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Background: Complete blood cell count-based ratios (CBRs), including the neutrophil-lymphocyte ratio (NLR) and monocyte-lymphocyte ratio (MLR), are inflammatory markers associated with postoperative morbidity. Given the link between the surgical stress response and complications after total joint arthroplasty (TJA), this study aimed to evaluate whether higher preoperative CBR values predict greater postoperative benefits associated with dexamethasone utilization. Methods: The Premier Healthcare Database was queried for adult patients who underwent primary, elective total hip or knee arthroplasty (THA or TKA). Multivariable logistic regression models using dexamethasone exposure and CBRs as independent variables assessed primary end points of 90-day postoperative complications and length of stay (LOS) of ≥3 days. The probability difference between the dexamethasone and non-dexamethasone groups for each primary end point was determined across all values of each CBR. Probability differences were compared across CBR quartiles. Results: A total of 32,849 primary, elective TJAs (12,788 THAs [38.93%], 20,061 TKAs [61.07%]) performed between 2016 and 2021 were identified, and 22,282 (67.83%) of the patients received perioperative dexamethasone. Among patients with an NLR value of >1.00, those receiving dexamethasone had a lower probability of postoperative complications (all p < 0.05). Dexamethasone was associated with lower odds of an LOS of ≥3 days among patients in the highest NLR quartile (≥4.67) compared with the lowest quartile (NLR <1.84) (p = 0.002). Among patients with an MLR value of ≥0.36, those receiving dexamethasone had significantly lower odds of postoperative complications. Dexamethasone was associated with lower odds of an LOS of ≥3 days among patients with an MLR of ≥0.33 (the 2 highest quartiles) compared with an MLR of <0.24 (the lowest quartile) (p = 0.039). Conclusions: Higher NLR and MLR values were associated with greater marginal benefit from perioperative dexamethasone treatment, establishing a modifiable link between adverse outcomes and perioperative inflammation in TJA. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: Morbidly obese patients are an ever-growing high-risk population undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) for end-stage osteoarthritis. This study sought to identify preoperative laboratory values that may serve as predictors of periprosthetic joint infection (PJI) in morbidly obese patients undergoing THA or TKA. Methods: All morbidly obese patients with preoperative laboratory data before undergoing primary elective TKA or THA were identified using the Premier Healthcare Database. Patients who developed PJI within 90 days after surgery were compared with patients without PJI. Laboratory value thresholds were defined by clinical guidelines or primary literature. Univariate and multivariate regression analyses were utilized to assess the association between PJI and preoperative laboratory values, including total lymphocyte count, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), albumin level, platelet count, albumin-globulin ratio, hemoglobin level, and hemoglobin A1c. Results: Of the 6,780 patients identified (TKA: 76.67%; THA: 23.33%), 47 (0.69%) developed PJI within 90 days after surgery. The rate of PJI was 1.69% for patients with a hemoglobin level of <12 g/dL (for females) or <13 g/dL (for males), 2.14% forthose with a platelet count of <142,000/µL or >417,000/µL, 1.11% for those with an NLR of >3.31,1.69% for those with a PLR of >182.3, and 1.05% for those with an SII of >776.2. After accounting for potential confounding factors, we observed an association between PJI and an abnormal preoperative NLR (adjusted odds ratio [aOR]: 2.38, 95% confidence interval [CI]: 1.04 to 5.44, p = 0.039), PLR (aOR: 4.86, 95% CI: 2.15 to 10.95, p < 0.001), SII (aOR: 2.44, 95% CI: 1.09 to 5.44, p = 0.029), platelet count (aOR: 3.50, 95% CI: 1.11 to 10.99, p = 0.032), and hemoglobin level (aOR: 2.62, 95% CI: 1.06 to 6.50, p = 0.038). Conclusions: This study identified preoperative anemia, abnormal platelet count, and elevated NLR, PLR, and SII to be associated with an increased risk of PJI among patients with a body mass index of ≥40 kg/m². These findings may help surgeons risk-stratify this high-risk patient population. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

