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The association between student motivation and learning, and changes in motivation across a course, were evaluated for students enrolled in one-semester foundation-level inorganic chemistry courses at multiple postsecondary institutions across the United States. The Academic Motivation Scale for Chemistry (AMS-Chemistry) and the Foundations of Inorganic Chemistry American Chemical Society Exam (i.e., a content knowledge measure) were used in this study. Evidence of validity, reliability, and longitudinal measurement invariance for data obtained from the AMS-Chemistry instrument with this population were found using methodologies appropriate for ordinal, non-parametric data. Positive and significant associations between intrinsic motivation measures and academic performance corroborate theoretical and empirical investigations; however, a lack of pre/post changes in motivation suggest that motivation may be less malleable in courses primarily populated by chemistry majors. Implications for inorganic chemistry instructors include paths for incorporating engaging pedagogies known to promote intrinsic motivation and methods for incorporating affect measures into assessment practices. Implications for researchers include a need for more work that disaggregates chemistry majors when evaluating relationships between affect and learning, and when making pre/post comparisons. Additionally, this work provides an example of how to implement more appropriate methods for treating data in studies using Likert-type responses and nested data.

Diagnostic Reasoning (DR) is an essential competency requiring mastery for safe, independent Nurse Practitioner (NP) practice, but little is known about DR content included in NP education programs. The aims of this study were to identify whether and how the concept of DR is addressed in NP education.We conducted a scoping review on DR-related content and teaching innovations in U.S. primary care NP education programs, with implications for NP education programs worldwide. Concepts and principles with global applicability include: conducting focused and hypothesis-directed histories and exams, generating the problem statement, formulating the differential diagnosis, appropriate and relevant diagnostic testing, determining the working diagnosis and developing evidence-based, patient-centred management plans.N = 1115 articles retrieved from Medline, Embase, PsycINFO, and CINAHL for the period 2005-2021. Forty-one scholarly articles met inclusion/exclusion criteria.Data were extracted, synthesized and grouped by theoretical frameworks, content included, educational interventions and assessment measures.Most articles provided descriptions of approaches for teaching NP clinical or diagnostic reasoning. Ten papers directly referenced the current science and theory of DR.The US NP education literature addressing DR is limited and demonstrates a lack of shared conceptualizations of DR. Whilst numerous components of DR are identifiable in the literature, a robust teaching/learning scholarship for DR has not yet been established in the US NP education literature.Whilst primary care NP education programs are beginning to incorporate DR education into their curricula, little research has been conducted to demonstrate the effectiveness of educational outcomes. Increased integration of DR content into NP education is needed, including increased educational research on teaching DR competencies.No patient or public contribution was included in this review, as the public is generally not familiar with DR or its teaching approaches.

OBJECTIVE To determine the frequency of germline and somatic pathogenic BRCA1 and BRCA2 variants in patients with high-grade serous ovarian cancer tested by next-generation sequencing (NGS), with the aim of defining the best strategy to be implemented in future routine testing. DESIGN National retrospective audit. SETTING The All Wales Medical Genomics Service (AWMGS). POPULATION Patients with high-grade serous ovarian/fallopian tube/peritoneal cancer referred by oncologists to the AWMGS between February 2015 and February 2021 for germline and/or tumour testing of the BRCA1 and BRCA2 genes by NGS. METHODS Analysis of NGS data from germline and/or tumour testing. MAIN OUTCOME MEASURES Frequency of BRCA1 and BRCA2 pathogenic variants. RESULTS The overall observed germline/somatic pathogenic variant detection rate was 11.6% in the 844 patients included in this study, with a 9.2% (73/791) germline pathogenic variant detection rate. Parallel tumour and germline testing was carried out for 169 patients and the overall pathogenic variant detection rate for this cohort was 14.8%, with 6.5% (11/169) shown to have a somatic pathogenic variant. Two BRCA1 dosage variants were found during germline screens, representing 2.0% (2/98) of patients with a pathogenic variant that would have been missed through tumour testing alone. CONCLUSIONS Parallel germline and tumour BRCA1 and BRCA2 testing maximises the detection of pathogenic variants in patients with high-grade serous ovarian cancer. TWEETABLE ABSTRACT Parallel germline and tumour testing maximises BRCA pathogenic variant detection in ovarian cancer.

Classroom observation data using tools such as the Classroom Observation Protocol for Undergraduate STEM (COPUS) are frequently collected in instructional settings for large-scale research studies ...

