. …

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)

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.

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

Bariatric Surgery Procedures

MedlinePlus

... Meetings of Interest Online Education Job Board CME Policies CBN Fellowship Certificate Research Grant Program Resources All Resources Approved Procedures Patient Safety Vignettes Dr. Mason Historical Library Governing Documents Guidelines Access and Insurance Position and ...

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

ERIC Educational Resources Information Center

Olson, Curtis A.; Tooman, Tricia R.

2012-01-01

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

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

PubMed

Stewart, Grant D; Khadra, Mohamed H

2009-02-01

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

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)

National Marrow Donor Program. HLA Typing for Bone Marrow Transplantation

DTIC Science & Technology

2014-11-30

educate the transplant community about the critical importance of establishing a nationwide contingency response plan. 2. Rapid Identification of...Expand Network Communications 59 IIB 4.2 Central Contingency Management 59 IIC Immunogenetic Studies 63 IIC.1.1 Donor Recipient Pair Project 63 IIC...Amendment CMCR Centers for Medical Countermeasures Against Radiation CMDP China Marrow Donor Program CME Continuing Medical Education CMF Community

2007 Simulation Education Summit

DTIC Science & Technology

2008-03-01

SUBJECT TERMS Simulation, healthcare, education , patient safety, technology 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT 18... education is about learning , not testing. Thus, CME/CE must not be mistaken for certification and should be seen as a mechanism for skills/knowledge...identify learning deficiencies and to help design an individualized educational program (IEP). Human feedback is required even if the simulator has built

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

PubMed

Williams, Jason G

2014-01-01

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

Estimate of Bariatric Surgery Numbers, 2011-2015

MedlinePlus

... Meetings of Interest Online Education Job Board CME Policies CBN Fellowship Certificate Research Grant Program Resources All Resources Approved Procedures Patient Safety Vignettes Dr. Mason Historical Library Governing Documents Guidelines Access and Insurance Position and ...

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

PubMed

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

2014-01-01

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

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.

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.

Academia-industry collaboration in continuing medical education: description of two approaches.

PubMed

Katz, Harvey P; Goldfinger, Stephen E; Fletcher, Suzanne W

2002-01-01

Although concerns have been raised about industry support of continuing medical education (CME), there are few published reports of academia-industry collaboration in the field. We describe and evaluate Pri-Med, a CME experience for primary care clinicians developed jointly by the Harvard Medical School (HMS) and M/C Communications. Since 1995, 19 Pri-Med conferences have been held in four cities, drawing more than 100,000 primary care clinicians. The educational core of each Pri-Med conference is a 3-day Harvard course, "Current Clinical Issues in Primary Care." Course content is determined by a faculty committee independent of any commercial influence. Revenues from multiple industry sources flow through M/C Communications to the medical school as an educational grant to support primary care education. Pri-Med also offers separate pharmaceutical company-funded symposia. Comparing the two educational approaches during four conferences, 221 HMS talks and 103 symposia were presented. The HMS course covered a wide range with 133 topics; the symposia focused on 30 topics, most of which were linked to recently approved new therapeutic products manufactured by the funders. Both the course and the symposia were highly rated by attendees. When CME presentations for primary care physicians receive direct support from industry, the range of offered topics is narrower than when programs are developed independently of such support. There appear to be no differences in the perceived quality of presentations delivered with and without such support. Our experience suggests that a firewall between program planners and providers of financial support will result in a broader array of educational subjects relevant to the field of primary care.

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.

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

ERIC Educational Resources Information Center

Hemmati, Nima; Omrani, Soghra; Hemmati, Naser

2013-01-01

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

Continuing Medical Education: What Delivery Format Do Physicians Prefer?

ERIC Educational Resources Information Center

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

2003-01-01

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

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…

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

PubMed

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

2006-05-01

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

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…

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.

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

PubMed Central

Heyden, Robin; Sternthal, Elliot; Merialdi, Mario

2010-01-01

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

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

PubMed

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

2010-01-23

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

Online continuing medical education as a key link for successful noncommunicable disease self-management: the CASALUD™ Model.

PubMed

Gallardo-Rincón, Héctor; Saucedo-Martínez, Rodrigo; Mujica-Rosales, Ricardo; Lee, Evan M; Israel, Amy; Torres-Beltran, Braulio; Quijano-González, Úrsula; Atkinson, Elena Rose; Kuri-Morales, Pablo; Tapia-Conyer, Roberto

2017-01-01

The purpose of this study is to evaluate how the benefits of online continuing medical education (CME) provided to health care professionals traveled along a patient "educational chain". In this study, the educational chain begins with the influence that CME can have on the quality of health care, with subsequent influence on patient knowledge, disease self-management, and disease biomarkers. A total of 422 patients with at least one noncommunicable disease (NCD) treated in eight different Mexican public health clinics were followed over 3 years. All clinics were participants in the CASALUD Model, an NCD care model for primary care, where all clinic staff were offered CME. Data were collected through a questionnaire on health care, patient disease knowledge, and self-management behaviors; blood samples and anthropometric measurements were collected to measure patient disease biomarkers. Between 2013 and 2015, the indexes measuring quality of health care, patient health knowledge, and diabetes self-management activities rose moderately but significantly (from 0.54 to 0.64, 0.80 to 0.84, and 0.62 to 0.67, respectively). Performing self-care activities - including owning and using a glucometer and belonging to a disease support group - saw the highest increase (from 0.65 to 0.75). A1C levels increased between 2013 and 2015 from 7.95 to 8.41% (63-68 mmol/mol) ( P <0.001), and blood pressure decreased between 2014 and 2015 from 143.7/76.8 to 137.5/74.4 (systolic/diastolic reported in mmHg) ( P <0.001). The mean levels of other disease biomarkers remained statistically unchanged, despite the improvements seen in the previous "links" of the educational chain. Online CME can effect certain changes in the educational chain linking quality of health care, patient knowledge, and self-management behaviors. However, in order to assure adequate NCD control, the entire health care system must be improved in tandem. Online CME programs, such as CASALUD's, are feasible strategies for impacting changes in disease self-management at a clinic level throughout a country.

Online continuing medical education as a key link for successful noncommunicable disease self-management: the CASALUD™ Model

PubMed Central

Gallardo-Rincón, Héctor; Saucedo-Martínez, Rodrigo; Mujica-Rosales, Ricardo; Lee, Evan M; Israel, Amy; Torres-Beltran, Braulio; Quijano-González, Úrsula; Atkinson, Elena Rose; Kuri-Morales, Pablo; Tapia-Conyer, Roberto

2017-01-01

Purpose The purpose of this study is to evaluate how the benefits of online continuing medical education (CME) provided to health care professionals traveled along a patient “educational chain”. In this study, the educational chain begins with the influence that CME can have on the quality of health care, with subsequent influence on patient knowledge, disease self-management, and disease biomarkers. Methods A total of 422 patients with at least one noncommunicable disease (NCD) treated in eight different Mexican public health clinics were followed over 3 years. All clinics were participants in the CASALUD Model, an NCD care model for primary care, where all clinic staff were offered CME. Data were collected through a questionnaire on health care, patient disease knowledge, and self-management behaviors; blood samples and anthropometric measurements were collected to measure patient disease biomarkers. Results Between 2013 and 2015, the indexes measuring quality of health care, patient health knowledge, and diabetes self-management activities rose moderately but significantly (from 0.54 to 0.64, 0.80 to 0.84, and 0.62 to 0.67, respectively). Performing self-care activities – including owning and using a glucometer and belonging to a disease support group – saw the highest increase (from 0.65 to 0.75). A1C levels increased between 2013 and 2015 from 7.95 to 8.41% (63–68 mmol/mol) (P<0.001), and blood pressure decreased between 2014 and 2015 from 143.7/76.8 to 137.5/74.4 (systolic/diastolic reported in mmHg) (P<0.001). The mean levels of other disease biomarkers remained statistically unchanged, despite the improvements seen in the previous “links” of the educational chain. Conclusion Online CME can effect certain changes in the educational chain linking quality of health care, patient knowledge, and self-management behaviors. However, in order to assure adequate NCD control, the entire health care system must be improved in tandem. Online CME programs, such as CASALUD’s, are feasible strategies for impacting changes in disease self-management at a clinic level throughout a country. PMID:29089779

Assessment of Barriers to Changing Practice as CME Outcomes

ERIC Educational Resources Information Center

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

2010-01-01

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

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.

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,…

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…

CME and Change in Practice: An Alternative Perspective.

ERIC Educational Resources Information Center

Wergin, Jon F.; And Others

1988-01-01

Results of a study by the American College of Cardiology revealed that continuing medical education (CME) courses contain relatively little information that is new to the audience, that other influences on practice interact with CME content, and that change attributable to CME is subtle and often delayed. (JOW)

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…

[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.

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.

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…

A New Vision for Distance Learning and Continuing Medical Education

ERIC Educational Resources Information Center

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,…

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.

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.

Medical Education and Communication Companies Involved in CME: An Updated Profile

ERIC Educational Resources Information Center

Peterson, Eric D.; Overstreet, Karen M.; Parochka, Jacqueline N.; Lemon, Michael R.

2008-01-01

Introduction: Medical Education and Communication Companies (MECCs) represent approximately 21% of the providers accredited by the Accreditation Council for Continuing Medical Education (ACCME), yet relatively little is known about these organizations in the greater continuing medical education (CME) community. Two prior studies described them,…

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…

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.

Faculty development activities in family medicine: in search of innovation.

PubMed

Lawrence, Elizabeth A; Oyama, Oliver N

2013-01-01

To describe the Accreditation Council for Graduate Medical Education's (ACGME) faculty development requirements, explore the range of faculty development activities and support currently used by family medicine residencies to meet these requirements, and describe one innovative approach to satisfy this need. An electronic survey of faculty development activities and support offered to faculty by residency programs was sent to a random sample of 40 medical school and community based family medicine residency programs across the United States. Data were examined using t-tests, Fisher's exact tests, and Analysis of Variance. Faculty development, beyond traditional clinical CME, was strongly encouraged or required by a large proportion of the sample (73%). Only 58% of programs reported having discussed the ACGME's faculty development component areas (clinical, educational, administrative, leadership, research, and behavioral). In each component area except the "clinical" area, the absence of discussing the ACGME component areas with residency faculty was associated with fewer faculty development activities and support being offered by the program. These results, although preliminary, suggest that family medicine residency programs may value and encourage faculty development. The majority of programs use traditional activities and strategies such as CME, faculty meetings, faculty conferences and workshops; and a smaller number of programs are exploring the utility of mentoring programs, faculty discussion groups, and technology based learning systems. The challenge is to develop faculty development activities tailored to individual program and faculty needs and resources.

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.

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.

National Medical Association

MedlinePlus

... Updates Health Care Reform Policy Letters & Statements Health Information Technology Mazique Symposium Resources Policy Beat Links Contact Us Education About NMA CME Continuing Medical Education CME Mission Statement About William ... Information Appointments Meeting and Delegate Criteria HOD Private Page ...

Intersectional Analysis in Critical Mathematics Education Research: A Response to Figure Hiding

ERIC Educational Resources Information Center

Bullock, Erika C.

2018-01-01

In this chapter, I use figure hiding as a metaphor representing the processes of exclusion and suppression that critical mathematics education (CME) seeks to address. Figure hiding renders identities and modes of thought in mathematics education and mathematics education research invisible. CME has a commitment to addressing figure hiding by…

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.

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.

Comparative Study on the Education System of Traditional Medicine in China, Japan, Korea, and Taiwan.

PubMed

Park, Yu Lee; Huang, Ching Wen; Sasaki, Yui; Ko, Youme; Park, Sunju; Ko, Seong-Gyu

2016-01-01

China, Japan, Korea, and Taiwan have developed modernized education systems in traditional medicine. This study aims to provide an overview of the education systems in these countries and compare them. Data were collected through the websites of government agencies, universities, and relevant organizations. These countries have systemically developed basic medical education (BME), postgraduate medical education (PGME), and continuing medical education (CME) in traditional medicine. BME is provided at colleges of traditional medicine at the undergraduate level and graduate levels. The length of education at the undergraduate level is five, six, and seven years in China, Korea, and Taiwan, respectively; the length at the graduate level is four years in Korea and five years in Taiwan. A seven- or eight-year program combining undergraduate and graduate courses is unique to China. In Japan, unlike in other countries, there are two distinct education systems-one is comprised of courses on traditional medicine included in the curriculum for Western medical doctors, and the other is a three- or four-year undergraduate program for practitioners including acupuncturists and moxibustionists. PGME in Korea consists of one-year internship and three-year residency programs which are optional; however, in China and Taiwan, internship is required for the national licensing examination and further training is in the process of standardization. The required credits for maintenance of CME are eight per year in Korea, 25 per year in China, and 180 over six years in Taiwan. The design of the educational systems in these countries can provide useful information for the development of education in traditional medicine around the world. Copyright © 2016. Published by Elsevier Inc.

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.

Can didactic continuing education improve clinical decision making and reduce cost of quality? Evidence from a case study.

PubMed

Vuković, Mira; Gvozdenović, Branislav S; Ranković, Milena; McCormick, Bryan P; Vuković, Danica D; Gvozdenović, Biljana D; Kastratović, Dragana A; Marković, Srdjan Z; Ilić, Miodrag; Jakovljević, Mihajlo B

2015-01-01

Administration of human serum albumin (HSA) solutions for the resuscitation of critically ill patients remains controversial. The objective of this study was to assess the effect of continuing medical education (CME) on health care professionals' clinical decision making with regard to HSA administration and the costs of quality (COQ). A quasi-experimental study of time series association of CME intervention with COQ and use of HSA solution was conducted at the Surgery Department of the Hospital Valjevo, Serbia. The CME contained evidence-based criteria for HSA solution administration in surgical patients. The preintervention period was defined as January 2009 to May 2011. CME was provided in June 2011, with the postintervention period June 2011 to May 2012. Total mortality rate, the rate of nonsurgical mortality, the rate of surgical mortality, the rate of sepsis patient mortality, index of irrational use of HSA solutions, and number of hospital days per hospitalized patient were collected for each month as quality indicators. Statistical analysis was performed by multivariate autoregressive integrated moving average (MARIMA) modeling. The specification of the COQ was performed according to a traditional COQ model. The CME intervention resulted in an average monthly reduction of the hospital days per hospitalized patient, the rate of sepsis patient mortality, index of irrational use of HSA solutions, and COQ for $593,890.77 per year. Didactic CME presenting evidence-based criteria for HSA administration was associated with improvements in clinical decisions and COQ. In addition, this study demonstrates that models combining MARIMA and traditional COQ models can be useful in the evaluation of CME interventions aimed at reducing COQ. © 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.

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.

Improving CME: Using Participant Satisfaction Measures to Specify Educational Methods

ERIC Educational Resources Information Center

Olivieri, Jason J.; Regala, Roderick P.

2013-01-01

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

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 ...

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.

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…

ELE: An Ontology-Based System Integrating Semantic Search and E-Learning Technologies

ERIC Educational Resources Information Center

Barbagallo, A.; Formica, A.

2017-01-01

ELSE (E-Learning for the Semantic ECM) is an ontology-based system which integrates semantic search methodologies and e-learning technologies. It has been developed within a project of the CME (Continuing Medical Education) program--ECM (Educazione Continua nella Medicina) for Italian participants. ELSE allows the creation of e-learning courses…

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

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.

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

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.

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…

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 ...

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

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

ERIC Educational Resources Information Center

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

2007-01-01

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

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…

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

ERIC Educational Resources Information Center

Quigg, Mark; Lado, Fred A.

2009-01-01

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

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…

National Marrow Donor Program

DTIC Science & Technology

2008-08-05

Research in HLA Typing, Hematopoietic Stem Cell Transplantation and Clinical Studies to Improve Outcomes 16. SECURITY CLASSIFICATION OF: 19a. NAME...new action item was added to Workflow Management screen for the SCTOD ( Stem Cell Therapeutic Outcomes Data) Data Form. The information will be passed...Improvement Amendment NRP National Response Plan CME Continuing Medical Education NST Non-myeloablative Allogeneic Stem Cell Transplantation COG

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

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

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…

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…

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…

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.

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

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.

The SCEC Community Modeling Environment(SCEC/CME): A Collaboratory for Seismic Hazard Analysis

NASA Astrophysics Data System (ADS)

Maechling, P. J.; Jordan, T. H.; Minster, J. B.; Moore, R.; Kesselman, C.

2005-12-01

The SCEC Community Modeling Environment (SCEC/CME) Project is an NSF-supported Geosciences/IT partnership that is actively developing an advanced information infrastructure for system-level earthquake science in Southern California. This partnership includes SCEC, USC's Information Sciences Institute (ISI), the San Diego Supercomputer Center (SDSC), the Incorporated Institutions for Research in Seismology (IRIS), and the U.S. Geological Survey. The goal of the SCEC/CME is to develop seismological applications and information technology (IT) infrastructure to support the development of Seismic Hazard Analysis (SHA) programs and other geophysical simulations. The SHA application programs developed on the Project include a Probabilistic Seismic Hazard Analysis system called OpenSHA. OpenSHA computational elements that are currently available include a collection of attenuation relationships, and several Earthquake Rupture Forecasts (ERFs). Geophysicists in the collaboration have also developed Anelastic Wave Models (AWMs) using both finite-difference and finite-element approaches. Earthquake simulations using these codes have been run for a variety of earthquake sources. Rupture Dynamic Model (RDM) codes have also been developed that simulate friction-based fault slip. The SCEC/CME collaboration has also developed IT software and hardware infrastructure to support the development, execution, and analysis of these SHA programs. To support computationally expensive simulations, we have constructed a grid-based scientific workflow system. Using the SCEC grid, project collaborators can submit computations from the SCEC/CME servers to High Performance Computers at USC and TeraGrid High Performance Computing Centers. Data generated and archived by the SCEC/CME is stored in a digital library system, the Storage Resource Broker (SRB). This system provides a robust and secure system for maintaining the association between the data seta and their metadata. To provide an easy-to-use system for constructing SHA computations, a browser-based workflow assembly web portal has been developed. Users can compose complex SHA calculations, specifying SCEC/CME data sets as inputs to calculations, and calling SCEC/CME computational programs to process the data and the output. Knowledge-based software tools have been implemented that utilize ontological descriptions of SHA software and data can validate workflows created with this pathway assembly tool. Data visualization software developed by the collaboration supports analysis and validation of data sets. Several programs have been developed to visualize SCEC/CME data including GMT-based map making software for PSHA codes, 4D wavefield propagation visualization software based on OpenGL, and 3D Geowall-based visualization of earthquakes, faults, and seismic wave propagation. The SCEC/CME Project also helps to sponsor the SCEC UseIT Intern program. The UseIT Intern Program provides research opportunities in both Geosciences and Information Technology to undergraduate students in a variety of fields. The UseIT group has developed a 3D data visualization tool, called SCEC-VDO, as a part of this undergraduate research program.

[Internet-based continuing medical education: as effective as live continuing medical education].

PubMed

Maisonneuve, Hervé; Chabot, Olivier

2009-10-01

E-learning consists in using new multimedia and Internet technologies to improve the quality of learning activities by facilitating access to resources and services, as well as exchanges and remote collaboration. The Internet is used for adult education in most professional domains, but its use for continuing medical education is less developed. Advantages are observed for teachers (e.g., permanent updating, interactive links, illustrations, archiving, and collective intelligence) and for the learners (e.g., accessibility, autonomy, flexibility, and adaptable pace). Research and meta-analyses have shown that e-CME is as effective as live events for immediate and retained learning. English-language educational medical websites that grant CME credits are numerous; few such French-language sites can currently grant credits. Accreditation of websites for CME, in its infancy in Europe, is common in North America.

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

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…

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.

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…

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

PubMed

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

2016-01-01

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

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

PubMed

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

2010-09-01

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

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

PubMed

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

2017-12-01

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

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.

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.

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

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

ERIC Educational Resources Information Center

McDonald, Walter J.

2005-01-01

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

Who Is Driving Continuing Medical Education for Family Medicine?

ERIC Educational Resources Information Center

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

2009-01-01

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

Continuing Education That Matters: A Successful, Evidence-Based Course with Minimal Pharmaceutical Funding

ERIC Educational Resources Information Center

Wolfrey, Jeff; Brown, Steven R.; Ebell, Mark H.; Geng, Jamie

2012-01-01

Concerns about the influence of the pharmaceutical and medical device industries on continuing medical education (CME) have been voiced frequently over the past decade. Reliance on industry funding increases the potential for bias. Industry-supported CME often emphasizes conditions that can be treated with newer drugs or devices rather than those…

The Impact of an Educational Program Regarding Total Parenteral Nutrition on Infection Indicators in Neonates Admitted to the Neonatal Intensive Care Unit.

PubMed

Marofi, Maryam; Bijani, Nahid; Abdeyazdan, Zahra; Barekatain, Behzad

2017-01-01

One of the basic care measures for preterm infants is providing nutrition through total parenteral nutrition (TPN) and one of the most important complications of it is infection. Because prevention of nosocomial infections is an important issue for neonate's safety, this study aimed to determine the effects of a continuing medical education (CME) course on TPN for neonatal intensive care unit (NICU) nurses on indicators of infection in newborns. This quasi-experimental study was conducted on 127 neonates who fulfilled the inclusion criteria. They were selected through simple convenience sampling method at two stages of before and after the CME program. The inclusion criteria were prescription of TPN by the physician and lack of clinical evidences for infection in newborns before the beginning of TPN. Death of the infant during each stage of the study was considered as the exclusion criteria. The data gathering tool was a data record sheet including clinical signs of infection in the infants and their demographic characteristics. Data were analyzed using Chi-square test, Fisher's exact test, and student's t -test in SPSS software. The results showed the frequency of clinical markers for infection in newborns at the pre-intervention stage ( n = 41; 65.10%) was significantly less than at the post-intervention stage ( n = 30; 46.90%) ( p = 0.04). Nursing educational programs on TPN reduce infection rates among neonates in NICUs.

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…

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

PubMed

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

2016-10-19

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

Development of the Community Midwifery Education initiative and its influence on women’s health and empowerment in Afghanistan: a case study

PubMed Central

2014-01-01

Background Political transition in Afghanistan enabled reconstruction of the destroyed health system. Maternal health was prioritised due to political will and historically high mortality. However, severe shortages of skilled birth attendants - particularly in rural areas - hampered safe motherhood initiatives. The Community Midwifery Education (CME) programme began training rural midwives in 2002, scaling-up nationally in 2005. Methods This case study analyses CME development and implementation to help determine successes and challenges. Data were collected through documentary review and key informant interviews. Content analysis was informed by Walt and Gilson’s policy triangle framework. Results The CME programme has contributed to consistently positive indicators, including up to a 1273/100,000 reduction in maternal mortality ratios, up to a 28% increase in skilled deliveries, and a six-fold increase in qualified midwives since 2002. Begun as a small pilot, CME has gained support of international donors, the Afghan government, and civil society. Conclusion CME is considered by stakeholders to be a positive model for promoting women’s education, employment, and health. However, its future is threatened by insecurity, corruption, lack of regulation, and funding uncertainties. Strategic planning and resource mobilisation are required for it to achieve its potential of transforming maternal healthcare in Afghanistan. PMID:25220577

Development of the community midwifery education initiative and its influence on women's health and empowerment in Afghanistan: a case study.

