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PurposeUse of genomic sequencing is increasing at a pace that requires technological solutions to effectively meet the needs of a growing patient population. We developed GUÍA, a web-based application, to enhance the delivery of genomic results and related clinical information to patients and families.MethodsGUÍA development occurred in 5 phases: formative research, content development, user interface design, stakeholder/community member input, and web application development. Development was informed by qualitative research involving parents (N=22) whose children underwent genomic testing. Participants enrolled in the NYCKidSeq pilot study (N=18) completed structured feedback interviews post-result disclosure using GUÍA. Genetic specialists, researchers, patients, and community stakeholders provided their perspectives on GUÍA’s design to ensure technical, cultural, and literacy appropriateness.ResultsNYCKidSeq participants responded positively to the use of GUÍA to deliver their children’s results. All participants (N=10) with previous experience with genetic testing felt GUÍA improved result disclosure, and 17 (94%) participants said the content was clear.ConclusionsGUÍA communicates complex genomic information in an understandable and personalized manner. Initial piloting demonstrated GUÍA’s utility for families enrolled NYCKidSeq pilot study. Findings from the NYCKidSeq clinical trial will provide insight into GUÍA’s effectiveness in communicating results among diverse, multilingual populations.

Objective Electronic health record (EHR) systems contain structured data (such as diagnostic codes) and unstructured data (clinical documentation). Clinical insights can be derived from analyzing both. The use of natural language processing (NLP) algorithms to effectively analyze unstructured data has been well demonstrated. Here we examine the utility of NLP for the identification of patients with non-alcoholic fatty liver disease, assess patterns of disease progression, and identify gaps in care related to breakdown in communication among providers. Materials and Methods All clinical notes available on the 38,575 patients enrolled in the Mount Sinai BioMe cohort were loaded into the NLP system. We compared analysis of structured and unstructured EHR data using NLP, free-text search, and diagnostic codes with validation against expert adjudication. We then used the NLP findings to measure physician impression of progression from early-stage NAFLD to NASH or cirrhosis. Similarly, we used the same NLP findings to identify mentions of NAFLD in radiology reports that did not persist into clinical notes. Results Out of 38,575 patients, we identified 2,281 patients with NAFLD. From the remainder, 10,653 patients with similar data density were selected as a control group. NLP outperformed ICD and text search in both sensitivity (NLP: 0.93, ICD: 0.28, text search: 0.81) and F2 score (NLP: 0.92, ICD: 0.34, text search: 0.81). Of 2281 NAFLD patients, 673 (29.5%) were believed to have progressed to NASH or cirrhosis. Among 176 where NAFLD was noted prior to NASH, the average progression time was 410 days. 619 (27.1%) NAFLD patients had it documented only in radiology notes and not acknowledged in other forms of clinical documentation. Of these, 170 (28.4%) were later identified as having likely developed NASH or cirrhosis after a median 1057.3 days. Discussion NLP-based approaches were more accurate at identifying NAFLD within the EHR than ICD/text search-based approaches. Suspected NAFLD on imaging is often not acknowledged in subsequent clinical documentation. Many such patients are later found to have more advanced liver disease. Analysis of information flows demonstrated loss of key information that could have been used to help prevent the progression of early NAFLD (NAFL) to NASH or cirrhosis. Conclusion For identification of NAFLD, NLP performed better than alternative selection modalities. It then facilitated analysis of knowledge flow between physician and enabled the identification of breakdowns where key information was lost that could have slowed or prevented later disease progression.

A persistent challenge in supporting students’ proof activity is fostering the transition from less formal, empirical arguments to formal deductive arguments. A number of researchers have begun to investigate students’ thinking with examples, addressing how example use can support conjecture understanding, exploration, and proof. We extend this line of work in presenting the CAPS (Criteria, Affordances, Purposes, and Strategies) Framework, a framework addressing students’ choices, uses, strategies, and affordances gained with examples. Based on individual interviews with 38 participants from middle school through the undergraduate level, the CAPS Framework simultaneously addresses multiple aspects of students’ example-based exploration and provides a way to analyze how these different aspects mutually inform one another as students conjecture and prove. We present the framework, exemplify its use through vignettes of student thinking, and share findings on how students’ thinking with examples shifts across the populations of middle school, high school, and undergraduate students.

Examples can be a powerful tool for students to learn to prove, particularly if used purposefully and strategically, but there is a pressing need to better understand the nature of productive example use. Therefore, we examined the characteristics of the successful and unsuccessful cases of proving in the context of a number theory task across the three student populations (middle school, high school, undergraduate), where by successful case we mean the ability to develop a viable justification that accounts for why the conjecture must be true. We present the characteristics of the successful and unsuccessful provers regarding the purposes, strategies, and affordances of example use, offer detailed accounts of a few illustrative cases of students' proving processes, and highlight a couple factors that seemed to have hindered the unsuccessful provers' ability to gain greater affordances from examples. We conclude with a discussion of the instructional implications of the results. (C) 2017 Elsevier Inc. All rights reserved.

Using neutron reflectometry, we investigated the deuterium desorption of Pd-covered Ti films that have been deuterated at 1 bar deuterium at room temperature and then exposed to air. The deuterium content was monitored continuously for the first two days. Thereafter, measurements were conducted periodically, spanning a period of up to 2 years. The films were in the thickness range of 10–300 nm and the desorption behaviour showed a strong dependence on the film thickness. The smaller the Ti film thickness the faster the Ti films desorbed the stored deuterium.

