Improving estimates of the ionosphere during geomagnetic storm conditions through assimilation of thermospheric mass density

Dynamical changes in the ionosphere and thermosphere during geomagnetic storm times can have a significant impact on our communication and navigation applications, as well as satellite orbit determination and prediction activities. Because of the complex electrodynamics coupling processes during storms, which cannot be fully described with the sparse set of thermosphere–ionosphere (TI) observations, it is crucial to accurately model the state of the TI system. The approximation closest to the true state can be obtained by assimilating relevant measurements into physics-based models. Thermospheric mass density (TMD) derived from satellite measurements is ideal to improve the thermosphere through data assimilation. Given the coupled nature of the TI system, the changes in the thermosphere will also influence the ionosphere state. This study presents a quantification of the changes and improvement of the model state produced by assimilating TMD not only for the thermosphere density but also for the ionosphere electron density under storm conditions. TMD estimates derived from a single Swarm satellite and the Coupled Thermosphere Ionosphere Plasmasphere electrodynamics (CTIPe) physics-based model are used for the data assimilation. The results are presented for a case study during the St. Patricks Day storm 2015. It is shown that the TMD data assimilation generates an improvement of the model’s thermosphere density of up to 40% (measured along the orbit of the non-assimilated Swarm satellites). The model’s electron density during the course of the storm has been improved by approximately 8 and 22% relative to Swarm-A and GRACE, respectively. The comparison of the model’s global electron density against a high-quality 3D electron density model, generated through assimilation of total electron content, shows that TMD assimilation modifies the model’s ionosphere state positively and negatively during storm time. The major improvement areas are the mid-low latitudes during the storm’s recovery phase

Interprofessional education about patient decision support in specialty care

Specialty care involves services provided by health professionals who focus on treating diseases affecting one body system. In contrast to primary care - aimed at providing continuous, comprehensive care - specialty care often involves intermittent episodes of care focused around specific medical conditions. In addition, it typically includes multiple providers who have unique areas of expertise that are important in supporting patients' care. Interprofessional care involves multiple professionals from different disciplines collaborating to provide an integrated approach to patient care. For patients to experience continuity of care across interprofessional providers, providers need to communicate and maintain a shared sense of responsibility to their patients. In this article, we describe challenges inherent in providing interprofessional patient decision support in specialty care. We propose ways for providers to engage in interprofessional decision support and discuss promising approaches to teaching an interprofessional decision support to specialty care providers. Additional evaluation and empirical research are required before further recommendations can be made about education for interprofessional decision support in specialty care.Medical Decision MakingAnalysis and support of clinical decision makin

A High-Resolution Survey of HI Absorption toward the Central 200 pc of the Galactic Center

We present an HI absorption survey of the central 250 pc of the Galaxy. Very Large Array (VLA) observations were made at 21 cm in the DnC and CnB configurations and have a resolution of ~15"(0.6 pc at the Galactic Center (GC) distance) and a velocity resolution of ~2.5 km/s. This study provides HI data with high spatial resolution, comparable with the many high resolution observations which have been made of GC sources over the past ten years. Here we present an overview of the HI absorption toward ~40 well-known continuum sources and a detailed comparison of the ionized, atomic and molecular components of the interstellar medium for the Sgr B, Radio Arc and Sgr C regions. In these well-known regions, the atomic gas appears to be closely correlated in both velocity and distribution to the ionized and molecular gas, indicating that it resides in photo-dissociation regions related to the HII regions in the GC. Toward the majority of the radio continuum sources, HI absorption by the 3-kpc arm is detected, constraining these sources to lie beyond a 5 kpc distance in the Galaxy.Comment: 59 pages, including 41 figures; accepted for publication in Astrophysical Journal Supplement Series in December 201

Cerebral small vessel disease burden is associated with decreased abundance of gut Barnesiella intestinihominis bacterium in the Framingham Heart Study

