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Purpose: The purpose of this scoping review was to document how the literature reports morphological awareness instruction and interventions delivered by speech-language pathologists (SLPs) and/or educators in classroom settings for kindergarten to Grade 3 students. Method: We followed the Joanna Briggs Institute's methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews reporting guidelines. Six relevant databases were searched systematically with article screening and selection completed by two reviewers calibrated for reliability. For data charting, one reviewer extracted content and a second reviewer verified it was pertinent to the review question. Charting for the reported elements of morphological awareness instruction and interventions was guided by the Rehabilitation Treatment Specification System. Results: The database search yielded 4,492 records. After removal of duplicates and screening, 47 articles were selected for inclusion. Interrater reliability for source selection exceeded the pre-established criterion of k = .61. Our analysis generated a comprehensive description of the elements of morphological awareness instruction as reported in the included articles. Conclusions: Our findings provide school-based SLPs and educators a systematic means of reviewing the literature to identify key elements of morphological awareness instruction in published articles for application of evidence-based practices with fidelity, thus helping to close the research-to-practice gap. Our manifest content analysis revealed reporting of the elements for classroom-based morphological awareness instruction was varied, and in some cases, underspecified in the articles included in our study. Implications for clinical practice and future research to advance knowledge and promote implementation of evidence-based practices by SLPs and educators in today's classrooms are discussed. Supplemental Material: https://doi.org/10.23641/asha.22105142

Measuring, assessing and managing outcomes in school practice environments is difficult due to the complex nature of school communities as well as the recent shift in service-delivery models towards tiered approaches. In tiered approaches, multiple levels of service are offered to better match students' needs. Each level of service may require different outcomes and management techniques. Research to date on outcomes has focused on measuring outcomes in medical settings, leaving a substantive gap in the literature regarding practice in schools.The first aim was to explore how school-based speech-language therapists approached outcomes management as their clinical programmes transitioned to tiered service-delivery models The second aim was to describe the successes and challenges in outcomes management reported by clinicians in this context.A secondary deductive-inductive content analysis was performed using qualitative interviews with 24 clinical managers and senior therapists from schools across Ontario, Canada. Using a framework of outcomes measurement, assessment and management in schools based on previous research studies, data were grouped into broad categories deductively, and then the content of each category was further explored using inductive coding. Iterative peer debriefing and reflexive journaling were key strategies to increase the trustworthiness of the results.Participants reported measuring and qualitatively assessing seven key outcomes for school-based practice. These included: (1) student progress and achievement, (2) student participation and inclusion in the school community, (3) stakeholder perspectives, (4) 'buy-in', (5) expanded capacities, (6) responsiveness to needs and (7) accountability to systems. Participants reported more challenges than successes in outcomes management during this transition to tiered services. Challenges were attributed to idiosyncratic organizational barriers, the transition to tiered models and the philosophy of working within the educational system.School-based speech-language therapists measure, assess and manage multiple outcomes relevant to school-based practice in tiered service-delivery models. Many challenges remain. Solutions to support meaningful, systematic and proactive outcomes management in schools should address the broader set of outcomes relevant to tiered service-delivery models and the unique practice context of the educational system, while remaining responsive to idiosyncratic organizational factors. Sustained clinical-research collaboration and knowledge exchange is recommended.What is already known on the subject Systematic, proactive collection and interpretation of outcomes has long been encouraged within speech-language therapy. However, implementing outcomes management in clinical practice remains a substantial challenge. Additionally, research on outcomes to date has focused on medical practice environments, to the exclusion of school-based practice. What are the potential or actual clinical implications of this work? Outcomes management is valued in school practice environments; however, the current repertoire of techniques for outcomes management are a poor match for school-based practice. Clinicians in schools would benefit from the development of contextually relevant, meaningful and feasible outcomes management tools.

This review aimed to synthesize knowledge about multi-criteria decision analysis methods for supporting rehabilitation service design and delivery decisions, including: (1) describing the use of these methods within rehabilitation, (2) identifying decision types that can be supported by these methods, (3) describing client and family involvement, and (4) identifying implementation considerations. We conducted a rapid review in collaboration with a knowledge partner, searching four databases for peer-reviewed articles reporting primary research. We extracted relevant data from included studies and synthesized it descriptively and with conventional content analysis. We identified 717 records, of which 54 met inclusion criteria. Multi-criteria decision analysis methods were primarily used to understand the strength of clients’ and clinicians’ preferences (n = 44), and five focused on supporting decision making. Shared decision making with stakeholders was evident in only two studies. Clients and families were mostly engaged in data collection and sometimes in selecting the relevant criteria. Good practices for supporting external validity were inconsistently reported. Implementation considerations included managing cognitive complexity and offering authentic choices. Multi-criteria decision analysis methods are promising for better understanding client and family preferences and priorities across rehabilitation professions, contexts, and caseloads. Further work is required to use these methods in shared decision making, for which increased use of qualitative methods and stakeholder engagement is recommended. IMPLICATIONS FOR REHABILITATIONMulti-criteria decision analysis methods are promising for evidence-based, shared decision making for rehabilitation.However, most studies to date have focused on estimating stakeholder preferences, not supporting shared decision making.Cognitive complexity and modelling authentic and realistic decision choices are major barriers to implementation.Stakeholder-engagement and qualitative methods are recommended to address these barriers. Multi-criteria decision analysis methods are promising for evidence-based, shared decision making for rehabilitation. However, most studies to date have focused on estimating stakeholder preferences, not supporting shared decision making. Cognitive complexity and modelling authentic and realistic decision choices are major barriers to implementation. Stakeholder-engagement and qualitative methods are recommended to address these barriers.