Proof is central to mathematical practice, yet a perennial concern is that students of all ages struggle in learning to prove. Mathematics education scholars have suggested that overreliance on examples to justify the truth of statements is a contributing factor for students’ difficulties. While example-based reasoning has typically been viewed as a stumbling block to learning to prove, we view example-based reasoning as an important object of study and posit that examples play both a foundational and an essential role in the development, exploration, and understanding of conjectures, as well as in subsequent attempts to develop proofs of those conjectures. In this paper, we provide an overview of our project whose goals were to (a) investigate the nature of middle school and high school students’, undergraduate students’, and mathematicians’ thinking about the examples they use when developing, exploring, and proving conjectures; and (b) investigate ways in which thinking about and analyzing examples may facilitate the development of students’ learning to prove.

Background Clavicle nonunions in adolescent patients are exceedingly rare. The purpose of this study was to evaluate a series of clavicle nonunions from a pediatric multicenter study group to assess potential risk factors and treatment outcomes. Methods A retrospective review of all clavicle nonunions in patients younger than 19 years was performed at 9 pediatric hospitals between 2006 and 2016. Demographic and surgical data were documented. Radiographs were evaluated for initial fracture classification, displacement, shortening, angulation, and nonunion type. Clinical outcomes were evaluated, including rate of healing, time to union, return to sports, and complications. Risk factors for nonunion were assessed by comparing the study cohort with a separate cohort of age-matched patients with a diaphyseal clavicle fracture. Results There were 25 nonunions (mean age, 14.5 years; range, 10.0-18.9 years) identified, all of which underwent surgical fixation. Most fractures were completely displaced (68%) initially, but 21% were partially displaced and 11% were nondisplaced. Bone grafting was performed in 24 of 25 cases, typically using the hypertrophic callus. Radiographic healing was achieved in 96% of cases. One patient (4%) required 2 additional procedures to achieve union. The primary risk factor for development of a nonunion was a previous history of an ipsilateral clavicle fracture. Conclusions Clavicle nonunions can occur in the adolescent population but are an uncommon clinical entity. The majority occur in male patients with displaced fractures, many of whom have sustained previous fractures of the same clavicle. High rates of union were achieved with plate fixation and the use of bone graft.

The synthetic preparation of several Ni(II) complexed Schiff Bases of glycine will be introduced, as well as investigations into their reactivity and utility. Key to these investigations is the incorporation of electron-withdrawing trifluoromethyl groups within the framework of the conjugated system that stabilizes the enolate derived from the glycine component. Reactivity was evaluated for each of the complexes under phase transfer catalyzed alkylations with hydroxide bases, as well as the DBU catalyzed Michael Additions of optically active 3′-substituted-2-oxazoladinone amides of unsaturated carboxylic acids. It was found that the trifluoromethyl containing nucleophilic glycine equivalents were more reactive than their non-trifluoromethyl analogues in both reaction types. Therefore, the application of these modified Ni(II) complexes of glycine Schiff Bases are useful for the preparation of α-amino acids through phase transfer catalyzed alkylation as well as the preparation of optically pure β-substituted pyroglutamic acid precursors.

This paper introduces a quadratic growth learning trajectory, a series of transitions in students’ ways of thinking (WoT) and ways of understanding (WoU) quadratic growth in response to instructional supports emphasizing change in linked quantities. We studied middle grade (ages 12–13) students’ conceptions during a small-scale teaching experiment aimed at fostering an understanding of quadratic growth as phenomenon of constantly-changing rate of change. We elaborate the duality, necessity, repeated reasoning framework, and methods of creating learning trajectories. We report five WoT: Variation, Early Coordinated Change, Explicitly Quantified Coordinated Change, Dependency Relations of Change, and Correspondence. We also articulate instructional supports that engendered transitions across these WoT: teacher moves, norms, and task design features. Our integration of instructional supports and transitions in students’ WoT extend current research on quadratic function. A visual metaphor is leveraged to discuss the role of learning trajectories research in unifying research on teaching and learning.

Metatarsus adductus is a relatively common congenital foot deformity that is often unrecognized at birth. Thus, the adult foot with metatarsus adductus is prone to pathologic entities that have been theorized to result from lateral column overload. We present a descriptive study comparing plantar foot pressure distribution during gait in subjects with and without metatarsus adductus. A total of 65 subjects were recruited for the study: 28 subjects with and 37 subjects without metatarsus adductus. An EMED(®) pedobarograph was used to collect the data. The analysis of the peak pressure and pressure-time integral in each of the 8 regions of the plantar surface of the foot showed significant (p < .05) differences between each of the regions and a significant (p < .05) interaction effect between the 8 regions and the 2 groups. A series of independent Student's t tests were therefore performed to determine which of the plantar regions showed a significant difference between the 2 groups. The result of those t tests showed that the peak pressure and pressure-time integral were significantly different (p < .05) between the 2 groups for the "heel," "lateral midfoot," and "lateral forefoot." The results of the present study support the concept that during gait, the adult foot with metatarsus adductus has increased peak plantar pressures on the lateral side of the foot.