A bidirectional communication exists between the brain and the gut, in which the gut microbiota influences cognitive function and vice-versa. Gut dysbiosis has been linked to several diseases, including Alzheimer\u27s disease and related dementias (ADRD). However, the relationship between gut dysbiosis and markers of cerebral small vessel disease (cSVD), a major contributor to ADRD, is unknown. In this cross-sectional study, we examined the connection between the gut microbiome, cognitive, and neuroimaging markers of cSVD in the Framingham Heart Study (FHS). Markers of cSVD included white matter hyperintensities (WMH), peak width of skeletonized mean diffusivity (PSMD), and executive function (EF), estimated as the difference between the trail-making tests B and A. We included 972 FHS participants with MRI scans, neurocognitive measures, and stool samples and quantified the gut microbiota composition using 16S rRNA sequencing. We used multivariable association and differential abundance analyses adjusting for age, sex, BMI, and education level to estimate the association between gut microbiota and WMH, PSMD, and EF measures. Our results suggest an increased abundance of Pseudobutyrivibrio and Ruminococcus genera was associated with lower WMH and PSMD (p values \u3c 0.001), as well as better executive function (p values \u3c 0.01). In addition, in both differential and multivariable analyses, we found that the gram-negative bacterium Barnesiella intestinihominis was strongly associated with markers indicating a higher cSVD burden. Finally, functional analyses using PICRUSt implicated various KEGG pathways, including microbial quorum sensing, AMP/GMP-activated protein kinase, phenylpyruvate, and β-hydroxybutyrate production previously associated with cognitive performance and dementia. Our study provides important insights into the association between the gut microbiome and cSVD, but further studies are needed to replicate the findings

An innovative model using Promotores or Community Health Workers for home based dementia care

Background: Health disparities and issues with trust building and relationship building are prominent in Hispanic and underserved populations in south Texas. Community health workers can play a bridging role with underserved communities and may be essential in improving the quality and value of health care. The Texas Health and Human Services Commission certifies the training Community Health Workers under the label of “promotores”. Method: Community health workers were integrated into the primary health care team to serve as a bridge between patient/caregiver dyads and the health care team. Result: Community health workers (CHWs) connected patients to social determinants of health resources such as transportation, food pantries and/or social benefits, Medicaid services, and home care provider services. Caregiver education and resources for respite care, caregiver support in person and virtually. Additionally, CHW\u27s provided education on dementia care resources, caregiver support, recruiting and engaging Hispanic underserve participants in research. Our team was able to increase home visits by 229% to homebound patients throughout several underserved zip codes in Bexar County. This is a success as our team was able to increase health care access to persons with dementia that are homebound that may have not been seen by a healthcare provider until they required emergency care. In fact, we saw roughly 11% decrease of inpatient admissions between 2021 and 2022. Conclusion: Trust and familiarity allows the promotores to easily communicate interventions with cultural sensitivity and experiential knowledge of community values, leading to foster rapport with patients and families. The rapport and trust developed with the patients also helped to engage, and recruit Hispanic and underserved participants for research in dementia

The Impact of Severe Storms on Forecasting the Ionosphere-Thermosphere system through the assimilation of SWARM-derived neutral mass density into physics-based models

The response of the Ionosphere - Thermosphere (IT) system to severe storm conditions is of great importance to fully understand its coupling mechanisms. The challenge to represent the governing processes of the upper atmosphere depends, to a large extent, on an accurate representation of the true state of the IT system, that we obtain by assimilating relevant measurements into physics-based models. Thermospheric Mass Density (TMD) is the summation of total neutral mass within the atmosphere that is derived from accelerometer measurements of satellite missions such as CHAMP, GOCE, GRACE(-FO) and Swarm. TMD estimates can be assimilated into physics-based models to modify the state of the processes within the IT system. Previous studies have shown that this modification can potentially improve the simulations and predictions of the ionospheric electron density. These differences could also be interpreted as an indicator of the ionosphere-thermosphere interaction. The research presented here, aims to quantify the impact of data satellite based TMD assimilation on numerical model results. Subject of this study is the Coupled Thermosphere-Ionosphere-Plasmasphere electrodynamics (CTIPe) physics-based model in combination with the recently developed Thermosphere-Ionosphere Data Assimilation (TIDA) scheme. TMD estimates from the ESA’s Swarm mission are assimilated in CTIPe-TIDA during the 16 to the 20 of March 2015. This period was characterized by a strong geomagnetic storm that triggered significant changes in the IT system, the so-called St. Patrick day storm 2015. To assess the changes in the IT system during storm conditions due to data assimilation, the model results from assimilating SWARM mass density normalized to the altitude of 400 km are compared to independent thermospheric estimates like GRACE-TMDS. In order to evaluate the impact of the data assimilation on the ionosphere, the corresponding output of electron density is compared to high-quality electron density estimates derived from data-driven model of the DGFI-TUM

Effects of Swarm neutral mass density assimilation in the ionospheric state estimate during St. Patrick’s Day storm 2015