Teaching practical laboratory skills is a key component of preparing undergraduate students for future careers in chemistry and elsewhere. In this paper, we present our new strategy to teach practical skills to undergraduate chemistry students. We report a Skills Inventory, a list of the suggested practical skills a graduate chemist should possess; this list was compiled by chemists across the UK. In our new practical course we begin by decoupling the practical skill from the theoretical background, compelling students to first master the basic processes needed to carry out a specific technique. In what we have termed a ‘spiral curriculum’ approach, skills are revisited on multiple occasions, with increasing complexity and greater emphasis on underlying theory. The new course makes links across traditional subdisciplines of chemistry to avoid compartmentalisation of ideas.

A practical focusing on the synthesis, isolation, and hydrolysis of ammonia borane (AB), H3N·BH3, was developed for first-year undergraduate students. By requiring students to propose their own experimental setup to measure the amount of gas produced upon hydrolysis, experimental design skills were introduced and developed during the practical. As a result of the COVID-19 pandemic, remote and face-to-face versions of the practical were created to enable inclusivity in which experimental design skills were a key feature. Students identified and reported an appreciable increase in their experimental design skills. The multifaceted nature of the practical allows for flexibility in its implementation, dependent on students’ prior knowledge, local logistical considerations, and the learning objectives of an institution.

Purpose To investigate the injury rate in National Football League (NFL) athletes during the first 4 weeks of the 2020 NFL season. Methods This study was a retrospective review of all NFL players who were placed on the injury report during the preseason and the first 4 weeks of the regular season from the 2016-2017 through the 2020-2021 NFL regular seasons. Players’ dates of injury were cross-referenced with an absence of statistics from the respective games for which they were ruled out so as to ensure accuracy. Injury rates were calculated per 1,000 athletic exposures. Relative risk with 95% confidence intervals compared injury rates between the 2 cohorts. Results Over the course of the study period of 4 NFL seasons, 3,025 injuries were reported. Of the 3,025 injuries reported, 582 (19%) occurred during weeks 1-4 of the 2020-2021 regular season, whereas 1,292 (53%) occurred during preseason weeks 1-4, and 1,151 (38%) occurred during regular-season weeks 1-4 of NFL seasons 2016-2017, 2018-2019, and 2019-2020. There was a significant increase in the injury rate during weeks 1-4 of the 2020-2021 regular season for all comparisons with the injury rate both during the preseasons and the regular seasons of 3 recent past NFL seasons. Conclusions The rate of injury in NFL players during weeks 1-4 of the 2020-2021 regular seasons was significantly higher than during 3 recent past NFL preseasons and regular seasons. Level of Evidence Level IV, diagnostic case series.

Teaching practical chemistry skills remotely is not a task that would have been high on the agenda only a few months ago. However, in light of the COVID-19 pandemic, students around the world are having to work from home, and the chemistry education community has been forced to adapt to the new circumstances. In response, we discuss the use of simulations in place of practical laboratory work, with emphasis on the development of students’ experimental design skills. The simulation of Michaelis–Menten enzyme kinetics is given as an example exercise, which other instructors could implement with immediate effect.

There has been a reinvigoration of public interest in space exploration in what has been deemed the new space race, which aims to eventually take humans to Mars in the 2030s. This type of Earth‐independent deep space mission presents a multitude of challenges for providing astronauts with adequate nutrition, which are not currently posed by our presence in low earth orbit. For example, there are technical challenges associated with providing enough food with sufficient nutrient content, bioavailability and increased shelf life. Environmental stressors may also impact physiology and in turn affect nutritional status. Increased exposure of radiation, for example, causes changes in the gut and liver that might facilitate nutrient deficiency. Current or potential countermeasures for these challenges are explored including the use of bio‐regenerative systems such as growing crops or biomass, or inducing torpor to reduce nutritional needs. Additionally, the beneficial role of nutrients has also been explored for alleviating the harmful effects of spaceflight exposure. It is clear that such countermeasures will be necessary to maintain astronaut health during long‐duration missions to potentially counteract physiological stresses and to allow us to continue pushing the boundaries of space exploration.

Funding Acknowledgements Type of funding sources: None. Background Current guidelines advocate for a multi-parametric approach to echocardiographic quantitation of tricuspid regurgitation (TR). The primary quantitative measure of TR severity uses the proximal isovelocity surface area (PISA) method to calculate effective regurgitant orifice area (EROA) and regurgitant volume (RegVol). However, EROA-PISA may underestimate TR severity due to low flow and tethering of the tricuspid leaflets. Purpose The purpose of this study was to compare standard EROA-PISA quantitation of TR to alternative quantitative measures, including quantitative Doppler (EROA-Doppler), flow- and angle-corrected PISA method (EROA-Corrected), and three-dimensional vena contracta area (3D-VCA), in addition to the comparison of calculated RegVol-PISA, RegVol-Doppler, and RegVol-3DVCA. Methods Patients undergoing both transthoracic (TTE) and transesophageal (TEE) echocardiographic evaluation of TR severity for transcatheter treatment were included in this study. Patients were excluded if they had ≥ moderate aortic regurgitation. TTE measurements of EROA-PISA and RegVol-PISA were performed as per American Society of Echocardiography guidelines. EROA-Doppler was performed by quantifying RegVol-Doppler (diastolic stroke volume using biplane annular area, minus left ventricular outflow stroke volume) and deriving EROA. EROA-Corrected was calculated by adjusting for both aliasing velocity and leaflet angle as per published methods. 3D-VCA was measured on TEE performed within 14 days of TTE. Results Of 44 consecutive patients, the median age was 80 ± 9 years, 61% were female, and 89% had atrial fibrillation. Most patients (86%) had functional TR, 71% had a EROA-PISA ≥ 0.4 cm2. Table 1 shows the EROA and RegVol results for each method. EROA-PISA and RegVol-PISA were significantly lower than EROA-Doppler and RegVol-Doppler, as well as 3D-VCA and RegVol-3DVCA (all p < 0.0001). There was no significant difference between EROA-Doppler and 3D-VCA (p = 0.51), and RegVol-Doppler and RegVol-3DVCA (p = 0.66). EROA-Corrected reduced the absolute difference with EROA-Doppler (51% to 33%, p < 0.0001) and 3D-VCA (52% to 32%, p < 0.0001), but remained statistically lower than EROA-Doppler and 3D-VCA. Although EROA-PISA was strongly correlated to EROA-Doppler (r = 0.75, p < 0.0001) and 3D-VCA (r = 0.68, p < 0.0001), the correlation between EROA-Doppler and 3D-VCA was greatest (r = 0.77, p < 0.0001). Adjusting EROA-PISA for angle and flow demonstrated improved correlation to EROA-Doppler without affecting correlation to 3D-VCA (Figure 1). Conclusion Our study demonstrated that EROA-PISA significantly underestimates the severity of TR by EROA-Doppler and 3D-VCA. Although PISA correction methods reduced the underestimation, both EROA-Corrected and RegVol-Corrected remained significantly lower. EROA-Doppler and 3D-VCA and the calculated RegVol by each method, were closely correlated and not significantly different. Abstract Table 1 Abstract Figure 1

