Development of cross-service training and job performance criterion measures for the U.S. Military.

As part of an effort to provide standardized criterion measures across the Armed Services, the current research effort developed a set of service-wide criterion measures for first-term enlisted personnel using a recently developed model of cross-service job performance. Two concurrent work streams developed criterion measures which provide complete construct coverage of the cross-service performance model. Using existing service-specific instruments, methods for development of the Cross-Service Situational judgment Test (CSSJT), the Cross-Service Job Performance Ratings Scales (CSPRS), and two cross-service self-report measures (end of training and in unit surveys) are described and discussed.

Primary Care Provider HIV PrEP Knowledge, Attitudes, and Prescribing Habits: A Cross-Sectional Survey of Late Adopters in Rural and Suburban Practice.

OBJECTIVE: Pre-exposure prophylaxis (PrEP) is a recommended strategy for HIV prevention, yet PrEP prescribing rates in primary care remain low. The aim of this study was to further describe the current knowledge, attitudes, and prescribing behaviors of HIV PrEP in primary care providers with a focus on the perceived barriers and facilitators to PrEP prescribing. METHODS: Cross-sectional survey of primary care providers at rural and suburban practices in a large academic institution. RESULTS: Survey response rate was 48.0% (n = 134). Most respondents (96.3%) reported little clinical experience in care of persons living with HIV. Respondents self-reported positive attitudes and high overall knowledge of PrEP with low prescribing rates and less comfort with lab testing. More respondents are asked about PrEP by patients (54%) than start conversations about PrEP with patients (39%). Family Physicians and providers 5 to 10 years from completion of training overall reported higher knowledge, attitudes and prescribing behaviors. Lack of PrEP education was identified as the greatest barrier and an electronic medical record order set as the greatest facilitator to prescribing PrEP. CONCLUSIONS: With the goal to end the HIV epidemic, PrEP provision in nonurban primary care settings may be an important strategy for increased access to PrEP and reduced HIV transmission. This study, which includes a variety of providers that possess high knowledge, yet low experience prescribing PrEP, likely demonstrates the limitations of interventions which solely focus on provider education. System-based practice solutions, such as order sets, may be needed to target infrequent prescribers of PrEP.

Gender Trends in Psychotropic Medication Use in Autism.

Autism is a neurodevelopmental condition that includes differences in social communication and restrictive, repetitive behavior. Its diagnosis is far more common in men than women. Therefore, a female phenotype of autism might not concern caregivers or be detected early by clinical assessments. Given that medications address problematic behaviors rather than autism, different problems associated with autism necessitate other treatments. We reviewed existing literature on gender differences in psychotropic drug usage in autism patients and found that antidepressants, anticonvulsants, and mood stabilizers were more common in females, while stimulants and antipsychotics were predominant in males. This review highlights that autistic men and women receive different pharmacologic agents, likely attributable to gender-specific trends in presenting problematic behaviors.

Increased perioperative mortality for femoral neck fractures in patients with coronavirus disease 2019 (COVID-19): experience from the United Kingdom during the first wave of the pandemic.

BACKGROUND: The coronavirus disease 19 (COVID-19) pandemic has presented modern healthcare with an unprecedented challenge. At the peak of the pandemic, trauma and orthopaedic services at our institutions undertook internal restructuring, diverting resources to frontline medical care. Consequently, we sought to assess the impact on the elderly and comorbid patients presenting with femoral neck fractures, with a particular focus on 30-day mortality, length of stay, multidisciplinary team involvement and departmental structuring. METHOD: A retrospective analysis of patients presenting with femoral neck fractures at three separate West London NHS Trusts was undertaken between March 11, 2020, to April 30, 2020. Length of stay, 30-day mortality and adherence to parameters constituting the best care evidence-based practice tariffs were compared between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive and negative patients. A similar comparison was also conducted between our cohort and the equivalent period in 2018 using data from the National Hip Fracture Database. RESULTS: A total of 68 patients presenting with femoral neck fractures were identified, mean age 81 (range 38-98), 73% female. There were 10 confirmed/suspected cases of COVID-19 on admission and a further seven confirmed as inpatients. The 30-day mortality within our cohort was 11.76% compared to 6% nationally in 2018 (p = 0.045). Orthogeriatric reviews occurred within 72 h in 71% of cases compared to 88% in the equivalent 2018 period. Within the cohort, mean length of stay was 17.13 days (SD 5.6, range 8-27 days) for SARS-CoV-2 positive patients compared to 10 days (SD 8.7, range 1-53 days) for negative patients (p < 0.05). Thirty-two patients (47%) required increased packages of care on discharge or rehabilitation. CONCLUSIONS: The increase in 30-day mortality for SARS-CoV-2 positive patients presenting with femoral neck fractures is multifactorial, resulting from a combination of the direct effects of COVID-19 pneumonia as well as changes to the delivery of orthopaedic services. The provision of multidisciplinary care was directly affected by staff redeployment, particularly reorganisation of orthogeriatric services and lack of continuity of ward based clinical care. Our experiences have re-directed efforts towards the management of theatre teams, patient services and staffing, should we be faced with either a resurgence of COVID-19 or a future pandemic.