Chronic widespread pain (CWP), including fibromyalgia, is a highly prevalent condition with a range of disabling symptoms, both physical and psychological. The British Pain Society (BPS) is supporting the treatment of this group of patients through a care pathway and this article describes the rationale and discussion points relevant to the CWP and fibromyalgia pathway. There are several aims in producing this pathway: to reduce variation in the standards of care, to reduce delays at all stages of care, and in particular, to enable clinicians to help patients accept a diagnosis of CWP. This diagnosis should be based on the presence and distribution of symptoms in the absence of another defined pathological process: the features in the history or clinical examination are generally more important than laboratory investigations. There is an emphasis on addressing all aspects of symptomatology (physical, psychological, social, and personal needs) without an overemphasis on any one treatment modality. The pathway has focused on the potential pitfalls in the use of long-term opioids and the rationale is provided why these are not recommended. Patients with CWP value explanation and education and although clinicians may be unfamiliar with the condition, the majority of clinicians have generic skills in managing long-term conditions which can be supplemented by the interventions and actions detailed in this pathway.

Purpose The purpose of this study was to document 10-year outcomes and total knee arthroplasty (TKA) rate after arthroscopic treatment of knee osteoarthritis and compare survivorship of patients with Kellgren-Lawrence (KL) grade 3 and 4 knees. Methods Eighty-one knees in 73 patients (49 male, 32 female; mean age, 58 years; range, 37 to 79 years) that underwent an arthroscopic regimen for knee osteoarthritis between August 2000 and November 2001 were included in this institutional review board-approved study. The inclusion criterion was Kellgren-Lawrence (KL) grade 3 or 4 radiographic changes. A TKA had been recommended to all patients; however, none wished to undergo arthroplasty. All patients underwent arthroscopic treatment. Endpoint was defined as TKA for survivorship analysis. Outcomes were collected at a minimum follow-up of 10 years (Lysholm, Tegner, patient satisfaction, and WOMAC scores). Results Of 81 knees, 7 were in patients who died and 2 in patients who refused to participate, leaving 72 knees available for follow-up. Follow-up was obtained for 95% of patients ( n = 69). Forty-three knees (62%) were converted to TKA at a mean of 4.4 years (range 1.0 to 9.6) after index arthroscopy. Mean survival time was 6.8 years (95% confidence interval [CI], 5.9 to 7.6 years). Survivorship was 60% at 5 years and 40% at 10 years. Patients with KL grade 4 osteoarthritis were 5.3 times more likely to fail (95% CI, 1.3 to 23.4) than those with KL grade 3 ( P = .012). Mean survival time for patients with KL grade 4 was 5.7 years (95% CI, 4.5 to 6.9), and mean survival time for those with KL grade 3 was 7.5 years (95% CI, 6.2 to 8.7) ( P = .022). For 26 knees that did not undergo arthroplasty, the mean Lysholm score was 74 (95% CI, 67 to 80), the median Tegner activity scale score was 3 (range, 0 to 8), the median patient satisfaction with outcome was 9 (range, 1 to 10), and the mean WOMAC score was 18.5 (95% CI, 13 to 24) at 10 years of follow-up. Conclusions The mean survival time after arthroscopic treatment of osteoarthritis with a defined protocol was 6.8 years. Forty percent delayed arthroplasty for a minimum of 10 years. Patients with KL grade 4 changes in their knee had a higher risk of conversion to arthroplasty and a significantly lower mean survival time. Level of Evidence Level III, retrospective comparative study.

Purpose The purpose of this study was to compare the forearm supination and elbow flexion strength of the upper extremity in patients who have had an arthroscopic long head of the biceps tendon (LHBT) release with patients who have had an LHBT tenodesis. Methods Cybex isokinetic strength testing (Cybex Division of Lumex, Ronkonkoma, NY) was performed on 17 patients who underwent arthroscopic LHBT tenotomy, 19 patients who underwent arthroscopic LHBT tenodesis, and 31 age-, gender-, and body mass index–matched control subjects. Subjects were considered fully recovered from shoulder surgery, were released for unrestricted activities, and were at least 6 months after surgery before testing. Subjects were tested for forearm supination and elbow flexion strength of both arms by use of a Cybex II NORM isokinetic dynamometer at 60°/s and 120°/s. Testing was performed on injured and uninjured arms as well as dominant and nondominant arms in control subjects. Both forearm supination and elbow flexion strength values were recorded. Results Comparison between the involved and uninvolved upper extremities within each group by use of a paired t test showed a 7% increase in elbow flexion strength when the dominant and nondominant arms were compared at 60°/s. Neither the tenotomy nor tenodesis groups exhibited elbow flexion strength differences at 120°/s (all P ≥ .147). Comparison between groups by use of 2 × 3 analysis of variance (speed × group) showed no statistical difference in either forearm supination or elbow flexion strength when we compared the tenotomy, tenodesis, and control groups. Conclusions In asymptomatic patients who have had biceps tenotomy or tenodesis, no statistically significant forearm supination or elbow flexion strength differences existed in the involved extremity between the 2 study groups. Level of Evidence Level III, case-control study.