While medication reconciliation is necessary to reduce errors, it is often challenging to gather an accurate history in the clinic. Telemedicine offers a relative advantage over clinic and hospital-based interviews by enabling the clinician to inspect the home environment, review pill bottles, and identify social determinants affecting adherence, such as financial instability. To be effective, however, clinicians must be trained in best-practice interview methods and the proper use of telemedicine. There is very little information in the literature describing the best strategies for teaching students or measuring competencies in telemedicine. Therefore, we created an educational module with a telemedicine simulation and an evaluation rubric. We piloted this module with 48 medical and physician assistant students. Most students could complete a virtual interview and gather a medication history. However, only half identified an over-the-counter medication missing from the list. Most students were either entrustable or approaching entrustment in the six telemedicine competencies measured in this simulation. This simulation is valuable for teaching students about medication reconciliation, using telemedicine to close gaps in access to care, and identifying health-related social needs affecting medication adherence. [ABSTRACT FROM AUTHOR]

Given the importance of telemedicine in improving healthcare access for underserved patients, professional students need experience using virtual clinical workflows. We developed an educational workshop with (1) readings, (2) a knowledge assessment test, (3) dermatology and teledermatology lectures, (5) a telemedicine simulation with a standardized patient, and (6) a debriefing session. The simulation included a "hybrid" workflow with live videoconferencing and store-and-forward image review. We measured student performance using three American Association of Medical Colleges (AAMC) Telemedicine Competencies for medical education. Ninety-eight medical and physician assistant students completed this workshop between 2021 and 2022, and 80% were entrustable or approaching entrustment in each competency. Some students struggled with data collection and technology use. Our results suggest that this workshop offers a practical and generalizable way to teach about multiple virtual workflows and strengthen students' telemedicine competencies. [ABSTRACT FROM AUTHOR]

A description is given of recent progress in the understanding of mechanisms in fluid-body interactions where the motion of a body and the motion of the surrounding fluid affect each other substantially. The mathematical modelling of such unsteady interactions is for internal channel and external near-wall flows in two spatial dimensions and time. The emphasis throughout is on analytical developments with accompanying reduced computation. The successive aspects studied here are interactions and impacts in inviscid flows, skimming and sinking, the lift-off, fly-away or bouncing of a body, and viscous effects including especially the interplay between viscous and inviscid contributions. The main findings are concerned with physical and mechanical insights into impact times, lift-off criteria, the borders between impact and fly-away, the principal parameters and their ranges and the influences from body shape and mass. [ABSTRACT FROM AUTHOR]

A dense Ecklonia radiata (Laminariales) kelp forest extending at least 35 km has been found between 45 and 60 m depth range within the mesophotic zone inside the iSimangaliso marine-protected area (MPA) at the iSimangaliso Wetland park World Heritage Site on the east coast of South Africa. This is the first visual confirmation of the occurrence of E. radiata beds in subtropical South Africa, in an area situated between the tropical and subtropical bioregions, in an area that spans the Natal and Delagoa bioregions of the south-western Indian Ocean, more than 350 km north of its previously documented South African range. The kelp was found to be present across the length of the MPA, but dense beds were present only in the southern Natal bioregion, with sparse occurrences observed elsewhere on soft-coral and sponge-dominated reefs in the upper mesophotic zone. The footage was collected in November 2020, May 2021 and November 2022 during remotely operated vehicle and drop camera surveys of the mesophotic zone inside the MPA. This discovery adds to the body of knowledge on the global distribution of Laminariales populations in deep tropical and subtropical settings and the diversity of habitats within South Africa's largest coastal MPA. [ABSTRACT FROM AUTHOR]

Purpose: Obesity is prevalent among economically disadvantaged and racially underrepresented populations. It has been suggested that socioeconomic factors, race, and lifestyle habits are important factors associated with weight loss and comorbidity remission after bariatric surgery. This study analyzes outcomes of bariatric surgery at a private hospital (PH) versus an affiliated safety-net hospital (SNH). Methods: Retrospective review of laparoscopic sleeve gastrectomies (LSG) performed by the same surgeons at a PH and SNH in a large metropolitan setting. Demographics, socioeconomic status, insurance status, weight metrics, and perioperative outcomes were compared. A postoperative telephone survey was conducted to study dietary and lifestyle differences between cohorts. Results: Of the 243 LSG performed, 141 (58%) occurred at PH versus 102 (42%) at SNH. Most patients at SNH were Hispanic, lower socioeconomic status, and had government-sponsored insurance. Based off the results from the postoperative telephone survey, there were no significant differences in dietary and lifestyle habits between both cohorts. Postoperative weight loss outcomes were similar across cohorts. The two groups had similar percent excess weight loss (EWL) at all time points up to 36 months and similar rates of failure to achieve 50% EWL at 12 months. However, patients at PH had greater resolution of diabetes and hypertension after surgery. Conclusion: Our study demonstrates outcomes after bariatric surgery are similar at a PH and its affiliated SNH. Despite differences in race and socioeconomic factors between the two cohorts, perioperative outcomes, short-term postoperative weight loss, and weight loss failure rates were equivalent between SNH and PH patients. [ABSTRACT FROM AUTHOR]