Funding Acknowledgements Type of funding sources: None. Background The proximal isovelocity surface area (PISA) method to quantify tricuspid regurgitation (TR) severity relies on the geometric assumption of a circular, planar regurgitant orifice. However, the TR orifice is often non-circular resulting in underestimation of TR severity when calculating the effective regurgitant orifice area (EROA) and regurgitant volume (RegVol). Purpose To evaluate the effect of ellipticity of the tricuspid annulus on EROA-PISA correlation with quantitative Doppler (EROA-Dopp), and three-dimensional vena contracta area (VCA-3D). Methods Patients undergoing both transthoracic (TTE) and transesophageal (TEE) echo evaluation of TR severity were included in this study. Regurgitant orifice ellipticity was calculated as the ratio of the vena contracta maximum and minimum widths (VC-Ratio). Quantification of EROA and RegVol were performed on TTE for EROA-PISA and EROA-Dopp. Vena contract area was measured on TEE (VCA-3D). Results Of 44 total pts, the median age was 80 ± 9, 61% were female, 89% had atrial fibrillation, (86%) had functional TR, 32% were graded as severe, and 71% had a EROA-PISA ≥ 0.4 cm2. Median VC-Ratio was 1.3 (IQR 1.1-1.8) and was used to differentiate more circular orifices (VC-Ratio 0.5 for all). EROA-PISA correlated better with both EROA-Dopp and VCA-3D in circular compared to elliptical orifices (Table). EROA-Dopp and VCA-3D demonstrated high correlation for both circular and elliptical orifices (r = 0.76, p < 0.0001 and r = 0.77, p < 0.0001 respectively). Conclusion Our study demonstrated that there is a significant difference in quantitative measurements of tricuspid regurgitant orifice area, with EROA-PISA significantly underestimating both EROA-Dopp and VCA-3D. In more circular orifices, the EROA-PISA correlation was higher, however EROA-Dopp and VCA-3D were still significantly larger. Whether EROA-Dopp and VCA-3D are more predictive of outcomes requires further study. Abstract Table 1 Abstract Figure 1

Hexaboride compounds are a subset of borides with many interesting thermal, electrical, magnetic and physical properties. As such, interest has grown in this class of ceramics not only to understand their peculiar characteristics, but also to apply them to modern scientific and engineering problems. Hexaborides are currently used or show promise for a variety of applications such as electron emitters, thermoelectric materials, coatings, single-photon detectors and superconductors. A shared crystal structure amongst all hexaborides permits them to readily form solid solutions, allowing for fine-tuning of electrical, optical and thermal properties with mixed-metal compounds. Recent advances in characterization techniques have allowed researchers to gain new insights and renewed interest in some of the more exotic hexaboride behaviors such as surface conductivity in SmB6 or magnetic ordering in CeB6. Like many other non-oxide ceramics, borides present certain synthesis and processing challenges. This paper presents an overview of the structure, synthesis and processing of hexaboride compounds in an effort to guide researchers with the first step in pursuing these interesting and unique materials. Keywords: Hexaboride, Synthesis, Sintering, Processing, Ceramic

Earth’s field nuclear magnetic resonance (EFNMR) spectroscopy offers students a unique opportunity to consolidate their understanding of NMR spectroscopic theory through hands-on practice with a simple spectrometer. A comprehensive, 6 h experiment is presented for the introduction of low-field NMR techniques, covering spectroscopy, relaxivity, and imaging experiments in the Earth’s magnetic field. This multifaceted practical session explores the concepts of free induction decay, pulse sequences, field homogeneity, relaxation times, J-coupling, and magnetic resonance imaging (MRI), which are reinforced through a series of experiments carried out within an undergraduate teaching laboratory. Students are required to alter parameters as they see fit in order to obtain data, ensuring their understanding of the theory behind NMR spectroscopy. The challenges overcome for the implementation of EFNMR spectroscopy in a modern undergraduate laboratory are also discussed, and detailed instructions are included for spectrometer setup.

We demonstrate the synthesis of high-surface-area, low-density refractory aerogels. The monolithic hafnium boride (HfB2) and zirconium boride (ZrB2) aerogels are prepared via borothermal reduction ...

The International Council on Systems Engineering (INCOSE) Space System Working Group (SSWG) has created the CubeSat System Reference Model (CSRM), a representation of the logical architecture of a CubeSat system, intended to be used by system architects and engineers as a starting point as they develop the physical architecture of the Space and Ground segments of the CubeSat mission of interest to them. The CSRM is based on Model-Based System Engineering (MBSE) principles, is System Modeling Language (SysML) compliant, is hosted in a graphical modeling tool, and is intended to foster completeness and economies of scale associated with reusability. The CSRM has been vetted by System Engineering professionals and has been introduced to the CubeSat mission development team community with favorable results. The CSRM has been submitted to the Object Management Group (OMG) as a CubeSat specification, and is being evaluated for that role. Mission Engineering, a concept where the mission itself is looked at as a system is being explored as a means to maintain balance between the spacecraft system, operations (including ground systems), and the mission (the integration of needed capabilities). Now opportunities exist to extend the already-developed CSRM to enable the application of Mission Engineering to modeling a complete CubeSat mission. This paper presents the challenges and approach that the INCOSE SSWG will address, including a path for extension of the CRSM for use in exploring its applicability to the Mission Engineering concept, and capturing the Mission as a Model to create a unifying environment for universities to build on each other's successes as they learn to design for Space.