Background A clinical characteristic of posttraumatic stress disorder (PTSD) is persistently elevated fear responses to stimuli associated with the traumatic event. The objective herein is to determine whether extinction of fear responses is impaired in PTSD and whether such impairment is related to dysfunctional activation of brain regions known to be involved in fear extinction, viz., amygdala, hippocampus, ventromedial prefrontal cortex (vmPFC), and dorsal anterior cingulate cortex (dACC). Methods Sixteen individuals diagnosed with PTSD and 15 trauma-exposed non-PTSD control subjects underwent a 2-day fear conditioning and extinction protocol in a 3-T functional magnetic resonance imaging scanner. Conditioning and extinction training were conducted on day 1. Extinction recall (or extinction memory) test was conducted on day 2 (extinguished conditioned stimuli presented in the absence of shock). Skin conductance response (SCR) was scored throughout the experiment as an index of the conditioned response. Results The SCR data revealed no significant differences between groups during acquisition and extinction of conditioned fear on day 1. On day 2, however, PTSD subjects showed impaired recall of extinction memory. Analysis of functional magnetic resonance imaging data showed greater amygdala activation in the PTSD group during day 1 extinction learning. During extinction recall, lesser activation in hippocampus and vmPFC and greater activation in dACC were observed in the PTSD group. The magnitude of extinction memory across all subjects was correlated with activation of hippocampus and vmPFC during extinction recall testing. Conclusions These findings support the hypothesis that fear extinction is impaired in PTSD. They further suggest that dysfunctional activation in brain structures that mediate fear extinction learning, and especially its recall, underlie this impairment.

We consider an extension of the 2-person R��nyi-Ulam liar game in which lies are governed by a channel $C$, a set of allowable lie strings of maximum length $k$. Carole selects $x\in[n]$, and Paul makes $t$-ary queries to uniquely determine $x$. In each of $q$ rounds, Paul weakly partitions $[n]=A_0\cup >... \cup A_{t-1}$ and asks for $a$ such that $x\in A_a$. Carole responds with some $b$, and if $a\neq b$, then $x$ accumulates a lie $(a,b)$. Carole's string of lies for $x$ must be in the channel $C$. Paul wins if he determines $x$ within $q$ rounds. We further restrict Paul to ask his questions in two off-line batches. We show that for a range of sizes of the second batch, the maximum size of the search space $[n]$ for which Paul can guarantee finding the distinguished element is $\sim t^{q+k}/(E_k(C)\binom{q}{k})$ as $q\to\infty$, where $E_k(C)$ is the number of lie strings in $C$ of maximum length $k$. This generalizes previous work of Dumitriu and Spencer, and of Ahlswede, Cicalese, and Deppe. We extend Paul's strategy to solve also the pathological liar variant, in a unified manner which gives the existence of asymptotically perfect two-batch adaptive codes for the channel $C$., 26 pages

The one-lie Renyi-Ulam liar game is a two-player perfect information zero-sum game, lasting q rounds, on the set [n]@?{1,...,n}. In each round Paul chooses a subset [email protected]?[n] and Carole either assigns one lie to each element of A or to each element of [n]@?A. Paul wins the original (resp. pathological) game if after q rounds there is at most one (resp. at least one) element with one or fewer lies. We exhibit a simple, unified, optimal strategy for Paul to follow in both games, and use this to determine which player can win for all q,n and for both games.

A binary code with covering radius R is a subset C of the hypercube Qn={0,1}n such that every x∈Qn is within Hamming distance R of some codeword c∈C, where R is as small as possible. For a fixed coordinate i∈[n], define Cb(i) to be the set of codewords with a b in the ith position. Then C is normal if there exists an i∈[n] such that for any v∈Qn, the sum of the Hamming distances from v to C0(i) and C1(i) is at most 2R+1. We newly define what it means for an asymmetric covering code to be normal, and consider the worst-case asymptotic densities ν*(R) and ν+*(R) of constant radius R symmetric and asymmetric normal covering codes, respectively. Using a probabilistic deletion method, and analysis adapted from previous work by Krivelevich, Sudakov, and Vu, we show that ν*(R)⩽e(RlogR+logR+loglogR+4) and ν+*(R)⩽e(RlogR+logR+loglogR+4)ν+*(1), giving evidence that minimum size constant radius covering codes could still be normal.

This article presents secondary students’ generalizations about the connections between algebraic and graphical representations of quadratic functions, focusing specifically on the roles of the parameters a, b, and c in the general form of a quadratic function, y = ax2 + bx + c. Students’ generalizations about these connections led to a surprising finding: two-thirds of the students interviewed identified the parameter a as the “slope” of the parabola. Analysis of qualitative data from interviews and classroom observations led to the development of three focusing phenomena in the classroom environment that inadvertently supported a focus on slope-like properties of quadratic functions: (a) the use of linear analogies, (b) the rise over run method, and (c) viewing a as dynamic rather than static.

The irradiation of Cu(10-methyl-1,4,8,12-tetraazacyclopentadecan-10-NO 2 )X + , X = halide, HCO 2 − , CH 3 CO 2 − and C 6 H 5 CH 2 CO 2 − , in deaerated CH 3 CN or CH 3 OH at 350 nm resulted in the reduction of the pendent NO 2 to NO. Flash photolysis revealed the formation of the nitroso products via the photo-induced oxidation of the axial ligand X − . Intermediates in a 10 ns–1 s time scale have been tentatively assigned as species formed by the addition of the X radicals to the NO 2 . Similar redox processes were observed when the irradiation of the complexes was carried out in the ligand field band, λ exc = 560 nm. Conversion of the ligand field excited states to X − to Cu(II) charge transfer excited state account for the photoreactivity of the former excited states.

