Developing the Metacognitive Awareness of Grit Scale for a better understanding of learners of English as a foreign language.

The prominent impact of metacognition on learners' academic achievement is widely discussed. Learners armed with appropriate metacognitive strategies should witness enhancement in learning performance. Similarly, the concept of grit is also valued as a crucial factor contributing to the improvement of academic achievement. Nevertheless, discussion of the relationship between metacognition and grit or their collective influence on other educational and psychological variables is limited, not to mention that an instrument measuring learners' metacognitive awareness of grit is a desideratum. Hence, by incorporating the constructs of metacognition and grit, the present research developed a measurement scale to address this need, named the Metacognitive Awareness of Grit Scale (MCAGS). The MCAGS consists of four components and initially included 48 items. It was later distributed to 859 participants for the purpose of scale validation. Confirmatory factor analysis was applied to evaluate the scale's validity and explore the factor-item relationship. A final model containing 17 items was retained. Implications and future directions were discussed.

Changes in Chinese students' academic emotions after examinations: Pride in success, shame in failure, and self-loathing in comparison.

BACKGROUND: Several attempts have been made to examine students' academic emotions (AEs) in Western contexts, but less is known about how students' self-reported emotions vary over time. AIMS: The study aimed to understand Chinese students' emotional responses to academic events and the impact of high-stakes testing on their AEs in the first year with a repeated-measures survey after the Semester 1 and Semester 2 mid-term examinations. SAMPLES: 351 first-year university students completed both surveys in an elite Chinese university, where the top 10% of first-year students were assigned to an honours programme. METHODS: Self-reported AEs survey responses were evaluated with confirmatory factor analysis. Invariance testing between honours and ordinary students and between semesters was used to examine between-group differences across time. RESULTS: A three-factor model of AEs (i.e., admired, shame, and self-loathing) was found in both semesters, with strong invariance between semesters. Mean scores between groups were equivalent and semester. However, self-loathing had the lowest mean (mean = 2.50; between mostly disagree and slightly agree), admired was at moderately agree (mean = 4.00), and shame was strongest at just over moderately agree (mean = 4.20). CONCLUSIONS: This study reveals a three-factor structure of AEs and the stability of these emotions among highly successful Chinese learners. Despite being elite students, this sample of Chinese learners felt shame and pride in response to mid-term examinations.

Heroin Adulterated with the Novel Synthetic Cannabinoid, 5F-MDMB-PINACA: A Case Series.

INTRODUCTION: Heroin can be adulterated with various substances that may or may not have pharmacological effects. Here we report a case series of 8 patients who presented to the emergency department after overdose with intravenous heroin preparation adulterated with the synthetic cannabinoid methyl 2-(1-(5-fluoropentyl)-1H-indazole-3-carboxamido)-3,3-dimethylbutanoate (5F-MDMB-PINACA). CASE SERIES: Except for one patient, all of them presented with a typical initial opioid toxidrome consisting of central nervous system and respiratory depression along with pinpoint pupils. Naloxone was given to them, triggering severe agitation and combative behavior along with overlapping features of anticholinergic and sympathomimetic toxidrome. All patients required multiple doses of benzodiazepines. Three were successfully treated with physostigmine. DISCUSSION: 5F-MDMB-PINACA is a synthetic cannabinoid that was added to heroin in samples obtained from patients reported in this case series. Patients demonstrated significant agitation after receiving naloxone for opioid toxidrome, presumably because of the removal of the depressant effect of opioids, which unmasked the excitatory effects of the synthetic cannabinoids. Three patients required physostigmine along with the benzodiazepines for control of their agitation, urine retention and abnormal vitals, suggesting the possibility of an anticholinergic toxidrome to have developed in these patients. CONCLUSION: Heroin contaminated with 5F-MDMB-PINACA exhibits variable severities of anticholinergic effects, some on presentation and others only after opiate antagonism.

An Unusual Case of Carbon Monoxide Poisoning from Formic and Sulfuric Acid Mixture.