PubMed

Speakman, Elizabeth M; Shafi, Ahmad; Sondorp, Egbert; Atta, Nooria; Howard, Natasha

2014-09-15

Political transition in Afghanistan enabled reconstruction of the destroyed health system. Maternal health was prioritised due to political will and historically high mortality. However, severe shortages of skilled birth attendants--particularly in rural areas--hampered safe motherhood initiatives. The Community Midwifery Education (CME) programme began training rural midwives in 2002, scaling-up nationally in 2005. This case study analyses CME development and implementation to help determine successes and challenges. Data were collected through documentary review and key informant interviews. Content analysis was informed by Walt and Gilson's policy triangle framework. The CME programme has contributed to consistently positive indicators, including up to a 1273/100,000 reduction in maternal mortality ratios, up to a 28% increase in skilled deliveries, and a six-fold increase in qualified midwives since 2002. Begun as a small pilot, CME has gained support of international donors, the Afghan government, and civil society. CME is considered by stakeholders to be a positive model for promoting women's education, employment, and health. However, its future is threatened by insecurity, corruption, lack of regulation, and funding uncertainties. Strategic planning and resource mobilisation are required for it to achieve its potential of transforming maternal healthcare in Afghanistan.

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.

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

PubMed

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

2013-02-01

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

Continuing medical education revisited: theoretical assumptions and practical implications: a qualitative study.

PubMed

Dionyssopoulos, Alexander; Karalis, Thanassis; Panitsides, Eugenia A

2014-12-31

Recent research has evidenced that although investment in Continuing Medical Education (CME), both in terms of participation as well as financial resources allocated to it, has been steadily increasing to catch up with accelerating advances in health information and technology, effectiveness of CME is reported to be rather limited. Poor and disproportional returns can be attributed to failure of CME courses to address and stimulate an adult audience. The present study initially drew on research findings and adult learning theories, providing the basis for comprehending adult learning, while entailing practical implications on fostering effectiveness in the design and delivery of CME. On a second level, a qualitative study was conducted with the aim to elucidate parameters accounting for effectiveness in educational interventions. Qualitative data was retrieved through 12 in-depth interviews, conducted with a random sample of participants in the 26th European Workshop of Advanced Plastic Surgery (EWAPS). The data underwent a three level qualitative analysis, following the "grounded theory" methodology, comprising 'open coding', 'axial coding' and 'selective coding'. Findings from the EWAPS study come in line with relevant literature, entailing significant implications for the necessity to apply a more effective and efficient paradigm in the design and delivery of educational interventions, advocating for implementing learner-centered schemata in CME and benefiting from a model that draws on the learning environment and social aspects of learning. What emerged as a pivotal parameter in designing educational interventions is to focus on small group educational events which could provide a supportive friendly context, enhance motivation through learner-centered approaches and allow interaction, experimentation and critical reflection. It should be outlined however that further research is required as the present study is limited in scope, having dealt with a limited sample.

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.

Motivating Learning and Assessing Outcomes in Continuing Medical Education Using a Personal Learning Plan

ERIC Educational Resources Information Center

Reed, Virginia A.; Schifferdecker, Karen E.; Turco, Mary G.

2012-01-01

Introduction: Although there is increasing focus on provider behavior change as an outcome of continuing medical education (CME), it has long been known that an increase in knowledge alone is rarely sufficient to induce such change. The Personal Learning Plan (PLP), designed to motivate and assess CME learning, was partly derived from SMART goals…

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.

Raising the bar: the importance of hospital library standards in the continuing medical education accreditation process*

PubMed Central

Cyr Gluck, Jeannine; Hassig, Robin Ackley

2001-01-01

The Connecticut State Medical Society (CSMS) reviews and accredits the continuing medical education (CME) programs offered by Connecticut's hospitals. As part of the survey process, the CSMS assesses the quality of the hospitals' libraries. In 1987, the CSMS adopted the Medical Library Association's (MLA's) “Minimum Standards for Health Sciences Libraries in Hospitals.” In 1990, professional librarians were added to the survey team and, later, to the CSMS CME Committee. Librarians participating in this effort are recruited from the membership of the Connecticut Association of Health Sciences Librarians (CAHSL). The positive results of having a qualified librarian on the survey team and the invaluable impact of adherence to the MLA standards are outlined. As a direct result of this process, hospitals throughout the state have added staffing, increased space, and added funding for resources during an era of cutbacks. Some hospital libraries have been able to maintain a healthy status quo, while others have had proposed cuts reconsidered by administrators for fear of losing valuable CME accreditation status. Creating a relationship with an accrediting agency is one method by which hospital librarians elsewhere may strengthen their efforts to ensure adequate library resources in an era of downsizing. In addition, this collaboration has provided a new and important role for librarians to play on an accreditation team. PMID:11465686

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

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 ...

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.

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.

[CME-certified online education in Germany - status in ophthalmology 2011].

PubMed

Handzel, D M

2012-06-01

The use of the internet is becoming more and more important in every aspect of daily life, also in professional education. Online education and face-to-face learning have proven to be equally efficient. The aim of this study is to evaluate the amount of online education in the German-speaking internet 2011. The terms "ophthalmology", "online-education", "continuing medical education" and "CME" (partly in German language) were searched by an internet-search engine. The first 100 pages were visited. Pages were evaluated in respect of quality and quantity, authorship and possible influence of sponsors. Only 9 of the first 100 hits had an actual offer for ophthalmology. Nearly all of these were websites of ophthalmological scientific journals. The content represented the same educational format (pictures and text) as in the print issue. CME-certified online education can be found in Germany as offspring of print issues only. The content is identical with educational texts in the print issues. An enlargement of the offer, which uses the possibilities of modern internet technology is highly probable. This estimation is supported by the growing use of the internet and developments on English-speaking websites for online-education. © Georg Thieme Verlag KG Stuttgart · New York.

Standardized training in nurse model travel clinics.

PubMed

Sofarelli, Theresa A; Ricks, Jane H; Anand, Rahul; Hale, Devon C

2011-01-01

International travel plays a significant role in the emergence and redistribution of major human diseases. The importance of travel medicine clinics for preventing morbidity and mortality has been increasingly appreciated, although few studies have thus far examined the management and staff training strategies that result in successful travel-clinic operations. Here, we describe an example of travel-clinic operation and management coordinated through the University of Utah School of Medicine, Division of Infectious Diseases. This program, which involves eight separate clinics distributed statewide, functions both to provide patient consult and care services, as well as medical provider training and continuing medical education (CME). Initial training, the use of standardized forms and protocols, routine chart reviews and monthly continuing education meetings are the distinguishing attributes of this program. An Infectious Disease team consisting of one medical doctor (MD) and a physician assistant (PA) act as consultants to travel nurses who comprise the majority of clinic staff. Eight clinics distributed throughout the state of Utah serve approximately 6,000 travelers a year. Pre-travel medical services are provided by 11 nurses, including 10 registered nurses (RNs) and 1 licensed practical nurse (LPN). This trained nursing staff receives continuing travel medical education and participate in the training of new providers. All nurses have completed a full training program and 7 of the 11 (64%) of clinic nursing staff serve more than 10 patients a week. Quality assurance measures show that approximately 0.5% of charts reviewed contain a vaccine or prescription error which require patient notification for correction. Using an initial training program, standardized patient intake forms, vaccine and prescription protocols, preprinted prescriptions, and regular CME, highly trained nurses at travel clinics are able to provide standardized pre-travel care to international travelers originating from Utah. © 2010 International Society of Travel Medicine.

Medical education and communication companies involved in CME: an updated profile.

PubMed

Peterson, Eric D; Overstreet, Karen M; Parochka, Jacqueline N; Lemon, Michael R

2008-01-01

Medical Education and Communication Companies (MECCs) represent approximately 21% of the providers accredited by the Accreditation Council for Continuing Medical Education (ACCME), yet relatively little is known about these organizations in the greater continuing medical education (CME) community. Two prior studies described them, but powerful changes in the regulatory environment have impacted the structure and organization of these companies. The investigators administered a 32-item questionnaire to a select sample of 157 MECCs involved in CME, achieving a response rate of 50.3%. Of the responding organizations, 87% were accredited by the ACCME, with 27% also holding accreditation from the Accreditation Council for Pharmacy Education and the American Nurses Credentialing Center Commission on Accreditation. Eighty-six percent reported no immediate involvement of the company in promotional activities. Fifty-three percent of the survey responders reported being part of a larger organization that included companies involved in promotion, and 88% of these organizations reported implementation of firewalls designed to protect the independence of certified education. The survey reveals a sector that is largely privately held and moving from an organizational model that included both certified and promotional activities to one that includes only certified education. These changes, along with the implementation of firewalls to protect certified education from the promotional interests of other companies within their own corporate structure, may help to alleviate concerns about the independence of CME produced by MECCs. However, because MECCs continue to receive the majority of their support from commercial interests, the influence of funding is likely to be an area of lingering concern.

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.

Reflections on CME Congress 2012

ERIC Educational Resources Information Center

Knox, Alan B.

2013-01-01

This commentary reflects the author's impressions of Continuing Medical Education (CME) Congress 2012, a provocative international conference on professional development and quality improvement in the health professions that took place in Toronto, Ontario, last spring. The sessions he attended and conversations he had with other attendees were…

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.

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

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

PubMed

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

2008-08-01

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

Don't forget the learner: an essential aspect for developing effective hypermedia online learning in continuing medical education.

PubMed

Sandars, John; Homer, Matthew; Walsh, Kieran; Rutherford, Alaster

2012-03-01

There is increasing use of hypermedia online learning in continuing medical education (CME) that presents the learner with a wide range of different learning resources, requiring the learner to use self-regulated learning (SRL) skills. This study is the first to apply an SRL perspective to understand how learners engage with hypermedia online learning in CME. We found that the main SRL skills used by learners were use of strategies and monitoring. The increasing use of strategies was associated with increasing interest in the topic and with increasing satisfaction with the learning experience. Further research is recommended to understand SRL processes and its impact on learning in other aspects of hypermedia online learning across the different phases of medical education. Research is also recommended to implement and evaluate the learning impact of a variety of approaches to develop the SRL skills of hypermedia online learners in CME.

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

Sun-to-Earth Analysis of a Major Solar Eruption

NASA Astrophysics Data System (ADS)

Patsourakos, Spiros

During the interval of 7-10 March 2012, Earth's space environment experienced a barrage of space weather phenomena. Early during 7 March 2012, the biggest proton event of 2012 took place, while on 8 March 2012, an interplanetary shock and coronal mass ejection (CME) arrived at 1 AU. This sequence trigerred the biggest geomagnetic storm of cycle 24 so far. The solar source of these activities was a pair of homologous, eruptive X-class flares associated with two ultra-fast CMEs. The two eruptions originated from NOAA active region 11429 during the early hours of 7 March 2012 and within an hour from each other. Using satellite data from a flotilla of solar, heliospheric and magnetospheric missions and monitors, we perform a synergistic Sun-to-Earth study of various observational aspects of the event sequences. We will present an attempt to formulate a cohesive scenario which couples the eruption initiation, interplanetary propagation, and geospace consequences. Our main focus is on building a framework that starting from solar and near-Sun estimates of the magnetic and dynamic content and properties of the Earth-directed CME assess in advance the subsequent geomagnetic response expected, once the associated interplanetary CME reaches 1 AU. This research has been co-financed by the European Union (European Social Fund - ESF) and Greek national funds through the Operational Program "Education and Lifelong Learning" of the National Strategic Reference Framework (NSRF) - Research Funding Program: Thales. Investing in knowledge society through the European Social Fund.

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.

Effectiveness of a medical education intervention to treat hypertension in primary care.

PubMed

Martínez-Valverde, Silvia; Castro-Ríos, Angélica; Pérez-Cuevas, Ricardo; Klunder-Klunder, Miguel; Salinas-Escudero, Guillermo; Reyes-Morales, Hortensia

2012-04-01

In Mexico, hypertension is among the top five causes for visits to primary care clinics; its complications are among the main causes of emergency and hospital care. The present study reports the effectiveness of a continuing medical education (CME) intervention to improve appropriate care for hypertension, on blood pressure control of hypertensive patients in primary care clinics. A secondary data analysis was carried out using data of hypertensive patients treated by family doctors who participated in the CME intervention. The evaluation was designed as a pre-/post-intervention study with control group in six primary care clinics. The effect of the CME intervention was analysed using multiple logistic regression modelling in which the dependent variable was uncontrolled blood pressure in the post-intervention patient measurement. After the CME intervention, the net reduction of uncontrolled blood pressure between stages in the intervention group was 10.3%. The model results were that being treated by a family doctor who participated in the CME intervention reduced by 53% the probability of lack of control of blood pressure; receiving dietary recommendations reduced 57% the probability of uncontrolled blood pressure. Having uncontrolled blood pressure at the baseline stage increased the probability of lack of control in 166%, and per each unit of increase in body mass index the lack of control increased 7%. CME intervention improved the medical decision-making process to manage hypertension, thus increasing the probability of hypertensive patients to have blood pressure under control. © 2010 Blackwell Publishing Ltd.

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.

Integrating interprofessional education into continuing education: a planning process for continuing interprofessional education programs.

PubMed

Owen, John A; Schmitt, Madeline H

2013-01-01

Informal continuing interprofessional education (CIPE) can be traced back decades in the United States; however, interest in formal CIPE is recent. Interprofessional education (IPE) now is recognized as an important component of new approaches to continuing education (CE) that are needed to increase health professionals' ability to improve outcomes of care. Although there are examples of CIPE programs that are being successfully implemented, a clearly articulated, step-by-step planning process to help guide educators in providing effective CIPE programs is lacking. This lack of guidance poses a significant barrier to increasing the number of CIPE programs in the United States. In this article, we describe a process for developing, implementing, and evaluating CIPE programs using the familiar systematic CE planning process. Limitations of traditional CE also are addressed, and the relationship between CIPE and other new approaches to CE is clarified. Four examples of CIPE programs are provided to illustrate how the planning process can be adapted to include IPE, while implementing recommended changes in traditional CE offerings. The article is concluded with a discussion of some of the challenges that will face CE educators in moving toward a new vision of CE integrated with IPE. 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.

Enhanced Primary Care Treatment of Behavioral Disorders With ECHO Case-Based Learning.

PubMed

Komaromy, Miriam; Bartlett, Judy; Manis, Kathryn; Arora, Sanjeev

2017-09-01

The Extension for Community Healthcare Outcomes (ECHO) model offers a way for primary care providers to develop expertise in addressing behavioral health issues of primary care patients. It provides an alternative to traditional continuing medical education (CME) for ongoing training and support for health care providers. ECHO uses videoconferencing to connect multiple primary care teams simultaneously with academic specialists and builds capacity via mentorship and case-based learning. ECHO aims to expand access to care by developing capacity to treat common, complex conditions in underserved areas. Participants in an integrated addictions and psychiatry teleECHO program reported that when they presented a patient case, the feedback they received was highly valuable and led them to change their care plans more than 75% of the time. ECHO is an effective model for teaching primary care teams about behavioral health and may be more effective than traditional CME approaches.

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

PubMed

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

2008-07-01

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

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.

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

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

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.

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.

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.

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.

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.

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

PubMed

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

2013-06-01

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

Making cognitive decision support work: Facilitating adoption, knowledge and behavior change through QI.

PubMed

Weir, Charlene; Brunker, Cherie; Butler, Jorie; Supiano, Mark A

2017-07-01

This paper evaluates the role of facilitation in the successful implementation of Computerized Decision Support (CDS). Facilitation processes include education, specialized computerized decision support, and work process reengineering. These techniques, as well as modeling and feedback enhance self-efficacy, which we propose is one of the factors that mediate the effectiveness of any CDS. In this study, outpatient clinics implemented quality improvement (QI) projects focused on improving geriatric care. Quality Improvement is the systematic process of improving quality through continuous measurement and targeted actions. The program, entitled "Advancing Geriatric Education through Quality Improvement" (AGE QI), consisted of a 6-month, QI based, intervention: (1) 2h didactic session, (2) 1h QI planning session, (3) computerized decision support design and implementation, (4) QI facilitation activities, (5) outcome feedback, and (6) 20h of CME. Specifically, we examined the impact of the QI based program on clinician's perceived self-efficacy in caring for older adults and the relationship of implementation support and facilitation on perceived success. The intervention was implemented at 3 institutions, 27 community healthcare system clinics, and 134 providers. This study reports the results of pre/post surveys for the forty-nine clinicians who completed the full CME program. Self-efficacy ratings for specific clinical behaviors related to care of older adults were assessed using a Likert based instrument. Self-ratings of efficacy improved across the following domains (depression, falls, end-of-life, functional status and medication management) and specifically in QI targeted domains and were associated with overall clinic improvements. Published by Elsevier Inc.

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 ...

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

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 ...

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.

Intellectual and language functions in children of mothers with epilepsy.

PubMed

Thomas, Sanjeev V; Sukumaran, Sajith; Lukose, Neetha; George, Annamma; Sarma, P S

2007-12-01

To compare the intellectual and language functions of children of mothers with epilepsy (CME) with that of controls matched for age and socioeconomic status. Cases were CME, aged six years or more (n = 71), drawn from a prospective cohort in the Kerala Registry of Epilepsy and Pregnancy. Controls were 201 children of parents without epilepsy, matched for age and socioeconomic status. The outcome measures included Indian adaptation of Wechsler Intelligence Scale for children and MLT-a locally developed proficiency test for regional language. All relevant data were abstracted from the registry records. The Full Scale IQ and MLT scores were significantly lower for the cases (87.7 +/- 22.6 and 73.4 +/- 17.3) compared to controls (93.0 +/- 14.4 and 83.2 +/- 11.8). Compared to controls, CME scored poor on all subtests of MLT but their impairment was confined to only some of the subtests of IQ. Maternal education and maternal IQ significantly correlated with low IQ and MLT scores for CME whereas type of epilepsy, seizures during pregnancy or low birth weight did not have any significant association with these outcome measures. Polytherapy and higher dosage of antiepileptic drugs (AEDs) were associated with significant impairment in outcome measures. Infants with low developmental quotient at one year of age continued to have low scores on outcome measures at six years. Low maternal IQ, maternal education, and antenatal AED exposure were associated with significant impairment of intellectual and language functions for CME at six years.

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.

Effectiveness of an individual, online e-learning program about sexually transmitted infections: a prospective cohort study.

PubMed

Bos-Bonnie, Linda H A; van Bergen, Jan E A M; Te Pas, Ellen; Kijser, Michael A; van Dijk, Nynke

2017-04-24

Primary health-care professionals play an important role in the treatment and prevention of Sexually Transmitted Infections (STI). Continuing Medical Education (CME)-courses can influence the knowledge and behavior of health-care professionals concerning STI. We performed a prospective cohort study to evaluate if the individual and online e-learning program "The STI-consultation", which uses the Commitment-to-Change (CtC)-method, is able to improve the knowledge, attitude and behavior of Dutch General Practitioners (GPs), concerning the STI-consultation. This e-learning program is an individual, accredited, online CME-program, which is freely available for all GPs and GP-trainees in the Netherlands. In total 2192 participants completed the questionnaire before completing the e-learning program and 249 participants completed the follow-up questionnaire after completing the e-learning program. The effect of the program on their knowledge, attitude and behavior concerning the STI-consultation was evaluated. In total 193 participants formulated 601 learning points that matched the learning objectives of the program. The knowledge and attitude of the participants improved, which persisted up to two years after completing the program. Another 179 participants formulated a total of 261 intended changes concerning the sexual history taking, additional investigation and treatment of STI, 97.2% of these changes was partially or fully implemented in daily practice. Also, 114 participants formulated a total of 180 "unintended" changes in daily practice. These changes concerned the attitude of participants towards STI and the working conditions concerning the STI-consultation. The individual, online e-learning program "The STI-consultation", which uses the CtC-method, has a small but lasting, positive effect on the knowledge, attitude, and behavior of GPs concerning the STI-consultation.

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 ...

77 FR 18288 - Self-Regulatory Organizations; Chicago Mercantile Exchange Inc.; Notice of Filing and Order...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-27

... amendments to rules dealing with outsourcing to third parties. CME will also make corresponding changes to... in order for eligible clearing members to receive risk offsets across CME's listed interest rate... rate products that will be eligible for this program will be those with price risks that are [[Page...

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

PubMed

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

2015-01-01

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

ER/LA opioid REMS and accredited education: Survey results provide insight into clinical roles, educational needs, and learner preferences.

PubMed

Kear, Cynthia; McKeithen, Tom; Robertson, Sheila

2017-01-01

The Collaborative for REMS (Risk Evaluation and Mitigation Strategy) Education (CO*RE) includes 13 organizations that provide REMS Program Companies (RPC) grant-supported accredited education on extended-release and long-acting (ER/LA) opioid therapy. This report summarizes results of a survey designed to investigate the impact of participant criteria and to better understand the roles and preferences of continuing medical education/continuing education (CME/CE) participants. In April 2015, the authors made an online survey available to an estimated 10,000 clinicians who had completed a CO*RE CME/CE activity since 2013. The purpose of the survey was to (1) examine possible reasons learners may underreport prescribing status, (2) investigate ways in which learners engage in nonprescribing roles relevant to reducing adverse patient outcomes, and (3) determine the acceptability of a potential test-based learning tool that allows participants with mastery to test out in lieu of participating in 2- to 3-hour education. Findings revealed that there was little confusion or reluctance by learners to answer questions about Drug Enforcement Administration (DEA) licensing and whether they prescribed opioids in the past year. REMS "prescriber" education covers opioid management responsibilities that are distributed among team members who play critical nonprescribing roles in reducing serious adverse outcomes from both ER/LA and immediate-release (IR) opioids. Seventy-three percent of study participants would favor a test-based learning tool should future circumstances warrant it. The authors concluded the likelihood of underreporting is small, but there is an opportunity to clarify license and prescribing questions; opioid management responsibilities are distributed among nonprescribing team members who play roles in reducing adverse outcomes from both ER/LA and IR opioids, who would therefore benefit from REMS education; and clinicians favor a test-based learning tool, should future circumstances warrant it. These findings could have implications for planning future ER/LA opioid REMS curriculum and for setting and interpreting training goals for the US Food and Drug Administration's (FDA) ER/LA opioid REMS program.

A cancer genetics education campaign: delivering parallel messages to clinicians and the public.

PubMed

Piniewski-Bond, Joanne; Celestino, Paul B; Mahoney, Martin C; Farrell, Carolyn D; Bauer, Joseph E; Hastrup, Janice L; Cummings, K Michael

2003-01-01

Up to 10% of all cancers are thought to have a familial basis through complex interactions between genes and environment. A community-wide education campaign was conducted that included several elements: a five part television news series; an educational newsletter; web site pages and links to educational materials; a Continuing Medical Education (CME) program for professionals; and an evaluation survey. Survey estimates revealed that 39000 households recalled seeing the series; 14800 households changed their views about the risks of hereditary cancers; and about 9900 households were made more aware/informed about cancer and hereditary risk. This awareness campaign broadened public knowledge about the myths and realities associated with genetic factors and cancer risk. It reinforced the importance of early screening for persons at high risk of cancer due to hereditary factors.

Quinoa Well Tolerated in Patients with Celiac Disease

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Staying Active: Physical Activity and Exercise

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[CME MMC: Evaluation of a continuous medical education tool by e-learning from the morbi-mortality conferences of the Burgundy].

PubMed

Serrand, M; Lefèbvre, A; Desplanches, T; Yacoub, A; Semama, D; Sagot, P

2016-10-01

The objective of this study was to validate a continuing medical education e-learning tool. The CME MMC was for all health professionals maternity Burgundy and concerned regional morbidity and mortality conferences. It was divided into steps: a pre-test for an assessment of initial knowledge, an access to the recommendations of each RMM and a post-test to assess the progress of participants. A satisfaction questionnaire was proposed after the test. The primary endpoint was the comparison of the post-test scores than the pre-test. CME MMC was opened 3 months and recorded 156 participants among 598 health professionals in Burgundy, a rate 2.4 times higher than the average participation rate at MMC the past two years. A statistically significant increase was demonstrated individually by comparing the post-test scores than the pre-test (P<0.00001). The increase was significantly higher for midwives and professionals absents at the RMM. Finally, 96.2% of participants have been satisfied by this formation. This prospective multicenter study validates our tool. CME MMC is accessible, without geographic or time restrictions, not expensive, and efficient because it proves that it can update our knowledge in obstetrics and perinatology. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

A cross-sectional study of learning styles among continuing medical education participants.