During geomagnetic storms, rapid changes in the upper atmosphere can dramatically affect communication and navigation instruments. Therefore, it is necessary to monitor these events through a good representation of the thermosphere-ionosphere (TI) system. This can be achieved by assimilating data into physical models by means of an ensemble Kalman filter. Due to the coupled nature of the TI system, the ionosphere can be affected by, among others, changes in the neutral atmosphere, especially during storm conditions. In this study, we investigate the ability of the Coupled Thermosphere Ionosphere Plasmasphere electrodynamics physics-based model (CTIPe) to improve the representation of the ionosphere by assimilating Swarm neutral mass density during the 2015 St. Patrick's Day storm. To gauge the ionospheric improvement due to data assimilation we compare the results of the assimilation and non-assimilation runs with along the orbit electron density measurements of GRACE satellite. The results show a reduction in the root mean square error (RMSE) by a 22% with respect to the non-assimilation run. The impact on the global scale is evaluated by comparing CTIPe results with the corresponding output of the 3D B-Spline electron density model. The electron density results show that the equatorial region is the most affected area by the assimilation of neutral density

The Bolocam Galactic Plane Survey IV: 1.1 and 0.35 mm Dust Continuum Emission in the Galactic Center Region

The Bolocam Galactic Plane Survey (BGPS) data for a six square degree region of the Galactic plane containing the Galactic center is analyzed and compared to infrared and radio continuum data. The BGPS 1.1 mm emission consists of clumps interconnected by a network of fainter filaments surrounding cavities, a few of which are filled with diffuse near-IR emission indicating the presence of warm dust or with radio continuum characteristic of HII regions or supernova remnants. New 350 {\mu}m images of the environments of the two brightest regions, Sgr A and B, are presented. Sgr B2 is the brightest mm-emitting clump in the Central Molecular Zone and may be forming the closest analog to a super star cluster in the Galaxy. The Central Molecular Zone (CMZ) contains the highest concentration of mm and sub-mm emitting dense clumps in the Galaxy. Most 1.1 mm features at positive longitudes are seen in silhouette against the 3.6 to 24 {\mu}m background observed by the Spitzer Space Telescope. However, only a few clumps at negative longitudes are seen in absorption, confirming the hypothesis that positive longitude clumps in the CMZ tend to be on the near-side of the Galactic center, consistent with the suspected orientation of the central bar in our Galaxy. Some 1.1 mm cloud surfaces are seen in emission at 8 {\mu}m, presumably due to polycyclic aromatic hydrocarbons (PAHs). A ~0.2\degree (~30 pc) diameter cavity and infrared bubble between l \approx 0.0\degree and 0.2\degree surrounds the Arches and Quintuplet clusters and Sgr A. The bubble contains several clumpy dust filaments that point toward Sgr A\ast; its potential role in their formation is explored. [abstract truncated]Comment: 76 pages, 22 figures, published in ApJ: http://iopscience.iop.org/0004-637X/721/1/137

Decision-making in Multiple Sclerosis consultations in Italy: third observer and patient assessments

Objective: To assess decision-making in multiple sclerosis (MS) from third observer and patient perspectives. Method: Audio recordings of first-ever consultations with a participating physician (88 outpatients, 10 physicians) at four tertiary MS care clinics in Italy, were rated by a third observer using the Observing Patient Involvement in Shared Decision Making (OPTION) and by patients using the Perceived Involvement in Care Scale (PICS). Results: Mean patient age was 37.5, 66% were women, 72% had MS, and 28% had possible MS or other disease. Mean PICS subscale scores (range 0 poor, 100 best possible) were 71.9 (SD 24.3) for "physician facilitation" (PICS-F); 74.6 (SD 22.9) for "patient information exchange" (PICS-I); and only 22.5 (SD 16.2) for "patient decision making" (PICS-DM). Mean OPTION total score (0 poor, 100 best possible) was 29.6 (SD 10.3). Poorest OPTION scores were found for items assessing ‘‘preferred patient approach to receiving information’’ and ‘‘preferred patient level of involvement.’’ Highest scores were for ‘‘clinician drawing attention to identified problem’’, ‘‘indicating need for decision making,’’ and ‘‘need to review the decision.’’ Consultation time, woman physician, patient-physician gender concordance and PICS-F were associated with higher OPTION total score; older physician and second opinion consultation were associated with lower OPTION score. Conclusions: In line with findings in other settings, our third observer findings indicated limited patient involvement abilities of MS physicians during first consultations. Patient perceptions of physician skills were better than third observers’, although they correlated. Consultations with women physicians, and younger physicians, were associated with higher third observer and patient-based scores. Our findings reveal a need to empower Italian MS physicians with better communication and shared decision-making skills, and show in particular that attention to MS patient preferences for reception of information and involvement in health decisions, need to be improved.</br