This study addresses the question of whether a thin, relatively heavy solid body with a smooth under-surface can skim on a shallow layer of liquid (for example water), i.e. impact on the layer and rebound from it. The body impacts obliquely onto the liquid layer with the trailing edge of the underbody making the initial contact. The wetted region then spreads along the underbody and eventually either retracts, generating a rebound, or continues to the leading edge of the body and possibly leads to the body sinking. The present inviscid study involves numerical investigations for increased mass (M, in scaled terms) and moment of inertia (I, proportional to the mass) together with an asymptotic analysis of the influential parameters and dynamics at different stages of the skimming motion. Comparisons between the asymptotic analysis and numerical results show close agreement as the body mass becomes large. A major finding is that, for a given impact angle of the underbody relative to the liquid surface, only a narrow band of initial conditions is found to allow the heavy-body skim to take place. This band includes reduced impact velocities of the body vertically and rotationally, both decreasing like M−2/3, while the associated total time of the skim from entry to exit is found to increase like M1/3 typically. Increased mass thereby enhances the super-elastic behaviour of the skim. [ABSTRACT FROM AUTHOR]

Simulations offer a safe environment for health professional training and the opportunity to predictably and consistently introduce events or variables that may be rare or dangerous in a live setting. Exposing trainees to unanticipated events during simulations can improve their ability to adapt and improvise. The COVID19 pandemic accelerated the adoption of telehealth worldwide and highlighted the need for better training in health professional schools. In the United States, the Association of American Medical Colleges (AAMC) published new telehealth competency standards in 2021. The AAMC stated that health care providers should be aware of the risks of technology failures, capable of troubleshooting them, and lead systems interventions to improve safety. However, the AAMC does not provide guidance on the specific failures or solutions. In this study, we developed a set of technology failures that can be simulated in a telehealth curriculum. We incorporated one technology failure into a simulated telehealth encounter and gathered students’ (N = 53) feedback on the exercise. Students’ feedback was overwhelmingly positive. They agreed that integrating technology failures into telehealth simulations provides important practice managing these events during clinical encounters. While telehealth is an important healthcare delivery modality that can improve access-to-care, it is imperative to train medical students to navigate technology failures so that can adeptly manage these issues in clinical practice. [ABSTRACT FROM AUTHOR]

Understanding how fish associate with habitats across marine landscapes is crucial to developing effective marine spatial planning (MSP) in an expanding and diversifying ocean economy. Globally, anthropogenic pressures impact the barely understood temperate mesophotic ecosystems and South Africa's remote Amathole shelf is no exception. The Kei and East London region encompass three coastal marine protected areas (MPAs), two of which were recently extended to the shelf-edge. The strong Agulhas current (exceeding 3 m/s), which runs along the narrow shelf exacerbates sampling challenges. For the first time, a remotely operated vehicle (ROV) surveyed fish and their associated habitats across the shelf. Results indicated fish assemblages differed between the two principle sampling areas, and across the shelf. The number of distinct fish assemblages was higher inshore and on the shelf-edge, relative to the mid-shelf. However, the mid-shelf had the highest species richness. Unique visuals of rare Rhinobatos ocellatus (Speckled guitarfish) and shoaling Polyprion americanus (wreckfish) were collected. Visual evidence of rhodolith beds, deep-water lace corals and critically endangered endemic seabreams were ecologically important observations. The ROV enabled in situ sampling without damaging sensitive habitats or extracting fish. This study provided information that supported the Amathole MPA expansions, which extended protection from the coast to beyond the shelf-edge and will guide their management. The data gathered provides baseline information for future benthopelagic fish and habitat monitoring in these new MPAs. [ABSTRACT FROM AUTHOR]