NiTi wires were functionalized with silane coupling agents to improve interfacial adhesion between the inorganic constituent and a host matrix for composite applications. Surface derivatization was characterized by X-ray Photoelectron Spectroscopy, and mechanical pullout tests were performed to quantify the increase in adhesion between the NiTi shape memory alloy wires and polymer matrix. Improvements of roughly 100% in the adhesion was realized as compared to unfunctionalized samples or to samples functionalized with an unreactive silane coupling agent.

Dual phase (α+β) copper–tin alloys were synthesized from elemental nanoparticle precursors following consolidation, annealing and quenching steps. The precursors were derived from the sequential reduction of tin and copper salts in ethanolic solution. The dual phase microstructure exhibits a duplex character with a mixture of Cu-rich and Sn-rich (α+β) regions.

We consider a variation of the chip-firing game in an induced subgraph S of a graph G. Starting from a given chip configuration, if a vertex v has at least as many chips as its degree, we can fire v by sending one chip along each edge from v to its neighbors. Chips are removed at the boundary δS. The game continues until no vertex can be fired. We will give an upper bound, in terms of Dirichlet eigenvalues, for the number of firings needed before a game terminates. We also examine the relations among three equinumerous families, the set of spanning forests on S with roots in the boundary of S, a set of “critical” configurations of chips, and a coset group, called the sandpile group associated with S.

Mercury-mediated synthesis was shown to be a practical approach for preparing oxides of certain metals with the particle size in the nanoscale range. Growth of oxide monoliths of active metals such as Al, Sc and Y was achieved by dissolving the metal in mercury and subsequently exposing the solution to ambient air. According to X-ray data, all ‘as-grown’ materials were amorphous, but annealing the products at 850–1000 °C produced crystalline oxides. Growth of oxide monoliths of mixed composition was observed when mercury solutions containing Al and Y were used. A complete range of single-phase mixed oxides of the general formula ScxY2−xO3 (0≤x≤2) was shown to grow from Sc–Y mercury solutions.

The influence of the PMMA content in a composite binder comprising PMMA and PEG on the moulding, debinding and sintering behaviour of injection moulded samples of 316L stainless steel powder has been investigated. The PEGs component of the binder is readily soluble in water, so that, after leaching, a network of open pores is provided to facilitate the extraction of the PMMA by pyrolysis. This has been shown to lead to a reduction in overall debinding time. It is shown in the present study that reduction in the PMMA content allows injection moulding to be carried out at a lower temperature, while having the unfavourable consequences of reducing the stiffness and the green and brown strengths of the mouldings. It was also found that the mouldings had to be left in the die for a longer period before ejection because the temperature at which the binder stiffens was significantly reduced. It was shown that reducing the PMMA content of the binder enhanced the rate of removal of the PEGs during the leaching. The sintered densities of the mouldings were found to increase as the PMMA content increased as, consequently, did the hardness.

We employ a combination of high vacuum (chemical beam) epitaxy and in situ mass spectrometry to examine precursor surface decomposition chemistry during film growth of LiNbO 3 and its constituent metal oxides on sapphire and Si (0 0 1). The four most common CVD precursors for LiNbO 3 — [Li(OBu t )] 6 , Li(tmhd), [Nb(OEt) 5 ] 2 , and Nb(tmhd) 4 — are examined (OBu t =tertiary butoxide, OEt=ethoxide, tmhd=2,2,6,6-tetramethyl-3,5-heptanedionate). The metal diketonates are unstable at low pressures and temperatures, adversely impacting both storage and use. The metal alkoxides, while of greater thermodynamic stability, are subject to autocatalytic processes that can inhibit the film growth: these processes generate volatile metal-containing moieties that subsequently desorb from the surface. The degree of crystallinity of niobium oxide films grown from [Nb(OEt) 5 ] 2 depends on the presence of one of the autocatalytic elements, water. The growth rate of lithium niobate films depends strongly on the Li/Nb precursor ratio, suggesting a chemical interaction between the two precursors.

This paper argues the case for a tripartite model involving the manager educator and practitioner in the selection of candidates to programmes of continuing professional education (CPE). Nurse educators are said to play a key link in the education practice chain (Pendleton & Myles 1991), yet with the introduction of a market philosophy for education, the educator appears to have little, if any, influence over the selection of CPE candidates. Empirical studies on the value of an effective system for identifying the educational needs of the individual and the locality are unequivocal in specifying the benefits of a collaborative selection process (Larcombe & Maggs 1991). However, there are few studies that offer a model of collaboration and fewer still on how to operationalize such a model. This paper presents the policy and legislative context of CPE leading to the development of a market philosophy. The tension between educational reforms such as life-long learning and diminishing and finite resources are highlighted. These strategic issues provide the backdrop and rationale for considering the process for identifying CPE needs, and the characteristics of an effective system as suggested in the literature. Finally, this paper outlines recommendations for a partnership between the manager practitioner and educationalist in the selection of CPE candidates.