PubMed

Collins, C Scott; Nanda, Sanjeev; Palmer, Brian A; Mohabbat, Arya B; Schleck, Cathy D; Mandrekar, Jayawant N; Mahapatra, Saswati; Beckman, Thomas J; Wittich, Christopher M

2018-04-27

Experiential learning has been suggested as a framework for planning continuing medical education (CME). We aimed to (1) determine participants' learning styles at traditional CME courses and (2) explore associations between learning styles and participant characteristics. Cross-sectional study of all participants (n = 393) at two Mayo Clinic CME courses who completed the Kolb Learning Style Inventory and provided demographic data. A total of 393 participants returned 241 surveys (response rate, 61.3%). Among the 143 participants (36.4%) who supplied complete demographic and Kolb data, Kolb learning styles included diverging (45; 31.5%), assimilating (56; 39.2%), converging (8; 5.6%), and accommodating (34; 23.8%). Associations existed between learning style and gender (p = 0.02). For most men, learning styles were diverging (23 of 63; 36.5%) and assimilating (30 of 63; 47.6%); for most women, diverging (22 of 80; 27.5%), assimilating (26 of 80; 32.5%), and accommodating (26 of 80; 32.5%). Internal medicine and psychiatry CME participants had diverse learning styles. Female participants had more variation in their learning styles than men. Teaching techniques must vary to appeal to all learners. The experiential learning theory sequentially moves a learner from Why? to What? to How? to If? to accommodate learning styles.

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

PubMed

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

2017-12-22

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

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

PubMed

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

2017-11-01

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

Zika Virus and Pregnancy

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The Virtual Hospital: an IAIMS integrating continuing education into the work flow.

PubMed

D'Alessandro, M P; Galvin, J R; Erkonen, W E; Curry, D S; Flanagan, J R; D'Alessandro, D M; Lacey, D L; Wagner, J R

1996-01-01

Researchers at the University of Iowa are developing an integrated academic information management system (IAIMS) for use on the World Wide Web. The focus is on integrating continuing medical education (CME) into the clinicians' daily work and incorporating consumer health information into patients' life styles. Phase I of the project consists of loosely integrating patients' data, printed library information, and digital library information. Phase II consists of more tightly integrating the three types of information, and Phase III consists of awarding CME credits for reviewing educational, material at the point of patient care, when it has the most potential for improving outcomes. This IAIMS serves a statewide population. Its design and evolution have been heavily influenced by user-centered evaluation.

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.

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.

[The age of Gutenberg is over: a consideration of medical education--past, present and future].

PubMed

Burg, G; French, L E

2012-04-01

Education is the basis for reliable medical care and medical progress. Our medical knowledge has increased more in the past 50 years than in the 500 years before. The spatial and human resource capacity of our universities cannot cope with the existing academic structures and needs. Part of the problem can be solved by "blended learning", that is a combination of traditional teaching methods (frontal lectures, courses, bedside teaching) with supplementary web-based e-learning. In addition to conveying a sound basic knowledge, the ability to cope with modern media and prepare for lifelong learning must also be taught. Out of the large number of e-learning platforms for undergraduate students offered in the internet, we present the program DOIT (Dermatology Online with Interactive Technology; http://www.swisdom.org) and the program Dermokrates (http://www.Dermokrates.com) of the German, Austrian and Swiss Dermatological Societies for postgraduate Continuing Medical Education (CME). The biggest obstacle in the implementation of new developments is the stubborn adherence to traditional structures.

Web-based education for postpartum depression: conceptual development and impact.

PubMed

Wisner, Katherine L; Logsdon, M Cynthia; Shanahan, Brian R

2008-12-01

Postpartum depression (PPD) is a major public health problem that occurs in one of every seven women in the first 3 months after birth. Left untreated, PPD can persist for months to years and lead to adverse consequences for both mother and child. Primary care providers have the most medical contact with postpartum women and are well positioned to screen for and identify PPD. However, PPD recognition and treatment is generally not included in physician training, and few continuing education programs on PPD are available. Developed with support from NIMH SBIR contract (# HHSN278200554096C), the Web site MedEdPPD was designed to provide professionals with the tools to successfully engage, screen, diagnose, treat, and refer women with PPD. Resources on the site include CME/CE modules; interactive case studies; classic papers and current literature; provider tools; a comprehensive slide library; events calendar; and resources. MedEdPPD also contains materials for women with PPD, their friends and family members. As of March 2008, the site had over 17,000 visitors who represented both consumers and a broad distribution of health care professional disciplines. The nine CME/CE learning modules on MedEdPPD have been particularly heavily utilized by nurses. The number of repeat and new visitors has increased steadily since the site's launch. User feedback has been consistently positive. Based upon theories of adult education, MedEdPPD offers diverse strategies to facilitate learning. The site promotes education and training in PPD treatment that is flexible, cost-effective, and meets the needs of health care professionals.

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.

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.

Description of a multi-university education and collaborative care child psychiatry access program: New York State's CAP PC.

PubMed

Kaye, D L; Fornari, V; Scharf, M; Fremont, W; Zuckerbrot, R; Foley, C; Hargrave, T; Smith, B A; Wallace, J; Blakeslee, G; Petras, J; Sengupta, S; Singarayer, J; Cogswell, A; Bhatia, I; Jensen, P

2017-09-01

Although, child mental health problems are widespread, few get adequate treatment, and there is a severe shortage of child psychiatrists. To address this public health need many states have adopted collaborative care programs to assist primary care to better assess and manage pediatric mental health concerns. This report adds to the small literature on collaborative care programs and describes one large program that covers most of New York state. CAP PC, a component program of New York State's Office of Mental Health (OMH) Project TEACH, has provided education and consultation support to primary care providers covering most of New York state since 2010. The program is uniquely a five medical school collaboration with hubs at each that share one toll free number and work together to provide education and consultation support services to PCPs. The program developed a clinical communications record to track information about all consultations which forms the basis of much of this report. 2-week surveys following consultations, annual surveys, and pre- and post-educational program evaluations have also been used to measure the success of the program. CAP PC has grown over the 6years of the program and has provided 8013 phone consultations to over 1500 PCPs. The program synergistically provided 17,523 CME credits of educational programming to 1200 PCPs. PCP users of the program report very high levels of satisfaction and self reported growth in confidence. CAP PC demonstrates that large-scale collaborative consultation models for primary care are feasible to implement, popular with PCPs, and can be sustained. The program supports increased access to child mental health services in primary care and provides child psychiatric expertise for patients who would otherwise have none. Copyright © 2017. Published by Elsevier Inc.

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

PubMed

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

2016-01-01

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

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.

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.

Using an intervention mapping framework to develop an online mental health continuing education program for pharmacy staff.

PubMed

Wheeler, Amanda; Fowler, Jane; Hattingh, Laetitia

2013-01-01

Current mental health policy in Australia recognizes that ongoing mental health workforce development is crucial to mental health care reform. Community pharmacy staff are well placed to assist people with mental illness living in the community; however, staff require the knowledge and skills to do this competently and effectively. This article presents the systematic planning and development process and content of an education and training program for community pharmacy staff, using a program planning approach called intervention mapping. The intervention mapping framework was used to guide development of an online continuing education program. Interviews with mental health consumers and carers (n = 285) and key stakeholders (n = 15), and a survey of pharmacy staff (n = 504) informed the needs assessment. Program objectives were identified specifying required attitudes, knowledge, skills, and confidence. These objectives were aligned with an education technique and delivery strategy. This was followed by development of an education program and comprehensive evaluation plan. The program was piloted face to face with 24 participants and then translated into an online program comprising eight 30-minute modules for pharmacists, 4 of which were also used for support staff. The evaluation plan provided for online participants (n ≅ 500) to be randomized into intervention (immediate access) or control groups (delayed training access). It included pre- and posttraining questionnaires and a reflective learning questionnaire for pharmacy staff and telephone interviews post pharmacy visit for consumers and carers. An online education program was developed to address mental health knowledge, attitudes, confidence, and skills required by pharmacy staff to work effectively with mental health consumers and carers. Intervention mapping provides a systematic and rigorous approach that can be used to develop a quality continuing education program for the health workforce. 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.

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…

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

PubMed Central

Moradhvaj; Rammohan, Anu; Shruti; Pradhan, Jalandhar

2016-01-01

Background and Objectives 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. Methods and Findings 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. Conclusion 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. PMID:27341520

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.

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.

CSAM Metrology Software Tool

NASA Technical Reports Server (NTRS)

Vu, Duc; Sandor, Michael; Agarwal, Shri

2005-01-01

CSAM Metrology Software Tool (CMeST) is a computer program for analysis of false-color CSAM images of plastic-encapsulated microcircuits. (CSAM signifies C-mode scanning acoustic microscopy.) The colors in the images indicate areas of delamination within the plastic packages. Heretofore, the images have been interpreted by human examiners. Hence, interpretations have not been entirely consistent and objective. CMeST processes the color information in image-data files to detect areas of delamination without incurring inconsistencies of subjective judgement. CMeST can be used to create a database of baseline images of packages acquired at given times for comparison with images of the same packages acquired at later times. Any area within an image can be selected for analysis, which can include examination of different delamination types by location. CMeST can also be used to perform statistical analyses of image data. Results of analyses are available in a spreadsheet format for further processing. The results can be exported to any data-base-processing software.

Compliant Metal Enhanced Convection Cooled Reverse-Flow Annular Combustor

NASA Technical Reports Server (NTRS)

Paskin, Marc D.; Acosta, Waldo A.

1994-01-01

A joint Army/NASA program was conducted to design, fabricate, and test an advanced, reverse-flow, small gas turbine combustor using a compliant metal enhanced (CME) convection wall cooling concept. The objectives of this effort were to develop a design method (basic design data base and analysis) for the CME cooling technique and tben demonstrate its application to an advanced cycle, small, reverse-flow combustor with 3000 F (1922 K) burner outlet temperature (BOT). The CME concept offers significant improvements in wall cooling effectiveness resulting in a large reduction in cooling air requirements. Therefore, more air is available for control of burner outlet temperature pattern in addition to the benefit of improved efficiency, reduced emissions, and smoke levels. Rig test results demonstrated the benefits and viability of the CME concept meeting or exceeding the aerothermal performance and liner wall temperature characteristics of similar lower temperature-rise combustors, achieving 0.15 pattern factor at 3000 F (1922 K) BOT, while utilizing approximately 80 percent less cooling air than conventional, film-cooled combustion systems.

[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.

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.

The Royal College experience and plans for the maintenance of certification program.

PubMed

Campbell, Craig M; Parboosingh, John

2013-01-01

The Royal College of Physicians and Surgeons of Canada, in 2001, implemented a mandatory maintenance of certification (MOC) program that is required for fellows to maintain membership and fellowship. Participation in the MOC program is one of the recognized pathways approved by provincial medical regulatory authorities in Canada by which specialists can demonstrate their commitment to continued competent performance in practice. This article traces the historical beginnings of the MOC program, highlighting the educational foundation and scientific evidence that influenced its philosophy, goals, and strategic priorities. The MOC program has evolved into a complex system of continuing professional development to facilitate and enable a "cultural shift'' in how we conceptualize and support the continuing professional development (CPD) of specialists. The MOC program is an educational strategy that supports a learning culture where specialists are able to design, implement and document their accomplishments from multiple learning activities to build evidence-informed practices. In the future, the MOC Program must evolve from assisting fellows to use effective educational resources "for credit" to enable fellows, leveraging a competency-based CPD model, to demonstrate their capacity to continuously improve practice. This will require innovative methods to capture learning and practice improvements in real time, integrate learning during the delivery of health care, expand automation of reporting strategies, and facilitate new sociocultural methods of emergent learning and practice change. Collectively, these directions will require a research agenda that will generate evidence for how transformative cultural change in continuing professional education of the profession can be realized. 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.

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.

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

An atlas of solar events: 1996 2005

NASA Astrophysics Data System (ADS)

Artzner, G.; Auchère, F.; Delaboudinière, J. P.; Bougnet, M.

2006-01-01

Coronal mass ejections (CMEs) are observed in the plane of the sky in coronographic images. As the solar surface is masked by an occulting disk it is not clear whether halo CMEs are directed towards or away from the Earth. Observations of the solar corona on the solar disk by the extreme ultraviolet imaging telescope (EIT) on board the Solar Heliospheric Observatory SoHO can help to resolve this. Quasi-continuous observations of the solar corona were obtained from April 1997 up to the current date at a 12 min cadence in the coronal line of FeXII, as part of a “CME watch program”. At a slower 6 h cadence an additional synoptic program investigates the chromosphere and the corona at four different wavelengths. Large coronal solar events appear when viewing animations of the CME watch program. Fainter events do appear when viewing running difference animations of the CME watch program. When looking for additional spectral information from raw running differences of the synoptic program it is difficult to disentangle intrinsic solar events from the parasitic effect of the solar rotation. We constructed at www.ias.u-psud.fr/medoc/EIT/movies/ an atlas of more than 40,000 difference images from the synoptic programme, corrected for an average solar rotation, as well as more than 200,000 instantaneous and difference images from the CME watch program. We present case studies of specific events in order to investigate the source of darkenings or dimmings in difference images, due to the removal of emitting material, the presence of obscuring material or large changes in temperature. As the beneficial effect of correcting for the solar rotation vanishes at the solar limb, we do not investigate the case of prominence Doppler dimming. As a by-product of the atlas of solar events we obtain a number of quiet time sequences well suited to precisely measure the differential solar rotation by the apparent displacement of tracers.

Assessment of Nutrition Education Among Pediatric Gastroenterologists: A Survey of NASPGHAN Members

PubMed Central

Lin, Henry C; Kahana, Doron; Vos, Miriam B; Black, Dennis; Port, Zack; Shulman, Robert; Scheimann, Ann; Mascarenhas, Maria R.

2012-01-01

Pediatric gastroenterology is the only pediatric subspecialty with nutrition as part of its official curriculum and objective. However, pediatric gastroenterology fellows feel that their baseline knowledge in nutrition is suboptimal. The purpose of this study was to assess the perceived effectiveness of nutrition training among pediatric gastroenterologists, identify areas of need for additional education, and determine the perceived role of the gastroenterologist in obesity management. Methods A survey was sent to members and fellows of the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) to assess general nutrition education as well as obesity management and educational needs. Results A total of 272 responses were received, for an overall response rate of 15.2% (272/1,784). Most responders reported having average or above-average knowledge base in all nutritional topics. There was strong interest in additional resources and a continuing medical education (CME) module on several nutrition topics including: nutritional requirements in specific gastrointestinal (GI) disease, failure to thrive/growth failure, and parenteral nutrition support, with the format of CME dependent on the topic. There was also a strong interest in additional CME on the management of pediatric obesity (67%), as most responders felt that the management of obesity in children requires subspecialty care. However, the perceived role of the pediatric gastroenterologist was one of support to treat the gastrointestinal and hepatic co-morbidities of obesity rather than serve as the main provider of comprehensive obesity care. Conclusion Pediatric gastroenterologists identified gaps in their nutrition knowledge base that may be attributed to the current nutrition education training during fellowship. Multiple topics were identified for additional nutrition education, including obesity management. The nutrition management challenges of today necessitate improved baseline nutrition knowledge and this focus on nutrition should begin at the fellowship level. PMID:22699840

Assessment of nutrition education among pediatric gastroenterologists: a survey of NASPGHAN members.

PubMed

Lin, Henry C; Kahana, Doron; Vos, Miriam B; Black, Dennis; Port, Zack; Shulman, Robert; Scheimann, Ann; Mascarenhas, Maria R

2013-02-01

Pediatric gastroenterology is the only pediatric subspecialty with nutrition as part of its official curriculum and objective; however, pediatric gastroenterology fellows believe that their baseline knowledge in nutrition is suboptimal. The purpose of the present study was to assess the perceived effectiveness of nutrition training among pediatric gastroenterologists, identify areas of need for additional education, and determine the perceived role of the gastroenterologist in obesity management. A survey was sent to members and fellows of the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition to assess general nutrition education as well as obesity management and educational needs. A total of 272 responses were received, for an overall response rate of 15.2% (272/1784). Most responders reported having average or above-average knowledge base in all nutritional topics. There was strong interest in additional resources and a continuing medical education (CME) module on several nutrition topics including nutritional requirements in specific gastrointestinal (GI) disease, failure to thrive/growth failure, and parenteral nutrition support, with the format of CME dependent on the topic. There was also a strong interest in additional CME on the management of pediatric obesity (67%), as most responders believed that the management of obesity in children requires subspecialty care. The perceived role of the pediatric gastroenterologist was, however, one of support to treat the GI and hepatic comorbidities of obesity rather than serve as the main provider of comprehensive obesity care. Pediatric gastroenterologists identified gaps in their nutrition knowledge base that may be attributed to the present nutrition education training during fellowship. Multiple topics were identified for additional nutrition education, including obesity management. The nutrition management challenges of today necessitate improved baseline nutrition knowledge and this focus on nutrition should begin at the fellowship level.

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.

Pericarditis

MedlinePlus

... Daily Conferences Fellowships and Residencies School of Perfusion Technology Education Resources Library & Learning Resource Center CME Resources THI Journal THI Cardiac Society Save the Date: International Symposium on Cardiovascular Regenerative ...

Cardiomyopathy

MedlinePlus

... Daily Conferences Fellowships and Residencies School of Perfusion Technology Education Resources Library & Learning Resource Center CME Resources THI Journal THI Cardiac Society Save the Date: International Symposium on Cardiovascular Regenerative ...

Cyanosis

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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...

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.

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 ...

Fetal Heart

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... Daily Conferences Fellowships and Residencies School of Perfusion Technology Education Resources Library & Learning Resource Center CME Resources THI Journal THI Cardiac Society Save the Date: International Symposium on Cardiovascular Regenerative ...

Rheumatic Fever

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... Daily Conferences Fellowships and Residencies School of Perfusion Technology Education Resources Library & Learning Resource Center CME Resources THI Journal THI Cardiac Society Save the Date: International Symposium on Cardiovascular Regenerative ...

Silent Ischemia

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... Daily Conferences Fellowships and Residencies School of Perfusion Technology Education Resources Library & Learning Resource Center CME Resources THI Journal THI Cardiac Society Save the Date: International Symposium on Cardiovascular Regenerative ...

Pulmonary Atresia

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... Daily Conferences Fellowships and Residencies School of Perfusion Technology Education Resources Library & Learning Resource Center CME Resources THI Journal THI Cardiac Society Save the Date: International Symposium on Cardiovascular Regenerative ...

Vulnerable Plaque

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... Daily Conferences Fellowships and Residencies School of Perfusion Technology Education Resources Library & Learning Resource Center CME Resources THI Journal THI Cardiac Society Save the Date: International Symposium on Cardiovascular Regenerative ...

Intravascular Ultrasound

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... Daily Conferences Fellowships and Residencies School of Perfusion Technology Education Resources Library & Learning Resource Center CME Resources THI Journal THI Cardiac Society Save the Date: International Symposium on Cardiovascular Regenerative ...

[E-learning with journal articles].

PubMed

Adriaanse, Marcel T; van Eijsden, Pieter; de Leeuw, Peter W

2014-01-01

E-learning is a popular method of continuous medical education (CME) which is becoming increasingly available to doctors. A specific form of E-learning is an online knowledge test accompanying a journal article. CME accreditation points can be obtained by reading an article and then answering test questions on it. This is a user-friendly form of CME which an increasing number of journals are offering as a service to their readers. The Dutch Journal of Medicine (NTvG) has been offering accredited tests to its readers since 2011. On comparison with international journals, a high standard has been set by the development of a test concept in which interpretation and reflection play integral roles. In the Dutch setting, the concept of the test was developed by professional bodies working closely together and it is a concept that is used as an example to other journals.

A randomized trial of teaching clinical skills using virtual and live standardized patients.

PubMed

Triola, M; Feldman, H; Kalet, A L; Zabar, S; Kachur, E K; Gillespie, C; Anderson, M; Griesser, C; Lipkin, M

2006-05-01

We developed computer-based virtual patient (VP) cases to complement an interactive continuing medical education (CME) course that emphasizes skills practice using standardized patients (SP). Virtual patient simulations have the significant advantages of requiring fewer personnel and resources, being accessible at any time, and being highly standardized. Little is known about the educational effectiveness of these new resources. We conducted a randomized trial to assess the educational effectiveness of VPs and SPs in teaching clinical skills. To determine the effectiveness of VP cases when compared with live SP cases in improving clinical skills and knowledge. Randomized trial. Fifty-five health care providers (registered nurses 45%, physicians 15%, other provider types 40%) who attended a CME program. Participants were randomized to receive either 4 live cases (n=32) or 2 live and 2 virtual cases (n=23). Other aspects of the course were identical for both groups. Participants in both groups were equivalent with respect to pre-post workshop improvement in comfort level (P=.66) and preparedness to respond (P=.61), to screen (P=.79), and to care (P=.055) for patients using the skills taught. There was no difference in subjective ratings of effectiveness of the VPs and SPs by participants who experienced both (P=.79). Improvement in diagnostic abilities were equivalent in groups who experienced cases either live or virtually. Improvements in performance and diagnostic ability were equivalent between the groups and participants rated VP and SP cases equally. Including well-designed VPs has a potentially powerful and efficient place in clinical skills training for practicing health care workers.

Heart Information Center

MedlinePlus

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Mitral Valve Prolapse

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Transmyocardial Laser Revascularization

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Coronary Artery Anomalies

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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.

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...

Diagnostic Tests and Procedures

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Vasculature of the Leg

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Ongoing evolution of practice gaps in gastrointestinal and endoscopic surgery: 2014 report from the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Continuing Education Committee.

PubMed

McLemore, Elisabeth C; Paige, John T; Bergman, Simon; Hori, Yumi; Schwarz, Erin; Farrell, Timothy M

2015-11-01

In an effort to fulfill the charge to develop and maintain a comprehensive educational program to serve the members of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), the SAGES Continuing Education Committee reports a summary of findings related to the evaluation of the 2014 SAGES annual meeting. All attendees to the 2014 annual meeting had the opportunity to complete an immediate post-meeting questionnaire as part of their continuing medical education (CME) certification, and identify up to two learning themes, answer questions related to potential practice change items based on these learning themes, and complete a needs assessment for relevant learning topics for future meetings. In addition, participants in the postgraduate and hands-on courses were asked to complete questions about case volume and comfort level related to procedures/topics in those courses. All respondents to this initial survey were sent a 3-month follow-up questionnaire in which they were asked how successful they had been in the implementation of the targeted practice changes and what, if any, barriers were encountered. Descriptive statistical analysis of de-identified data was undertaken. SAGES University attendees respond to a post-test and post-activity evaluation. Response rates were 43 and 31 % for CME-eligible attendees/respondents for the immediate post-meeting and 3-month follow-up questionnaires, respectively. Top learning themes for respondents were foregut, hernia, bariatric, and colorectal. Improving minimally invasive surgical (MIS) technique and managing complications related to MIS procedures were top intended practice changes. Partial implementation was common with top barriers including lack of resources and lack of time. Desired topics for future meetings included management of complications, enhanced recovery after surgery, introduction of new procedures into clinical practice, and re-operative surgery. The SAGES 2014 annual meeting analysis provides insight into the educational needs among respondents, which is meaningful information for planning future meeting educational content.