Advances in technology have led to a massive expansion in the capacity for genomic analysis, with a commensurate fall in costs. The clinical indications for genomic testing have evolved markedly; the volume of clinical sequencing has increased dramatically; and the range of clinical professionals involved in the process has broadened. There is general acceptance that our early dichotomous paradigms of variants being pathogenic–high risk and benign–no risk are overly simplistic. There is increasing recognition that the clinical interpretation of genomic data requires significant expertise in disease–gene-variant associations specific to each disease area. Inaccurate interpretation can lead to clinical mismanagement, inconsistent information within families and misdirection of resources. It is for this reason that ‘national subspecialist multidisciplinary meetings’ (MDMs) for genomic interpretation have been articulated as key for the new NHS Genomic Medicine Service, of which Cancer Variant Interpretation Group UK (CanVIG-UK) is an early exemplar. CanVIG-UK was established in 2017 and now has >100 UK members, including at least one clinical diagnostic scientist and one clinical cancer geneticist from each of the 25 regional molecular genetics laboratories of the UK and Ireland. Through CanVIG-UK, we have established national consensus around variant interpretation for cancer susceptibility genes via monthly national teleconferenced MDMs and collaborative data sharing using a secure online portal. We describe here the activities of CanVIG-UK, including exemplar outputs and feedback from the membership.

Barkcloths, non-woven textiles originating from the Pacific Islands, form part of many museum collections and date back to the 18th and 19th centuries. The ability to determine different plant species which have been used for producing barkcloth is required by art historians to help understand the origin and use of the cloths and by conservators for whom the species type may have an impact on textile durability, deterioration and hence conservation. However, to date the development of a non-destructive, robust analytical technique has been elusive. This article describes the use of Fourier transform infrared spectroscopy with attenuated total reflection (ATR-FTIR) and principal component analysis (PCA) todifferentiation between historic barkcloths. Three distinct groups of historic cloths were identified using PCA of the FTIR region between 1200 and 1600 cm−1 where molecular vibrations associated with tannins and lignins are dominant. Analysis of contemporary cloths only identified Pipturus albidus cloth as different and highlighted the difficulties around producing a representative textile sample to mimic the historic cloths. While the methodology does not itself identify species, the use of historically well-provenanced samples allows cloths showing similarities to group together and is a significant aid to identification.

This study examines success factors for a team project. The influence of three success factors—(1) project management tools, (2) project management best practices, and (3) managerial support on the performance of individuals, teams, and projects was measured. We surveyed 121 business students with team project experience. Exploratory factor analysis confirms that success factors (project management tools, project management best practices, and managerial support) in a project tend to respond more to individual team members’ performance compared to team performance and project performance. Our findings indicate that project management tools, project management best practices, and support are equally important to success during project implementation. We also find that harmonious relationships among team members lead to extrinsic motivation within project teams and enhance team and project performance. However, most of the time, the system—not the individual—causes a project to fail. Therefore, this study suggests that project managers make a clear plan and agenda by utilizing project management tools.

Objectives To examine outcome of bilateral extracranial to intracranial (EC-IC) bypass surgeries for a Down syndrome patient with hard-to-treat epilepsy and moyamoya. Materials and methods Superficial temporal arteries were anastamosed using an indirect bypass technique to middle cerebral arteries bilaterally to help limit perfusion deficits and seizure controls. Results Two superficial temporal to middle cerebral artery indirect bypass surgeries were performed within 3 months. Post-revascularization improvements included seizure control, gait, perfusion, wakefulness, language and quality of life. Conclusion In patients with Down syndrome and moyamoya, improvements in seizure control and quality of life may occur with EC-IC bypass procedures., Highlights • Moyamoya blood flow compromises can be seen in Down syndrome. • Both moyamoya and Down syndrome are associated with Epilepsy. • If moyamoya related perfusion worsens, so can seizure control. • We report bilateral indirect extracranial to intracranial bypass surgeries in a Down syndrome patient with moyamoya. • The surgeries markedly improved seizure control and quality of life.