We have cloned two splice variants of the human homolog of the alpha1A subunit of voltage-gated Ca2+ channels. The sequences of human alpha1A-1 and alpha1A-2 code for proteins of 2510 and 2662 amino acids, respectively. Human alpha1A-2alpha2bdeltabeta1b Ca2+ channels expressed in HEK293 cells activate rapidly (tau+10mV = 2.2 ms), deactivate rapidly (tau-90mV = 148 micros), inactivate slowly (tau+10mV = 690 ms), and have peak currents at a potential of +10 mV with 15 mM Ba2+ as charge carrier. In HEK293 cells transient expression of Ca2+ channels containing alpha1A/B(f), an alpha1A subunit containing a 112 amino acid segment of alpha1B-1 sequence in the IVS3-IVSS1 region, resulted in Ba2+ currents that were 30-fold larger compared to wild-type (wt) alpha1A-2-containing Ca2+ channels, and had inactivation kinetics similar to those of alpha1B-1-containing Ca2+ channels. Cells transiently transfected with alpha1A/B(f)alpha2bdeltabeta1b expressed higher levels of the alpha1, alpha2bdelta, and beta1b subunit polypeptides as detected by immunoblot analysis. By mutation analysis we identified two locations in domain IV within the extracellular loops S3-S4 (N1655P1656) and S5-SS1 (E1740) that influence the biophysical properties of alpha1A. alpha1AE1740R resulted in a threefold increase in current magnitude, a -10 mV shift in steady-state inactivation, and an altered Ba2+ current inactivation, but did not affect ion selectivity. The deletion mutant alpha1ADeltaNP shifted steady-state inactivation by -20 mV and increased the fast component of current inactivation twofold. The potency and rate of block by omega-Aga IVA was increased with alpha1ADeltaNP. These results demonstrate that the IVS3-S4 and IVS5-SS1 linkers play an essential role in determining multiple biophysical and pharmacological properties of alpha1A-containing Ca2+ channels.

The beta subunits of voltage-dependent calcium channels (VDCC) modulate the electrophysiology and cell surface expression of pore-forming alpha1 subunits. In the present study we have investigated the distribution of beta1,beta2,beta3 and beta4 in the human hippocampus using in situ hybridization (ISH) and immunohistochemistry. ISH studies showed a similar distribution of expression of beta1,beta2 and beta3 subunit mRNAs, including labelling of the dentate granule cell layer, all CA pyramidal regions, and the subiculum. Relatively low levels of expression of beta1 and beta2 subunit mRNAs correlated with low protein expression in the immunocytochemical (ICC) studies. There was a relative lack of beta4 expression by both ISH and ICC in the CA1 region, compared with high levels of expression in the subiculum. Immunostaining for beta1 and beta2 subunits was weak and relatively homogeneous throughout the hippocampus. The beta3 and beta4 subunits appeared to be more discretely localized. In general, beta3-immunoreactivity was moderate both in cell bodies, and as diffuse staining in the surrounding neuropil. Strongest staining was observed in mossy fibres and their terminal region in the CA3 stratum lucidum. In contrast, beta4-immunoreactivity in the neuropil showed intense dendritic localisation. Unlike the other subunits, beta4-immunoreactivity was absent from CA1 pyramidal neurones but was present in a small population of interneurone-like cells. The localisation of beta3 and beta4 may represent presynaptic and postsynaptic compartments in some populations of hippocampal neurones. Comparison of beta subunit distribution with previously published data on alpha1 subunits indicates certain neuronal groups and subcellular compartments in which the subunit composition of native pre- and postsynaptic VDCC can be predicted.

Neuronal voltage-dependent calcium channels (VDCCs) each comprising of alpha 1, alpha 2 delta, and beta subunits, are one mechanism by which excitable cells regulate the flux of calcium ions across the cell membrane following depolarisation Studies have shown the expression of several alpha 1 and beta subtypes within neuronal tissue. The comparative distribution of these in normal human brain is largely unknown. The aim of this work is to prepare antibodies directed specifically to selected subunits of human neuronal VDCCs for use in biochemical and mapping studies of calcium channel subtypes in the brain. Previous studies have defined DNA sequences specific for each subunit Comparison of these sequences allows the selection of unique amino acid sequences for use as immunogens which are prepared as glutathione-S-transferase (GST) fusion proteins in E. coli. Polyclonal antibodies raised against these fusion proteins are purified by Protein A chromatography, followed by immunoaffinity chromatography and extensive adsorptions using the appropriate fusion protein-GST Sepharose 4B columns. The resultant antibodies are analysed for specificity against the fusion proteins by ELISA, and by immunofluorescence and Western immunoblot analysis of recombinant HEK293 cells stably transfected with cDNAs encoding alpha 1, alpha 2 delta and beta subunits.

The distribution of voltage-dependent calcium channel subunits in the central nervous system may provide information about the function of these channels. The present study examined the distribution of three alpha-1 subunits, alpha 1A, alpha 1B and alpha 1E, in the normal human hippocampal formation and parahippocampal gyrus using the techniques of in situ hybridization and immunocytochemistry. All three subunit mRNAs appeared to be similarly localized, with high levels of expression in the dentate granule and CA pyramidal layer. At the protein level, alpha 1A, alpha 1B and alpha 1E subunits were differentially localized. In general, alpha 1A-immunoreactivity was most intense in cell bodies and dendritic processes, including dentate granule cells, CA3 pyramidal cells and entorhinal cortex pre-alpha and pri-alpha cells. The alpha 1B antibody exhibited relatively weak staining of cell bodies but stronger staining of neuropil, especially in certain regions of high synaptic density such as the polymorphic layer of the dentate gyrus and the stratum lucidum and radiatum of the CA regions. The alpha 1E staining pattern shared features in common with both alpha 1A and alpha 1B, with strong immunoreactivity in dentate granule, CA3 pyramidal and entorhinal cortex pri-alpha cells, as well as staining of the CA3 stratum lucidum. These findings suggest regions in which particular subunits may be involved in synaptic communication. For example, comparison of alpha 1B and alpha 1E staining in the CA3 stratum lucidum with calbindin-immuno-reactivity suggested that these two calcium channels subunits may be localized presynaptically in mossy fibre terminals and therefore may be involved in neurotransmitter release from these terminals.