Morphea

MedlinePlus

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

Atypical Moles

MedlinePlus

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

Lichen Striatus

MedlinePlus

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

Diseases of the Tricuspid Valve

MedlinePlus

... Daily Conferences Fellowships and Residencies School of Perfusion Technology Education Resources Library & Learning Resource Center CME Resources THI Journal THI Cardiac Society Save the Date: International Symposium on Cardiovascular Regenerative ...

Cutaneous Larva Migrans

MedlinePlus

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Core competencies for shared decision making training programs: insights from an international, interdisciplinary working group.

PubMed

Légaré, France; Moumjid-Ferdjaoui, Nora; Drolet, Renée; Stacey, Dawn; Härter, Martin; Bastian, Hilda; Beaulieu, Marie-Dominique; Borduas, Francine; Charles, Cathy; Coulter, Angela; Desroches, Sophie; Friedrich, Gwendolyn; Gafni, Amiram; Graham, Ian D; Labrecque, Michel; LeBlanc, Annie; Légaré, Jean; Politi, Mary; Sargeant, Joan; Thomson, Richard

2013-01-01

Shared decision making is now making inroads in health care professionals' continuing education curriculum, but there is no consensus on what core competencies are required by clinicians for effectively involving patients in health-related decisions. Ready-made programs for training clinicians in shared decision making are in high demand, but existing programs vary widely in their theoretical foundations, length, and content. An international, interdisciplinary group of 25 individuals met in 2012 to discuss theoretical approaches to making health-related decisions, compare notes on existing programs, take stock of stakeholders concerns, and deliberate on core competencies. This article summarizes the results of those discussions. Some participants believed that existing models already provide a sufficient conceptual basis for developing and implementing shared decision making competency-based training programs on a wide scale. Others argued that this would be premature as there is still no consensus on the definition of shared decision making or sufficient evidence to recommend specific competencies for implementing shared decision making. However, all participants agreed that there were 2 broad types of competencies that clinicians need for implementing shared decision making: relational competencies and risk communication competencies. Further multidisciplinary research could broaden and deepen our understanding of core competencies for shared decision making training. Copyright © 2013 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

Training and action for patient safety: embedding interprofessional education for patient safety within an improvement methodology.

PubMed

Slater, Beverley L; Lawton, Rebecca; Armitage, Gerry; Bibby, John; Wright, John

2012-01-01

Despite an explosion of interest in improving safety and reducing error in health care, one important aspect of patient safety that has received little attention is a systematic approach to education and training for the whole health care workforce. This article describes an evaluation of an innovative multiprofessional, team-based training program that embeds patient safety within quality improvement methods. Kirkpatrick's "levels of evaluation" model was adopted to evaluate the program in health organizations across one city in the north of England. Questionnaires were used to assess reaction of participants to the program (Level 1). Improvements in patient safety knowledge and patient safety culture (Level 2) were assessed using a 12-item multiple-choice questionnaire and a culture questionnaire. Interviews and project-specific quantitative measurements were used to assess changes in professional practice and patient outcomes (Levels 3 and 4). All aspects of the program were positively received by participants. Few participants completed the MCQ at both time points, but those who did showed improvement in knowledge. There were some small but significant improvements in patient safety culture. Interviews revealed a number of additional benefits beyond the specific problems addressed. Most importantly, 8 of the 11 teams showed improvements in patient safety practices and/or outcomes. This program is an example of interprofessional education in practice and demonstrates that team-based learning using quality improvement methods is feasible and can be effective in improving patient safety, but requires time and space for participants. Alignment with continuing education arrangements could support mainstream adoption of this approach within organizations. 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.

Telogen Effluvium Hair Loss

MedlinePlus

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

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

PubMed

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

2011-01-01

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

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.

Tapping the Educational Potential of Facebook: Guidelines for Use in Higher Education

ERIC Educational Resources Information Center

Wang, Rex; Scown, Phil; Urquhart, Cathy; Hardman, Julie

2014-01-01

Facebook is a frequently used Computer Mediated Environment (CME) for students and others to build social connections, with identities and deposited self-expression. Its widespread use makes it appropriate for consideration as an educational tool; though one that does not yet have clear guidelines for use. Whether a social networking site can be…

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.

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

PubMed

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

2015-01-01

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

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

PubMed

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

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

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

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

PubMed

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

2009-10-01

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

A novel approach for needs assessment to build global orthopedic surgical capacity in a low-income country.

PubMed

Bhashyam, Abhiram R; Fils, Jacky; Lowell, Jim; Meara, John G; Dyer, George S M

2015-01-01

Visiting surgical teams are a vital aspect of capacity-building continuing medical education (CME) in low-income countries like Haiti. Imperfect understanding of the genuine needs of local surgeons limit CME initiatives. Previous paper-based needs assessment efforts have been unsuccessful because of low response rates. We explored using an electronic audience response system (ARS) during a Haitian CME conference to improve the response rates and better assess needs. Data were prospectively collected using an ARS from 78 conference participants (57 Haitian and 21 foreign) about current and desired knowledge of 7 topic and 8 skill areas using a 5-point Likert scale presented in English and in French. The response rates using ARS vs a similar paper survey were compared using a 2-sample test of proportions. The current and desired knowledge levels were compared using paired t tests. Analysis of variance and post hoc unpaired t tests were used to compare between demographic groups. The response rates were significantly greater for ARS vs a paper survey (87.7 vs 63.2%, p = 0.002). The 4 areas of least self-confidence for Haitians were pelvic and articular injury, joint dislocation, and osteomyelitis. The 4 skills of least self-confidence for Haitians were arthroscopy, open reduction and internal fixation-plate, external fixation, and fasciotomy. Haitians desired improvements in knowledge and management of articular, diaphyseal, and pelvic injury, joint dislocation, and osteomyelitis to a greater extent than foreigners (p < 0.05). Participants who previously attended the conference on open fractures felt more knowledgeable about open fractures as a topic (p < 0.05), but not in its management. We are the first to show that an ARS improves response rates to allow for better characterization of surgeon needs in the developing world. We also demonstrate the importance of skill building paired with topic area teaching. Lastly, we show how a CME conference is an effective tool to build surgical capacity and increase confidence level. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

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.

Sex and Sexuality and HIV

MedlinePlus

... Education Home HIV Meds Updates Online Courses (CME) Case Studies Journal Articles Glossary Quick References Quick References Home ... against HIV: oral contraceptive ("the pill") injectable contraceptive (shot) contraceptive implant IUD (intrauterine device) emergency contraception ("morning- ...

Trace Elements: What They Do and Where to Get Them

MedlinePlus

... Daily Conferences Fellowships and Residencies School of Perfusion Technology Education Resources Library & Learning Resource Center CME Resources THI Journal THI Cardiac Society Save the Date: International Symposium on Cardiovascular Regenerative ...

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.

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.

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.

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.

Multi-viewpoint Coronal Mass Ejection Catalog Based on STEREO COR2 Observations

NASA Astrophysics Data System (ADS)

Vourlidas, Angelos; Balmaceda, Laura A.; Stenborg, Guillermo; Dal Lago, Alisson

2017-04-01

We present the first multi-viewpoint coronal mass ejection (CME) catalog. The events are identified visually in simultaneous total brightness observations from the twin SECCHI/COR2 coronagraphs on board the Solar Terrestrial Relations Observatory mission. The Multi-View CME Catalog differs from past catalogs in three key aspects: (1) all events between the two viewpoints are cross-linked, (2) each event is assigned a physics-motivated morphological classification (e.g., jet, wave, and flux rope), and (3) kinematic and geometric information is extracted semi-automatically via a supervised image segmentation algorithm. The database extends from the beginning of the COR2 synoptic program (2007 March) to the end of dual-viewpoint observations (2014 September). It contains 4473 unique events with 3358 events identified in both COR2s. Kinematic properties exist currently for 1747 events (26% of COR2-A events and 17% of COR2-B events). We examine several issues, made possible by this cross-linked CME database, including the role of projection on the perceived morphology of events, the missing CME rate, the existence of cool material in CMEs, the solar cycle dependence on CME rate, speeds and width, and the existence of flux rope within CMEs. We discuss the implications for past single-viewpoint studies and for Space Weather research. The database is publicly available on the web including all available measurements. We hope that it will become a useful resource for the community.

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

Continuing Medical Education and Professional Revalidation in Europe: Five Case Examples

ERIC Educational Resources Information Center

Maisonneuve, Herve; Matillon, Yves; Negri, Alfonso; Pallares, Luis; Vigneri, Ricardo; Young, Howard L.

2009-01-01

Introduction: 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). Methods: A tested questionnaire was sent to 2 experts per country (except in Germany), during August-September 2004.…

The Relevance of the Alliance for CME Competencies for Planning, Organizing, and Sustaining an Interorganizational Educational Collaborative

ERIC Educational Resources Information Center

Balmer, Jann T.; Bellande, Bruce J.; Addleton, Robert L.; Havens, Carol S.

2011-01-01

The heightened demand for accountability, access, and quality performance from health care professionals has resulted in linkages between continuing education (CE), performance improvement (PI), and outcomes. CE health professionals must also expand their skills and abilities to design, implement, and measure CE activities consistent with these…

eLearning: A Review of Internet-Based Continuing Medical Education

ERIC Educational Resources Information Center

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

2004-01-01

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

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

ERIC Educational Resources Information Center

Pazirandeh, Mahmood

2002-01-01

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

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

ERIC Educational Resources Information Center

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

2007-01-01

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

What motivates family physicians to participate in training programs in shared decision making?

PubMed

Allaire, Anne-Sophie; Labrecque, Michel; Giguere, Anik; Gagnon, Marie-Pierre; Légaré, France

2012-01-01

Little is known about the factors that influence family physician (FP) participation in continuing professional development (CPD) programs in shared decision making (SDM). We sought to identify the factors that motivate FPs to participate in DECISION+, a CPD program in SDM. In 2007-2008, we collected data from 39 FPs who participated in a pilot randomized trial of DECISION+. In 2010, we collected data again from 11 of those participants and from 12 new subjects. Based on the theory of planned behavior, our questionnaire assessed FPs' intentions to participate in a CPD program in SDM and evaluated FPs' attitudes, subjective norms and perceived behavioral control. We also conducted 4 focus groups to explore FPs' salient beliefs. In 2010, FPs' mean intention to participate in a CPD program in SDM was relatively strong (2.6 ± 0.5 on a scale from -3 = "strongly disagree" to +3 = "strongly agree"). Affective attitude was the only factor significantly associated with intention (r = .51, p = .04). FPs identified the attractions of participating in a CPD program in SDM as (1) its interest, (2) the pleasure of learning, and (3) professional stimulation. Facilitators of their participation were (1) a relevant clinical topic, (2) an interactive program, (3) an accessible program, and (4) decision support tools. To attract FPs to a CPD program in SDM, CPD developers should make the program interesting, enjoyable, and professionally stimulating. They should choose a clinically relevant topic, ensure that the program is interactive and accessible, and include decision support tools. 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.

[Quality control in medical education and continuing medical education in allergology in Germany].

PubMed

Ring, Johannes; Rakoski, Jürgen

2003-10-01

Quality control in education and training in allergology comprises activities at the different levels of the curriculum of medical schools, residency programs and postgraduate education. Unfortunately, until now allergology in Germany has not yet been regularly embedded in the medical curriculum of all medical schools. Therefore, the German Society for Allergology and Clinical Immunology (DGAI) has demanded for years that chairs and departments of allergology be introduced at every Medical Faculty in Germany. The new Medical Licensure Rules (Approbationsordnung) offer the possibility to select allergology, amongst others, as an obligatory subject in the medical state examination. Furthermore, allergological topics can now be introduced into the newly established interdisciplinary fields (Querschnittsbereiche). At the level of residency training, doctors who want to become allergists have to undergo a special curriculum in the field of allergology, formerly called additional specialisation in allergology (Zusatzbezeichnung) after having finished their board examination in an organ-related specialty subject. Following a decision of the German "Arztetag" in May 2003, this 24-months curriculum has unfortunately been reduced to 18 months. 12 months of this 18 months requirement may be fulfilled during a residency programme in either dermatovenerology, otolaryngology, internal medicine, pulmology and/or paediatrics. Compared to previous years, this results in a drastic deterioration of allergy training in Germany. The DGAI has decided to take up the fight for its improvement in both a quantitative and qualitative respect. The crucial issue is to develop quality criteria for persons as well as institutions eligible as training centres in allergology. As regards post-graduate education, the German Academy of Allergology and Environmental Medicine (Deutsche Akademie für Allergie und Umweltmedizin, DAAU) has introduced a system of certified continuing medical education (CME), which has been widely accepted in Germany. CME credit points are awarded in co-operation with the regional physicians' chambers ("Landesärztekammer"). Quality control in allergology has to be re-enforced and improved at all levels of medical curricula, training programmes and post-graduate education in order to achieve sustainable improvements in patient care for the large number of people in Germany suffering from allergies.

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;

Evaluation of an online bioterrorism continuing medical education course.

PubMed

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

2006-01-01

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

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

PubMed

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

2016-07-01

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

Ensemble Modeling of the July 23, 2012 CME Event

NASA Astrophysics Data System (ADS)

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

2013-12-01

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

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

PubMed

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

2014-02-01

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

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

Cologne Consensus Conference: providers in accredited CME/CPD 11–12 September 2015, Cologne, Germany

PubMed Central

Simper, Julie

2016-01-01

On 11–12 September 2015, the fourth annual Cologne Consensus Conference (CCC) was held in Cologne, Germany. The 2-day educational event was organised by the European Cardiology Section Foundation (ECSF) and the European Board for Accreditation in Cardiology (EBAC), a specialty continuing medical education–continuing professional development (CME—CPD) accreditation board of the European Union of Medical Specialists (UEMS). The conference was again planned in cooperation with an impressive group of international organisations and faculty members representing leading European and North American institutions. Each year, the CCC is organised around a specific topic area. For the conference's fourth iteration, the providers in accredited CME/CPD were the focus. The CCC 2015 set out to share ideas, discuss concepts, and increase collaborations amongst the various groups. This report provides a summary of the presentations and discussions from the educational event. PMID:29644122

Doctors Online: Learning Using an Internet Based Content Management System

ERIC Educational Resources Information Center

Pullen, Darren

2013-01-01

The past century has seen spectacular gains in the breadth and depth of medical knowledge, but the potential of these gains has been hampered by a slow system of disseminating knowledge. Over the course of medical education numerous technologies and methods have been used to deliver continuing medical education (CME) to health care professionals…

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…

A Qualitative Evaluation of an Online Expert-Facilitated Course on Tobacco Dependence Treatment.

PubMed

Ebn Ahmady, Arezoo; Barker, Megan; Dragonetti, Rosa; Fahim, Myra; Selby, Peter

2017-01-01

Qualitative evaluations of courses prove difficult due to low response rates. Online courses may permit the analysis of qualitative feedback provided by health care providers (HCPs) during and after the course is completed. This study describes the use of qualitative methods for an online continuing medical education (CME) course through the analysis of HCP feedback for the purpose of quality improvement. We used formative and summative feedback from HCPs about their self-reported experiences of completing an online expert-facilitated course on tobacco dependence treatment (the Training Enhancement in Applied Cessation Counselling and Health [TEACH] Project). Phenomenological, inductive, and deductive approaches were applied to develop themes. QSR NVivo 11 was used to analyze the themes derived from free-text comments and responses to open-ended questions. A total of 277 out of 287 participants (96.5%) completed the course evaluations and provided 690 comments focused on how to improve the program. Five themes emerged from the formative evaluations: overall quality, content, delivery method, support, and time. The majority of comments (22.6%) in the formative evaluation expressed satisfaction with overall course quality. Suggestions for improvement were mostly for course content and delivery method (20.4% and 17.8%, respectively). Five themes emerged from the summative evaluation: feedback related to learning objectives, interprofessional collaboration, future topics of relevance, overall modifications, and overall satisfaction. Comments on course content, website function, timing, and support were the identified areas for improvement. This study provides a model to evaluate the effectiveness of online educational interventions. Significantly, this constructive approach to evaluation allows CME providers to take rapid corrective action.

A Qualitative Evaluation of an Online Expert-Facilitated Course on Tobacco Dependence Treatment

PubMed Central

Ebn Ahmady, Arezoo; Barker, Megan; Dragonetti, Rosa; Fahim, Myra; Selby, Peter

2017-01-01

Qualitative evaluations of courses prove difficult due to low response rates. Online courses may permit the analysis of qualitative feedback provided by health care providers (HCPs) during and after the course is completed. This study describes the use of qualitative methods for an online continuing medical education (CME) course through the analysis of HCP feedback for the purpose of quality improvement. We used formative and summative feedback from HCPs about their self-reported experiences of completing an online expert-facilitated course on tobacco dependence treatment (the Training Enhancement in Applied Cessation Counselling and Health [TEACH] Project). Phenomenological, inductive, and deductive approaches were applied to develop themes. QSR NVivo 11 was used to analyze the themes derived from free-text comments and responses to open-ended questions. A total of 277 out of 287 participants (96.5%) completed the course evaluations and provided 690 comments focused on how to improve the program. Five themes emerged from the formative evaluations: overall quality, content, delivery method, support, and time. The majority of comments (22.6%) in the formative evaluation expressed satisfaction with overall course quality. Suggestions for improvement were mostly for course content and delivery method (20.4% and 17.8%, respectively). Five themes emerged from the summative evaluation: feedback related to learning objectives, interprofessional collaboration, future topics of relevance, overall modifications, and overall satisfaction. Comments on course content, website function, timing, and support were the identified areas for improvement. This study provides a model to evaluate the effectiveness of online educational interventions. Significantly, this constructive approach to evaluation allows CME providers to take rapid corrective action. PMID:28992759

The recent changes and topics in CONTRAIL project

NASA Astrophysics Data System (ADS)

Machida, Toshinobu; Umezawa, Taku; Sawa, Yousuke; Niwa, Yosuke; Matsueda, Hidekazu

2016-04-01

CONTRAIL (Comprehensive Observation Network for TRace gases by AIrLiner) project has been conducted since 2005 with Continuous CO2 Measuring Equipment (CME) and Automatic air Sampling Equipment (ASE) onboard commercial airliners for observations of atmospheric greenhouse gases. Japan Airlines (JAL) offers eight Boeing 777-200ER airplanes modified for CONTRAIL; CME and ASE can be installed on all and five of them, respectively. ASE measurements have provided the long records of greenhouse gases in the upper troposphere along the flight route between Japan and Australia. In addition, we started a new sampling program between Japan and Europe in 2012 to obtain data at higher latitudes and the UT/LS region. When the 777-200ER airplane was not operated for the observation route, we used Manual air Sampling Equipment (MSE) for taking air onboard as substitute for ASE. Since flight routes with 777-200ER have been restricted only to Asian countries and Hawaii in the last few years, additional two Boeing 777-300ERs were modified to install CME and expand area coverage of CO2 observations to Europe, Australia and the east coast of US in 2015-2016. We also present our recent data analysis for intensive CME observations over Delhi, India, which indicates a significant impact of Indian wintertime agriculture on the regional carbon budget.

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.

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.

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.

Who is teaching psychopharmacology? Who should be teaching psychopharmacology?

PubMed

Dubovsky, Steven L

2005-01-01

To review the current status of psychopharmacology education for medical students, residents, and practitioners in psychiatry and other specialties. A search of the MEDLINE and PsychInfo data bases was conducted using four keywords: pharmacology, psychopharmacology, teaching, and student. Additional references were obtained from citations in these articles. Published material was supplemented with the experience of the author and others involved in psychopharmacology teaching. The majority of psychopharmacology education is provided by faculty from disciplines that include psychiatry, primary care medicine, basic science, and pharmacy. The pharmaceutical industry supports a substantial amount of continuing medical education (CME) by psychiatrists, pharmacists, and other medical practitioners, while much of the information that office practitioners receive and an increasing amount of material provided to residents comes from pharmaceutical representatives. The most important attributes of the effective psychopharmacology educator are knowledge, enthusiasm, honesty, an ability to encourage critical thinking, and genuine interest in the student. However, the primary criteria for participation in psychopharmacology education are faculty who are most available and willing in the academic medical center and those who engage in paid CME activities. Educators with clinical experience should play a core role in helping students to integrate research with actual clinical practice and should be able to teach students how to evaluate new research in psychopharmacology, especially if it is industry sponsored.

Community-based faculty: motivation and rewards.

PubMed

Fulkerson, P K; Wang-Cheng, R

1997-02-01

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

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.

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

NASA Astrophysics Data System (ADS)

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

2017-12-01

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

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

NASA Technical Reports Server (NTRS)

Moore, Ron; Sterling, Alphonse; Suess, Steve

2007-01-01

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

76 FR 37162 - Self-Regulatory Organizations; The Options Clearing Corporation; Order Approving Proposed Rule...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-24

... (February 7, 2011). \\3\\ Letter from Gene Thomas (Retired), (April 24, 2011); letter from Andrew S. Margolin... CFTC's regulations. OCC By-Laws, Article I, Definitions. OCC's current internal cross-margining program...-CME program. Article VI, Section 25(b) of OCC's By-Laws currently requires clearing members to obtain...

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.

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

ERIC Educational Resources Information Center

Swanson, Richard W.; Jennett, Penny A.

1992-01-01

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

The relevance of the alliance for CME competencies for planning, organizing, and sustaining an interorganizational educational collaborative.

PubMed

Balmer, Jann T; Bellande, Bruce J; Addleton, Robert L; Havens, Carol S

2011-01-01

The heightened demand for accountability, access, and quality performance from health care professionals has resulted in linkages between continuing education (CE), performance improvement (PI), and outcomes. CE health professionals must also expand their skills and abilities to design, implement, and measure CE activities consistent with these new expectations. In addition to administrative and meeting-planning activities, new competencies associated with educational consultation and performance coaching are needed. This article utilizes the Alliance competencies as the framework for discussion of the competencies of CE professionals and applies it to the unique setting of a collaborative. The CS2day initiative serves as an example of the application of these competencies in this environment. The framework of the Alliance competencies can serve as a guide and a tool for self-assessment, work design, and professional development at individual, organization, and systems levels. Continual reassessment of the Alliance competencies for CE in the health professions will be critical to the continued effectiveness of CE that is linked to performance improvement and outcomes for the CE professional and the health care professionals we serve. A collaborative can provide one option for meeting these new expectations for professional development for CE professionals and the creation of effective educational initiatives. 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.

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

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

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

PubMed Central

Badran, Hani; Grad, Roland

2015-01-01

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

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

PubMed

Badran, Hani; Pluye, Pierre; Grad, Roland

2015-02-27

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

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.

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.

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.

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

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

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.

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

DTIC Science & Technology

2006-06-30

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

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

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

PubMed

Böthin, Elke

2013-01-01

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

CAT-PUMA: CME Arrival Time Prediction Using Machine learning Algorithms

NASA Astrophysics Data System (ADS)

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

2018-04-01

CAT-PUMA (CME Arrival Time Prediction Using Machine learning Algorithms) quickly and accurately predicts the arrival of Coronal Mass Ejections (CMEs) of CME arrival time. The software was trained via detailed analysis of CME features and solar wind parameters using 182 previously observed geo-effective partial-/full-halo CMEs and uses algorithms of the Support Vector Machine (SVM) to make its predictions, which can be made within minutes of providing the necessary input parameters of a CME.

Confidence-based learning CME: overcoming barriers in irritable bowel syndrome with constipation.