Individuals with the three base pair deletion NM_000267.3(NF1):c.2970_2972del p.(Met992del) have been recognised to present with a milder neurofibromatosis type 1 (NF1) phenotype characterised by café-au-lait macules (CALs) and intertriginous freckling, as well as a lack of cutaneous, subcutaneous and plexiform neurofibromas and other NF1-associated complications. Examining large cohorts of patients over time with this specific genotype is important to confirm the presentation and associated risks of this variant across the lifespan. Forty-one individuals with the in-frame NF1 deletion p.Met992del were identified from 31 families. Clinicians completed a standardised clinical questionnaire for each patient and the resulting data were collated and compared to published cohorts. Thirteen patients have been previously reported, and updated clinical information has been obtained for these individuals. Both CALs and intertriginous freckling were present in the majority of individuals (26/41, 63%) and the only confirmed features in 11 (27%). 34/41 (83%) of the cohort met NIH diagnostic criteria. There was a notable absence of all NF1-associated tumour types (neurofibroma and glioma). Neurofibroma were observed in only one individual—a subcutaneous lesion (confirmed histologically). Nineteen individuals were described as having a learning disability (46%). This study confirms that individuals with p.Met992del display a mild tumoural phenotype compared to those with ‘classical’, clinically diagnosed NF1, and this appears to be the case longitudinally through time as well as at presentation. Learning difficulties, however, appear to affect a significant proportion of NF1 subjects with this phenotype. Knowledge of this genotype–phenotype association is fundamental to accurate prognostication for families and caregivers.

Introduction: Healthcare workers in hospital-based Emergency Departments (EDs) experience high rates of workplace violence perpetrated by patients. Aim: The purpose of this quality improvement project was to implement and evaluate the effectiveness of a risk for violence screening tool (RVST) in an urban, academic trauma center ED to reduce staff assaults through an alert system and focused assault prevention strategies. Method: Using the socioecological framework, facility, and literature-based risk factors for assaultive behavior, a RSVT to flag patients for aggression reduction strategies was developed, implemented and evaluated. Six steps included the following: (1) adult patients screened at triage for risk criteria for violence, (2) positive risk patients identified with a Golden Hand (GH), (3) Electronic Medical Record (EMR) tracking system flagged with GH symbol to alert staff to risk, (4) GH signage posted to communicate patients’ violence propensity, (5) assault prevention strategies implemented, (6) permanent EMR flag for repeatedly assaultive patients. Results: Physical assaults on staff were recorded and tracked monthly from January 2019, through January 2021, through a retrospective review of the hospital’s online incident report system. Patient-to-staff physical assaults decreased from a range of one to four per month to a range of zero to one per month. Triage screening accuracy and compliance for patients who were assaultive increased from 33% compliance and 0% accuracy, to 96% compliance and 83% accuracy. Conclusion: Risk for violence screening upon arrival, an alert system, and assault mitigation strategies provide an opportunity for nurse leaders to promote ED workplace safety. Keywords: workplace violence, healthcare worker assault, violence, aggression, emergency department, prevention, risk for violence screening tools, framework

Background Individuals with diabetic foot and ankle complications are at heightened risk for depression, anxiety, and stress. Purpose This study evaluated the effect of a stress management group education (SMGE) program in this population. Methods The 21-question Depression Anxiety Stress Scales and the Problem Areas in Diabetes scale were administered prior to, upon completion of, and at approximately 6 weeks after the program. Results Twenty-five patients from an urban diabetic foot and ankle center completed the study. Conclusion The SMGE program demonstrated decreased levels of anxiety, depression, and diabetes problem areas for our study population.

This article describes minority stress theory as applied to health disparities and health-care experiences of transgender and gender nonbinary (TGNB) persons. The combination of stigma, social and structural inequalities, and actual discrimination events result in mutually reinforcing dynamics that drive persistent and stubborn disparities in physical and mental health for TGNB persons (Halkitis, Kapadia, Ompad, & Perez-Figueroa, 2015). Together with distrust of the medical system and discomfort of health-care providers in caring for TGNB persons (Smith & Turell, 2017), minority stress contributes to poorer health outcomes and reduced quality of care for sexual and gender minority populations. Ways to reduce health-care-related minority stress for TGNB persons are proposed, with the goal of improving TGNB health and well-being.

