Effect of Mixing Ammonia and Alkylamines on Sulfate Aerosol Formation.

Sulfate aerosols' cooling effect on the global climate has spurred research to understand their mechanisms of formation. Both theoretical and laboratory studies have shown that the formation of sulfate aerosols is enhanced by the presence of a base like ammonia. Stronger alkylamine bases such as monomethylamine (MMA), dimethylamine (DMA), and trimethylamine (TMA) further increase aerosol formation rates by many orders of magnitude relative to that of ammonia. However, recent lab measurements have found that the presence of ammonia and alkylamines together increases nucleation rates by another 1-2 orders of magnitude relative to the stronger alkylamines alone. This work explores that observation by studying the thermodynamic stability of clusters containing up to two sulfuric acids and two bases of the same or different type. Initial configurational sampling is performed using genetic algorithm (GA) interfaced to semiempirical methods to find a large number of low-energy configurations. These structures are then subject to quantum mechanical calculations using PW91, M06-2X, and ωB97X-D functionals and MP2 with large basis sets. The thermodynamics of formation is reviewed to determine if it rationalizes why mixed base systems yield higher rates of aerosol formation than single base ones. The gas phase basicity of the bases in a cluster is the main determinant of binding strength in smaller clusters such as those in the current study while aqueous phase basicity is more important for larger particles. Besides thermodynamic considerations, the differences in aerosol formation mechanisms as a function of size and between the gas and particle phases are discussed.

Complete genome analysis of a frog virus 3 (FV3) isolate and sequence comparison with isolates of differing levels of virulence.

BACKGROUND: Frog virus 3 (FV3) is the type species of the genus Ranavirus, and in the past few decades, FV3 infections have resulted in considerable morbidity and mortality in a range of wild and cultivated amphibian species in the Americas, Europe, and Asia. The reasons for the pathogenicity of FV3 are not well understood. FINDINGS: We investigated three FV3 isolates designated SSME, wt-FV3, and aza-Cr, and reported that our wt-FV3 and aza-Cr strains showed similar levels of virulence, while SSME was the least virulent in an in vivo study with Lithiobates pipiens tadpoles. Using 454 GS-FLX sequencing technology, we sequenced SSME and compared it to the published wt-FV3 genome. SSME had multiple amino acid deletions in ORFs 49/50L, 65L, 66L, and 87L, which may explain its reduced virulence. We also investigated repeat regions and found that repeat copy number differed between isolates, with only one group of 3 isolates and 1 pair of isolates being identical at all 3 locations. CONCLUSIONS: In this study we have shown that genetic variability is present between closely related FV3 isolates, both in terms of deletions/insertions, and even more so at select repeat locations. These genomic areas with deletions/insertions may represent regions that affect virulence, and therefore require investigation. Furthermore, we have identified repeat regions that may prove useful in future phylogeographical tracking and identification of ranaviral strains across different environmental regions.

I like what you are saying, but only if i feel safe: Psychological safety moderates the relationship between voice and perceived contribution to healthcare team effectiveness.

Introduction: Are nurses who voice work-related concerns viewed as positive contributors to a team? We propose that the extent to which healthcare professionals consider voice by nurses as helpful for the team depends on how psychologically safe they feel. Specifically, we hypothesized that psychological safety moderates the relationship between voice of a lower ranking team member (i.e., a nurse) and perceived contribution by others, such that voice is more likely to be seen as valuable for team decision-making when psychological safety is high but not when it is low. Methods: We tested our hypotheses with a randomized between-subjects experiment using a sample of emergency medicine nurses and physicians. Participants evaluated a nurse who either did or did not speak up with alternative suggestions during emergency patient treatment. Results: Results confirmed our hypotheses: At higher levels of psychological safety the nurse's voice was considered as more helpful than withholding of voice for team decision-making. This was not the case at lower levels of psychological safety. This effect was stable when including important control variables (i.e., hierarchical position, work experience, gender). Discussion: Our results shed light on how evaluations of voice are contingent on perceptions of a psychologically safe team context.

To Reconstruct or Not: A Case of Acute Reconstruction of the Forearm Interosseous Membrane with CMC Mini Tight Rope.