The {alpha}{sub 1} subunit genes encoding voltage-dependent Ca{sup 2+} channels are members of a gene family. We have used human brain cDNA probes to localize the neuronal isoform genes CACNL1A4 ({alpha}{sub 1A}), CACNL1A5 ({alpha}{sub 1B}), and CACNL1A6 ({alpha}{sub 1E}) to 19p13, 9q34, and 1q25-q31, respectively, using fluorescene in situ hybridization on human chromosomes. These genes are particularly interesting gene candidates in the pathogenesis of neuronal disorders. Although genetic disorders have been linked to loci 9q34 and 19p13, no genetic disease related to Ca{sup 2+} signaling defects has yet been linked to these loci. 22 refs., 2 figs., 1 tab.

Little is known about the comparative distribution of voltage-dependent calcium channel subtypes in normal human brain. Previous studies in experimental animals have predominantly focused on the regional expression of single α 1 genes. We describe the preparation of riboprobes and antisera specific for human α 1A , α 1B and α 1E subunits and their application in comprehensive mapping studies of the human cerebellum. Within the cerebellar cortex, these pore forming proteins were found to have differential localisations when examined in adjacent sections. The α 1A and α 1B subunits broadly colocalised and were both present, though at apparently different levels, in the molecular, Purkinje and granule cell layers whilst α 1E was predominantly expressed in Purkinje cells. In the dentate nucleus, an area which has received little attention in previous studies, α 1A was highly expressed in regions in which Purkinje cell nerve terminals form synapses with deep cerebellar neurones.

Doped barium cerate perovskites, first investigated by Iwahara and co-workers, have ionic conductivities of the order of 20 mS/cm at 800 °C making them attractive as fuel cell electrolytes for this temperature region. They have been used to construct laboratory scale fuel cells, which, in addition to performance data, have provided an unexpected insight into the transport processes operating in these materials. In the temperature range of 600–1000 °C, the dominant transport process varies from protonic to oxide-ion dominated. This transition has been confirmed by measurement of water vapour transfer in a cell in which the perovskite is exposed to wet hydrogen on both sides. The evolution of transport properties with temperature is discussed in relation to structure. Neutron diffraction studies of doped and undoped barium cerate are reported, revealing a series of phase transitions between ambient temperature and 1000 °C. The available literature on chemical stability of cerate perovskites to reduction and attack by carbon dioxide is reviewed in brief.

Ammonia, phosphine, and arsine gases used in metalorganic vapor phase epitaxy (MOVPE) are detected using the photoluminescence (PL) response of a single-crystal n-CdSe sample deployed in the flow stream. Exposure of the CdSe crystal to any of these gases causes a reversible enhancement in the band gap PL intensity relative to the intensity in pure hydrogen carrier gas. The PL changes appear to derive from adduct-induced changes in depletion width, and can be fit using a dead-layer model. Equilibrium binding constants are on the order of 103 atm−1.

We have cloned overlapping cDNAs encoding alpha 1E Ca2+ channel subunits from mouse and human brain. We observed that these alpha 1E transcripts were widely distributed in the central nervous system. We also demonstrated the existence of two variants of the human alpha 1E subunit. Comparison of the sequence of these alpha 1E subunits to those from other species suggests that at least four alternatively spliced variants of alpha 1E exist. Expression of human alpha 1E in HEK293 cells and Xenopus oocytes produced high voltage-activated Ca2+ currents that inactivated rapidly (tau approximately 20 ms at 0 mV). The size of the currents obtained were enhanced approximately 40-fold by co-expression with human neuronal alpha 2 and beta Ca2+ channel subunits. alpha 1E currents were insensitive to the drugs and toxins previously used to define other classes of voltage-activated Ca2+ channels. Thus, alpha 1E-mediated Ca2+ channels appear to be a pharmacologically distinct class of voltage-activated Ca2+ channels.

Stable, reproducible, iron(III) ion-modified silica stationary phases were prepared in aqueous media by a batch process. The catalytic activity of this modified stationary phase for oxidation of hydroquinone to benzoquinone was considerably greater than that of earlier iron(III) ion-modified silicas from non-aqueous media. Capacity factors of selected solutes were used to compare the retention properties of the aqueous to increase with the iron(III) ion-modified silica relative to those for the unmodified silica column, whereas the capacity factors for carbonyl-containing compounds (esters, ketones and aldehydes) became smaller or were unaffected.

Based on a novel perovskite solid electrolyte, BaCeO 3 :Gd (10 mol%), hydrogen-oxygen fuel cells have been constructed and operated, giving open circuit voltages of 1.2 to 1.0 V at 600 and 800°C respectively. Under load, current densities varied inversely with electrolyte thickness, the highest values at a terminal voltage of 700 mV being 25 and 105 mA cm −2 at 600 and 800°C respectively. Fuel cells based on this material gave current-voltage performances significantly better than those of a comparable cell based on ceria-gadolinia (20 mol%). The stability of BaCeO 3 :Gd was demonstrated by operation of a fuel cell under load for 1000 h with no degradation of performance. Measurement of the water content of exhaust gases indicated that the ionic transport mechanism varied from purely protonic, at 600°C or below, to predominantly oxide ion above 900°C. The compound is judged to be a good candidate solid electrolyte for fuel cells operating in the temperature range 600 to 800°C.