BackgroundIn contrast with the setting of acute myocardial infarction, there are limited data regarding the impact of diabetes mellitus on clinical outcomes in contemporary cohorts of patients with chronic coronary syndromes. We aimed to investigate the prevalence and prognostic impact of diabetes according to geographical regions and ethnicity.Methods and resultsCLARIFY is an observational registry of patients with chronic coronary syndromes, enrolled across 45 countries in Europe, Asia, America, Middle East, Australia, and Africa in 2009–2010, and followed up yearly for 5 years. Chronic coronary syndromes were defined by ≥1 of the following criteria: prior myocardial infarction, evidence of coronary stenosis >50%, proven symptomatic myocardial ischaemia, or prior revascularization procedure.Among 32 694 patients, 9502 (29%) had diabetes, with a regional prevalence ranging from below 20% in Northern Europe to ∼60% in the Gulf countries. In a multivariable-adjusted Cox proportional hazards model, diabetes was associated with increased risks for the primary outcome (cardiovascular death, myocardial infarction, or stroke) with an adjusted hazard ratio of 1.28 (95% confidence interval 1.18, 1.39) and for all secondary outcomes (all-cause and cardiovascular mortality, myocardial infarction, stroke, heart failure, and coronary revascularization). Differences on outcomes according to geography and ethnicity were modest.ConclusionIn patients with chronic coronary syndromes, diabetes is independently associated with mortality and cardiovascular events, including heart failure, which is not accounted by demographics, prior medical history, left ventricular ejection fraction, or use of secondary prevention medication. This is observed across multiple geographic regions and ethnicities, despite marked disparities in the prevalence of diabetes.ClinicalTrials identifierISRCTN43070564

The International Council on Systems Engineering (INCOSE) Space System Working Group (SSWG) has created the CubeSat System Reference Model (CSRM), a representation of the logical architecture of a CubeSat system, intended to be used by system architects and engineers as a starting point as they develop the logical architecture of the Space and Ground components of the CubeSat mission of interest to them. The CSRM is based on Model-Based System Engineering (MBSE) principles, is System Modeling Language (SysML) compliant, is hosted in a graphical modeling tool, and is intended to introduce quality enhancements and economies associated with reusability. The CSRM has been vetted by System Engineering professionals and has been introduced to the CubeSat mission development team community with favorable results. It has been submitted to the Object Management Group (OMG) as a CubeSat specification, and is being evaluated for that role. The SSWG has created a notional outline describing how the CSRM can be applied to a specific mission development effort; and has also identified possible future efforts to expand the applicability, value, and use of the CSRM by the satellite development community.

The local structures of ternary alkaline-earth hexaborides (MB6, M = Ca0.5Sr0.5, Ca0.5Ba0.5 and Sr0.5Ba0.5) have been analysed using X-ray pair distribution function (PDF) analysis, Raman spectroscopy and transmission electron microscopy (TEM). The results show significant local deviations from the average cubic structure within the boron sub-lattice and support the conclusion that rapid synthesis processes lead to the formation of coherent nanodomains over length scales of about 10 nm. Reverse Monte Carlo fitting of the PDFs allows for quantification of the displacement disorder within the boron sub-lattice as a function of sample composition. Detailed Raman spectroscopy studies and high-resolution TEM support the models derived from X-ray scattering. The average magnitude of the static displacement disorder varies by sample composition and positively correlates with the cation radius ratios across the three compositions. The new models form a foundation for future computational and experimental studies aimed at understanding and predicting properties of hexaborides.

We present the devitrification behavior of an Fe-based amorphous metal (SAM2×5) during a current-assisted extrusion process. The alloy is of composition Fe49.7Cr17.7Mn1.9Mo7.4W1.6B15.2C3.8Si2.4 and contains Y2O3 nanoparticles as a reinforcing phase. Detailed analysis of phase formation and microstructural analysis verifies that the SAM2×5 devitrified (SAM2×5-Dev) materials can be successfully extruded up to several centimeters in length with extrusion temperatures in the range between 1000 °C and 1100 °C. Subsequent analysis of mechanical properties via microhardness testing, together with microstructural characterization by scanning electron microscopy, demonstrates that the properties of the extruded SAM2×5-Dev composites significantly surpass those of common steels. These results open new horizons in the area of structural amorphous materials and expand their potential industrial processing.

We present a modeling framework and discuss the energetics and structural features of the surface terminations of Ca, Ba, Sr and La hexaborides using density functional theory analysis in combination with X-ray photoelectron spectroscopy. There is significant uncertainty in the literature about the nature of the surface terminations in metal hexaborides in terms of metal versus boron terminations. We show from electronic structure calculations that segregated regions of metal and boron-terminations produce the lowest energies for di-cations of CaB6, SrB6 and BaB6, while trivalent LaB6 minimizes the surface energy by arranging the metal ions in parallel rows on the surface. XPS measurements show that CaB6 and SrB6 have surfaces that are close to stoichiometric for the compound, while BaB6 has surfaces that are Ba-rich. Energetic barriers are calculated for transitions between each of the surface geometries considered. There is a substantial increase in the activation energy for the lanthanum migrations compared to the divalent cations. We also find that the boron octahedra units in these materials tend to contract or expand from their bulk values depending on the proximity to regions of high metal concentrations. These materials have many attractive features, such as low work functions, high hardness, low thermal expansion coefficients, and high melting points, among many other properties of interest for industrial applications. Promising uses of these materials also include catalytic applications for chemical dissociation reactions of various molecules such as hydrogen, water and carbon monoxide, for example, thus, the interest in determining relevant surface properties.