Spinal Anesthetic in a Patient With a Platelet Count of 7000 × 109/L and Undiagnosed Thrombotic Thrombocytopenic Purpura: A Case Report.

A parturient with unknown thrombotic thrombocytopenic purpura (TTP) received spinal anesthesia for cesarean delivery with subsequent discovery of a platelet count of 7000 × 10/L. Neurologic recovery was normal. Limited data exist to determine the risk of spinal epidural hematoma (SEH) in severely thrombocytopenic patients because they often receive alternate labor analgesia or general anesthesia during cesarean delivery. There is reporting bias in the literature toward cases in which severely thrombocytopenic patients sustain complications after regional anesthesia. It is important to report all cases of neuraxial anesthesia in severely thrombocytopenic patients, including those such as ours, wherein patients recover normally.

Enhanced vibrational solvatochromism and spectral diffusion by electron rich substituents on small molecule silanes.

Fourier transform infrared and two-dimensional IR (2D-IR) spectroscopies were applied to two different silanes in three different solvents. The selected solutes exhibit different degrees of vibrational solvatochromism for the Si-H vibration. Density functional theory calculations confirm that this difference in sensitivity is the result of higher mode polarization with more electron withdrawing ligands. This mode sensitivity also affects the extent of spectral diffusion experienced by the silane vibration, offering a potential route to simultaneously optimize the sensitivity of vibrational probes in both steady-state and time-resolved measurements. Frequency-frequency correlation functions obtained by 2D-IR show that both solutes experience dynamics on similar time scales and are consistent with a picture in which weakly interacting solvents produce faster, more homogeneous fluctuations. Molecular dynamics simulations confirm that the frequency-frequency correlation function obtained by 2D-IR is sensitive to the presence of hydrogen bonding dynamics in the surrounding solvation shell.

Quantitative and Qualitative Assessment Methods for Biofilm Growth: A Mini-review.

Biofilms are microbial communities attached to a surface and embedded in an extracellular polymeric substance which provides for the protection, stability and nutrients of the various bacterial species indwelling. These communities can build up in a variety of different environments from industrial equipment to medical devices resulting in damage, loss of productivity and disease. They also have great potential for economic and societal benefits as bioremediation agents and renewable energy sources. The great potential benefits and threats of biofilms has encouraged researchers across disciplines to study biofilm characteristics and antibiofilm strategies resulting in chemists, physicists, material scientists, and engineers, to develop beneficial biofilm applications and prevention methods. The ultimate outcome is a wealth of knowledge and innovative technology. However, without extensive formal training in microbes and biofilm research, these scientists find a daunting array of established techniques for growing, quantifying and characterizing biofilms while trying to design experiments and develop innovative laboratory protocols. This mini-review focuses on enriching interdisciplinary efforts and understanding by overviewing a variety of quantitative and qualitative biofilm characterization methods to assist the novice researcher in assay selection. This review consists of four parts. Part 1 is a brief overview of biofilms and the unique properties that demand a highly interdisciplinary approach. Part 2 describes the classical quantification techniques including colony forming unit (CFU) counting and crystal violet staining, but also introduces some modern methods including ATP bioluminescence and quartz crystal microbalance. Part 3 focuses on the characterization of biofilm morphology and chemistry including scanning electron microscopy and spectroscopic methods. Finally, Part 4 illustrates the use of software, including ImageJ and predictive modeling platforms, for biofilm analysis. Each section highlights the most common methods, including literature references, to help novice biofilm researchers make choices which commensurate with their study goals, budget and available equipment.