PubMed

Cash, Brooks; Mitchner, Natasha A; Ravyn, Dana

2011-01-01

Performance of health care professionals depends on both medical knowledge and the certainty with which they possess it. Conventional continuing medical education interventions assess the correctness of learners' responses but do not determine the degree of confidence with which they hold incorrect information. This study describes the use of confidence-based learning (CBL) in an activity designed to enhance learners' knowledge, confidence in their knowledge, and clinical competence with regard to constipation-predominant IBS (IBS-C), a frequently underdiagnosed and misdiagnosed condition. The online CBL activity included multiple-choice questions in 2 modules: Burden of Care (BOC; 28 questions) and Patient Scenarios (PS; 9 case-based questions). After formative assessment, targeted feedback was provided, and the learner focused on material with demonstrated knowledge and/or confidence gaps. The process was repeated until 85% of questions were answered correctly and confidently (ie, mastery was attained). Of 275 participants (24% internal medicine, 13% gastroenterology, 32% family medicine, and 31% other), 249 and 167 completed the BOC and PS modules, respectively. Among all participants, 61.8% and 98.2% achieved mastery in the BOC and PS modules, respectively. Baseline mastery levels between specialties were significantly different in the BOC module (p = 0.002); no significant differences were evident between specialties in final mastery levels. Approximately one-third of learners were confident and wrong in topics of epidemiology, defining IBS and constipation, and treatments in the first iteration. No significant difference was observed between specialties for the PS module in either the first or last iterations. Learners achieved mastery in topics pertaining to IBS-C regardless of baseline knowledge or specialty. These data indicate that CME activities employing CBL can be used to address knowledge and confidence gaps. Copyright © 2010 The Alliance for Continuing Medical Education, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

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.

Variations of GHGs from the lower-troposphere to the UT/LS revealed by two Japanese regular aircraft observation programs

NASA Astrophysics Data System (ADS)

Niwa, Yosuke; Machida, Toshinobu; Sawa, Yousuke; Tsuboi, Kazuhiro; Matsueda, Hidekazu; Imasu, Ryoichi

2014-05-01

A Japan-centered observation network consisting of two regular aircraft programs have revealed the greenhouse gases variations from the lower-troposphere to the upper-troposphere/lower-stratosphere (UT/LS) regions. In the Comprehensive Observation Network for Trace gases by Airliner (CONTRAIL) project, in-situ continuous measurement equipment (CME) onboard commercial passenger aircraft world-widely observes CO2 profiles in vertical over tens of airports and in horizontal in the UT/LS regions. The CONTRAIL-CME has revealed three-dimensional structure of the global CO2 distribution and has exposed significant inter-hemispheric transport of CO2 through the upper-troposphere. In inverse modeling, the CME data have provided strong constraints on CO2 flux estimation especially for the Asian tropics. Automatic flask air sampling equipment (ASE) is also onboard the CONTRAIL aircraft and has been observing CO2 mixing ratios as well as those of methane, carbon monoxide, nitrous oxide and other trace species in the upper-troposphere between Japan and Australia. The observation period of the ASE has reached 20 years. In recent years, the ASE program has extended to the northern subarctic UT/LS region and has given an insight of transport mechanisms in the UT/LS by observing seasonal GHGs variations. In the other aircraft observation program by Japan Meteorological Agency, variations of GHGs have been observed by flask-sampling onboard a C-130H aircraft horizontally in the mid-troposphere over the western North Pacific as well as vertically over Minamitorishima-Island. The C-130H aircraft has persistently observed high mixing ratios of CH4 in the mid-troposphere, which seems to be originated from fossil fuel combustion throughout the year as well as from biogenic sources during summer in the Asian regions. Those above aircraft observation programs have a significant role for constraining GHGs flux estimates by filling the data gap of the existing surface measurement network specifically in the regions of Asia and the western North Pacific.

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.

Improving collaborative care in managing eating disorders: a pilot study.

PubMed

Heath, Olga; English, Denise; Simms, Joanne; Ward, Pamela; Hollett, Ann; Dominic, Anna

2013-01-01

The purpose of this pilot study was to evaluate the impact of a continuing interprofessional educational workshop focused on eating disorders in a rural area in Newfoundland and Labrador (NL), Canada. The pilot study helped determine if the eating disorder workshop was feasible for implementation to a broader audience. A conceptual model developed by our eating disorder team and described in the article guided this innovative program. The intensive 2-day workshop was piloted in one community with 41 health and education professionals in attendance. A key element was the focus on creating and sustaining collaborative care for eating disorders. Participants completed pre-post workshop measures of interprofessional attitudes and skills, self-reported knowledge, confidence, and intention to change practice (post questionnaire only). A 6-month follow-up survey measured self-reported practice change. There were significant positive changes in interprofessional attitudes and skills as well as knowledge and confidence in collaborative management of eating disorders. Post-workshop, 69% (n = 24/35) of participants indicated intention to change practice, and on follow-up, 7 of 10 respondents reported implementing changes in practice as a result of the workshop. Low response rate at follow-up was a limitation. Results support the impact of the workshop in improving knowledge, confidence, and attitudes toward collaboration and changing practice and the value of implementing the program province-wide. 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.

Creating opportunities for training California's public health workforce.

PubMed

Demers, Anne L; Mamary, Edward; Ebin, Vicki J

2011-01-01

Today there are significant challenges to public health, and effective responses to them will require complex approaches and strategies implemented by a qualified workforce. An adequately prepared workforce requires long-term development; however, local health departments have limited financial and staff resources. Schools and programs accredited by the Council for Education on Public Health (CEPH) are required to provide continuing education but are constrained by the lack of resources, limited time, and geography. To meet these challenges, a statewide university/community collaborative model for delivering continuing education programs was developed. A needs assessment of California's public health workforce was conducted to identify areas of interest, and two continuing education trainings were developed and implemented using innovative distance education technology. Thirty-six percent of the participants completed electronic evaluations of learning outcomes and use of the digital technology platform. Participants indicated a significant increase in knowledge, reported that the trainings were cost effective and convenient, and said that they would participate in future online trainings. Collaborative partners found that this model provides a cost-effective, environmentally sound, and institutionally sustainable method for providing continuing education to public health professionals. Offering continuing education via distance technology requires substantial institutional infrastructure and resources that are often beyond what many public institutions can provide alone. This project provides a model for collaborating with community partners to provide trainings, using a digital technology platform that requires minimal training and allows presenters and participants to log on from anywhere there is Internet access. 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.

Determination of Geometric and Kinematical Parameters of Coronal Mass Ejections Using STEREO Data

NASA Astrophysics Data System (ADS)

Fainshtein, V. G.; Tsivileva, D. M.; Kashapova, L. K.

2010-03-01

We present a new, relatively simple and fast method to determine true geometric and kinematical CME parameters from simultaneous STEREO A, B observations of CMEs. These parameters are the three-dimensional direction of CME propagation, velocity and acceleration of CME front, CME angular sizes and front position depending on time. The method is based on the assumption that CME shape may be described by a modification of so-called ice-cream cone models. The method has been tested for several CMEs.

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

PubMed

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

2007-01-01

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

Is it worth investing in online continuous education for healthcare staff?

PubMed

Mazzoleni, M Cristina; Maugeri, Chiara; Rognoni, Carla; Cantoni, Alessio; Imbriani, Marcello

2012-01-01

Educational activities for hospital staff don't easily match with the congestive rhythm of healthcare personnel working life. Online learning could make it easier for healthcare personnel to attend courses, but there is still uncertainty about the feasibility of using distance learning to effectively meet education goals in healthcare institutions. Fondazione Salvatore Maugeri (FSM) started an online educational program, as pilot project, in October 2010. The present study hence is aimed at evaluating the impact of this initiative (in terms of extent and intensity of healthcare staff attendance; objective and subjective effectiveness) in order to take informed decisions for the future. In 15 months, 5 elearning courses have been provided to 2261 potential users of 14 FSM hospitals, in parallel with traditional education. 1099 users from all the hospital have intensively attended the courses (58% of nurses, 50% of therapists, 44%, of technicians, 25% of physicians) for a total of 27459 CME credits. Effectiveness in terms of knowledge gain is satisfactory and subjective evaluation is good (more than 95% of satisfied users). Elearning is not appropriate for all the educational needs and is not a panacea, but the reported results point out that it may be an effective and economically convenient mean to support massive educational interventions reaching results hardly attainable with traditional education. Users should be better educated about how to exploit online education at best.

Determination of CME 3D parameters based on a new full ice-cream cone model

NASA Astrophysics Data System (ADS)

Na, Hyeonock; Moon, Yong-Jae

2017-08-01

In space weather forecast, it is important to determine three-dimensional properties of CMEs. Using 29 limb CMEs, we examine which cone type is close to a CME three-dimensional structure. We find that most CMEs have near full ice-cream cone structure which is a symmetrical circular cone combined with a hemisphere. We develop a full ice-cream cone model based on a new methodology that the full ice-cream cone consists of many flat cones with different heights and angular widths. By applying this model to 12 SOHO/LASCO halo CMEs, we find that 3D parameters from our method are similar to those from other stereoscopic methods (i.e., a triangulation method and a Graduated Cylindrical Shell model). In addition, we derive CME mean density (ρmean=Mtotal/Vcone) based on the full ice-cream cone structure. For several limb events, we determine CME mass by applying the Solarsoft procedure (e.g., cme_mass.pro) to SOHO/LASCO C3 images. CME volumes are estimated from the full ice-cream cone structure. From the power-law relationship between CME mean density and its height, we estimate CME mean densities at 20 solar radii (Rs). We will compare the CME densities at 20 Rs with their corresponding ICME densities.

Deflected Propagation of CMEs and Its Importance on the CME Arrival Forecasting

NASA Astrophysics Data System (ADS)

Wang, Yuming; Zhuang, Bin; Shen, Chenglong

2017-04-01

As the most important driver of severe space weather, coronal mass ejections (CMEs) and their geoeffectiveness have been studied intensively. Previous statistical studies have shown that not all the front-side halo CMEs are geoeffective, and not all non-recurrent geomagnetic storms can be tracked back to a CME. These phenomena may cause some failed predictions of the geoeffectiveness of CMEs. The recent notable event exhibiting such a failure was on 2015 March 15 when a fast CME originated from the west hemisphere. Space Weather Prediction Center (SWPC) of NOAA initially forecasted that the CME would at most cause a very minor geomagnetic disturbance labeled as G1. However, the CME produced the largest geomagnetic storm so far, at G4 level with the provisional Dst value of -223 nT, in the current solar cycle 24 [e.g., Kataoka et al., 2015; Wang et al., 2016]. Such an unexpected phenomenon naturally raises the first question for the forecasting of the geoeffectiveness of a CME, i.e., whether or not a CME will hit the Earth even though we know the source location and initial kinematic properties of the CME. A full understanding of the propagation trajectory, e.g., the deflected propagation, of a CME from the Sun to 1 AU is the key. With a few cases, we show the importance of the deflection effect in the space weather forecasting. An automated CME arrival forecasting system containing a deflected propagation model is presented.

Predicting the Magnetic Field of Earth-Impacting CMEs

NASA Technical Reports Server (NTRS)

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

2017-01-01

Predicting the impact of coronal mass ejections (CMEs) and the southward component of their magnetic field is one of the key goals of space weather forecasting. We present a new model, the ForeCAT In situ Data Observer (FIDO), for predicting the in situ magnetic field of CMEs. We first simulate a CME using ForeCAT, a model for CME deflection and rotation resulting from the background solar magnetic forces. Using the CME position and orientation from ForeCAT, we then determine the passage of the CME over a simulated spacecraft. We model the CME's magnetic field using a force-free flux rope and we determine the in situ magnetic profile at the synthetic spacecraft. We show that FIDO can reproduce the general behavior of four observed CMEs. FIDO results are very sensitive to the CME's position and orientation, and we show that the uncertainty in a CME's position and orientation from coronagraph images corresponds to a wide range of in situ magnitudes and even polarities. This small range of positions and orientations also includes CMEs that entirely miss the satellite. We show that two derived parameters (the normalized angular distance between the CME nose and satellite position and the angular difference between the CME tilt and the position angle of the satellite with respect to the CME nose) can be used to reliably determine whether an impact or miss occurs. We find that the same criteria separate the impacts and misses for cases representing all four observed CMEs.

Global Energetics of Solar Flares. VI. Refined Energetics of Coronal Mass Ejections

NASA Astrophysics Data System (ADS)

Aschwanden, Markus J.

2017-09-01

In this study, we refine the coronal mass ejection (CME) model that was presented in an earlier study of the global energetics of solar flares and associated CMEs and apply it to all (860) GOES M- and X-class flare events observed during the first seven years (2010-2016) of the Solar Dynamics Observatory (SDO) mission. The model refinements include (1) the CME geometry in terms of a 3D volume undergoing self-similar adiabatic expansion, (2) the solar gravitational deceleration during the propagation of the CME, which discriminates between eruptive and confined CMEs, (3) a self-consistent relationship between the CME center-of-mass motion detected during EUV dimming and the leading-edge motion observed in white-light coronagraphs, (4) the equipartition of the CME’s kinetic and thermal energies, and (5) the Rosner-Tucker-Vaiana scaling law. The refined CME model is entirely based on EUV-dimming observations (using Atmospheric Imager Assembly (AIA)/SDO data) and complements the traditional white-light scattering model (using Large-Angle and Spectrometric Coronagraph Experiment (LASCO)/Solar and Heliospheric Observatory data), and both models are independently capable of determining fundamental CME parameters. Comparing the two methods, we find that (1) LASCO is less sensitive than AIA in detecting CMEs (in 24% of the cases), (2) CME masses below {m}{cme}≲ {10}14 g are underestimated by LASCO, (3) AIA and LASCO masses, speeds, and energies agree closely in the statistical mean after the elimination of outliers, and (4) the CME parameters speed v, emission measure-weighted flare peak temperature T e , and length scale L are consistent with the following scaling laws: v\\propto {T}e1/2, v\\propto {({m}{cme})}1/4, and {m}{cme}\\propto {L}2.

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.

Real­-Time Ensemble Forecasting of Coronal Mass Ejections Using the Wsa-Enlil+Cone Model

NASA Astrophysics Data System (ADS)

Mays, M. L.; Taktakishvili, A.; Pulkkinen, A. A.; Odstrcil, D.; MacNeice, P. J.; Rastaetter, L.; LaSota, J. A.

2014-12-01

Ensemble forecasting of coronal mass ejections (CMEs) provides significant information in that it provides an estimation of the spread or uncertainty in CME arrival time predictions. Real-time ensemble modeling of CME propagation is performed by forecasters at the Space Weather Research Center (SWRC) using the WSA-ENLIL+cone model available at the Community Coordinated Modeling Center (CCMC). To estimate the effect of uncertainties in determining CME input parameters on arrival time predictions, a distribution of n (routinely n=48) CME input parameter sets are generated using the CCMC Stereo CME Analysis Tool (StereoCAT) which employs geometrical triangulation techniques. These input parameters are used to perform n different simulations yielding an ensemble of solar wind parameters at various locations of interest, including a probability distribution of CME arrival times (for hits), and geomagnetic storm strength (for Earth-directed hits). We present the results of ensemble simulations for a total of 38 CME events in 2013-2014. For 28 of the ensemble runs containing hits, the observed CME arrival was within the range of ensemble arrival time predictions for 14 runs (half). The average arrival time prediction was computed for each of the 28 ensembles predicting hits and using the actual arrival time, an average absolute error of 10.0 hours (RMSE=11.4 hours) was found for all 28 ensembles, which is comparable to current forecasting errors. Some considerations for the accuracy of ensemble CME arrival time predictions include the importance of the initial distribution of CME input parameters, particularly the mean and spread. When the observed arrivals are not within the predicted range, this still allows the ruling out of prediction errors caused by tested CME input parameters. Prediction errors can also arise from ambient model parameters such as the accuracy of the solar wind background, and other limitations. Additionally the ensemble modeling sysem was used to complete a parametric event case study of the sensitivity of the CME arrival time prediction to free parameters for ambient solar wind model and CME. The parameter sensitivity study suggests future directions for the system, such as running ensembles using various magnetogram inputs to the WSA model.

Evidence for a current sheet forming in the wake of a coronal mass ejection from multi-viewpoint coronagraph observations

NASA Astrophysics Data System (ADS)

Patsourakos, S.; Vourlidas, A.

2011-01-01

Context. Ray-like features observed by coronagraphs in the wake of coronal mass ejections (CMEs) are sometimes interpreted as the white light counterparts of current sheets (CSs) produced by the eruption. The 3D geometry of these ray-like features is largely unknown and its knowledge should clarify their association to the CS and place constraints on CME physics and coronal conditions. Aims: If these rays are related to field relaxation behind CMEs, therefore representing current sheets, then they should be aligned to the CME axis. With this study we test these important implications for the first time. Methods: An example of such a post-CME ray was observed by various coronagraphs, including these of the Sun Earth Connection Coronal and Heliospheric investigation (SECCHI) onboard the Solar Terrestrial Relations Observatory (STEREO) twin spacecraft and the Large Angle Spectrometric Coronagraph (LASCO) onboard the Solar and Heliospheric Observatory (SOHO). The ray was observed in the aftermath of a CME which occurred on 9 April 2008. The twin STEREO spacecraft were separated by about 48° on that day. This significant separation combined with a third “eye” view supplied by LASCO allow for a truly multi-viewpoint observation of the ray and of the CME. We applied 3D forward geometrical modeling to the CME and to the ray as simultaneously viewed by SECCHI-A and B and by SECCHI-A and LASCO, respectively. Results: We found that the ray can be approximated by a rectangular slab, nearly aligned with the CME axis, and much smaller than the CME in both terms of thickness and depth (≈0.05 and 0.15 R⊙ respectively). The ray electron density and temperature were substantially higher than their values in the ambient corona. We found that the ray and CME are significantly displaced from the associated post-CME flaring loops. Conclusions: The properties and location of the ray are fully consistent with the expectations of the standard CME theories for post-CME current sheets. Therefore, our multi-viewpoint observations supply strong evidence that the observed post-CME ray is indeed related to a post-CME current sheet. Movies are only available in electronic form at http://www.aanda.org

Combining Stereo SECCHI COR2 and HI1 Images for Automatic CME Front Edge Tracking

NASA Technical Reports Server (NTRS)

Kirnosov, Vladimir; Chang, Lin-Ching; Pulkkinen, Antti

2016-01-01

COR2 coronagraph images are the most commonly used data for coronal mass ejection (CME) analysis among the various types of data provided by the STEREO (Solar Terrestrial Relations Observatory) SECCHI (Sun-Earth Connection Coronal and Heliospheric Investigation) suite of instruments. The field of view (FOV) in COR2 images covers 215 solar radii (Rs) that allow for tracking the front edge of a CME in its initial stage to forecast the lead-time of a CME and its chances of reaching the Earth. However, estimating the lead-time of a CME using COR2 images gives a larger lead-time, which may be associated with greater uncertainty. To reduce this uncertainty, CME front edge tracking should be continued beyond the FOV of COR2 images. Therefore, heliospheric imager (HI1) data that covers 1590 Rs FOV must be included. In this paper, we propose a novel automatic method that takes both COR2 and HI1 images into account and combine the results to track the front edges of a CME continuously. The method consists of two modules: pre-processing and tracking. The pre-processing module produces a set of segmented images, which contain the signature of a CME, for both COR2 and HI1 separately. In addition, the HI1 images are resized and padded, so that the center of the Sun is the central coordinate of the resized HI1 images. The resulting COR2 andHI1 image set is then fed into the tracking module to estimate the position angle (PA) and track the front edge of a CME. The detected front edge is then used to produce a height-time profile that is used to estimate the speed of a CME. The method was validated using 15 CME events observed in the period from January 1, 2008 to August 31, 2009. The results demonstrate that the proposed method is effective for CME front edge tracking in both COR2 and HI1 images. Using this method, the CME front edge can now be tracked automatically and continuously in a much larger range, i.e., from 2 to 90 Rs, for the first time. These improvement scan greatly help in making the quantitative CME analysis more accurate and have the potential to assist in space weather forecasting.

The 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.

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...

Confidence-Based Learning CME: Overcoming Barriers in Irritable Bowel Syndrome with Constipation

ERIC Educational Resources Information Center

Cash, Brooks; Mitchner, Natasha A.; Ravyn, Dana

2011-01-01

Introduction: Performance of health care professionals depends on both medical knowledge and the certainty with which they possess it. Conventional continuing medical education interventions assess the correctness of learners' responses but do not determine the degree of confidence with which they hold incorrect information. This study describes…

NCCAM's 5 Most Searched-For Herbs of 2012: What the Science Says about Evening Primrose Oil, St. John's Wort, Fenugreek,...

MedlinePlus

... Resources CME/CEU and Online Lectures Online Continuing Education Series Distinguished Lecture Series Integrated Medicine Research Lecture ... has been a source of many folk or traditional remedies and more modern medicinal and cosmetic products. At various times aloe ...

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

PubMed

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

2014-11-01

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

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.

CME Flux Rope and Shock Identifications and Locations: Comparison of White Light Data, Graduated Cylindrical Shell Model, and MHD Simulations

NASA Technical Reports Server (NTRS)

Schmidt, J. M.; Cairns, Iver H.; Xie, Hong; St. Cyr, O. C.; Gopalswamy, N.

2016-01-01

Coronal mass ejections (CMEs) are major transient phenomena in the solar corona that are observed with ground-based and spacecraft-based coronagraphs in white light or with in situ measurements by spacecraft. CMEs transport mass and momentum and often drive shocks. In order to derive the CME and shock trajectories with high precision, we apply the graduated cylindrical shell (GCS) model to fit a flux rope to the CME directed toward STEREO A after about 19:00 UT on 29 November 2013 and check the quality of the heliocentric distance-time evaluations by carrying out a three-dimensional magnetohydrodynamic (MHD) simulation of the same CME with the Block Adaptive Tree Solar-Wind Roe Upwind Scheme (BATS-R-US) code. Heliocentric distances of the CME and shock leading edges are determined from the simulated white light images and magnetic field strength data. We find very good agreement between the predicted and observed heliocentric distances, showing that the GCS model and the BATS-R-US simulation approach work very well and are consistent. In order to assess the validity of CME and shock identification criteria in coronagraph images, we also compute synthetic white light images of the CME and shock. We find that the outer edge of a cloud-like illuminated area in the observed and predicted images in fact coincides with the leading edge of the CME flux rope and that the outer edge of a faint illuminated band in front of the CME leading edge coincides with the CME-driven shock front.

CME Interaction with Large-Scale Coronal Structures

NASA Technical Reports Server (NTRS)

Gopalswarny, Nat

2012-01-01

This talk presents some key observations that highlight the importance of CME interaction with other large scale structures such as CMEs and coronal holes . Such interactions depend on the phase of the solar cycle: during maximum, CMEs are ejected more frequently, so CME-CME interaction becomes dominant. During the rise phase, the polar coronal holes are strong, so the interaction between polar coronal holes and CMEs is important, which also leads to a possible increase in the number of interplanetary CMEs observed as magnetic clouds. During the declining phase, there are more equatorial coronal holes, so CMEs originating near these coronal holes are easily deflected. CMEs can be deflected toward and away from the Sun-Earth line resulting in interesting geospace consequences. For example, the largest geomagnetic storm of solar cycle 23 was due to a CME that was deflected towards the Sun-earth line from E22. CME deflection away from the Sun-Earth line diminishes the chance of a CME producing a geomagnetic storm. CME interaction in the coronagraphic field of view was first identified using enhanced radio emission, which is an indication of acceleration of low energy (approx.10 keV) electrons in the interaction site. CME interaction, therefore, may also have implications for proton acceleration. For example, solar energetic particle events typically occur with a higher intensity, whenever multiple CMEs occur in quick succession from the same source region. CME deflection may also have implications to the arrival of energetic particles to earth because magnetic connectivity may be changed by the interaction. I illustrate the above points using examples from SOHO, STEREO, Wind, and ACE data .