Introduction: Essex Lopresti fractures are rare injuries of the forearm. Extent of damage to the interosseous membrane (IOM) in this setting is variable and can lead to disabling sequelae when not recognized and managed appropriately. While chronic reconstruction for longitudinal radioulnar dissociation is well studied, acute reconstruction of the membrane is infrequently documented and surgical techniques vary. There are only five documented cases of acute IOM reconstruction for Essex Lopresti injuries (ELIs). This is the first described case using a mini suture-button construct in conjunction with a radial head replacement and distal radioulnar joint (DRUJ) pinning, while also providing long-term radiographic and functional follow-up of 2 years. Case Report: We present a case of a 40-year-old male who sustained an Essex Lopresti fracture that was acutely recognized and surgically managed with a radial head replacement, DRUJ pinning, and acute reconstruction of the IOM with a Mini TightRope suture button construct. We also provide a post-operative rehabilitation protocol with early range of motion and pin removal. At our final 2-year postoperative follow-up, the patient demonstrated excellent functional outcomes. Conclusion: This case illustrates that a CMC Mini TightRope can be used for acute reconstruction of the IOM in the setting of ELIs which allows for early range of motion and DRUJ pin removal due to the maintenance of longitudinal radioulnar reduction.

Progression From Steroid Injection to Surgery in Carpal Tunnel Syndrome Patients With Concurrent Ulnar Nerve Compression: A Retrospective Analysis.

BACKGROUND: Steroid injections are a common treatment option in the management of carpal tunnel syndrome (CTS). This study assesses various prognostic factors for progression to carpal tunnel release (CTR) after a first-time steroid injection for CTS with specific focus on concomitant ulnar nerve compression (UNC). METHODS: This is a retrospective study of 426 hands with CTS treated with a first-time steroid injection in the Long Island region of New York. The main predictor variable was UNC measured in two analytical models of positive UNC and location of UNC (wrist or elbow). Multivariate logistic regression analyses adjusted for demographic, medical, and CTS-related variables for 2 study outcomes occurring within 1 year: (1) CTR; and (2) steroid reinjection. RESULTS: Overall progression to CTR within 1 year of steroid injection was 23.0%. Ulnar nerve compression was present in 16.7% of patients and was significantly associated with increased odds for CTR but not with steroid reinjection. These results were further localized to be specific for UNC at the elbow. A moderate or severe result on electrodiagnostic studies was associated with increased odds for CTR. Increased age was associated with slightly increased odds of steroid reinjection while a history of distal radius fracture was associated with decreased odds of steroid reinjection. CONCLUSIONS: Carpal tunnel syndrome patients with UNC may benefit from earlier definitive treatment with CTR rather than attempting steroid injections, as they are more likely to seek reintervention within 1 year of their initial injection.

The impact of an objective structured teaching evaluation on faculty teaching skills.

BACKGROUND: Objective structured teaching evaluations (OSTEs) have been utilized to evaluate educational curricula and for resident and faculty development. PURPOSE: This study examines the impact of an OSTE on faculty teaching effectiveness and faculty satisfaction. METHODS: From 2004 to 2007, 46 faculty members participated in the OSTE. Faculty assessed their teaching abilities with a retrospective pre-post-test analysis. Faculty teaching evaluations for the 6 months before and after the OSTE were compared. Faculty participants completed satisfaction questionnaires regarding their OSTE experience and made teaching plans for the future. RESULTS: After the OSTE, faculty reported statistically significant improvements in all self-assessed teaching skills. There was, however, no improvement in their teaching evaluations. Faculty satisfaction with the OSTE experience was high. They indicated teaching plans incorporating lessons from the OSTE. CONCLUSIONS: Faculty felt the OSTE was a rewarding experience and reported improvement in their teaching abilities; however, faculty teaching evaluations did not improve.

Validity and Reliability of the Scale to Report Emotional Stress Signs-Multiple Sclerosis (STRESS-MS) in Assessing Abuse and Neglect of Adults With Multiple Sclerosis.