The phase stability of cBN is critically dependent on the content and amount of impurities present. While studies have shown qualitatively that the addition of certain impurities can either increase or decrease the cBN-hBN phase transition temperature, studies have yet to show this effect quantitatively. This is because analytical methods to characterize minor and trace impurities in cBN are currently lacking. To this end, we present flux fusion methods capable of fully digesting cBN samples for ICPMS analyses. The materials used in this study are commercially available cBN powders in three different sizes. Two types of fluxes (LiOH and NaOH·H2O) are utilized so that both Li and Na impurities can be determined. To ensure the accuracy of Si measurements, a column chromatography method has been developed to purify Si from flux materials in order to increase the amount of dissolved sample sent to the ICP. Detection limits have been determined using procedural blanks and are found to be below 20 μg/g for all 58 elements analyzed except for Si, for which the detection limit is 312 μg/g. Nonetheless, all cBN powders studied are found to have high Si impurity levels that are above detection limit. This study provides a much-needed analytical protocol to enable comprehensive screening of impurities in cBN.

Zinc ion dependent β-lactamases (MBLs) catalyze the hydrolysis of almost all β-lactam antibiotics and resist the action of clinically available β-lactamase inhibitors. We report how application of in silico fragment-based molecular design employing thiol-mediated metal anchorage leads to potent MBL inhibitors. The new inhibitors manifest potent inhibition of clinically important B1 subfamily MBLs, including the widespread NDM-1, IMP-1 and VIM-2 enzymes; with lower potency, some of them also inhibit clinically relevant Class A and D serine-β-lactamases. The inhibitors show selectivity for bacterial MBL enzymes compared to human MBL fold nucleases. Co-crystallization of one inhibitor, which shows potentiation of meropenem activity against MBL-expressing Enterobacteriaceae, with VIM-2 reveals an unexpected binding mode, involving interactions with residues from conserved active site bordering loops.

INTRODUCTION Delirium has been well studied among patients in the intensive care unit (ICU); however, data beyond the ICU is limited. The purpose of this study is to prospectively evaluate the incidence and associated risk factors for delirium in noncritical care areas (NCCA). METHODS After institutional review board approval, a prospective cohort study was conducted at our urban Level I Trauma Center from December 2015 to February 2016. All patients admitted to the designated study area by a trauma surgeon were included. The Confusion Assessment Method (CAM) was administered every 12 hours until discharge. Delirious patients (CAM+) were administered the CAM-S to quantify the severity of delirium. Demographics, laboratory data, and inpatient medication lists were analyzed. RESULTS Of 148 participants, 12 (8%) were CAM+ and 136 (92%) were CAM-. The average CAM-S of CAM+ patients was 7 ± 3. Included patients were aged 52 ± 20 years and 45% were men. Of patients 65 years or older, 9 (21%) were CAM+. Medications associated with delirium were: albuterol (p = 0.01), atorvastatin (p = 0.01), duloxetine (p = 0.04), sertraline (p = 0.04), folic acid (p = 0.01), thiamine (p = 0.01), vitamin D (p < 0.001), haloperidol (p = 0.04), metoprolol (p = 0.02), and vancomycin (p = 0.02). Abnormal laboratory values associated with delirium included: Albumin (p = 0.03; odds ratio [OR], 7.94, 95% confidence interval [CI], 1.1-63.20), Calcium (p = 0.01; OR, 4.95; 95% CI, 1.5-16.7), Sodium (p = 0.04; OR, 3.91; 95% CI, 1.13-13.5), hematocrit (p = 0.04), and mean corpuscular hemoglobin concentration (p < 0.05; OR, 5.29; 95% CI, 1.19-23.46). CONCLUSIONS Our study demonstrated an 8% incidence of delirium overall in NCCA, increasing to 21% in patients 65 years or older. Many risk factors identified among NCCA patients are consistent with the ICU literature; however, our CAM+ patients had additional risk factors which have not been previously associated with the development of delirium. Screening of NCCA patients for delirium should be considered. LEVEL OF EVIDENCE Prognostic and Epidemological, level IV.

Introduction The literature regarding outcomes in patients on irreversible antithrombotic therapy (IAT) undergoing urgent laparoscopic appendectomy is limited. The aim of this multicenter retrospective study was to examine the impact of prehospital IAT on outcomes in this population. Methods From 2010 to 2014, seven institutions from the Southwest Surgical Multicenter Trials (SWSC MCT) group conducted a retrospective study to evaluate the clinical course of all patients on IAT who underwent urgent/emergent laparoscopic appendectomy. The IAT+ group was subdivided into IAT+ (Aspirin only) and IAT+ (Aspirin-Plavix). These groups were matched 1:1 to controls. The primary outcomes were estimated blood loss (EBL) and transfusion requirement. Secondary outcomes included infections (SSI – Surgical Site Infection, DSI – Deep Space Infection, and OSI – Organ Space Infection), hospital length of stay (HLOS), complications, 30-day readmissions, and mortality. Results Out of the 2903 patients included in the study, 287 IAT+ patients were identified and matched in a 1:1 ratio to 287 IAT-patients. In the IAT+ vs IAT-analysis, no significant differences in EBL (p = 1.0), transfusion requirement during the preoperative (p = 0.5), intraoperative (p = 0.3) or postoperative periods (p = 0.5), infectious complications (SSI; p = 1.0, DSI; p = 1.0, and OSI; p = 0.1), overall complications (p = 0.3), HLOS (p = 0.7), 30-day readmission (p = 0.3), or mortality (p = 0.1) were noted. Similarly, outcomes in the IAT+ (Aspirin only) and IAT+ (Aspirin-Plavix) subgroups failed to demonstrate any significant differences when compared to controls. Conclusions Our analysis suggests that IAT is not associated with worse outcomes in urgent/emergent laparoscopic appendectomy. Prehospital use of IAT should not be used to delay laparoscopic appendectomy.