Formic acid, when combined with sulfuric acid, gets dehydrated to form carbon monoxide (CO). A 27-year-old female was found unconscious inside a car, next to a container with a mixture of sulfuric acid and formic acid. Concentrations of up to 400 parts per million of CO were measured inside the car post ventilation. Serum carboxyhemoglobin level was 15% after receiving 100% oxygen for two hours. The patient received hyperbaric oxygen therapy after which she was extubated with normal mental status. On follow-up after three months, she demonstrated neurocognitive abnormalities suggestive of delayed neurological sequelae from CO exposure.

Dual Defibrillation is Highly Variable: An Analysis of Pulse Interval Delivered in Dual Defibrillation.

Background: Dual defibrillation (DD) is a technique where two external defibrillators are applied with two different pad configurations and discharged to treat refractory ventricular fibrillation (RVF). Although commonly called dual sequential defibrillation (DSD), if the delivered electrical pulses overlap with no pulse interval, the shocks are actually dual simultaneous defibrillation (DSiD). Manual DD technique is not standardized and the effect that the method of activation has on the delivered pulse interval has never been studied. Objectives: This study measured the timing of four methods of DD and the resulting inter-shock intervals, frequency with which they were either DSiD or DSD, and frequency which the true DSDs delivered any previously reported optimum pulse interval. Methods: This was a single-blinded prospective evaluation of a convenience sample of volunteer physicians, nurses, and paramedics each performing DD in our simulation center on two types of defibrillators using four techniques: single operator-simultaneous with 2 hands (SOSI), two operators-simultaneous (TOSI), single operator-sequential with 1 hand (SOSE1), and single operator-sequential with 2 hands (SOSE2). Results: The four DD methods generated a variable set of pulse intervals depending on the technique and defibrillator employed. The pulse intervals ranged from 0 msec (i.e., overlapping waveforms or DSiD) to 1800 msec. Of all DD attempts, 85.9% met the definition of DSD, 14.1% were DSiD, and 49.4% delivered any one of the optimum pulse intervals previously described in the literature. SOSI and TOSI techniques resulted in DSD between 47.2 and 87.6% of the time, depending on the technique and defibrillator. Shocks delivered sequentially on purpose (SOSE2 and SOSE1) were always DSD but with widely variable pulse intervals. SOSI resulted in the shortest pulse intervals, SOSE1 resulted in the longest, and TOSI and SOSE2 were the least skewed. Conclusion: DD using the various methods currently employed produces a highly variable set of pulse intervals even within a single method. It is difficult to reach a conclusion about the efficacy of DD unless the delivered pulse interval is measured or the method of activation reproducibly produces a precise pulse interval.

The Hahnemann University Hospital Closure and What Matters: A Department Chair's Perspective.

The closure of Hahnemann University Hospital, which was announced on June 26, 2019, resulted in the most significant graduate medical education displacement in history, sending over 550 residents to new institutions within a month of the announcement. Over 2,000 physicians, nurses, and staff lost their jobs. While seemingly predictable in retrospect, the closure came as a cataclysmic event to all involved. In this Invited Commentary, a department chair reflects on the lessons learned from these unprecedented circumstances. These lessons cover areas that are not a typical concern for faculty who are focused on teaching their trainees, but are worthy of their attention. Corporate and organizational structure, leadership, and financing of the hospital were critical determining characteristics of the failure. The roles that the Accreditation Council for Graduate Medical Education and the Centers for Medicare and Medicaid Services played in this event were key stabilizers. However, examining their roles in this event offers opportunities to play a more active role in future events and alter how the next massive displacement unfolds, possibly preserving teaching programs. Highly competitive health systems should rethink noncollaborative strategies before allowing struggling institutions to succumb to market forces. Finally, a commitment by a hospital to the mission of academic medicine is a sacred trust with the faculty, trainees, and patients that it serves. It should not be undertaken by any enterprise that is not well resourced and equipped with the knowledge and expertise to meet this most serious of commitments.