Background: Approximately 30% of people with multiple sclerosis (MS) require caregiving, with unknown prevalence of abuse and neglect. To explore these issues, we created the Scale to Report Emotional Stress Signs-Multiple Sclerosis (STRESS-MS). The objective was to develop, validate, and field-test a self-report questionnaire for screening people with MS for mistreatment. Methods: We developed the STRESS-MS questionnaire and administered it to 102 adults with advanced MS-related disability and 97 primary informal caregivers, correlating responses with direct observation of mistreatment, conducting an item analysis, and evaluating validity using a Longitudinal, Expert, All Data (LEAD) panel. Results: Most STRESS-MS subscales correlated highly with criterion-standard LEAD panel evaluations of mistreatment, with strong concurrent and discriminant validity. Nearly 53% of participants with MS reported experiencing psychological abuse; 9.8%, financial exploitation; 6.9%, physical abuse; 4.9%, neglect; and 3.9%, sexual abuse. Protective factors for people with MS included social support and older age; risk factors included depression and aggressiveness. The greatest risk factor was an informal caregiver who spent 20 or more hours per week caring for the person with MS. Conclusions: The STRESS-MS questionnaire is reasonably reliable and valid for detecting caregiver mistreatment in adults with MS. Although most informal caregivers are not abusive, this study highlights an underrecognized need to detect and prevent abuse and neglect of people with MS.

Radiographic Predictors of Delayed Carpal Tunnel Syndrome After Distal Radius Fracture in the Elderly.

BACKGROUND: Delayed-onset carpal tunnel syndrome (DCTS) can develop weeks and months after distal radius fracture (DRFx). A better understanding of the risk factors of DCTS can guide surgeon's decision making regarding the management of DRFx and also provides another discussion point to be had with elderly patients when discussing outcomes of nonoperative management. METHODS: We reviewed 216 nonoperatively managed DRFx between June 2015 and January 2019 at a single level 1 trauma center and senior author's office. We identified 26 patients who developed DCTS at a minimum of 6 weeks after DRFx, which constituted our case group. The remaining 190 patients served as the control group (non-carpal tunnel syndrome [CTS]). Differences between case and control group were evaluated through univariate and multivariate analyses. RESULTS: The prevalence of DCTS among nonoperatively managed DRFx was 12%. In univariate analysis, volar tilt (VT) and teardrop angle (TDA) were significant independent predictors of development of DCTS. Multivariate logistic regression analysis determined that the odds of developing CTS increased by 12% and 24% for each degree of decrease in VT and TDA, respectively. No other significant risk factors were identified. CONCLUSIONS: Decreasing VT and TDA are the most significant risk factors associated with DCTS in nonoperatively managed DRFx. These are simple and reliable radiographic measurements that provide significant prognostic value. These parameters can be used to guide surgeon decision making regarding management of DRFx in the elderly while aiding patient expectations and outcomes following nonoperative management of DRFx.

How the COVID-19 Pandemic has changed multiple sclerosis clinical practice: Results of a nationwide provider survey.

BACKGROUND: The COVID-19 crisis has created unanticipated changes in health care delivery for people living with multiple sclerosis (MS). The pandemic's rapid evolution has resulted in a knowledge gap in how COVID-19 has affected MS clinical practice. Our objective was to understand how the COVID-19 pandemic has affected clinical practice patterns in a nationwide cohort of MS clinicians across the United States. METHODS: In collaboration with the National Multiple Sclerosis Society (NMSS), we developed a 28-item SurveyMonkeyTM electronic questionnaire exploring MS specialists' perceptions of how COVID-19 has altered how they prescribe MS disease-modifying therapies (DMTs), provide telehealth and other services, and view issues affecting their own well-being including re-deployment to the front lines of COVID-19 care and availability of personal protective equipment (PPE). NMSS staff sent a recruitment email containing the electronic survey link to 188 clinicians who serve on regional NMSS Healthcare Provider Councils across the US, 86 (45.7%) of whom were MS specialist physicians. RESULTS: Eighty-six of 188 potential respondents (45.7%) from 32 US states completed the survey including 45 physicians (41 neurologists, 3 physiatrists and 1 family physician), 18 rehabilitation therapists, 7 psychologists, 6 nurse practitioners, 4 social workers, 2 physician assistants, 2 nurses and 2 health professionals from other disciplines. More than 80% of all respondents working on-site in a health care setting believed they had adequate PPE. More than 41% were able to distance safely from others at work. Nearly 10% of respondents reported they had been re-deployed to the front lines of COVID-19 patient care, and an additional 16.9% anticipated being re-deployed. Among the MS specialist physician subgroup, nearly one-third reported using telemedicine to provide over 75% of their clinical care. Only 16.7% believed COVID-19 had not changed how they prescribe DMTs. Therapies prescribed more often during the pandemic included ß-IFNs (28.6% of prescribers), natalizumab (23.8%), glatiramer acetate (21.4%) and teriflunomide (19%). DMTs prescribed less often included alemtuzumab (64.3% of prescribers), cladribine (54.8%), ocrelizumab and rituximab (50%), and fingolimod and siponimod (40.5%). For at least some of their patients during the pandemic, some MS specialists reported suspending certain DMTs including alemtuzumab (21.4% of prescribers), ocrelizumab and rituximab (16.7%) and cladribine (11.9%). Others reported extending DMT dosing intervals for natalizumab (38.1%), fingolimod and siponimod (11.9%). CONCLUSIONS: In this nationwide survey, MS specialist physicians and other clinicians serving on regional NMSS Healthcare Provider Councils across the US reported profound changes in how they are delivering MS care during the COVID-19 pandemic.