Cross-national comparisons of intelligence require the use of measurement instruments that are equivalent across cultural groups. One method for insuring equivalent measures is to use only those test items for which the relationship between ability andand probability of a correct response is the same for both national groups. American and German intelligence tests, based on Thurstone's primary mental abilities, were administered to 205 American and 217 German male and female college students in their native languages. Effects of speed were minimized by examining only those items that the majority of subjects reached. Tests were then examined for items that exhibited differetial item functioning (dif). Group subtest scores were compared before and after dif items and the effects of speed were removed. Ability differences before and after were not the same. The benefits of using a dif analysis and removing the effects of speed in order to establish measurement equivalence in cross-national comparisons of intelligence are discussed.

Hydrogen uranyl phosphate (HUP), HUO 2 PO 4 ·4H 2 O, is a layered solid that undergoes intercalative ion-exchange reactions with guest cationic species spanning the periodic table. The host lattice exhibits highly efficient green photoluminescence (PL) characteristic of the uranyl (UO 2 2+ moiety. Structural and optical perturbations of the host and guest generally accompany intercalation reactions. Guest metal complexes have afforded an opportunity to study host-to-guest energy transfer, interlamellar acid-base/precipitation chemistry, interlamellar redox chemistry, and host lattice substitution chemistry. These reactions are summarized in this article.

Band edge photoluminescence (PL) of single-crystal n -CdSe provides evidence for adduct formation between the solid's surface and various mono- and diphosphines present in toluene solution. Relative to a toluene ambient, solutions of triphenylphosphine (PPh 3 ), ethyldiphenylphosphine (PEtPh 2 ), bis(diphenylphosphino)methane (dppm) and bis(diphenylphosphino)ethane (dppe) in toluene enhance the semiconductor's PL intensity. For all of the phosphines, the increases in PL intensity can be fit to a dead-layer model, allowing the estimation of the reduction in depletion width resulting from phosphine exposure; reductions in dead-layer widths are about 300–400 A for all phosphines except PEtPh 2 , which yields a reduction roughly twice as large. Fits of the PL changes to the Langmuir adsorption isotherm model yield formation constants for the phosphine/CdSe adducts of 30±7 M −1 for PPh 3 and 220± 30 M −1 for PEtPh 2 ; the diphosphines, which do not fit this simple model as well, give adsorption equilibrium constants of ∼ 100–200 M −1 . The results suggest that the diphosphines do not coordinate to the surface in a chelating fashion, but in some combination of bridging and monodentate bonding modes at lower effective surface coverages than the monophosphines.

Introduction There are many etiologies of adolescent hip impingement that, once symptomatic, can progress to labral tears or chondral lesions. As the teenager grows and engages sooner in competitive sports, more sport-induced hip pain is seen in this young athletic population, including femoroacetabular impingement (FAI). There are very few large studies with greater than one year outcomes of adolescent hip arthroscopy for hip impingement. The goal of this study is to report clinical outcomes and revision rates in the adolescent population after hip arthroscopy for FAI with subsequent labral tear and chondral lesions with a minimum 2 years follow-up. Methods After IRB approval was obtained, prospectively collected data on 70 consecutive adolescents who were 16 years of age or younger and underwent hip arthroscopy for FAI were retrospectively reviewed. All patients had either isolated cam impingement, isolated pincer impingement, or mixed pathology. Surgical treatment for FAI in this adolescent population was with hip arthroscopic acetabular or femoral head-neck osteoplasty, labral debridement versus suture anchor repair, or a chondroplasty for articular cartilage defects. A limited osteoplasty was performed on cam lesion with an open physis. Data analyzed included patient demographics, radiographic parameters, intra-operative findings, and clinical outcomes at a minimum of 2 years. Clinical outcomes measurements included the modified Harris Hip Score (mHHS), and patient satisfaction with outcome (10=very satisfied, 1=very unsatisfied). Results Mean age at time of surgery was 15 years (range, 13 to 16 years) with 22 males and 48 females. CAM impingement was found in 10% of cases, pincer type in 15%, and mixed-type in 75%. Femoral head-neck osteoplasty was performed in 56 patients and rim trimming was performed in 55 patients. Labral tears were identified in all patients, and 83% of these were repaired. The remaining labral tears were debrided. 7 had grade 3-4 chondral defect on the femoral head and 3 on the acetabulum. All were treated with chondroplasty. The mean time of follow up was 3 years (range, 2 to 5 years). Mean preoperative mHHS was 60 (range, 31 to 85), and it improved to an average of 93 (range, 68 to 100). The median patient satisfaction was 10 (range, 5 to 10). After the index procedure, 8 patients needed revision arthroscopy for adhesions at the capsule/labral junction. All revision were females. Median satisfaction following revision was 9 (range 7 to 10). Conclusion Arthroscopic treatment of FAI, labral tears, and chondral lesions in the adolescent population is a safe procedure with excellent clinical outcomes. Females had a higher revision rate but with improved satisfaction after revision surgery.