Anterior cruciate ligament reconstructions (ACLR) are a relatively common procedure in orthopedic sports medicine with an estimated 130,000 arthroscopic operations performed annually. Most procedures are carried out on an outpatient basis, and though success rates of ACLR are as high as 95%, pain remains the most common postoperative complication delaying patient discharge, and thereby increasing the costs associated with patient care. Despite the success and relative frequency of ACLR surgery, optimal and widely accepted strategies and regimens for controlling perioperative pain are not well established. In recent years, the paradigm of pain control has shifted from exclusively utilizing opiates and opioid medications in the acute postoperative period to employing other agents and techniques including nerve blocks, intra-articular and periarticular injections of local anesthetic agents, NSAIDs, and less commonly, ketamine, tranexamic acid (TXA), sedatives, gabapentin, and corticosteroids. More often, these agents are now used in combination and in synergy with one another as part of a multimodal approach to pain management in ACLR, with the goal of reducing postoperative pain, opioid consumption, and the incidence of delayed hospital discharge. The purpose of this review is to consolidate current literature on various agents involved in the management of postoperative pain following ACLR, including the role of classically used opiate and opioid medications, as well as to describe other drugs currently utilized in practice either individually or in conjunction with other agents as part of a multimodal regimen in pain management in ACLR. [ABSTRACT FROM AUTHOR]

A key aim of biocatalysis is to mimic the ability of eukaryotic cells to carry out multistep cascades in a controlled and selective way. As biocatalytic cascades get more complex, reactions become unattainable under typical batch conditions. Here a number of continuous flow systems were used to overcome batch incompatibility, thus allowing for successful biocatalytic cascades. As proof‐of‐principle, reactive carbonyl intermediates were generated in situ using alcohol oxidases, then passed directly to a series of packed‐bed modules containing different aminating biocatalysts which accordingly produced a range of structurally distinct amines. The method was expanded to employ a batch incompatible sequential amination cascade via an oxidase/transaminase/imine reductase sequence, introducing different amine reagents at each step without cross‐reactivity. The combined approaches allowed for the biocatalytic synthesis of the natural product 4O‐methylnorbelladine. [ABSTRACT FROM AUTHOR]

A key aim of biocatalysis is to mimic the ability of eukaryotic cells to carry out multistep cascades in a controlled and selective way. As biocatalytic cascades get more complex, reactions become unattainable under typical batch conditions. Here a number of continuous flow systems were used to overcome batch incompatibility, thus allowing for successful biocatalytic cascades. As proof‐of‐principle, reactive carbonyl intermediates were generated in situ using alcohol oxidases, then passed directly to a series of packed‐bed modules containing different aminating biocatalysts which accordingly produced a range of structurally distinct amines. The method was expanded to employ a batch incompatible sequential amination cascade via an oxidase/transaminase/imine reductase sequence, introducing different amine reagents at each step without cross‐reactivity. The combined approaches allowed for the biocatalytic synthesis of the natural product 4O‐methylnorbelladine. [ABSTRACT FROM AUTHOR]

Direct numerical solutions are described for flow past a body placed in an otherwise uniform shear layer adjoining a wall. The study is associated with potential impact of the body onto the wall. Steady two-dimensional flow solutions are calculated for an inclined flat plate in particular, covering cases of zero wall velocity, positive wall velocity and negative wall velocity, with the plate being at varying orientations and distances from the wall. Substantial flow separation is found with reduced proximity to the wall or increased plate incidence, caused partly by the cutting off of the mass flux in the gap between the body and the wall as impact is neared. Other distinct flow characteristics that emerge with increased local Reynolds number are the extent of the enhanced wake responses, greatly condensed upstream influence near the leading edge, increased sensitivity to body orientation, the pressure dominance in the total lift and moment on the body, new insight into the complex flow structure and quantitative agreement with a recent viscous-inviscid interaction analysis on scales. [ABSTRACT FROM AUTHOR]