Genome-scale evaluation of core one-carbon metabolism in gammaproteobacterial methanotrophs grown on methane and methanol.

Methylotuvimicrobium alcaliphilum 20Z is a promising platform strain for bioconversion of one-carbon (C1) substrates into value-added products. To carry out robust metabolic engineering with methylotrophic bacteria and to implement C1 conversion machinery in non-native hosts, systems-level evaluation and understanding of central C1 metabolism in methanotrophs under various conditions is pivotal but yet elusive. In this study, a genome-scale integrated approach was used to provide in-depth knowledge on the metabolic pathways of M. alcaliphilum 20Z grown on methane and methanol. Systems assessment of core carbon metabolism indicated the methanol assimilation pathway is mostly coupled with the efficient Embden-Meyerhof-Parnas (EMP) pathway along with the serine cycle. In addition, an incomplete TCA cycle operated in M. alcaliphilum 20Z on methanol, which might only supply precursors for de novo synthesis but not reducing powers. Instead, it appears that the direct formaldehyde oxidation pathway supply energy for the whole metabolic system. Additionally, a comparative transcriptomic analysis in multiple gammaproteobacterial methanotrophs also revealed the transcriptional responses of central metabolism on carbon substrate change. These findings provided a systems-level understanding of carbon metabolism and new opportunities for strain design to produce relevant products from different C1-feedstocks.

Rapid, label-free genetic detection of enteropathogens in stool without genetic isolation or amplification.

Current genetic detection methods require gene isolation, gene amplification and detection with a fluorescent-tagged probe. They typically require sophisticated equipment and expensive fluorescent probes, rendering them not widely available for rapid acute infection diagnoses at the point of care to ensure timely treatment of the diseases. Here we report a rapid genetic detection method that can detect the bacterial gene directly from patient stools using a piezoelectric plate sensor (PEPS) in conjunction with a continuous flow system with two temperature zones. With stools spiked with sodium dodecyl sulfate (SDS) in situ bacteria lysing and DNA denaturation occurred in the high-temperature zone whereas in situ specific detection of the denatured DNA by the PEPS occurred in the lower-temperature zone. The outcome was a rapid genetic detection method that directly detected bacterial genes from stool in < 40 min without the need of gene isolation, gene amplification, or expensive fluorescent tag but with polymerase chain reaction (PCR) sensitivity. In 40 blinded patient stools, it detected the toxin B gene of Clostridium difficile with 95% sensitivity and 95% specificity. The all-electrical, label-free nature of the detection further supports its potential as a low-cost genetic test that can be used at the point of care.

Rare Earth Elements Alter Redox Balance in Methylomicrobium alcaliphilum 20ZR.

Background: Rare Earth Elements (REEs) control methanol utilization in both methane- and methanol-utilizing microbes. It has been established that the addition of REEs leads to the transcriptional repression of MxaFI-MeDH [a two-subunit methanol dehydrogenase (MeDH), calcium-dependent] and the activation of XoxF-MeDH (a one-subunit MeDH, lanthanum-dependent). Both enzymes are pyrroquinoline quinone-dependent alcohol dehydrogenases and show significant homology; however, they display different kinetic properties and substrate specificities. This study investigates the impact of the MxaFI to XoxF switch on the behavior of metabolic networks at a global scale. Results: In this study we investigated the steady-state growth of Methylomicrobium alcaliphilum 20ZR in media containing calcium (Ca) or lanthanum (La, a REE element). We found that cells supplemented with La show a higher growth rate compared to Ca-cultures; however, the efficiency of carbon conversion, estimated as biomass yield, is higher in cells grown with Ca. Three complementary global-omics approaches-RNA-seq transcriptomics, proteomics, and metabolomics-were applied to investigate the mechanisms of improved growth vs. carbon conversion. Cells grown with La showed the transcriptional activation of the xoxF gene, a homolog of the formaldehyde-activating enzyme (fae2), a putative transporter, genes for hemin-transport proteins, and nitrate reductase. In contrast, genes for mxaFI and associated cytochrome (mxaG) expression were downregulated. Proteomic profiling suggested additional adjustments of the metabolic network at the protein level, including carbon assimilation pathways, electron transport systems, and the tricarboxylic acid (TCA) cycle. Discord between gene expression and protein abundance changes points toward the possibility of post-transcriptional control of the related systems including key enzymes of the TCA cycle and a set of electron-transport carriers. Metabolomic data followed proteomics and showed the reduction of the ribulose-monophosphate (RuMP) pathway intermediates and the increase of the TCA cycle metabolites. Conclusion: Cells exposed to REEs display higher rates of growth but have lower carbon conversion efficiency compared to cells supplemented with Ca. The most plausible explanation for these physiological changes is an increased conversion of methanol into formate by XoxF-MeDH, which further stimulates methane oxidation but limits both the supply of reducing power and flux of formaldehyde into the RuMP pathway.