I do not need feedback! Or do I? Self-efficacy, perspective taking, and feedback seeking.

A central idea in the feedback seeking literature is that there should be a positive relationship between self-efficacy and the likelihood of seeking feedback. Yet empirical findings have not always matched this theoretical claim. Departing from current theorizing, we argue that high self-efficacy may sometimes decrease feedback seeking by making people undervalue feedback and that perspective taking is an important factor in determining whether or not this occurs. Results from 5 studies, utilizing diverse methodologies and samples, support our hypothesis that the relationship between self-efficacy and feedback seeking depends on the extent to which one engages in perspective taking. In the absence of perspective taking, self-efficacy tends to be more negatively related to feedback seeking. However, when perspective taking occurs, this relationship tends to be more positive. We also provide evidence that this interaction effect is mediated by perceptions of the value of feedback. We discuss the implications of our theory and findings for the feedback seeking literature and more broadly. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Abuse and neglect of people with multiple sclerosis: A survey with the North American Research Committee on Multiple Sclerosis (NARCOMS).

BACKGROUND: An estimated 100,000 Americans with advanced multiple sclerosis (MS) are at risk of mistreatment, yet we lack national prevalence data on abuse and neglect. Our objective was to determine the incidence and prevalence of caregiver abuse and neglect among U.S. adults with advanced MS. METHODS: Through an anonymous telephone survey with the North American Research Committee on Multiple Sclerosis (NARCOMS), we administered the validated Scale to Report Emotional Stress Signs - Multiple Sclerosis (STRESS-MS) and other study measures to 206 U.S. adults who had unpaid caregivers because of MS-related disability. RESULTS: 54.9% of respondents disclosed undergoing some form of mistreatment since first requiring caregiving by a family member or friend, including psychological abuse (44.2%), financial abuse (25.2%), neglect (16.5%), physical abuse (11.2%) or sexual abuse (8.3%). Many had experienced multiple forms of mistreatment. Mistreated respondents reported less social support, more alcohol use, and higher levels of fatigue and cognitive impairment. Daily caregiving increased mistreatment risk. Caregivers with mental illness were 13 times more likely to be abusive or neglectful. Poor premorbid relationships with caregivers nearly tripled mistreatment risk, while any significant alcohol use history by people with MS or caregivers doubled risk. CONCLUSIONS: In a nationwide survey, over 50% of American adults with advanced MS reported mistreatment by caregivers.

Differences in hepatic phenotype between hemochromatosis patients with HFE C282Y homozygosity and other HFE genotypes.