Initiation and Early Evolution of the Coronal Mass Ejection on 2009 May 13 from Extreme-ultraviolet and White-light Observations

NASA Astrophysics Data System (ADS)

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

2014-10-01

We present the results of the observations of a coronal mass ejection (CME) that occurred on 2009 May 13. The most important feature of these observations is that the CME was observed from the very early stage (the solar surface) up to a distance of 15 solar radii (R ⊙). Below 2 R ⊙, we used the data from the TESIS extreme-ultraviolet telescopes obtained in the Fe 171 Å and He 304 Å lines, and above 2 R ⊙, we used the observations of the LASCO C2 and C3 coronagraphs. The CME was formed at a distance of 0.2-0.5R ⊙ from the Sun's surface as a U-shaped structure, which was observed both in the 171 Å images and in the white light. Observations in the He 304 Å line showed that the CME was associated with an erupting prominence, which was not located above—as the standard model predicts—but rather in the lowest part of the U-shaped structure close to the magnetic X point. The prominence location can be explained with the CME breakout model. Estimates showed that CME mass increased with time. The CME trajectory was curved—its heliolatitude decreased with time. The CME started at a latitude of 50° and reached the ecliptic plane at distances of 2.5 R ⊙. The CME kinematics can be divided into three phases: initial acceleration, main acceleration, and propagation with constant velocity. After the CME, onset GOES registered a sub-A-class flare.

Using the Coronal Evolution to Successfully Forward Model CMEs' In Situ Magnetic Profiles

NASA Astrophysics Data System (ADS)

Kay, C.; Gopalswamy, N.

2017-12-01

Predicting the effects of a coronal mass ejection (CME) impact requires knowing if impact will occur, which part of the CME impacts, and its magnetic properties. We explore the relation between CME deflections and rotations, which change the position and orientation of a CME, and the resulting magnetic profiles at 1 AU. For 45 STEREO-era, Earth-impacting CMEs, we determine the solar source of each CME, reconstruct its coronal position and orientation, and perform a ForeCAT (Forecasting a CME's Altered Trajectory) simulation of the coronal deflection and rotation. From the reconstructed and modeled CME deflections and rotations, we determine the solar cycle variation and correlations with CME properties. We assume no evolution between the outer corona and 1 AU and use the ForeCAT results to drive the ForeCAT In situ Data Observer (FIDO) in situ magnetic field model, allowing for comparisons with ACE and Wind observations. We do not attempt to reproduce the arrival time. On average FIDO reproduces the in situ magnetic field for each vector component with an error equivalent to 35% of the average total magnetic field strength when the total modeled magnetic field is scaled to match the average observed value. Random walk best fits distinguish between ForeCAT's ability to determine FIDO's input parameters and the limitations of the simple flux rope model. These best fits reduce the average error to 30%. The FIDO results are sensitive to changes of order a degree in the CME latitude, longitude, and tilt, suggesting that accurate space weather predictions require accurate measurements of a CME's position and orientation.

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

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

PubMed

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

2016-01-01

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

USING ForeCAT DEFLECTIONS AND ROTATIONS TO CONSTRAIN THE EARLY EVOLUTION OF CMEs

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

Kay, C.; Opher, M.; Colaninno, R. C.

2016-08-10

To accurately predict the space weather effects of the impacts of coronal mass ejection (CME) at Earth one must know if and when a CME will impact Earth and the CME parameters upon impact. In 2015 Kay et al. presented Forecasting a CME’s Altered Trajectory (ForeCAT), a model for CME deflections based on the magnetic forces from the background solar magnetic field. Knowing the deflection and rotation of a CME enables prediction of Earth impacts and the orientation of the CME upon impact. We first reconstruct the positions of the 2010 April 8 and the 2012 July 12 CMEs frommore » the observations. The first of these CMEs exhibits significant deflection and rotation (34° deflection and 58° rotation), while the second shows almost no deflection or rotation (<3° each). Using ForeCAT, we explore a range of initial parameters, such as the CME’s location and size, and find parameters that can successfully reproduce the behavior for each CME. Additionally, since the deflection depends strongly on the behavior of a CME in the low corona, we are able to constrain the expansion and propagation of these CMEs in the low corona.« less

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

[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.

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.

EMS providers do not use FOAM for education.

PubMed

Bucher, Joshua; Donovan, Colleen; McCoy, Jonathan

2018-05-24

Free open access to medical education (FOAM, #FOAM) is the free availability of educational materials on various medicine topics. We hope to evaluate the use of social media and FOAM by emergency medical services (EMS) providers. We designed an online survey distributed to EMS providers with questions about demographics and social media/FOAM use by providers. The survey was sent to the American College of Emergency Physicians (ACEP) EMS Listserv of medical directors and was asked to be distributed to their respective agencies. The survey was designed to inquire about the providers' knowledge of FOAM and social media and their use of the above for EMS education. There were 169 respondents out of a total of 523 providers yielding a response rate of 32.3%. Fifty-three percent of respondents are paramedics, 37% are EMT-Basic trained, and the remainder (16%) were "other." The minority (20%) of respondents had heard of FOAM. However, 54% of respondents had heard of "free medical education online" regarding pertinent topics. Of the total respondents who used social media for education, 31% used Facebook and 23% used blogs and podcasts as resources for online education. Only 4% of respondents stated they produced FOAM content. Seventy-six percent of respondents said they were "interested" or "very interested" in using FOAM for medical education. If FOAM provided continuing medical education (CME), 83% of respondents would be interested in using it. Social media is not used frequently by EMS providers for the purposes of FOAM. There is interest within EMS providers to use FOAM for education, even if CME was not provided. FOAM can provide a novel area of education for EMS.

Real-time Ensemble Forecasting of Coronal Mass Ejections using the WSA-ENLIL+Cone Model

NASA Astrophysics Data System (ADS)

Mays, M. L.; Taktakishvili, A.; Pulkkinen, A. A.; MacNeice, P. J.; Rastaetter, L.; Kuznetsova, M. M.; Odstrcil, D.

2013-12-01

Ensemble forecasting of coronal mass ejections (CMEs) provides significant information in that it provides an estimation of the spread or uncertainty in CME arrival time predictions due to uncertainties in determining CME input parameters. Ensemble modeling of CME propagation in the heliosphere is performed by forecasters at the Space Weather Research Center (SWRC) using the WSA-ENLIL cone model available at the Community Coordinated Modeling Center (CCMC). SWRC is an in-house research-based operations team at the CCMC which provides interplanetary space weather forecasting for NASA's robotic missions and performs real-time model validation. A distribution of n (routinely n=48) CME input parameters are generated using the CCMC Stereo CME Analysis Tool (StereoCAT) which employs geometrical triangulation techniques. These input parameters are used to perform n different simulations yielding an ensemble of solar wind parameters at various locations of interest (satellites or planets), including a probability distribution of CME shock arrival times (for hits), and geomagnetic storm strength (for Earth-directed hits). Ensemble simulations have been performed experimentally in real-time at the CCMC since January 2013. We present the results of ensemble simulations for a total of 15 CME events, 10 of which were performed in real-time. The observed CME arrival was within the range of ensemble arrival time predictions for 5 out of the 12 ensemble runs containing hits. The average arrival time prediction was computed for each of the twelve ensembles predicting hits and using the actual arrival time an average absolute error of 8.20 hours was found for all twelve ensembles, which is comparable to current forecasting errors. Some considerations for the accuracy of ensemble CME arrival time predictions include the importance of the initial distribution of CME input parameters, particularly the mean and spread. When the observed arrivals are not within the predicted range, this still allows the ruling out of prediction errors caused by tested CME input parameters. Prediction errors can also arise from ambient model parameters such as the accuracy of the solar wind background, and other limitations. Additionally the ensemble modeling setup was used to complete a parametric event case study of the sensitivity of the CME arrival time prediction to free parameters for ambient solar wind model and CME.

Initiation and early evolution of a Coronal Mass Ejection on May 13, 2009 from EUV and white-light observations

NASA Astrophysics Data System (ADS)

Reva, Anton; Kuzin, Sergey; Bogachev, Sergey; Ulyanov, Artyom

In this talk we present results of the observations of a CME, which occurred on May 13, 2009. The most important feature of these observations is that the CME was observed from the very beginning stage (the solar surface) up to the distance of 15 solar radii (R_⊙). Below 2 R_⊙ we used the data from the TESIS EUV telescopes obtained in the Fe 171 Å and He 304 Å lines, and above 2 R_⊙ we used the observations of the LASCO C2 and C3 coronagraphs. Using data of these three instruments, we have studied the evolution of the CME in details. The CME had a curved trajectory -- its helio-latitude decreased with time. The mass ejection originated at a latitudes of about 50(°) and reached the ecliptic plane at a distance of 2.5 R_⊙ from the Sun’s center. The CME velocity and acceleration increased as the CME went away from the Sun. At the distance of 15 R_⊙ from the Sun’s center the CME had a velocity of 250 km/s and an acceleration of 5 m/s(2) . The CME was not associated with a flare, and didn’t have an impulsive acceleration phase. The mass ejection had U-shaped structure which was observed both in the 171 Å images and in white-light. The CME was formed at a distance of about 0.2 -- 0.5 R_⊙ from the Sun’s surface. Observations in the line 304 Å showed that the CME was associated with the erupting prominence, which was located in the lowest part of the U-shaped structure close to the X-point of the magnetic reconnection. The prominence disappeared at the height of 0.4 R_⊙ above the solar limb. Some aspects of these observations can’t be explained in the standard CME model, which predicts that the prominence should be located inside the U-shaped structure, and the CME should be associated with a flare and have an impulsive acceleration phase.

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.

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

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.

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.

76 FR 72414 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-23

... participating in a CME activity to determine the degree to which the learning activities with integrated EHC... awareness of and willingness to learn about results from comparative effectiveness research studies. The... learning programs for delivery through the Eisenberg Center for Clinical Decisions and Communications...

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.

Participation of National Medical Associations in quality improvement activities - International comparison and the Israeli case

PubMed Central

2014-01-01

Background Many countries have devoted considerable efforts in an attempt to improve the performance of their health care systems. National Medical Associations (NMAs), along with other stakeholders, play a part in the promotion of such activities. The purpose of this paper is to explore the nature and level of participation of NMAs in activities of quality improvement in medicine, with a specific emphasis on Israel. Methods The authors conducted a survey among NMAs around the world inquiring as to their involvement in three central aspects of quality improvement: clinical guidelines, quality measurement and continuing medical education (CME). In addition, they conducted a review of the literature in order to gather more information and complete the data collected in the survey. The findings were processed and analyzed comparatively. Results Most of the NMAs surveyed participate in quality improvement activities at least to some extent. NMAs' main involvement is in the regulation of CME and they are involved to a much lesser extent in the preparation of clinical guidelines and in quality measurement. In Israel, the Israeli Medical Association (IMA) has a dominant role in both the preparation of clinical guidelines and the regulation of CME credits. Discussion It is possible that the expertise maintained by the profession, coupled with the organizational power of the NMA as a union, is viewed as beneficial for regulating educational activities in medicine such as CME. Conversely, the issuing of clinical guidelines is usually regarded as a typical scientific activity, and therefore often rests in the hands of professional medical societies. Quality measurement is regarded as a distinctive administrative tool and is usually found in the province of governments. Based on the typology that we introduced in our previous paper, we discovered that the extent of NMAs’ involvement in quality improvement coincides with the mode of governance of the health care system. Conclusions The nature and level of participation of NMAs in activities of quality improvement varies widely. Collaboration of NMAs in this field with other stakeholders is not uncommon, and may contribute to the further development of quality improvement in medicine. PMID:24808940

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.

Norway. [CME Country Reports].

ERIC Educational Resources Information Center

Council of Europe, Strasbourg (France). Documentation Center for Education in Europe.

In Norway all children, regardless of nationality, who are of compulsory school age (7-16 years old) have a right and obligation to attend compulsory school. The local school board is responsible for arranging auxiliary teaching for pupils who require extra help, in accordance with the instructions issued by the Ministry of Church and Education.…

Primary Health Care Providers' Knowledge Gaps on Parkinson's Disease

ERIC Educational Resources Information Center

Thompson, Megan R.; Stone, Ramona F.; Ochs, V. Dan; Litvan, Irene

2013-01-01

In order to determine primary health care providers' (PCPs) knowledge gaps on Parkinson's disease, data were collected before and after a one-hour continuing medical education (CME) lecture on early Parkinson's disease recognition and treatment from a sample of 104 PCPs participating at an annual meeting. The main outcome measure was the…

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,…

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

PubMed

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

2018-03-01

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

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

PubMed

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

2014-08-06

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

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.

National Marrow Donor Program

DTIC Science & Technology

2010-11-05

from power or Internet outages to severe weather. • Received 50 mobile broadband air cards at minimal cost to the organization and ONR to allow for...CLlA CME CMF COG CREG CSS CT CTA DC DHHS-ASPR DIY DKMS DMSO DoD DNA DIR EBMT EM EMDIS ENS ERSI FBI QUARTER PROGRESS REPORT

Design and Implementation of Training to Improve Management of Pediatric Overweight

ERIC Educational Resources Information Center

Beno, Luke; Hinchman, Josephine; Kibbe, Debra; Trowbridge, Frederick

2005-01-01

Introduction: Clinicians report a low proficiency in treating overweight children and using behavioral management strategies. This paper documents the design and implementation of a training program to improve clinicians' skills in the assessment and behavioral management of pediatric overweight. Methods: Two one-hour CME trainings were designed…

Calculating Coronal Mass Ejection Magnetic Field at 1 AU Using Solar Observables

NASA Astrophysics Data System (ADS)

Chen, J.; Kunkel, V.

2013-12-01

It is well-established that most major nonrecurrent geomagnetic storms are caused by solar wind structures with long durations of strong southward (Bz < 0) interplanetary magnetic field (IMF). Such geoeffective IMF structures are associated with CME events at the Sun. Unfortunately, neither the duration nor the internal magnetic field vector of the ejecta--the key determinants of geoeffectiveness--is measurable until the observer (e.g., Earth) passes through the ejecta. In this paper, we discuss the quantitative relationships between the ejecta magnetic field at 1 AU and remotely observable solar quantities associated with the eruption of a given CME. In particular, we show that observed CME trajectories (position-time data) within, say, 1/3 AU of the Sun, contain sufficient information to allow the calculation of the ejecta magnetic field (magnitude and components) at 1 AU using the Erupting Flux Rope (EFR) model of CMEs. Furthermore, in order to accurately determine the size and arrival time of the ejecta as seen by a fixed observer at 1 AU (e.g., ACE), it is essential to accurately calculate the three-dimensional geometry of the underlying magnetic structure. Accordingly, we have extended the physics-based EFR model to include a self-consistent calculation of the transverse expansion taking into account the non-symmetric drag coupling between an expanding CME flux rope and the ambient solar wind. The dependence of the minor radius of the flux rope at 1 AU that determines the perceived size of the ejecta on solar quantities is discussed. Work supported by the NRL Base Program.

GLOBAL ENERGETICS OF SOLAR FLARES. IV. CORONAL MASS EJECTION ENERGETICS

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

Aschwanden, Markus J., E-mail: aschwanden@lmsal.com

2016-11-01

This study entails the fourth part of a global flare energetics project, in which the mass m {sub cme}, kinetic energy E {sub kin}, and the gravitational potential energy E {sub grav} of coronal mass ejections (CMEs) is measured in 399 M and X-class flare events observed during the first 3.5 years of the Solar Dynamics Observatory (SDO) mission, using a new method based on the EUV dimming effect. EUV dimming is modeled in terms of a radial adiabatic expansion process, which is fitted to the observed evolution of the total emission measure of the CME source region. The modelmore » derives the evolution of the mean electron density, the emission measure, the bulk plasma expansion velocity, the mass, and the energy in the CME source region. The EUV dimming method is truly complementary to the Thomson scattering method in white light, which probes the CME evolution in the heliosphere at r ≳ 2 R {sub ⊙}, while the EUV dimming method tracks the CME launch in the corona. We compare the CME parameters obtained in white light with the LASCO/C2 coronagraph with those obtained from EUV dimming with the Atmospheric Imaging Assembly onboard the SDO for all identical events in both data sets. We investigate correlations between CME parameters, the relative timing with flare parameters, frequency occurrence distributions, and the energy partition between magnetic, thermal, nonthermal, and CME energies. CME energies are found to be systematically lower than the dissipated magnetic energies, which is consistent with a magnetic origin of CMEs.« less

Improving Our Understanding of the 3D Coronal Evolution of CME Propagation

NASA Astrophysics Data System (ADS)

Hess Webber, Shea A.; Thompson, Barbara J.; Ireland, Jack; Kwon, Ryun Young

2017-08-01

An improved understanding of the kinematic properties of CMEs and CME-associated phenomena has several impacts: 1) a less ambiguous method of mapping propagating structures into their inner coronal manifestations, 2) a clearer view of the relationship between the “main” CME and CME-associated brightenings, and 3) an improved identification of the heliospheric sources of shocks, Type II bursts, and SEPs. We present the results of a mapping technique that facilitates the separation of CMEs and CME-associated brightenings (such as shocks) from background corona. The Time Convolution Mapping Method (TCMM) segments coronagraph data to identify the time history of coronal evolution, the advantage being that the spatiotemporal evolution profiles allow users to separate features with different propagation characteristics. For example, separating “main” CME mass from CME-associated brightenings or shocks is a well-known obstacle, which the TCMM aids in differentiating. A TCMM CME map is made by first recording the maximum value each individual pixel in the image reaches during the traversal of the CME. Then the maximum value is convolved with an index to indicate the time that the pixel reached that value. The TCMM user is then able to identify continuous “kinematic profiles,” indicating related kinematic behavior, and also identify breaks in the profiles that indicate a discontinuity in kinematic history (i.e. different structures or different propagation characteristics). The maps obtained from multiple spacecraft viewpoints (i.e., STEREO and SOHO) can then be fit with advanced structural models to obtain the 3D properties of the evolving phenomena.

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

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.

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.

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.

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

PubMed

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

2006-07-01

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

Verification of real-time WSA-ENLIL+Cone simulations of CME arrival-time at the CCMC/SWRC from 2010-2016

NASA Astrophysics Data System (ADS)

Wold, A. M.; Mays, M. L.; Taktakishvili, A.; Odstrcil, D.; MacNeice, P. J.; Jian, L. K.

2017-12-01

The Wang-Sheeley-Arge (WSA)-ENLIL+Cone model is used extensively in space weather operations world-wide to model CME propagation. As such, it is important to assess its performance. We present validation results of the WSA-ENLIL+Cone model installed at the Community Coordinated Modeling Center (CCMC) and executed in real-time by the CCMC/Space Weather Research Center (SWRC). CCMC/SWRC uses the WSA-ENLIL+Cone model to predict CME arrivals at NASA missions throughout the inner heliosphere. In this work we compare model predicted CME arrival-times to in-situ ICME leading edge measurements near Earth, STEREO-A and STEREO-B for simulations completed between March 2010-December 2016 (over 1,800 CMEs). We report hit, miss, false alarm, and correct rejection statistics for all three spacecraft. For all predicted CME arrivals, the hit rate is 0.5, and the false alarm rate is 0.1. For the 273 events where the CME was predicted to arrive at Earth, STEREO-A, or STEREO-B and we observed an arrival (hit), the mean absolute arrival-time prediction error was 10.4 ± 0.9 hours, with a tendency to early prediction error of -4.0 hours. We show the dependence of the arrival-time error on CME input parameters. We also explore the impact of the multi-spacecraft observations used to initialize the model CME inputs by comparing model verification results before and after the STEREO-B communication loss (since September 2014) and STEREO-A side-lobe operations (August 2014-December 2015). There is an increase of 1.7 hours in the CME arrival time error during single, or limited two-viewpoint periods, compared to the three-spacecraft viewpoint period. This trend would apply to a future space weather mission at L5 or L4 as another coronagraph viewpoint to reduce CME arrival time errors compared to a single L1 viewpoint.

Structure-Specific Movement Patterns in Patients With Chronic Low Back Dysfunction Using Lumbar Combined Movement Examination.

PubMed

Monie, Aubrey P; Price, Roger I; Lind, Christopher R P; Singer, Kevin P

2017-06-01

A test-retest cohort study was conducted to assess the use of a novel computer-aided, combined movement examination (CME) to measure change in low back movement after pain management intervention in 17 cases of lumbar spondylosis. Additionally we desired to use a CME normal reference range (NRR) to compare and contrast movement patterns identified from 3 specific structural pathologic conditions: intervertebral disc, facet joint, and nerve root compression. Computer-aided CME was used before and after intervention, in a cohort study design, to record lumbar range of movement along with pain, disability, and health self-report questionnaires in 17 participants who received image-guided facet, epidural, and/or rhizotomy intervention. In the majority of cases, CME was reassessed after injection together with 2 serial self-reports after an average of 2 and 14 weeks. A minimal clinically important difference of 30% was used to interpret meaningful change in self-reports. A CME NRR (n = 159) was used for comparison with the 17 cases. Post hoc observation included subgrouping cases into 3 discrete pathologic conditions, intervertebral disc, facet dysfunction, and nerve root compression, in order to report intergroup differences in CME movement. Seven of the 17 participants stated that a "combined" movement was their most painful CME direction. Self-report outcome data indicated that 4 participants experienced significant improvement in health survey, 5 improved by ≥30% on low back function, and 8 reported that low back pain was more bothersome than stiffness, 6 of whom achieved the minimal clinically important difference for self-reported pain. Subgrouping of cases into structure-specific groups provided insight to different CME movement patterns. The use of CME assists in identifying atypical lumbar movement relative to an age and sex NRR. Data from this study, exemplified by representative case studies, provide preliminary evidence for distinct intervertebral disc, facet joint, and nerve root compression CME movement patterns in cases of chronic lumbar spondylosis. Copyright © 2017. Published by Elsevier Inc.

Source Regions of the Type II Radio Burst Observed During a CME-CME Interaction on 2013 May 22

NASA Technical Reports Server (NTRS)

Makela, P.; Gopalswamy, N.; Reiner, M. J.; Akiyama, S.; Krupar, V.

2016-01-01

We report on our study of radio source regions during the type II radio burst on 2013 May 22 based on direction finding analysis of the Wind/WAVES and STEREO/WAVES (SWAVES) radio observations at decameter-hectometric wavelengths. The type II emission showed an enhancement that coincided with the interaction of two coronal mass ejections (CMEs) launched in sequence along closely spaced trajectories. The triangulation of the SWAVES source directions posited the ecliptic projections of the radio sources near the line connecting the Sun and the STEREO-A spacecraft. The WAVES and SWAVES source directions revealed shifts in the latitude of the radio source, indicating that the spatial location of the dominant source of the type II emission varies during the CME-CME interaction. The WAVES source directions close to 1MHz frequencies matched the location of the leading edge of the primary CME seen in the images of the LASCO/C3 coronagraph. This correspondence of spatial locations at both wavelengths confirms that the CME-CME interaction region is the source of the type II enhancement. Comparison of radio and white-light observations also showed that at lower frequencies scattering significantly affects radio wave propagation.

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.

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

PubMed

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

2008-04-01

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

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/.

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

ERIC Educational Resources Information Center

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

2008-01-01

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

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,…

Internet Point of Care Learning at a Community Hospital

ERIC Educational Resources Information Center

Sinusas, Keith

2009-01-01

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

Deflection and Distortion of CME internal magnetic flux rope due to the interaction with a structured solar wind

NASA Astrophysics Data System (ADS)

Shiota, D.; Iju, T.; Hayashi, K.; Fujiki, K.; Tokumaru, M.; Kusano, K.