Interaction between body motion and fluid motion is considered inside a nonlinear viscous wall layer, with this unsteady two-way coupling leading to impact of the body on the wall. The present paper involves a reduced system analysis which is shown to be consistent with computational solutions from direct numerical simulations for a basic flat-plate shape presented in an allied paper (Palmer & Smith, J. Fluid Mech., 2020). The occurrence of impact depends mainly on fluid parameters and initial conditions. The body considered is translating upstream or downstream relative to the wall. Subsequent analysis focusses on the unusual nature of the impact at the leading edge. The impacting flow structure is found to have two nonlinear viscous–inviscid regions lying on either side of a small viscous region. The flow properties in the regions dictate the lift and torque which drive the body towards the wall. Pronounced flow separations are common as the impact then cuts off the mass flux in the gap between the body and the wall; here, a nonlinear similarity solution sheds extra light on the separations. Comparisons are made between results from direct simulations and asymptotics at increased flow rate. [ABSTRACT FROM AUTHOR]

Service networks are common throughout the modern world, yet understanding how their individual services effect each other and contribute to overall system performance can be difficult. An important metric in these systems is the quality of service. This is an often overlooked measure when modelling and relates to how customers are affected by a service. Presented is a novel perspective for evaluating the performance of multi-class queueing networks through a combination of operational performance and service quality—denoted the "flow of outcomes". Here, quality is quantified by customers moving between or remaining in classes as a result of receiving service or lacking service. Importantly, each class may have different flow parameters, hence the positive/negative impact of service quality on the system's operational performance is captured. A fluid–diffusion approximation for networks of stochastic queues is used since it allows for several complex flow dynamics: the sequential use of multiple services; abandonment and possible rejoin; reuse of the same service; multiple customers classes; and, class and time dependent parameters. The scalability of the approach is a significant benefit since, the modelled systems may be relatively large, and the included flow dynamics may render the system analytically intractable or computationally burdensome. Under the right conditions, this method provides a framework for quickly modelling large time-dependent systems. This combination of computational speed and the "flow of outcomes" provides new avenues for the analysis of multi-class service networks where both service quality and operational efficiency interact. [ABSTRACT FROM AUTHOR]

Investigated in this paper is the coupled fluid–body motion of a thin solid body undergoing a skimming impact on a shallow-water layer. The underbody shape (the region that makes contact with the liquid layer) is described by a smooth polynomic curve for which the magnitude of underbody thickness is represented by the scale parameter C. The body undergoes an oblique impact (where the horizontal speed of the body is much greater than its vertical speed) onto a liquid layer with the underbody's trailing edge making the initial contact. This downstream contact point of the wetted region is modelled as fixed (relative to the body) throughout the skimming motion with the liquid layer assumed to detach smoothly from this sharp trailing edge. There are two geometrical scenarios of interest: the concave case ( C < 0 producing a hooked underbody) and the convex case ( C > 0 producing a rounded underbody). As C is varied the rebound dynamics of the motion are predicted. Analyses of small-time water entry and of water exit are presented and are shown to be broadly in agreement with the computational results of the shallow-water model. Reduced analysis and physical insights are also presented in each case alongside numerical investigations and comparisons as C is varied, indicating qualitative analytical/numerical agreement. Increased body thickness substantially changes the interaction structure and accentuates inertial forces in the fluid flow. [ABSTRACT FROM AUTHOR]

Community health care services are considered integral to overcoming future problems in health care. However, this sector faces its own challenges, such as how to organise services to provide coordinated care given: their physical distribution, patients using multiple services, increased patient use and differing patient needs. The aim of this work was to explore, analyse and understand patterns in community referrals for patients aged 65 years and over, and their use of multiple services through data visualisation. Working with a large community provider, these methods helped researchers and service managers to investigate questions that were otherwise difficult to answer from raw data. Each map focuses on a different characteristic of community referrals: patients reusing services, concurrent uses of different services and patterns of subsequent referrals. We apply these methods to routine patient data and discuss their implications in designing of a single point of access – a service for streamlining referrals. [ABSTRACT FROM AUTHOR]