While it is reasonable to predict that photosynthetic rates are inhibited while leaves are wet, leaf gas exchange measurements during wet conditions are challenging to obtain due to equipment limitations and the complexity of canopy-atmosphere interactions in forested environments. Thus, the objective of this study was to evaluate responses of seven tropical and three semiarid savanna plant species to simulated leaf wetness and test the hypotheses that (i) leaf wetness reduces photosynthetic rates (Anet), (ii) leaf traits explain different responses among species and (iii) leaves from wet environments are better adapted for wet leaf conditions than those from drier environments. The two sites were a tropical rainforest in northern Costa Rica with ~4200 mm annual rainfall and a savanna in central Texas with ~1100 mm. Gas exchange measurements were collected under dry and wet conditions on five sun-exposed leaf replicates from each species. Additional measurements included leaf wetness duration and stomatal density. We found that Anet responses varied greatly among species, but all plants maintained a baseline of activity under wet leaf conditions, suggesting that abaxial leaf Anet was a significant percentage of total leaf Anet for amphistomatous species. Among tropical species, Anet responses immediately after wetting ranged from -31% (Senna alata (L.) Roxb.) to +21% (Zamia skinneri Warsz. Ex. A. Dietr.), while all savanna species declined (up to -48%). After 10 min of drying, most species recovered Anet towards the observed status prior to wetting or surpassed it, with the exception of Quercus stellata Wangenh., a savanna species, which remained 13% below Anet dry. The combination of leaf wetness duration and leaf traits, such as stomatal density, trichomes or wax, most likely influenced Anet responses positively or negatively. There was also overlap between leaf traits and Anet responses of savanna and tropical plants. It is possible that these species converge on a relatively conservative response to wetness, each for divergent purposes (cooling, avoiding stomatal occlusion, or by several unique means of rapid drying). A better understanding of leaf wetness inhibiting photosynthesis is vital for accurate modeling of growth in forested environments; however, species adapted for wet environments may possess compensatory traits that mitigate these effects.

We present the behavior of multiple solid solutions within ternary (BaxCa1–x)B6 and (BaxSr1–x)B6 compounds and demonstrate that nanodomain formation is preferred over uniform solid solutions under certain processing conditions. Instead of the expected single solid solution of M1 and/or M2 atoms within the MB6 phase, we note separation into nanodomain regions rich in either M1 or M2. This phase separation has been observed from detailed analyses of the shapes of the peaks in X-ray diffraction data, where peak splitting and asymmetry are the result of multiple solid solutions with lattice parameters differing by up to 1.4%. High-resolution transmission electron microscopy confirms the presence of these nanodomains, which are about 2–3 nm in size, and reveals varying degrees of lattice misalignment. We also present X-ray diffraction analysis of (BaxCa1–x)B6 powders calcined from 1273 to 1973 K and document the enhancement in sample homogeneity as the separated phases merge into a uniform solid solution. As s...

Spatial and temporal variation in wet canopy conditions following precipitation events can influence processes such as transpiration and photosynthesis, which can be further enhanced as upper canopy leaves dry more rapidly than the understory following each event. As part of a larger study aimed at improving land surface modelling of evapotranspiration processes in wet tropical forests, we compared transpiration among trees with exposed and shaded crowns under both wet and dry canopy conditions in central Costa Rica, which has an average 4200 mm annual rainfall. Transpiration was estimated for 5 months using 43 sap flux sensors in eight dominant, ten midstory and eight suppressed trees in a mature forest stand surrounding a 40-m tower equipped with micrometeorological sensors. Dominant trees were 13% of the plot's trees and contributed around 76% to total transpiration at this site, whereas midstory and suppressed trees contributed 18 and 5%, respectively. After accounting for vapour pressure deficit and solar radiation, leaf wetness was a significant driver of sap flux, reducing it by as much as 28%. Under dry conditions, sap flux rates (Js) of dominant trees were similar to midstory trees and were almost double that of suppressed trees. On wet days, all trees had similarly low Js. As expected, semi-dry conditions (dry upper canopy) led to higher Js in dominant trees than midstory, which had wetter leaves, but semi-dry conditions only reduced total stand transpiration slightly and did not change the relative proportion of transpiration from dominant and midstory. Therefore, models that better capture forest stand wet–dry canopy dynamics and individual tree water use strategies are needed to improve accuracy of predictions of water recycling over tropical forests. Copyright © 2016 John Wiley & Sons, Ltd.

The transformation of boron nitride from the cubic to hexagonal phase has been investigated between 1560 and 1660 °C. High-purity cBN powders of three different particle sizes (

BackgroundThe β-lactam antibiotics represent the most successful drug class for treatment of bacterial infections. Resistance to them, importantly via production of β-lactamases, which collectively are able to hydrolyse all classes of β-lactams, threatens their continued widespread use. Bicyclic boronates show potential as broad spectrum inhibitors of the mechanistically distinct serine- (SBL) and metallo- (MBL) β-lactamase families.MethodsUsing biophysical methods, including crystallographic analysis, we have investigated the binding mode of bicyclic boronates to clinically important β-lactamases. Induction experiments and agar-based MIC screening against MDR-Enterobacteriaceae (n = 132) were used to evaluate induction properties and the in vitro efficacy of a bicyclic boronate in combination with meropenem.ResultsCrystallographic analysis of a bicyclic boronate in complex with AmpC from Pseudomonas aeruginosa reveals it binds to form a tetrahedral boronate species. Microbiological studies on the clinical coverage (in combination with meropenem) and induction of β-lactamases by bicyclic boronates further support the promise of such compounds as broad spectrum β-lactamase inhibitors.ConclusionsTogether with reported studies on the structural basis of their inhibition of class A, B and D β-lactamases, biophysical studies, including crystallographic analysis, support the proposal that bicyclic boronates mimic tetrahedral intermediates common to SBL and MBL catalysis.General significanceBicyclic boronates are a new generation of broad spectrum inhibitors of both SBLs and MBLs.