Giant coral reef fishes display markedly different susceptibility to night spearfishing.

The humphead wrasse (Cheilinus undulatus) and bumphead parrotfish (Bolbometopon muricatum) are two of the largest, most iconic fishes of Indo-Pacific coral reefs. Both species form prized components of subsistence and commercial fisheries and are vulnerable to overfishing. C. undulatus is listed as Endangered and B. muricatum as Vulnerable on the IUCN Red List of Threatened Species. We investigated how night spearfishing pressure and habitat associations affected both species in a relatively lightly exploited setting; the Kia fishing grounds, Isabel Province, Solomon Islands. We used fisheries-independent data from underwater visual census surveys and negative binomial models to estimate abundances of adult C. undulatus and B. muricatum as a function of spearfishing pressure and reef strata. Our results showed that, in Kia, night spearfishing pressure from free divers had no measurable effect on C. undulatus abundances, but abundances of B. muricatum were 3.6 times lower in areas of high spearfishing pressure, after accounting for natural variations due to habitat preferences. It is likely the species' different nocturnal aggregation behaviors, combined with the fishers' use of night spearfishing by spot-checking underpin these species' varying susceptibility. Our study highlights that B. muricatum is extremely susceptible to night spearfishing; however, we do not intend to draw conservation attention away from C. undulatus. Our data relate only to the Kia fishing grounds, where human population density is low, the spot-checking strategy is effective for reliably spearing large numbers of fish, particularly B. muricatum, and fisheries have only recently begun to be commercialized; such conditions are increasingly rare. Instead, we recommend that regional managers assess the state of their fisheries and the dynamics affecting the vulnerability of the fishes to fishing pressure based on local-scale, fisheries-independent data, where resources permit.

Single centre audit of early impact of inclusion of the three vessel and trachea view in obstetric screening.

Detection rates of congenital cardiac malformations have traditionally remained low. The NHS Fetal Anomaly Screening Programme (FASP) aims to increase these detection rates for various reasons, including influencing perinatal management and aiding parental decision making. The inclusion of the three vessel view and trachea (3VT) view in 2015 aimed to improve detection rates of arch abnormalities in particular. This study evaluated the early impact of the new initiative at one NHS Trust. Departmental screen-positive rates were compared for a full year before and after implementation. Referrals to, and opinions of, the foetal medicine unit (FMU) were assessed; as were undetected congenital heart defects for the two time periods. Compared with the pre-implementation (pre-3VT) period, the number of completed anomaly scans performed after implementation (post-3VT) increased by 3% and the number of FMU referrals increased by 625%. Departmental screen-positive rates for cardiac abnormalities increased from 40% (pre-3VT) to 91% (post-3VT). Over half (52%) of the FMU referrals were made due to a suspected abnormal 3VT view. Early evaluation of 3VT implementation at this NHS Trust indicates that it has been a success. Departmental screen-positive rates for congenital cardiac malformations have risen. However, this performance has come at a cost: Some abnormalities now being detected, such as loose vascular ring and PLSVC, are frequently asymptomatic and likely to be clinically insignificant. The implementation of 3VT achieves the aims of FASP but may begin to exceed what is expected from a low risk population screening programme.