Background and Objectives: Competency-based medical education (CBME) has been incorporated into graduate medical education accreditation and is being introduced in undergraduate medical education. Family medicine (FM) faculty at one institution developed a CBME FM clerkship to intentionally maintain the integrity of FM specialty-specific teaching during their institutional CBME curricular revision.Methods: From the five FM domains (Access to Care, Continuity of Care, Comprehensive Care, Coordination of Care, and Contextual Care), 10 competencies and 23 FM educational activities (EAs) were defined. The set of EAs encompasses the wide scope of care available to FM clerkship students. Students complete four required EAs (preventive care, care transitions, chronic disease management, and acute care) and select four additional EAs matching their interests. EA selection frequency and course evaluations were assessed for the first cohort of learners (N=156; February 2016-July 2017).Results: The most frequently selected EAs were: information coordination, procedures, and care of the family. The least selected were: patient e-communication, end-of-life care, and shared medical decision making. Student perceptions of the experience were strong prior to and after implementation.Conclusions: Having both required and selective EAs ensures a robust FM experience tailored to students' interests. The FM CBME curriculum allowed comparable clinical experiences despite variations in clinical sites and preceptor scope. Because of its breadth, FM is uniquely suited to address multiple competencies; this demonstrates the educational value of required FM clerkships to institutional leaders interested in implementing CBME curriculum. The CBME framework can provide a structure for more intentional student-clinic assignments based on EAs available at specific sites. [ABSTRACT FROM AUTHOR]

Background and Objectives: A strong US primary care workforce is necessary to meet health care needs, yet fewer than 9% of allopathic medical students choose family medicine each year. No validated instrument exists to identify students likely to enter family medicine upon medical school matriculation.Methods: A subset of a larger survey at the University of Washington School of Medicine (UWSOM) was used to create the Family Medicine Interest Survey (FMIS), a 15-item instrument to predict eventual practice in family medicine for a 2003-2007 matriculating cohort. A single-item screen asking about top specialty choice was administered at UWSOM for the same cohort and for a 2006-2012 matriculating cohort of students at Oregon Health & Science University (OHSU). Test performance measures including D (discrimination) and Cronbach α were calculated. Logistic regression determined whether FMIS score or reporting family medicine as the top specialty choice predicted family medicine practice for 601 UWSOM graduates or family medicine residency match for 744 OHSU graduates.Results: The FMIS is reliable (Cronbach α=0.76). Both tests significantly predicted the probability of entering family medicine. Listing family medicine as the preferred specialty choice yielded a 47% predicted probability for UWSOM graduates entering family medicine. OHSU graduates listing family medicine first had an eightfold odds of matching to family medicine residencies. Combining the two instruments for UWSOM graduates showed a dose-response curve for predicted probability of entering family medicine with increasing levels of interest.Conclusion: Each screening tool can predict students more likely to enter family medicine upon matriculation. [ABSTRACT FROM AUTHOR]

We developed a teledermatology simulation to give medical and physician assistant students practice with live videoconferencing and store-andforward workflows. The simulation included (1) pre-session reading; (2) a brief teledermatology didactic; (3) a simulated encounter with a standardized patient; and (4) faculty-led debriefs. The faculty observed students during the simulation and distributed a post-session learner satisfaction survey. Although students had mixed feelings about the simulation, 88% said the workshop met or exceeded expectations. [ABSTRACT FROM AUTHOR]

This paper reads Karen Tei Yamashita’s novelTropic of orangeas an interrogation of neoliberalism, accomplished through its critique of the impact of the North American Free Trade Agreement (NAFTA) on the marginalised homeless in Los Angeles and its disenfranchisement of indigenous peoples in Mexico. It examines the issues of environmental justice presented in the novel and links these to California’s citrus industry and its history of labour relations, engaging with the ways in which Yamashita draws on the aesthetics of film noir in order to frame these problematics. [ABSTRACT FROM AUTHOR]

The recent recognition that a single metal site is capable of mediating the multiple electron and proton transfer events associated with water oxidation represents a pivotal discovery for the field. This finding has led to a remarkable expansion of known synthetic water oxidation catalysts, and has provided the means to gain unprecedented insight into the reaction steps involved with O–O bond formation. This perspective reflects on the key studies that have advanced our understanding of water oxidation catalysis while summarizing molecular features that are integral to negotiating this complicated reaction pathway with the goal of helping identify new frontiers of discovery for the field. [ABSTRACT FROM AUTHOR]