While much has been written about technical measurement and Model-Based Systems Engineering (MBSE), very little literature exists that ties the two together. What does exist treats the topic in a general manner and is void of details. Given the vital role that technical measurement plays in the systems engineering process, and the ever increasing adoption of the MBSE approach, there is a growing need to define how technical measurement would be implemented as part of a MBSE approach. The purpose of this paper is to address that need. Technical measurement is defined as the set of measurement activities used to provide insight into the progress made in the definition and development of the technical solution and the associated risks and issues [1]. Technical measures are used to: determine if the technical solution will meet stakeholder needs, provide early indications if the development effort is not progressing as needed to meet key milestones, predict the likelihood of the delivered solution to meet performance requirements, monitor high risk items, and assess the effectiveness of risk mitigation actions. MBSE is defined as the formalized application of modeling to support system requirements, design, analysis, verification, and validation activities beginning in the conceptual design phase and continuing throughout development and later life cycle phases [2]. The benefits of using an MBSE approach over a traditional document-based systems engineering approach are: enhanced communications, reduced development risk, improved quality, and enhanced knowledge transfer. This paper defines a MBSE approach for technical measurement that begins with a set of mission objectives derived from stakeholder concerns. The objectives and concerns are represented as elements captured in the system model. Next, Measures of Effectiveness (MOEs) are derived from the mission objectives. Initially, these MOEs are captured in a special model element that allows for the MOEs to be described in a natural language format that stakeholders will understand. Those initial MOEs are then quantified and captured as value properties of the Enterprise block. The MOEs are traced back to their originating source in the mission objectives. Next, Measures of Performance (MOPs) are derived from the enterprise-level MOEs and captured as value properties of the System block. The derivation of the MOPs is captured through the development of constraint blocks and parametric diagrams. This provides for traceability between MOPs and MOEs and supports performance analysis of the MOPs to predict if the MOEs will be met. MOPs are also traced to system requirements captured in the system model. Next, the process steps at the system-level are repeated at the subsystem-level to derive Technical Performance Measures (TPMs). These TPMs are traced back to MOPs and subsystem requirements in the same manner as described for MOPs. Examples are provided throughout the paper which illustrate the application of this approach to a CubeSat. Using a CubeSat example is appropriate given the historically high failure rate and rapid growth of these missions and the role technical measurement could play in increasing their success.

Experiments have repeatedly revealed the existence of a dynamical structured fractal 3-space, with a speed relative to the Earth of some 500 km sec−1 from a southerly direction. Experiments have ranged from optical light speed anisotropy interferometers to zener diode quantum detectors. This dynamical space has been missing from theories from the beginning of physics. This dynamical space generates a growing universe and gravity when included in a generalised Schrodinger equation and light bending when included in generalised Maxwell equations. Here we review ongoing attempts to construct a deeper theory of the dynamical space starting from a stochastic pattern generating model that appears to result in 3-dimensional geometrical elements, “gebits” and accompanying quantum behaviour. The essential concept is that reality is a process and geometrical models for space and time are inadequate.

Just prior to the outbreak of the War on Terror, the Department of Defense was focused on the somewhat, mundane aspects of managing the world’s largest military. Issues of importance to military families such as improving child care, upgrading housing, and bettering schools were front and center. Unfortunately, there was little impetus to consider roles and responsibilities for the injured and their families during war time and beyond.

We present the effect of pulsed direct current on metal ion diffusion in CaB6–SrB6 diffusion couples, showing that the diffusivity of Ca2+ and Sr2+ across the diffusion couple interface is higher toward the positive electrode when subjected to a current flow of 2.2 kA at a temperature of 2007 K. We attribute this enhanced mobility to the movement of negatively charged metal vacancies toward the positive electrode in the system. Energy-dispersive spectroscopy is used to map the concentration of Ca2+ and Sr2+ in the region near the interface, and diffusion profiles are fitted with error functions. The concentration curves display concentration-dependent Boltzmann–Matano diffusivity. Total dopant values (Q) have been used to numerically compare the differences between Ca2+ diffusion in SrB6 and Sr2+ diffusion in CaB6. We determine an enhancement of 3.8× for Ca2+ into SrB6 versus an enhancement of 1.8× for Sr2+ into CaB6. No new phases are formed at the interface between CaB6 and SrB6, since hexaboride compou...

Delirium was first described in the 1800s as acute, fluctuating confusion. Recent studies note an incidence of 15% in adult intensive care unit patients. Here we present the first prospective study to evaluate the incidence and risk factors for delirium in patients admitted to the trauma surgeon (TS) in non-critical care areas (NCCAs). Patients 18 years or older admitted to any TS in the designated NCCA were evaluated and consented for participation over a 3-month period. Participants were screened with the Confusion Assessment Method (CAM) every 12 hr. Those positive for delirium (CAM+) were administered the CAM-Severity. In addition, 69 other previously identified risk factors were evaluated. Over 3 months, 148 patients were evaluated, 12 of whom were CAM+ (8%). Of patients 65 years or older, 21% screened positive for delirium. Age, education level, presence of Foley catheter, respiratory distress, orthopedic operation, and lack of ambulation were risk factors associated with delirium (p < .05). Among all TS patients in the NCCA, we found delirium to be present in 8%. Our nurses identified a 21% incidence of delirium in patients 65 years or older. Given this significant incidence, screening at-risk patients in the NCCA should be considered.