Author Correction: Methane utilization in Methylomicrobium alcaliphilum 20ZR: a systems approach.

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has not been fixed in the paper.

Methane utilization in Methylomicrobium alcaliphilum 20ZR: a systems approach.

Biological methane utilization, one of the main sinks of the greenhouse gas in nature, represents an attractive platform for production of fuels and value-added chemicals. Despite the progress made in our understanding of the individual parts of methane utilization, our knowledge of how the whole-cell metabolic network is organized and coordinated is limited. Attractive growth and methane-conversion rates, a complete and expert-annotated genome sequence, as well as large enzymatic, 13C-labeling, and transcriptomic datasets make Methylomicrobium alcaliphilum 20ZR an exceptional model system for investigating methane utilization networks. Here we present a comprehensive metabolic framework of methane and methanol utilization in M. alcaliphilum 20ZR. A set of novel metabolic reactions governing carbon distribution across central pathways in methanotrophic bacteria was predicted by in-silico simulations and confirmed by global non-targeted metabolomics and enzymatic evidences. Our data highlight the importance of substitution of ATP-linked steps with PPi-dependent reactions and support the presence of a carbon shunt from acetyl-CoA to the pentose-phosphate pathway and highly branched TCA cycle. The diverged TCA reactions promote balance between anabolic reactions and redox demands. The computational framework of C1-metabolism in methanotrophic bacteria can represent an efficient tool for metabolic engineering or ecosystem modeling.

Estimating the footprint of pollution on coral reefs with models of species turnover.

Ecological communities typically change along gradients of human impact, although it is difficult to estimate the footprint of impacts for diffuse threats such as pollution. We developed a joint model (i.e., one that includes multiple species and their interactions with each other and environmental covariates) of benthic habitats on lagoonal coral reefs and used it to infer change in benthic composition along a gradient of distance from logging operations. The model estimated both changes in abundances of benthic groups and their compositional turnover, a type of beta diversity. We used the model to predict the footprint of turbidity impacts from past and recent logging. Benthic communities far from logging were dominated by branching corals, whereas communities close to logging had higher cover of dead coral, massive corals, and soft sediment. Recent impacts were predicted to be small relative to the extensive impacts of past logging because recent logging has occurred far from lagoonal reefs. Our model can be used more generally to estimate the footprint of human impacts on ecosystems and evaluate the benefits of conservation actions for ecosystems.

Mechanochemical ablation for symptomatic great saphenous vein reflux: A two-year follow-up.

Background Several studies have shown comparable early efficacy of mechanochemical ablation to endothermal techniques. The goal of this report was to show if early efficacy is maintained at 24 months. Methods This was a two-year analysis on the efficacy of mechanochemical ablation in patients with symptomatic C2 or more advanced chronic venous disease. Patients with reflux in the great saphenous vein involving the sapheno-femoral junction and no previous venous interventions were included. Demographic information, clinical, and procedural data were collected. The occlusion rate of treated veins was assessed with duplex ultrasound. Patient clinical improvement was assessed by Clinical-Etiology-Anatomy-Pathophysiology (CEAP) class and venous clinical severity score. Results Of the initial 126 patients, there were 65 patients with 24 month follow-up. Of these 65 patients, 70% were female, with a mean age of 70 ± 14 years and an average body mass index (BMI) of BMI of 30.5 ± 6. The mean great saphenous vein diameter in the upper thigh was 7.6 mm and the mean treatment length was 39 cm. Adjunctive treatment of the varicosities was performed in 14% of patients during the procedure. Closure rates were 100% at one week, 98% at three months, 95% at 12 months, and 92% at 24 months. There was one patient with complete and four with partial recanalization ranging from 7 to 12 cm (mean length 9 cm). There was significant improvement in CEAP and venous clinical severity score (P < .001) for all time intervals. Conclusion Early high occlusion rate with mechanochemical ablation is associated with significant clinical improvement which is maintained at 24 months, making it a very good option for the treatment of great saphenous vein incompetence.