Correlating solvent dynamics and chemical reaction rates using binary solvent mixtures and two-dimensional infrared spectroscopy.

Two-dimensional infrared (2D-IR) spectroscopy was performed on Vaska's complex (VC) and its oxygen adduct (V C-O2) in binary solvent mixtures of chloroform or benzyl alcohol in d6-benzene. The second order rate constants for oxygenation were also measured in these solvent mixtures. The rate constant in chloroform mixtures is linear with mole fraction within the error of the measurements but changes nonlinearly in benzyl alcohol mixtures, displaying a preference for the alcohol over benzene. The rate constants were compared with FTIR spectra of the carbonyl ligand and the frequency-frequency correlation function of this mode determined by 2D-IR. The line shape broadening mechanisms of the linear spectra of the CO bound to VC and V C-O2 are similar to those previously reported for V C-I2. There is a particularly strong correlation between rate constants and homogeneous linewidths of the carbonyl vibration on the V C-O2 product state. Concurrently, the FTIR spectra and spectral diffusion observed by 2D-IR corroborate an increase in solvent heterogeneity around the product. We interpret these results in the context of the potential role of solvent dynamics in facilitating chemical reactivity.

Simple fully reflective method of scatter reduction in 2D-IR spectroscopy.

A fully reflective two-dimensional IR (2D-IR) setup is described that enables efficient cancellation of scattered light from multiple pulses in the phase-matched direction. The local oscillator pulse and the pulse that stimulates the vibrational echo signal are synchronously modulated (or fibrillated) in time maintaining their phase relationships with the echo wavepacket. The modification is cost-effective and can be easily implemented on existing 2D-IR instruments, and it avoids the addition of dispersive elements into the beam paths. The fibrillation results in a decrease of waiting-time resolution of only tens of femtoseconds and has no impact on the spectral lineshape, making it a general improvement for 2D-IR spectrometers even for weakly or non-scattering samples.

Solvent-mediated vibrational energy relaxation from Vaska's complex adducts in binary solvent mixtures.

A vibrational pump-probe and FTIR study was performed on two different adducts of Vaska's complex in two different sets of binary solvent mixtures. The carbonyl vibrational mode in the oxygen adduct exhibits solvatochromic shifts of ~10 cm(-1) in either benzyl alcohol or chloroform relative to benzene-d6, whereas this vibration is nearly unchanged for the iodine adduct for the same three solvents. The width and center frequency of the carbonyl stretch for each adduct are compared to its vibrational lifetime in binary mixtures of benzene-d6 with either benzyl alcohol or chloroform. In neat solvents, the trends in line width, frequency, and vibrational lifetime are consistent for the two adducts, but complex relationships emerge when the trends in each property are compared as a function of mixed solvent composition. ν(CO) is more sensitive to the solvation environment around the trans ligand, whereas the line width and lifetime depend on the environment around the CO group itself. The carbonyl frequency and width vary nonlinearly across the two binary solvent series, indicating preferential solvation. In contrast, the vibrational lifetime changes linearly with solvent composition and is correlated with the mole fraction of chloroform but anticorrelated with the mole fraction of benzyl alcohol. The results are explained by differences in the densities of solvent modes that affect intermolecular relaxation of the carbonyl mode.

Developmental validation of the PowerPlex® 18D System, a rapid STR multiplex for analysis of reference samples.