The class D (OXA) serine β-lactamases are a major cause of resistance to β-lactam antibiotics. The class D enzymes are unique amongst β-lactamases because they have a carbamylated lysine that acts as a general acid/base in catalysis. Previous crystallographic studies led to the proposal that β-lactamase inhibitor avibactam targets OXA enzymes in part by promoting decarbamylation. Similarly, halide ions are proposed to inhibit OXA enzymes via decarbamylation. NMR analyses, in which the carbamylated lysines of OXA-10, -23 and -48 were 13C-labelled, indicate that reaction with avibactam does not ablate lysine carbamylation in solution. While halide ions did not decarbamylate the 13C-labelled OXA enzymes in the absence of substrate or inhibitor, avibactam-treated OXA enzymes were susceptible to decarbamylation mediated by halide ions, suggesting halide ions may inhibit OXA enzymes by promoting decarbamylation of acyl-enzyme complex. Crystal structures of the OXA-10 avibactam complex were obtained with bromide, iodide, and sodium ions bound between Trp-154 and Lys-70. Structures were also obtained wherein bromide and iodide ions occupy the position expected for the ‘hydrolytic water’ molecule. In contrast with some solution studies, Lys-70 was decarbamylated in these structures. These results reveal clear differences between crystallographic and solution studies on the interaction of class D β-lactamases with avibactam and halides, and demonstrate the utility of 13C-NMR for studying lysine carbamylation in solution.

This paper describes an eight-step approach for defining the behaviors of CubeSats that begins with mission requirements and ends with a functional architecture modeled as an activity hierarchy using the Object Management Group's (OMG) Systems Modeling Language (SysML). This approach could be applied to other satellite development efforts but the emphasis here is on CubeSats because of their historically high mission failure rate and the rapid growth in the number of these missions over the last few years. In addition, this approach complements the International Council on Systems Engineering's (INCOSE) Space Systems Working Group's (SSWG) efforts to develop a CubeSat Reference Model. This approach provides a repeatable, generalized method for CubeSat development teams to follow that incorporates standard systems engineering practices such as: a top-down approach, requirements analysis, use case development, and functional analysis. This effort uses a Model-Based Systems Engineering (MBSE) approach. Some of the benefits of using an MBSE approach over a traditional document-based approach are: enhanced communications, reduced development risk, improved quality, and enhanced knowledge transfer [1]. Systems engineering artifacts produced using this approach, such as definitions of the mission domain elements, requirements, use cases, and activities, are captured in a system model which serves as a single-source-of-truth for members of the CubeSat development team. Examples are provided throughout the paper which illustrates the application of this approach to a CubeSat development effort. Since most space missions are concerned with the generation or flow of information, the examples focus on requirements to collect and distribute mission data ending with a definition of the required system functionality to satisfy those requirements.

In this study, we assess whether students and their faculty mentors in a Research Experience for Undergraduates program have similar perceptions about the relative importance of different outcomes of their study abroad experience. Results of a Q-analysis reveal a significant difference of opinion between the students and the faculty mentors. It is argued that the faculty mentors need to spend more time in the field with their students and recognize that undergraduate research provides students with skills and a confidence to conduct research in the future, rather than personal and professional development, and the ability to think like a scientist. © 2014 Taylor & Francis.

We present the mechanisms of formation of mesoporous scandia-stabilized zirconia using a surfactant-assisted process and the effects of solvent and thermal treatments on the resulting particle size of the powders. We determined that cleaning the powders with water resulted in better formation of a mesoporous structure because higher amounts of surfactant were preserved on the powders after washing. Nonetheless, this resulted in agglomerate sizes that were larger. The water-washed powders had particle sizes of5 μm in the as-synthesized state. Calcination at 450 and 600 °C reduced the particle size to ∼1-2 and 0.5 μm, respectively. Cleaning with ethanol resulted in a mesoporous morphology that was less well-defined compared to the water-washed powders, but the agglomerate size was smaller and had an average size of ∼250 nm that did not vary with calcination temperature. Our analysis showed that surfactant-assisted formation of mesoporous structures can be a compromise between achieving a stable mesoporous architecture and material purity. We contend that removal of the surfactant in many mesoporous materials presented in the literature is not completely achieved, and the presence of these organics has to be considered during subsequent processing of the powders and/or for their use in industrial applications. The issue of material purity in mesoporous materials is one that has not been fully explored. In addition, knowledge of the particle (agglomerate) size is essential for powder handling during a variety of manufacturing techniques. Thus, the use of dynamic light scattering or any other technique that can elucidate particle size is essential if a full characterization of the powders is needed for achieving postprocessing effectiveness.

The existence of space as a dynamical system was recently revealed in 2002, following the discovery that the Michelson-Morley light speed anisotropy experiment of 1887 was not null. Numerous later experiments have confirmed that discovery, as reviewed here, with the latest being the discovery of a very simple and cheap nanotechnology quantum detector method for observing space and its fluctuations/turbulence: Gravitational waves. As well over the last ten years the dynamical theory for space has been under development and has now been successfully tested against experiment and astronomical observations, explaining, in particular, the observed characteristics of galactic black holes, galactic rotations and universe expansion, all without &#34dark matter&#34 and &#34dark energy&#34.

The major extant relativity theories - Galileo's Relativity (GaR), Lorentz's Relativity (LR) and Einstein's Special Relativity (SR), with the latter much celebrated, while the LR is essentially ignored. Indeed it is often incorrectly claimed that SR and LR are experimentally indistinguishable. Here we show that (i) SR and LR are experimentally distinguishable, (ii) that comparison of gas-mode Michelson interferometer experiments with spacecraft earth-flyby Doppler shift data demonstrate that it is LR that is consistent with the data, while SR is in conflict with the data, (iii) SR is exactly derivable from GaR by means of a mere linear change of space and time coordinates that mixes the Galilean space and time coordinates. So it is GaR and SR that are equivalent. Hence the well-known SR relativistic effects are purely coordinate effects, and cannot correspond to the observed relativistic effects. The connections between these three relativity theories has become apparent following the discovery that space is an observable dynamical textured system, and that space and time are distinct phenomena, leading to a neo-Lorentz Relativity (nLR). The observed relativistic effects are dynamical consequences of nLR and 3-space. In particular a proper derivation of the Dirac equation from nLR is given, which entails the derivation of the rest mass energy mc^2, Comment: 10 pages