2016-12-01

CMEs are the most violent driver of geospace disturbances, and therefore their arrival to the Earth position is an important factor in space weather forecast. The dynamics of CME propagation is strongly affected by the interaction with background solar wind. To understand the interaction between a CME and background solar wind, we performed three-dimensional MHD simulations of the propagation of a CME with internal twisted magnetic flux rope into a structured bimodal solar wind. We compared three different cases in which an identical CME is launched into an identical bimodal solar wind but the launch dates of the CME are different. Each position relative to the boundary between slow and fast solar winds becomes almost in the slow wind stream region, almost in the fast wind stream region, or in vicinity of the boundary of the fast and slow solar wind stream (that grows to CIR). It is found that the CME is most distorted and deflected eastward in the case near the CIR, in contrast to the other two cases. The maximum strength of southward magnetic field at the Earth position is also highest in the case near CIR. The results are interpreted that the dynamic pressure gradient due to the back reaction from pushing the ahead slow wind stream and due to the collision behind fast wind stream hinders the expansion of the CME internal flux rope into the direction of the solar wind velocity gradient. As a result, the expansion into the direction to the velocity gradient is slightly enhanced and results in the enhanced deflection and distortion of the CME and its internal flux rope. These results support the pileup accident hypothesis proposed by Kataoka et al. (2015) to form unexpectedly geoeffective solar wind structure.

The Formation and Early Evolution of a Coronal Mass Ejection and its Associated Shock Wave on 2014 January 8

NASA Astrophysics Data System (ADS)

Wan, Linfeng; Cheng, Xin; Shi, Tong; Su, Wei; Ding, M. D.

2016-08-01

In this paper, we study the formation and early evolution of a limb coronal mass ejection (CME) and its associated shock wave that occurred on 2014 January 8. The extreme ultraviolet (EUV) images provided by the Atmospheric Imaging Assembly (AIA) on board the Solar Dynamics Observatory disclose that the CME first appears as a bubble-like structure. Subsequently, its expansion forms the CME and causes a quasi-circular EUV wave. Interestingly, both the CME and the wave front are clearly visible at all of the AIA EUV passbands. Through a detailed kinematical analysis, it is found that the expansion of the CME undergoes two phases: a first phase with a strong but transient lateral over-expansion followed by a second phase with a self-similar expansion. The temporal evolution of the expansion velocity coincides very well with the variation of the 25-50 keV hard X-ray flux of the associated flare, which indicates that magnetic reconnection most likely plays an important role in driving the expansion. Moreover, we find that, when the velocity of the CME reaches ˜600 km s-1, the EUV wave starts to evolve into a shock wave, which is evidenced by the appearance of a type II radio burst. The shock’s formation height is estimated to be ˜0.2 R sun, which is much lower than the height derived previously. Finally, we also study the thermal properties of the CME and the EUV wave. We find that the plasma in the CME leading front and the wave front has a temperature of ˜2 MK, while that in the CME core region and the flare region has a much higher temperature of ≥8 MK.

Problematic protocols: An overview of medical research protocols not approved by the LUMC medical ethics review committee.

PubMed

Tersmette, Derek Gideon; Engberts, Dirk Peter

2017-01-01

The Committee for Medical Ethics (CME) of Leiden University Medical Center (LUMC) was established as the first medical ethics reviewing committee (MREC) in the Netherlands. In the period 2000-2010 the CME received 2,162 protocols for review. Some of these protocols were never approved. Until now, there has existed neither an overview of these failed protocols nor an overview of the reasons for their failure. This report draws on data from the digital database, the physical archives, and the minutes of the meetings of the CME. Additional information has been obtained from the Central Committee on Research involving Human Subjects (CCRH) and survey-based research. Protocols were itemized based on characteristic features and their reviewing procedures were analyzed. In total, 1,952 out of 2,162 research protocols submitted during 2000-2010 (90.3%) were approved by the CME; 210 of 2,162 protocols (9.7%) were not approved. Of these 210 protocols, 177 failed due to reasons not related to CME reviewing. In 15 cases CME reviewing led to protocol failure, while another 10 protocols were rejected outright. Eight of the 210 submitted protocols without approval had been conducted prior to submission. In the aforementioned period, little protocol failure occurred. For the most part, protocol failure was caused by problems that are not CME related. This type of failure has several identifiable factors, none of which have anything to do with the ethical reviewing procedure by the CME. A mere 1.2% of protocols failed due to ethical review. Unacceptable burden and risks to the subject and an inadequate methodology are the most common reasons for this CME-related protocol failure.

The Significance of the Influence of the CME Deflection in Interplanetary Space on the CME Arrival at Earth

NASA Astrophysics Data System (ADS)

Zhuang, Bin; Wang, Yuming; Shen, Chenglong; Liu, Siqing; Wang, Jingjing; Pan, Zonghao; Li, Huimin; Liu, Rui

2017-08-01

As one of the most violent astrophysical phenomena, coronal mass ejections (CMEs) have strong potential space weather effects. However, not all Earth-directed CMEs encounter the Earth and produce geo-effects. One reason is the deflected propagation of CMEs in interplanetary space. Although there have been several case studies clearly showing such deflections, it has not yet been statistically assessed how significantly the deflected propagation would influence the CME’s arrival at Earth. We develop an integrated CME-arrival forecasting (iCAF) system, assembling the modules of CME detection, three-dimensional (3D) parameter derivation, and trajectory reconstruction to predict whether or not a CME arrives at Earth, and we assess the deflection influence on the CME-arrival forecasting. The performance of iCAF is tested by comparing the two-dimensional (2D) parameters with those in the Coordinated Data Analysis Workshop (CDAW) Data Center catalog, comparing the 3D parameters with those of the gradual cylindrical shell model, and estimating the success rate of the CME Earth-arrival predictions. It is found that the 2D parameters provided by iCAF and the CDAW catalog are consistent with each other, and the 3D parameters derived by the ice cream cone model based on single-view observations are acceptable. The success rate of the CME-arrival predictions by iCAF with deflection considered is about 82%, which is 19% higher than that without deflection, indicating the importance of the CME deflection for providing a reliable forecasting. Furthermore, iCAF is a worthwhile project since it is a completely automatic system with deflection taken into account.

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.

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

NASA Technical Reports Server (NTRS)

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

2015-01-01

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

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

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

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

2015-08-10

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

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 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.

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

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.

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 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.

77 FR 1775 - Self-Regulatory Organizations; Chicago Mercantile Exchange, Inc.; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-11

... SECURITIES AND EXCHANGE COMMISSION [Release No. 34-66102; File No. SR-CME-2011-22] Self-Regulatory... Change To Establish Certain Fee Programs in Connection With Its OTC Interest Rate Swap Clearing Offering...)(2). I. Self-Regulatory Organization's Statement of Terms of Substance of the Proposed Rule Change...

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...

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.

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

Experience with a Spanish-language laparoscopy website.

PubMed

Moreno-Sanz, Carlos; Seoane-González, Jose B

2006-02-01

Although there are no clearly defined electronic tools for continuing medical education (CME), new information technologies offer a basic platform for presenting training content on the internet. Due to the shortage of websites about minimally invasive surgery in the Spanish language, we set up a topical website in Spanish. This study considers the experience with the website between April 2001 and January 2005. To study the activity of the website, the registry information was analyzed descriptively using the log files of the server. To study the characteristics of the users, we searched the database of registered users. We found a total of 107,941 visits to our website and a total of 624,895 page downloads. Most visits to the site were made from Spanish-speaking countries. The most frequent professional profile of the registered users was that of general surgeon. The development, implementation, and evaluation of Spanish-language CME initiatives over the internet is promising but presents challenges.

Diagnosis and incidence risk of clinical canine monocytic ehrlichiosis under field conditions in Southern Europe.

PubMed

René-Martellet, Magalie; Lebert, Isabelle; Chêne, Jeanne; Massot, Raphaël; Leon, Marta; Leal, Ana; Badavelli, Stefania; Chalvet-Monfray, Karine; Ducrot, Christian; Abrial, David; Chabanne, Luc; Halos, Lénaïg

2015-01-06

Canine Monocytic Ehrlichiosis (CME), due to the bacterium Ehrlichia canis and transmitted by the brown dog tick Rhipicephalus sanguineus, is a major tick-borne disease in southern Europe. In this area, infections with other vector-borne pathogens (VBP) are also described and result in similar clinical expression. The aim of the present study was to evaluate the incidence risk of clinical CME in those endemic areas and to assess the potential involvement of other VBP in the occurrence of clinical and/or biological signs evocative of the disease. The study was conducted from April to November 2011 in veterinary clinics across Italy, Spain and Portugal. Sick animals were included when fitting at least three clinical and/or biological criteria compatible with ehrlichiosis. Serological tests (SNAP®4Dx, SNAP®Leish tests, Idexx, USA) and diagnostic PCR for E. canis, Anaplasma platys, Anaplasma phagocytophilum, Babesia spp, Hepatozoon canis and Leishmania infantum detection were performed to identify the etiological agents. Ehrlichiosis was considered when three clinical and/or biological suggestive signs were associated with at least one positive paraclinical test (serology or PCR). The annual incidence risk was calculated and data were geo-referenced for map construction. The probabilities of CME and other vector-borne diseases when facing clinical and/or biological signs suggestive of CME were then evaluated. A total of 366 dogs from 78 veterinary clinics were enrolled in the survey. Among them, 99 (27%) were confirmed CME cases, which allowed an estimation of the average annual incidence risk of CME amongst the investigated dog population to be 0.08%. Maps showed an increasing gradient of CME incidence risk from northern towards southern areas, in particular in Italy. It also suggested the existence of hot-spots of infections by VBP in Portugal. In addition, the detection of other VBP in the samples was common and the study demonstrated that a dog with clinical signs evocative of CME is as likely to be positive to Ehrlichia canis as to another VBP. The study confirms the endemicity of CME in southern Europe and highlights the difficulties encountered by veterinarians to differentiate CME from other vector-borne diseases under field conditions.

Verification of real-time WSA-ENLIL+Cone simulations of CME arrival-time at the CCMC from 2010 to 2016

NASA Astrophysics Data System (ADS)

Wold, Alexandra M.; Mays, M. Leila; Taktakishvili, Aleksandre; Jian, Lan K.; Odstrcil, Dusan; MacNeice, Peter

2018-03-01

The Wang-Sheeley-Arge (WSA)-ENLIL+Cone model is used extensively in space weather operations world-wide to model coronal mass ejection (CME) propagation. As such, it is important to assess its performance. We present validation results of the WSA-ENLIL+Cone model installed at the Community Coordinated Modeling Center (CCMC) and executed in real-time by the CCMC space weather team. CCMC uses the WSA-ENLIL+Cone model to predict CME arrivals at NASA missions throughout the inner heliosphere. In this work we compare model predicted CME arrival-times to in situ interplanetary coronal mass ejection leading edge measurements at Solar TErrestrial RElations Observatory-Ahead (STEREO-A), Solar TErrestrial RElations Observatory-Behind (STEREO-B), and Earth (Wind and ACE) for simulations completed between March 2010 and December 2016 (over 1,800 CMEs). We report hit, miss, false alarm, and correct rejection statistics for all three locations. For all predicted CME arrivals, the hit rate is 0.5, and the false alarm rate is 0.1. For the 273 events where the CME was predicted to arrive at Earth, STEREO-A, or STEREO-B, and was actually observed (hit event), the mean absolute arrival-time prediction error was 10.4 ± 0.9 h, with a tendency to early prediction error of -4.0 h. We show the dependence of the arrival-time error on CME input parameters. We also explore the impact of the multi-spacecraft observations used to initialize the model CME inputs by comparing model verification results before and after the STEREO-B communication loss (since September 2014) and STEREO-A sidelobe operations (August 2014-December 2015). There is an increase of 1.7 h in the CME arrival time error during single, or limited two-viewpoint periods, compared to the three-spacecraft viewpoint period. This trend would apply to a future space weather mission at L5 or L4 as another coronagraph viewpoint to reduce CME arrival time errors compared to a single L1 viewpoint.

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.

Medical-Legal Partnership: Collaborating with Lawyers to Identify and Address Health Disparities

PubMed Central

Cohen, Ellen; Fullerton, Danya Fortess; Retkin, Randye; Weintraub, Dana; Tames, Pamela; Brandfield, Julie

2010-01-01

Introduction Medical-legal partnerships (MLPs) bring together medical professionals and lawyers to address social causes of health disparities, including access to adequate food, housing and income. Setting Eighty-one MLPs offer legal services for patients whose basic needs are not being met. Program Description Besides providing legal help to patients and working on policy advocacy, MLPs educate residents (29 residency programs), health care providers (160 clinics and hospitals) and medical students (25 medical schools) about how social conditions affect health and screening for unmet basic needs, and how these needs can often be impacted by enforcing federal and state laws. These curricula include medical school courses, noon conferences, advocacy electives and CME courses. Program Evaluation Four example programs are described in this paper. Established MLPs have changed knowledge (MLP | Boston—97% reported screening for two unmet needs), attitudes (Stanford reported reduced concern about making patients “nervous” with legal questions from 38% to 21%) and behavior (NY LegalHealth reported increasing resident referrals from 15% to 54%) after trainings. One developing MLP found doctors experienced difficulty addressing social issues (NJ LAMP—67% of residents felt uncomfortable). Discussion MLPs train residents, students and other health care providers to tackle socially caused health disparities. PMID:20352508

Forecasting Propagation and Evolution of CMEs in an Operational Setting: What Has Been Learned

NASA Technical Reports Server (NTRS)

Zheng, Yihua; Macneice, Peter; Odstrcil, Dusan; Mays, M. L.; Rastaetter, Lutz; Pulkkinen, Antti; Taktakishvili, Aleksandre; Hesse, Michael; Kuznetsova, M. Masha; Lee, Hyesook;

Forecasting propagation and evolution of CMEs in an operational setting: What has been learned

NASA Astrophysics Data System (ADS)

Zheng, Yihua; Macneice, Peter; Odstrcil, Dusan; Mays, M. L.; Rastaetter, Lutz; Pulkkinen, Antti; Taktakishvili, Aleksandre; Hesse, Michael; Masha Kuznetsova, M.; Lee, Hyesook; Chulaki, Anna

2013-10-01

of the major types of solar eruption, coronal mass ejections (CMEs) not only impact space weather, but also can have significant societal consequences. CMEs cause intense geomagnetic storms and drive fast mode shocks that accelerate charged particles, potentially resulting in enhanced radiation levels both in ions and electrons. Human and technological assets in space can be endangered as a result. CMEs are also the major contributor to generating large amplitude Geomagnetically Induced Currents (GICs), which are a source of concern for power grid safety. Due to their space weather significance, forecasting the evolution and impacts of CMEs has become a much desired capability for space weather operations worldwide. Based on our operational experience at Space Weather Research Center at NASA Goddard Space Flight Center (http://swrc.gsfc.nasa.gov), we present here some of the insights gained about accurately predicting CME impacts, particularly in relation to space weather operations. These include: 1. The need to maximize information to get an accurate handle of three-dimensional (3-D) CME kinetic parameters and therefore improve CME forecast; 2. The potential use of CME simulation results for qualitative prediction of regions of space where solar energetic particles (SEPs) may be found; 3. The need to include all CMEs occurring within a 24 h period for a better representation of the CME interactions; 4. Various other important parameters in forecasting CME evolution in interplanetary space, with special emphasis on the CME propagation direction. It is noted that a future direction for our CME forecasting is to employ the ensemble modeling approach.

Anomalous chiral transport in heavy ion collisions from Anomalous-Viscous Fluid Dynamics

NASA Astrophysics Data System (ADS)

Shi, Shuzhe; Jiang, Yin; Lilleskov, Elias; Liao, Jinfeng

2018-07-01

Chiral anomaly is a fundamental aspect of quantum theories with chiral fermions. How such microscopic anomaly manifests itself in a macroscopic many-body system with chiral fermions, is a highly nontrivial question that has recently attracted significant interest. As it turns out, unusual transport currents can be induced by chiral anomaly under suitable conditions in such systems, with the notable example of the Chiral Magnetic Effect (CME) where a vector current (e.g. electric current) is generated along an external magnetic field. A lot of efforts have been made to search for CME in heavy ion collisions, by measuring the charge separation effect induced by the CME transport. A crucial challenge in such effort, is the quantitative prediction for the CME signal. In this paper, we develop the Anomalous-Viscous Fluid Dynamics (AVFD) framework, which implements the anomalous fluid dynamics to describe the evolution of fermion currents in QGP, on top of the neutral bulk background described by the VISH2+1 hydrodynamic simulations for heavy ion collisions. With this new tool, we quantitatively and systematically investigate the dependence of the CME signal to a series of theoretical inputs and associated uncertainties. With realistic estimates of initial conditions and magnetic field lifetime, the predicted CME signal is quantitatively consistent with measured change separation data in 200GeV Au-Au collisions. Based on analysis of Au-Au collisions, we further make predictions for the CME observable to be measured in the planned isobaric (Ru-Ru v.s. Zr-Zr) collision experiment, which could provide a most decisive test of the CME in heavy ion collisions.

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

ERIC Educational Resources Information Center

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

2006-01-01

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

Gamma-Ray Observations Related to the Acceleration of Ions in the Corona

NASA Astrophysics Data System (ADS)

Share, G. H.; Murphy, R. J.; Tolbert, A. K.; White, S. M.; Dennis, B. R.; Schwartz, R. A.; Tylka, A. J.

2016-12-01

High-energy gamma-rays associated with solar flares have been observed for over thirty-five years by various satellite experiments. The most sensitive observations have been made recently by the Large Area Telescope (LAT) experiment on the Fermi satellite. These observations confirm the earlier observations in which >100 MeV emission was detected coincident with the impulsive flare hard X-rays and also in the minutes and hours afterward. Spectral evidence from the largest of these latter, time-extended events, indicate they arise from the decay of neutral and charged pions produced by the interaction of protons and alpha particles with energies >300 MeV/nucl and >200 MeV/nucl, respectively. These high-energy time-extended events, are almost always associated with fast CME's and appear to begin from as short as 1 min to as long as 100 min after the onset of the CME. The events appear to last as short as 10 min to as long as 18 hr. Our analysis indicates that the number of >500 MeV protons producing the time-extended emission typically is an order magnitude larger than the number producing emission during the impulsive flare. The observed delays from the CME and energetic comparisons suggest that most of the energy in the ions producing the sustained time-extended emission came from a source other than the impulsive flare. It is likely that the particles were accelerated by shocks associated with the CME's and thus may have an origin common with SEPs observed in space. Our comparisons using GOES HEPAD and neutron monitor data, and those reported in this Session by DeNolfo et al. using data from PAMELA, suggest that the numbers of particles producing the gamma-ray emission are typically at least an order of magnitude smaller than those observed in space. We focus our discussion in this talk on the time-extended gamma-ray events that begin within minutes of the CME onset as they may reflect shock-acceleration of protons to hundreds of MeV deep in the corona. This work was supported by the SHINE/NSF, NASA Fermi GI and SR&T, Chief of Naval Research, and EU HESPERIA programs.

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

Integrated obesity care management system -implementation and research protocol

PubMed Central

Baillargeon, Jean-Patrice; Carpentier, André; Donovan, Denise; Fortin, Martin; Grant, Andrew; Simoneau-Roy, Judith; St-Cyr-Tribble, Denise; Xhignesse, Mariane; Langlois, Marie-France

2007-01-01

Background Nearly 50% of Canadians are overweight and their number is increasing rapidly. The majority of obese subjects are treated by primary care physicians (PCPs) who often feel uncomfortable with the management of obesity. The current research proposal is aimed at the development and implementation of an innovative, integrated, interdisciplinary obesity care management system involving both primary and secondary care professionals. Methods We will use both action and evaluative research in order to achieve the following specific objectives. The first one is to develop and implement a preceptorship-based continuing medical education (CME) program complemented by a web site for physicians and nurses working in Family Medicine Groups (FMGs). This CME will be based on needs assessment and will be validated by one FMG using questionnaires and semi structured interviews. Also, references and teaching tools will be available for participants on the web site. Our second objective is to establish a collaborative intra and inter-regional interdisciplinary network to enable on-going expertise update and networking for FMG teams. This tool consists of a discussion forum and monthly virtual meetings of all participants. Our third objective is to evaluate the implementation of our program for its ability to train 8 FMGs per year, the access and utilization of electronic tools and the participants' satisfaction. This will be measured with questionnaires, web logging tools and group interviews. Our fourth objective is to determine the impact for the participants regarding knowledge and expertise, attitudes and perceptions, self-efficacy for the management of obesity, and changes in FMG organization for obesity management. Questionnaires and interviews will be used for this purpose. Our fifth objective is to deliver transferable knowledge for health professionals and decision-makers. Strategies and pitfalls of setting up this program will also be identified. Conclusion This project is relevant to health system's decision-makers who are confronted with an important increase in the prevalence of obesity. It is therefore critical to develop strategies allowing the management of obesity in the 1st line setting. Results of this research project could therefore influence health care organization in the field of obesity but also eventually for other chronic diseases. PMID:17927835

Super- and sub-critical regions in shocks driven by radio-loud and radio-quiet CMEs

PubMed Central

Bemporad, Alessandro; Mancuso, Salvatore

2012-01-01

White-light coronagraphic images of Coronal Mass Ejections (CMEs) observed by SOHO/LASCO C2 have been used to estimate the density jump along the whole front of two CME-driven shocks. The two events are different in that the first one was a “radio-loud” fast CME, while the second one was a “radio quiet” slow CME. From the compression ratios inferred along the shock fronts, we estimated the Alfvén Mach numbers for the general case of an oblique shock. It turns out that the “radio-loud” CME shock is initially super-critical around the shock center, while later on the whole shock becomes sub-critical. On the contrary, the shock associated with the “radio-quiet” CME is sub-critical at all times. This suggests that CME-driven shocks could be efficient particle accelerators at the shock nose only at the initiation phases of the event, if and when the shock is super-critical, while at later times they lose their energy and the capability to accelerate high energetic particles. PMID:25685431

Comparison of the CME-associated shock arrival times at the earth using the WSA-ENLIL model with three cone models

NASA Astrophysics Data System (ADS)

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

2012-12-01

We have made a comparison of CME-associated shock arrival times at the earth based on the WSA-ENLIL model with three cone models using 29 halo CMEs from 2001 to 2002. These halo CMEs have cone model parameters from Michalek et al. (2007) as well as their associated interplanetary (IP) shocks. For this study we consider three different cone models (an asymmetric cone model, an ice-cream cone model and an elliptical cone model) to determine CME cone parameters (radial velocity, angular width and source location), which are used for input parameters of the WSA-ENLIL model. The mean absolute error (MAE) of the arrival times for the elliptical cone model is 10 hours, which is about 2 hours smaller than those of the other models. However, this value is still larger than that (8.7 hours) of an empirical model by Kim et al. (2007). We are investigating several possibilities on relatively large errors of the WSA-ENLIL cone model, which may be caused by CME-CME interaction, background solar wind speed, and/or CME density enhancement.

A Monster CME Obscuring a Demon Star Flare

NASA Astrophysics Data System (ADS)

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

2017-12-01

We explore the scenario of a coronal mass ejection (CME) being the cause of the observed continuous X-ray absorption of the 1997 August 30 superflare on the eclipsing binary Algol (the Demon Star). The temporal decay of the absorption is consistent with absorption by a CME undergoing self-similar evolution with uniform expansion velocity. We investigate the kinematic and energetic properties of the CME using the ice cream cone model for its three-dimensional structure in combination with the observed profile of the hydrogen column density decline with time. Different physically justified length scales were used that allowed us to estimate lower and upper limits of the possible CME characteristics. Further consideration of the maximum available magnetic energy in starspots leads us to quantify its mass as likely lying in the range 2× {10}21 {--} 2× {10}22 g and kinetic energy in the range 7× {10}35 {--} 3× {10}38 erg. The results are in reasonable agreement with extrapolated relations between flare X-ray fluence and CME mass and kinetic energy derived for solar CMEs.