Synthetic Cannabinoid Abuse Resulting in ST-Segment Elevation Myocardial Infarction Requiring Percutaneous Coronary Intervention.

BACKGROUND: Synthetic cannabinoids (SC) are recreational designer drugs intended to mimic delta-9-tetrahydrocannabinol while surreptitiously circumventing classification by the Drug Enforcement Administration. CASE REPORT: A 50-year-old black male arrived in the Emergency Department transported by Emergency Medical Services (EMS) for altered mental status after complaining of chest pain associated with smoking SCs. EMS found the patient with an empty foil pack labeled "Scooby Snax Limited Edition Blueberry Potpourri." The patient was somnolent, but became agitated when stimulated and complained of chest pain. Vital signs were blood pressure 87/52 mm Hg and pulse 52 beats/min. The electrocardiogram demonstrated an inferior wall myocardial infarction. Coronary angiography identified an occluded obtuse marginal second branch that was successfully opened with a drug-eluting stent. The patient recovered uneventfully. Urine drug screen was negative for cocaine, and gas chromatography/mass spectrometry testing of the smoked material identified PB-22 and AMB-FUBINACA as the active ingredients. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians and cardiologists need to be aware that the mechanism of action of synthetic cannabinoids on the endocannabinoid system may result in acute ST-segment elevation myocardial infarction requiring percutaneous coronary intervention.

Restricted grouper reproductive migrations support community-based management.

Conservation commonly requires trade-offs between social and ecological goals. For tropical small-scale fisheries, spatial scales of socially appropriate management are generally small-the median no-take locally managed marine area (LMMA) area throughout the Pacific is less than 1 km(2). This is of particular concern for large coral reef fishes, such as many species of grouper, which migrate to aggregations to spawn. Current data suggest that the catchment areas (i.e. total area from which individuals are drawn) of such aggregations are at spatial scales that preclude effective community-based management with no-take LMMAs. We used acoustic telemetry and tag-returns to examine reproductive migrations and catchment areas of the grouper Epinephelus fuscoguttatus at a spawning aggregation in Papua New Guinea. Protection of the resultant catchment area of approximately 16 km(2) using a no-take LMMA is socially untenable here and throughout much of the Pacific region. However, we found that spawning migrations were skewed towards shorter distances. Consequently, expanding the current 0.2 km(2) no-take LMMA to 1-2 km(2) would protect approximately 30-50% of the spawning population throughout the non-spawning season. Contrasting with current knowledge, our results demonstrate that species with moderate reproductive migrations can be managed at scales congruous with spatially restricted management tools.

Building a resident research program in emergency medicine.

Residency training programs requirements state, "Residents should participate in scholarly activity." However, there is little consensus regarding how best to achieve these requirements. The objective of this study is to implement a resident research program that emphasizes resident participation in quantitative or qualitative empirical work. A three-step program "Think, Do, Write" roughly follows the 3 years of the residency. During the first phase, the resident chooses a topic, formulates a hypothesis, and completes standard research certifications. Phase 2 involves obtaining Institutional Review Board approval, and conducting the study. The final phase entails analyzing and interpreting the data, and writing an abstract to present during an annual research day. Residents are encouraged to submit their projects for presentation at scientific conferences and for publication. Multiple departmental resources are available, including a Resident Research Fund, and full support of the faculty. Prior to the new program, most scholarly activity consisted of case reports, book chapters, review articles, or other miscellaneous projects; only 27 % represented empirical studies. Starting in 2012, the new program was fully implemented, resulting in notable growth in original empirical works among residents. Currently there is almost 100 % participation in studies, and numerous residents have presented at national conferences, and have peer-reviewed publications. With a comprehensive and supported program in place, emergency medicine residents proved capable of conducting high-quality empirical research within their relatively limited time. Overall, residents developed valuable skills in research design and statistical analysis, and greatly increased their productivity as academic and clinical researchers.