OBJECTIVE: There are limited data comparing hepatic phenotype among hemochromatosis patients with different HFE genotypes. The goal of this study was to compare hepatic histopathologic features and hepatic iron concentration (HIC) among patients with phenotypic hemochromatosis and different HFE genotypes. METHODS: We studied 182 US patients with phenotypic hemochromatosis. Degree of hepatic fibrosis, pattern of iron deposition, presence of steatosis or necroinflammation, and HIC were compared among different HFE genotypes. RESULTS: C282Y/H63D compound heterozygotes and patients with HFE genotypes other than C282Y/C282Y were more likely to have stainable Kupffer cell iron (31.1% vs. 9.5%; P=0.02), portal or lobular inflammation (28.9% vs. 15.6%; P=0.03), and steatosis (33.3% vs. 10.2%; P<0.01) on liver biopsy than C282Y homozygotes. Mean log10 HIC (P<0.05) and log10 ferritin (P<0.05) were higher among C282Y homozygotes than in patients with other HFE genotypes. In a logistic regression analysis using age, sex, HFE genotype, log10 ferritin, and log10 HIC as independent variables, log10 serum ferritin (P=0.0008), male sex (P=0.0086), and log10 HIC (P=0.047), but not HFE genotype (P=0.0554) were independently associated with presence or absence of advanced hepatic fibrosis. CONCLUSIONS: C282Y/H63D compound heterozygotes and other non-C282Y homozygotes which express the hepatic hemochromatosis phenotype frequently have evidence of steatosis or chronic hepatitis and lower body iron stores than C282Y homozygotes. These data suggest that presence of concomitant liver disease may explain expression of the hemochromatosis phenotype among non-C282Y homozygotes. Increased age, HIC, and ferritin are associated with advanced hepatic fibrosis, regardless of HFE genotype.

Outpatient oral misoprostol for prolonged pregnancies: a pilot investigation.

UNLABELLED: We evaluated the effectiveness of oral misoprostol for outpatient cervical ripening and labor induction in prolonged pregnancies. We performed a randomized, double-blind, placebo-controlled study of women at 40 to 42 weeks' gestation with well-dated pregnancies, singleton gestations, Bishop scores less than 6, vertex presentations, and intact membranes. Subjects received either oral misoprostol 100 microg or placebo daily for 3 days unless the subject developed significant cervical change or began labor spontaneously. Study drug was repeated every 24 hours for a maximum of three doses if subjects did not develop significant cervical change or enter labor. Induction of labor was not allowed while the subject was enrolled in the study. Forty-three subjects were randomized to receive misoprostol and 44 randomized to receive placebo. A significant difference was noted in reduction of time from study entry to both active phase (p < 0.001) and delivery (p < 0.001) in the misoprostol group. Fewer women remained undelivered after the 72-hour study period in the misoprostol group. There were no differences in route of delivery or neonatal outcomes between groups. CONCLUSION: Daily administration of oral misoprostol over 3 days to women with prolonged pregnancies shortened time intervals from dosing to entry into active labor and delivery compared with placebo.

Attributes of effective community preceptors for pre-clerkship medical students.

BACKGROUND: Attributes of effective precepting of pre-clerkship medical students in community settings are not adequately described. As part of preceptor needs assessment, we conducted site visits over three consecutive years. We also measured the preceptorships' educational quality, using students' post-rotation data, to identify priority areas for faculty development, corroborate site visit findings, and assess functions of the site visit. METHODS: Three university faculty directly observed teaching encounters in 83 community preceptors' offices during a 12-18-week second year (pre-clerkship) medical student rotation. Data were collected on practice demographics, teaching content, and educational quality, using multiple measures. Narrative responses to interview questions were coded for prevalent themes. Student post-rotation assessments were obtained by anonymous online evaluations. RESULTS: Good precepting attributes and suggestions for improvement were identified from both narrative analysis and student post-rotation evaluations in these key areas: independence in patient assessment, time spent teaching, giving feedback and orientation to the preceptor's practice. Student evaluations of preceptors' effectiveness significantly improved from year 1 to 2 and persisted into year 3. Appropriate faculty development strategies were derived from the combined results. CONCLUSIONS: The site visit by university faculty allows real-time observation and may itself be an effective intervention for improving teaching and learning.

Ratings of perceived exertion during aerobic exercise in multiple sclerosis.