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.

Phenotypic and genotypic anti-microbial resistance profiles of campylobacters from untreated feedlot cattle and their environment.

PubMed

Minihan, D; Whyte, P; O'mahony, M; Cowley, D; O'halloran, F; Corcoran, D; Fanning, S; Collins, J D

2006-05-01

Anti-microbial resistance is an emerging public health issue. Farmed animals may act as reservoirs and potential sources of anti-microbial resistant Campylobacters. The aim of this study was to investigate the anti-microbial resistance profile of cattle and environmental Campylobacter isolates from normal untreated feedlot cattle, the role of the gyrA Thr-86-Ile mutation in ciprofloxacin-resistant Campylobacter jejuni isolates and the involvement of the tripartite CmeABC efflux system for multi-resistant C. jejuni isolates. The phenotypic anti-microbial resistance testing was carried out on 500 Campylobacter isolates (445 cattle isolates and 55 environmental isolates). In general, there was a higher level of anti-microbial resistance for the environmental isolates compared with the animal isolates, 45% of the animal isolates were resistant to one or more of the seven anti-microbials compared with 84% of the environmental isolates. The combined cattle and environmental Campylobacters had 34 (6.8%) isolates resistant to three or more of the seven anti-microbials tested on all isolates and 11 (2.2%) isolates were resistant to the seven anti-microbials. There was a substantial level of ciprofloxacin-resistant Campylobacters in both animal (8.5%) and environmental (21.8%) isolates. The gyrA Thr-86-Ile mutation was only present in five of 22 ciprofloxacin-resistant C. jejuni isolates investigated. No multi-drug-resistant associated mutation was detected in the CmeB or the CmeR regions investigated. In conclusion, our study observed a substantial level of Campylobacter anti-microbial resistance, highlighting the need for an active anti-microbial surveillance program for food animals in Ireland and the importance of the chosen sampling point can have on the findings of such a program.

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

PubMed Central

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

2017-01-01

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

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

PubMed

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

2017-06-27

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

Observations on the 2016 World Congress on Continuing Professional Development: Advancing Learning and Care in the Health Professions.

PubMed

Turco, Mary G; Baron, Robert B

2016-01-01

The 2016 World Congress on Continuing Professional Development: Advancing Learning and Care in the Health Professions took place in San Diego, California, March 17-19, 2016. Hosts were the Association for Hospital Medical Education (AHME), Alliance for Continuing Education in the Health Professionals (ACEhp), and Society for Academic Continuing Medical Education (SACME). The target audience was the international community working to improve medical (CME), nursing (CNE), pharmacy (CPE), and interprofessional (CIPE) continuing education (CE) and continuing professional development (CPD). Goals included: addressing patients' concerns and needs; advancing global medical and interprofessional health sciences education; utilizing learning to address health disparities; and promoting international cooperation. The five keynote speakers were: patient advocate Alicia Cole ("Why What We Do Matters: The Patients Voice"); linguist Lorelei Lingard ("Myths about Healthcare Teamwork and Their Implications for How We Understand Competence"); futurist and philosopher Alex Jadad ("What Do We Need to Protect at All Costs in the 21st Century?"); ethicist and change agent Zeke Emanuel ("Learn to Change: Teaching Toward a Shifting Healthcare Horizon"); and technology innovator Stephen Downes ("From Individual to Community: The Learning Is in the Doing"). Organizers announced the new Dave Davis Distinguished Award for Excellence in Mentorship in Continuing Professional Development to honor the career of David Davis, MD, in CME/CPD scholarship in Canada, the United States, and beyond. Participants valued the emphasis on interprofessional education and practice, the importance of integrating the patient voice, the effectiveness of flipped classroom methods, and the power of collective competency theories. Attendee-respondents encouraged Congress planners to continue to strive for a broad global audience and themes of international interest.

Autonomic arousal and learning in Web-based simulation: a feasibility study.

PubMed

Gorrindo, Tristan; Chevalier, Lydia; Goldfarb, Elizabeth; Hoeppner, Bettina B; Birnbaum, Robert J

2014-01-01

Autonomic arousal is an important component of understanding learning as it is related to cognitive effort, attention, and emotional arousal. Currently, however, little is known about its relationship to online education. We conducted a study to determine the feasibility of measuring autonomic arousal and engagement in online continuing medical education (CME). Using the Computer Simulation Assessment Tool (CSAT) platform, health care providers were randomly assigned to either high- or low-valence versions of a Web-based simulation on risk assessment for a returning veteran. Data were collected on participants' actions within the simulation, self-reported cognitive engagement, knowledge retention, and autonomic arousal measured using galvanic skin response (GSR). Participants in the high-valence condition (n = 7) chose a lower percentage of critical actions (M = 79.2, SD = 4.2) than participants in the low valence (n = 8) condition (M = 83.9, SD = 3.6, t(1,14) = 2.44, p = .03). While not statistically significant, high-valence participants reported higher cognitive engagement. Participants in the high-valence condition showed a larger increase in physiologic arousal when comparing mean tonic GSR during the orientation simulation to the study simulation (high-valence mean difference = 4.21 μS, SD = 1.23 vs low-valence mean difference = 1.64 μS, SD = 2.32, t(1,13) = -2.62, p = .01). In addition to being consistent with previous engagement research, this experiment functioned as a feasibility study for measuring autonomic arousal in online CME. The current study provides a framework for future studies, which may use neurophysiology to identify the critical autonomic and engagement components associated with effective online learning. © 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.

Ultraviolet Observations of Coronal Mass Ejection Impact on Comet 67P/Churyumov–Gerasimenko by Rosetta Alice

NASA Astrophysics Data System (ADS)

Noonan, John W.; Stern, S. Alan; Feldman, Paul D.; Broiles, Thomas; Wedlund, Cyril Simon; Edberg, Niklas J. T.; Schindhelm, Eric; Parker, Joel Wm.; Keeney, Brian A.; Vervack, Ronald J., Jr.; Steffl, Andrew J.; Knight, Matthew M.; Weaver, Harold A.; Feaga, Lori M.; A’Hearn, Michael; Bertaux, Jean-Loup

2018-07-01

The Alice ultraviolet spectrograph on the European Space Agency Rosetta spacecraft observed comet 67P/Churyumov–Gerasimenko in its orbit around the Sun for just over two years. Alice observations taken in 2015 October, two months after perihelion, show large increases in the comet’s Lyβ, O I 1304, O I 1356, and C I 1657 Å atomic emission that initially appeared to indicate gaseous outbursts. However, the Rosetta Plasma Consortium instruments showed a coronal mass ejection (CME) impact at the comet coincident with the emission increases, suggesting that the CME impact may have been the cause of the increased emission. The presence of the semi-forbidden O I 1356 Å emission multiplet is indicative of a substantial increase in dissociative electron impact emission from the coma, suggesting a change in the electron population during the CME impact. The increase in dissociative electron impact could be a result of the interaction between the CME and the coma of 67P or an outburst coincident with the arrival of the CME. The observed dissociative electron impact emission during this period is used to characterize the O2 content of the coma at two peaks during the CME arrival. The mechanism that could cause the relationship between the CME and UV emission brightness is not well constrained, but we present several hypotheses to explain the correlation.

Dependence of the Peak Fluxes of Solar Energetic Particles on CME 3D Parameters from STEREO and SOHO

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

Park, Jinhye; Moon, Y.-J.; Lee, Harim, E-mail: jinhye@khu.ac.kr

We investigate the relationships between the peak fluxes of 18 solar energetic particle (SEP) events and associated coronal mass ejection (CME) 3D parameters (speed, angular width, and separation angle) obtained from SOHO , and STEREO-A / B for the period from 2010 August to 2013 June. We apply the STEREO CME Analysis Tool (StereoCAT) to the SEP-associated CMEs to obtain 3D speeds and 3D angular widths. The separation angles are determined as the longitudinal angles between flaring regions and magnetic footpoints of the spacecraft, which are calculated by the assumption of a Parker spiral field. The main results are asmore » follows. (1) We find that the dependence of the SEP peak fluxes on CME 3D speed from multiple spacecraft is similar to that on CME 2D speed. (2) There is a positive correlation between SEP peak flux and 3D angular width from multiple spacecraft, which is much more evident than the relationship between SEP peak flux and 2D angular width. (3) There is a noticeable anti-correlation ( r = −0.62) between SEP peak flux and separation angle. (4) The multiple-regression method between SEP peak fluxes and CME 3D parameters shows that the longitudinal separation angle is the most important parameter, and the CME 3D speed is secondary on SEP peak flux.« less

Coronal Current Sheet Evolution in the Aftermath of a CME

NASA Technical Reports Server (NTRS)

Bemporad, A.; Poletto, G.; Suess, S. T.; Ko, Y.-K.; Schwadron, N. A.; Elliott, H. A.; Raymond, J. C.

2005-01-01

We report on SOHO-UVCS observations of coronal restructuring following a Coronal Mass Ejection (CME) on November 26, 2002, at the time of a SOHO-Ulysses quadrature campaign. Starting about 3 hours after the CME, which was directed towards Ulysses, UVCS began taking spectra at 1.7 solar radii, covering emission from both cool and hot plasma. Observations continued, with occasional gaps, for more than 2 days. Emission in the 974.8 Angstrom line of [Fe XVIII], indicating temperatures above 6x10(6) K, was observed throughout the campaign in a spatially limited location. Comparison with EIT images shows the [Fe XVIII] emission to overlie a growing post-flare loop system formed in the aftermath of the CME. The emission most likely originates in a current sheet overlying the arcade. Analysis of the [Fe XVIII] emission allows us to infer the evolution of physical parameters in the current sheet over the entire span of our observations: in particular, we give the temperature vs. time in the current sheet and estimate the density. Ulysses was directly above the location of the CME and intercepted the ejecta. High ionization state Fe was detected by SWICS throughout the magnetic cloud associated with the CME, although the rapid temporal variation suggests bursty, rather than smooth, reconnection in the coronal current sheet. Both the remote and in situ observations are compared with predictions of theoretical CME models.

Current Sheet Evolution in the Aftermath of a CME Event

NASA Technical Reports Server (NTRS)

Bemporad, A.; Poletto, G.; Suess, S. T.; Ko, Y.-K.; Schwadron, N. A.; Elliott, H. A.; Raymond, J. C.

2005-01-01

We report on SOHO-UVCS observations of the coronal restructuring following a Coronal Mass Ejection (CME) on November 26,2002, at the time of a SOHO-Ulysses quadrature campaign. Starting about 3 hours after a CME in the NW quadrant, UVCS began taking spectra at 1.7 solar radius, covering emission from both cool and hot plasma. Observations continued, with occasional gaps, for more than 2 days. Emission in the 974.8 Angstrom line of [Fe XVIII], indicating temperatures above 6 x 10(exp 6) K, was observed throughout the campaign in a spatially limited location. Comparison with EIT images shows the Fe XVIII emission to overlie a growing post-flare loop system formed in the aftermath of the CME. The emission most likely originates in a current sheet overlying the arcade. Analysis of the [Fe XVIII] emission allows us to infer the evolution of physical parameters in the current sheet over the entire span of our observations: in particular, we give the temperature vs. time in the current sheet and estimate the density. At the time of the quadrature, Ulysses was directly above the location of the CME and intercepted the ejecta. High ionization state Fe was detected by Ulysses-SWICS throughout the magnetic cloud associated with the CME. Both the remote and in situ observations are compared with predictions of theoretical CME models.

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.

Clinical implications of patient-provider agreements in opioid prescribing.

PubMed

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

2015-01-01

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

76 FR 72493 - ITS Joint Program Office Webinar on Alternative Organizational Structures for a Certificate...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-23

... over time. (This study is an institutional analysis only, not a technical analysis, and it is not... Adam Hopps at (202) 680-0091. The ITS JPO will present results from an early analysis of organizational models. This analysis will describe the functions that need to be performed by a CME; identify key...

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…

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 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.

Two Distinct Types of CME-flare Relationships Based on SOHO and STEREO Observations

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

Jang, Soojeong; Moon, Yong-Jae; Kim, Rok-Soon

In this paper, we present two distinct types of coronal mass ejection (CME)-flare relationships according to their observing time differences using 107 events from 2010 to 2013. The observing time difference, Δ T , is defined as flare peak time minus CME first appearance time at Solar Terrestrial Relations Observatory ( STEREO ) COR1 field of view. There are 41 events for group A (Δ T < 0) and 66 events for group B (Δ T ≥ 0). We compare CME 3D parameters (speed and kinetic energy) based on multi-spacecraft data ( SOlar and Heliospheric Observatory ( SOHO ) andmore » STEREO A and B ) and their associated flare properties (peak flux, fluence, and duration). Our main results are as follows. First, there are better relationships between CME and flare parameters for group B than that of group A. In particular, CME 3D kinetic energy for group B is well correlated with flare fluence with the correlation coefficient of 0.67, which is much stronger than that (cc = 0.31) of group A. Second, the events belonging to group A have short flare durations of less than 1 hr (mean = 21 minutes), while the events for group B have longer durations up to 4 hr (mean = 81 minutes). Third, the mean value of height at peak speed for group B is 4.05 Rs, which is noticeably higher than that of group A (1.89 Rs). This is well correlated with the CME acceleration duration (cc = 0.75). A higher height at peak speed and a longer acceleration duration of CME for group B could be explained by the fact that magnetic reconnections for group B continuously occur for a longer time than those for group A.« less

The Radial Speed - Expansion Speed Relation for Earth-Directed CMEs

NASA Astrophysics Data System (ADS)

Makela, P. A.; Gopalswamy, N.; Yashiro, S.

2013-12-01

The propagation speed of Earth-directed coronal mass ejections (CMEs) is an essential parameter needed in space weather forecasting. However, the true propagation speed of Earth-directed CMEs cannot be measured accurately from coronagraph images taken from Earth's view. In order to circumvent the inaccuracies of speed measurements due to the projection effects, empirical relations expressing the radial speed (Vrad) of the CME as a function of the CME expansion speed (Vexp) have been suggested. Vexp is defined as the apparent speed the CME is spreading in the coronagraph's field of view. During 2010-2012 STEREO spacecraft provided a side view of Earth-directed CMEs, allowing measurements of true CME speeds and widths. In a case study of the 2011 February 15 CME Gopalswamy et al. (2012) compared three Vrad-Vexp relations (flat cone, full or shallow ice cream cone - Gopalswamy et al., 2009) and found the closest match with the observations for the (full ice cream cone) relation Vrad = 1/2(1 + cot w)Vexp, where w is the half width of the CME. Using the STEREO/SECCHI and SOHO/LASCO observations during this opportune period, we expand this analysis to a larger set of Earth-directed CMEs. We compare the computed CME speed estimates with the measured true speeds and estimate the accuracy of the Vrad-Vexp relations. References: Gopalswamy, N. et al. (2009), The expansion and radial speeds of coronal mass ejections, Cent. Eur. Astrophys. Bull., 33, 115. Gopalswamy, N. et al. (2012), The relationship between the expansion speed and radial speed of CMEs confirmed using quadrature observations of the 2011 February 15 CME, Sun and Geosphere, 7(1), 7.

The Width of a Solar Coronal Mass Ejection and the Source of the Driving Magnetic Explosion

NASA Technical Reports Server (NTRS)

Moore, Ronald L.; Sterling, Alphonse C.; Suess, Steven T.

2007-01-01

We show that the strength of the magnetic field in the area covered by the flare arcade following a CME-producing ejective solar eruption can be estimated from the final angular width of the CME in the outer corona and the final angular width of the flare arcade. We assume (1) the flux-rope plasmoid ejected from the flare site becomes the interior of the CME plasmoid, (2) in the outer corona (R greater than 2R(sub Sun)) the CME is roughly a spherical plasmoid with legs shaped like a light bulb, and (3) beyond some height in or below the outer corona the CME plasmoid is in lateral pressure balance with the surrounding magnetic field. The strength of the nearly radial magnetic field in the outer corona is estimated from the radial component of the interplanetary magnetic field measured by Ulysses. We apply this model to three well-observed CMEs that exploded from flare regions of extremely different size and magnetic setting. One of these CMEs is an over-and-out CME that exploded from a laterally far offset compact ejective flare. In each event, the estimated source-region field strength is appropriate for the magnetic setting of the flare. This agreement (1) indicates that CMEs are propelled by the magnetic field of the CME plasmoid pushing against the surrounding magnetic field, (2) supports the magnetic-arch-blowout scenario for over-and-out CMEs, and (3) shows that a CME s final angular width in the outer corona can be estimated from the amount of magnetic flux covered by the source-region flare arcade.

3D Polarized Imaging of Coronal Mass Ejections: Chirality of a CME

NASA Astrophysics Data System (ADS)

DeForest, C. E.; de Koning, C. A.; Elliott, H. A.

2017-12-01

We report on a direct polarimetric determination of the chirality of a coronal mass ejection (CME), using the physics of Thomson scattering applied to synoptic polarized images from the Solar Terrestrial Relations Observatories/COR2 coronagraph. We confirmed the determination using in situ magnetic field measurements of the same CME with the ACE spacecraft. CME chirality is related to the helicity ejected from the solar corona along with the mass and field entrained in the CME. It is also important to prediction of the space-weather-relevant Z component of the CME magnetic field. Hence, remote measurement of CME chirality is an important step toward both understanding CME physics and predicting geoeffectiveness of individual CMEs. The polarimetric properties of Thomson scattering are well known and can, in principle, be used to measure the 3D structure of imaged objects in the solar corona and inner heliosphere. However, reduction of that principle to practice has been limited by the twin difficulties of background subtraction and the signal-to-noise ratio in coronagraph data. Useful measurements of the 3D structure require relative photometry at a few percent precision level in each linear polarization component of the K corona. This corresponds to a relative photometric precision of order 10-4 in direct images of the sky before subtraction of the F corona and related signal. Our measurement was enabled by recent developments in signal processing, which enable a better separation of the photometric signal from noise in the synoptic COR2 data. We discuss the relevance of this demonstration measurement to future instrument requirements, and to the future measurements of 3D structures in CMEs and other solar wind features.

Studying the Kinematic Behavior of Coronal Mass Ejections and Other Solar Phenomena using the Time-Convolution Mapping Method

NASA Astrophysics Data System (ADS)

Hess Webber, Shea A.; Thompson, Barbara J.; Kwon, Ryun Young; Ireland, Jack

2018-01-01

An improved understanding of the kinematic properties of CMEs and CME-associated phenomena has several impacts: 1) a less ambiguous method of mapping propagating structures into their inner coronal manifestations, 2) a clearer view of the relationship between the “main” CME and CME-associated brightenings, and 3) an improved identification of the heliospheric sources of shocks, Type II bursts, and SEPs. We present the results of a mapping technique that facilitates the separation of CMEs and CME-associated brightenings (such as shocks) from background corona. The Time Convolution Mapping Method (TCMM) segments coronagraph data to identify the time history of coronal evolution, the advantage being that the spatiotemporal evolution profiles allow users to separate features with different propagation characteristics. For example, separating “main” CME mass from CME-associated brightenings or shocks is a well-known obstacle, which the TCMM aids in differentiating. A TCMM CME map is made by first recording the maximum value each individual pixel in the image reaches during the traversal of the CME. Then the maximum value is convolved with an index to indicate the time that the pixel reached that value. The TCMM user is then able to identify continuous “kinematic profiles,” indicating related kinematic behavior, and also identify breaks in the profiles that indicate a discontinuity in kinematic history (i.e. different structures or different propagation characteristics). The maps obtained from multiple spacecraft viewpoints (i.e., STEREO and SOHO) can then be fit with advanced structural models to obtain the 3D properties of the evolving phenomena. We will also comment on the TCMM's further applicability toward the tracking of prominences, coronal hole boundaries and coronal cavities.

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.

Forecast of geomagnetic storms using CME parameters and the WSA-ENLIL model

NASA Astrophysics Data System (ADS)

Moon, Y.; Lee, J.; Jang, S.; Na, H.; Lee, J.

2013-12-01

Intense geomagnetic storms are caused by coronal mass ejections (CMEs) from the Sun and their forecast is quite important in protecting space- and ground-based technological systems. The onset and strength of geomagnetic storms depend on the kinematic and magnetic properties of CMEs. Current forecast techniques mostly use solar wind in-situ measurements that provide only a short lead time. On the other hand, techniques using CME observations near the Sun have the potential to provide 1-3 days of lead time before the storm occurs. Therefore, one of the challenging issues is to forecast interplanetary magnetic field (IMF) southward components and hence geomagnetic storm strength with a lead-time on the order of 1-3 days. We are going to answer the following three questions: (1) when does a CME arrive at the Earth? (2) what is the probability that a CME can induce a geomagnetic storm? and (3) how strong is the storm? To address the first question, we forecast the arrival time and other physical parameters of CMEs at the Earth using the WSA-ENLIL model with three CME cone types. The second question is answered by examining the geoeffective and non-geoeffective CMEs depending on CME observations (speed, source location, earthward direction, magnetic field orientation, and cone-model output). The third question is addressed by examining the relationship between CME parameters and geomagnetic indices (or IMF southward component). The forecast method will be developed with a three-stage approach, which will make a prediction within four hours after the solar coronagraph data become available. We expect that this study will enable us to forecast the onset and strength of a geomagnetic storm a few days in advance using only CME parameters and the physics-based models.

CME Arrival-time Validation of Real-time WSA-ENLIL+Cone Simulations at the CCMC/SWRC

NASA Astrophysics Data System (ADS)

Wold, A. M.; Mays, M. L.; Taktakishvili, A.; Jian, L.; Odstrcil, D.; MacNeice, P. J.

2016-12-01

The Wang-Sheeley-Arge (WSA)-ENLIL+Cone model is used extensively in space weather operations worldwide to model CME propagation, as such it is important to assess its performance. We present validation results of the WSA-ENLIL+Cone model installed at the Community Coordinated Modeling Center (CCMC) and executed in real-time by the CCMC/Space Weather Research Center (SWRC). The SWRC is a CCMC sub-team that provides space weather services to NASA robotic mission operators and science campaigns, and also prototypes new forecasting models and techniques. CCMC/SWRC uses the WSA-ENLIL+Cone model to predict CME arrivals at NASA missions throughout the inner heliosphere. In this work we compare model predicted CME arrival-times to in-situ ICME shock observations near Earth (ACE, Wind), STEREO-A and B for simulations completed between March 2010 - July 2016 (over 1500 runs). We report hit, miss, false alarm, and correct rejection statistics for all three spacecraft. For hits we compute the bias, RMSE, and average absolute CME arrival time error, and the dependence of these errors on CME input parameters. We compare the predicted geomagnetic storm strength (Kp index) to the CME arrival time error for Earth-directed CMEs. The predicted Kp index is computed using the WSA-ENLIL+Cone plasma parameters at Earth with a modified Newell et al. (2007) coupling function. We also explore the impact of the multi-spacecraft observations on the CME parameters used initialize the model by comparing model validation results before and after the STEREO-B communication loss (since September 2014) and STEREO-A side-lobe operations (August 2014-December 2015). This model validation exercise has significance for future space weather mission planning such as L5 missions.

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.

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.

Best practices in specialty pharmacy management.

PubMed

Patterson, Courtney J

2013-01-01

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

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

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

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.