As short tandem repeat markers remain the foundation of human identification throughout the world, new STR multiplexes require rigorous testing to ensure the assays are sufficiently robust and reliable for genotyping purposes. The PowerPlex(®) 18D System was created for the direct amplification of buccal and blood samples from FTA(®) storage cards and reliably accommodates other sample materials. The PowerPlex(®) 18D System allows simultaneous amplification of the 13 CODIS loci and amelogenin along with four additional loci: Penta E, Penta D, D2S1338, and D19S433. To demonstrate suitability for human identification testing, the PowerPlex(®) 18D System was tested for sensitivity, concordance, inhibitor tolerance, and performance with thermal cycling and reaction condition variation following SWGDAM developmental validation guidelines. Given these results, PowerPlex(®) 18D System can confidently be used for forensic and human identification testing.

Vibrational solvatochromism in Vaska's complex adducts.

The vibrational solvatochromism of bis(triphenylphosphine) iridium(I) carbonyl chloride (Vaska's complex, VC) was investigated by FTIR spectroscopy. The carbonyl stretching frequency (ν(CO)) was measured in 16 different organic solvents with a wide range of Lewis acidities for VC and its dioxygen (VC-O(2)), hydride (VC-H(2)), iodide (VC-I(2)), bromide (VC-Br(2)), and sulfide (VC-S(X)) adducts. The ν(CO) of the VC-O(2) complex was sensitive to the solvent electrophilicity, whereas minimal correlation was found for VC and the other adducts. The stretching frequency of the trans-O(2) ligand on VC-O(2) was measured to be anticorrelated with ν(CO), supporting a model in which this ligand indirectly affects the carbonyl frequency by modulating the extent of metal-to-CO back-bonding. The ν(CO) values obtained from DFT calculations on VC adducts with solvent continua and explicit hydrogen bonds were used to aid the interpretations of the experimental results. The O(2) ligand is more susceptible to stronger specific solvent interactions and it binds in a fundamentally different mode from the monatomic ligands, providing a more direct communication channel with those metal d-orbitals that have the appropriate symmetry to back-bond into the carbonyl π*-orbital.

Recombination signal sequence-associated restriction on TCRdelta gene rearrangement affects the development of tissue-specific gammadelta T cells.

Assembly of TCRalpha and TCRdelta genes from the TCRalpha/delta locus is tightly controlled for the proper generation of alphabeta and gammadelta T cells. Of >100 shared variable gene segments in the TCRalpha/delta locus, only a few are predominantly used for the TCRdelta gene assembly, while most are for TCRalpha. However, the importance and mechanisms of the selective variable gene rearrangement for T cell development are not fully understood. We report herein that the development of a tissue-specific gammadelta T cell population is critically affected by recombination signal sequence-associated restriction on the variable gene usage for TCRdelta assembly. We found that the development of substitute skin gammadelta T cells in mice deficient of the TCRgamma3 gene, which is used in wild-type skin gammadelta T cells, was drastically affected by the strain background. A Vgamma2(+) skin gammadelta T cell population developed in mice of the B6 but not the 129 strain backgrounds, due to a difference in the rearrangement of endogenous Vdelta7(+) TCRdelta genes, which paired with the Vgamma2(+) TCRgamma gene to generate the Vgamma2/Vdelta7(+) skin gammadelta T cell precursors in fetal thymi of the B6 background mice. The defective TCRdelta rearrangement of the 129-"Vdelta7" gene was associated with specific variations in its recombination signal sequence, which renders it poorly compatible for rearrangement to Ddelta genes. These findings provide the first direct evidence that recombination signal sequence-associated restriction on the variable gene usage for TCRalpha/delta gene assembly plays an important role in T cell development.

Antibacterial oxazolidinones possessing a novel C-5 side chain. (5R)-trans-3-[3-Fluoro-4- (1-oxotetrahydrothiopyran-4-yl)phenyl]-2- oxooxazolidine-5-carboxylic acid amide (PF-00422602), a new lead compound.

Oxazolidinones possessing a C-5 carboxamide functionality (reverse amides) represent a new series of compounds that block bacterial protein synthesis. These reverse amides also exhibited less potency against monoamine oxidase (MAO) enzymes and thus possess less potential for the side effects associated with MAO inhibition. The title compound (14) showed reduced in vivo myelotoxicity compared to linezolid in a 14-day safety study in rats, potent in vivo efficacy in murine systemic infection models, and excellent pharmacokinetic properties.