OBJECTIVE: To compare ratings of perceived exertion (RPEs) during aerobic exercise in people with multiple sclerosis (MS) and control participants. DESIGN: Prospective experimental study. SETTING: An exercise testing laboratory. PARTICIPANTS: Sedentary adults (n=12) with mild MS (Expanded Disability Status Scale score < or = 3) aged 30 to 45 years and sedentary age-matched and sex-matched controls (n=12). INTERVENTIONS: All participants underwent a graded aerobic exercise test on a cycle ergometer with breath-by-breath gas measurements and continuous heart rate monitoring. MAIN OUTCOME MEASURES: After completing the Modified Fatigue Impact Scale, participants rated their effort sense every 30 seconds during exercise using the modified Borg 10-point scale. RESULTS: The 2 study groups showed similar baseline characteristics except for higher fatigue scores in the MS group. There were no significant differences for any fitness measure, including oxygen cost slope (in VO(2) x min(-1) x W(-1)), VO(2), or work rate during exercise. Neither heart rate nor RPE--measured at 25%, 50%, 75%, and 100% of VO(2)peak--differed between groups. CONCLUSIONS: Despite greater reported fatigue levels, participants with MS showed similar RPE and physiologic responses to submaximal and maximal exercise compared with controls. In MS, the Borg 10-point scale may help improve evidence-based exercise prescriptions, which otherwise may be limited by fatigue, motor impairment, heat sensitivity, or autonomic dysfunction.

Primary care for adults with physical disabilities: perceptions from consumer and provider focus groups.

BACKGROUND AND OBJECTIVES: Family physicians lack data on how best to address the needs of adults with physical disabilities. We undertook this study to understand how consumers, educators, and other professionals perceive primary care for people with disabilities. METHODS: We conducted six focus groups, three with 27 health professionals in primary care practices affiliated with an urban university medical center and three with 19 local adults, ages 21-64 years, with physical disabilities. From transcribed recordings, three investigators conducted separate content analyses. Independent author reviews and participant review confirmed saturation and agreement for major themes. RESULTS: All groups perceived that generalist physicians and other health professionals need more education about disability issues. Multiple barriers limit care, including physical access and transportation, funding, limitations in professionals' knowledge and attitudes, communication gaps, and health systems failures. Both consumers and professionals recommended reducing barriers by educating professionals and trainees about disabilities and resources, improving provider-patient communication, enhancing physical access (eg, high-low examination tables, wide automatic doors, high-contrast signs and lighting, wheelchair scales), and increasing appointment times. CONCLUSIONS: Primary care must address the unmet needs of people with disabilities. Family medicine educators can begin by teaching learners how to coordinate care, access resources, and communicate about disability issues.

Student perceptions of the one minute preceptor and traditional preceptor models.

BACKGROUND: The one-minute preceptor (OMP) model was developed to effectively and efficiently teach learners while simultaneously addressing patient needs. This study was conducted to determine if third- and fourth-year medical students prefer the OMP model over the traditional precepting model and what teaching points they needed from the clinical encounters. METHODS: Third- and fourth-year students (N = 164) at two medical schools completed a questionnaire and prompts on teaching points in response to viewing two videotaped precepting encounters. Differences between OMP and traditional precepting scores were computed using a factorial repeated measures analysis of co-variance (ANCOVA). Teaching points were coded and counted. RESULTS: Students preferred the OMP precepting model to the traditional teaching model (p = 0.001). While the desired teaching points changed as the case presentation/discussion progressed, students were most interested in learning about the clinical presentation or natural progression of the disease regardless of teaching model used. CONCLUSIONS: Students rate the OMP as a more effective model of teaching than the traditional model. The teaching points desired by students change as the case presentation/discussion unfolds. Work carried out at: University of California, San Francisco, Office of Medical Education and University of California, Irvine, Department of Family Medicine.

Disentangling role perceptions: how perceived role breadth, discretion, instrumentality, and efficacy relate to helping and taking charge.

The objective of this study was to empirically disentangle role perceptions related to organizational citizenship behavior (OCB) that have been confounded in past research, investigate their unique relationships with both an affiliative (helping) and a challenging (taking charge) form of OCB, and determine their relative importance in explaining these 2 forms of OCB. The authors also examined whether role discretion and role breadth independently moderate the procedural justice-to-OCB relationship. The authors surveyed 225 engineers in India and their direct supervisors. The results showed that 3 of the 4 facets of OCB role perception explain unique variance in either helping or taking charge, and that role breadth moderates the relationships between procedural justice and both helping and taking charge. The authors discuss implications of these findings for OCB theory and research, as well as for managerial practice.