BACKGROUND: The global obesity epidemic has sobering consequences to human health. Especially concerning is obesity-associated hepato-steatosis (HS), a common cause of chronic liver disease in the Americas and Western Europe that precedes non-alcoholic steatohepatitis (NASH). Maintenance of normal body weight is the only current means to prevent HS and NASH. We hypothesized that excess liver fat in obesity-associated HS could act as a pathophysiologic chemical depot for fat-soluble vitamins and alter normal physiology. Because clinical trials with Vitamin E (α-T) have shown that NASH partially responds to this supplement, we selected α-T as a model vitamin to test the sequestration hypothesis. INTERVENTIONS: Under an IND and IRB-approved protocol, two deuterium-labeled α-tocopherols (d3-α-T and d6-α-T) were administered orally and intravenously, respectively, to 10 healthy women and 6 women with HS. Serial blood samples obtained over 72 h were analyzed by LC-MS/MS. In parallel, we performed studies in hepatocytes in cell culture and mouse model. RESULTS: In healthy women who received oral d3- and intravenous d6-α-T, 85% of the initial plasma peak d6-α-T disappeared within 20 minute and reappeared in the plasma peaking between 6-8 h. Compared to healthy subjects, subjects with HS had similar d6-α-T entry rates into liver, but reduced release rates into plasma (p CONCLUSION: These findings suggest the unique role of the liver in vitamin E physiology which is dysregulated by excess liver fat (measured by magnetic resonance spectroscopy). Considered together, the findings imply that obesity-associated HS may produce unrecognized hepatic α-T sequestration, which might subsequently drive liver disease. The data here raise the intriguing possibility that timely α-T supplementation might attenuate progression of HS to NASH, perhaps by correcting an unrecognized fat-induced, localized, hepatic vitamin E deficiency prior to onset of inflammation, hepatitis, and fibrosis. Additionally, our findings raise the possibility that HS may similarly alter hepatic physiology of other fat-soluble vitamins.

National health expenditures are projected to grow at an average annual rate of 5.4 percent for 2019-28 and to represent 19.7 percent of gross domestic product by the end of the period. Price growth for medical goods and services is projected to accelerate, averaging 2.4 percent per year for 2019-28, which partly reflects faster expected growth in health-sector wages. Among all major payers, Medicare is expected to experience the fastest spending growth (7.6 percent per year), largely as a result of having the highest projected enrollment growth. The insured share of the population is expected to fall from 90.6 percent in 2018 to 89.4 percent by 2028.

No relationship is more important to the future of Asia than the one between Japan and China. PM Abe’s visit to Beijing last month put the relationship back on a firmer footing. Yet diplomacy alone...

ACS Examinations provide a lens through which to examine historical changes in topic coverage via analyses of course-specific examinations. This study is an extension of work completed previously by the ACS Exams Research Staff and collaborators in general chemistry, organic chemistry, and physical chemistry to explore content changes in the principal courses of the postsecondary chemistry curriculum. In this study, we consider how inorganic chemistry content coverage has varied over a 55-year period since the first inorganic chemistry ACS Examination was released in 1961. A total of 860 items was evaluated on the basis of problem type (i.e., algorithmic, conceptual, or recall), use of visual-spatial or reference components, and content coverage. Our analyses identify core content areas in the inorganic chemistry curriculum, consistent with those reported in faculty surveys. Each examination also contained questions addressing a variety of specialty areas that vary widely within the discipline between 19...

The elastic modulus, fracture toughness, ionic conductivity, Li and water stability of dense (~ 97%) fine-grain (~ 10 μm) Li 1.2 Zr 1.9 Sr 0.1 (PO 4 ) 3 (LZSP) consolidated by reactive hot-pressing was investigated. Low values of elastic modulus (25.2 and 40.9 GPa), fracture toughness (0.29 and 0.37 MPa-m 1/2 ), total conductivity (2.1 × 10 − 5 S/cm) at room temperature were exhibited as a result of the presence of microcracks formed during cooling from the hot-pressing temperature. The lattice conductivity of LZSP is 0.85 × 10 − 4 S/cm with an activation energy for bulk conductivity of 0.29 eV. The results of Li/LZSP/Li cell impedance as a function of time and surface examination suggest that LZSP is not stable against metallic lithium. The results of the water stability test suggest that LZSP is a possible membrane for use in aqueous Li-Air cells. The results of this study reveal for the case of lithium zirconium phosphates are as follows: 1] a small grain size is required to prevent microcracking to avoid a reduction in total conductivity and mechanical properties and 2] even though they do not contain a transition metal cation they are not stable against Li at room temperature.

Donald Trump shocked many in Japan during his presidential campaign. Trump suggested in a New York Times interview that Japan and South Korea should develop their own nuclear weapons to contend with North Korea, stating that "if we're attacked, they do not have to come to our defense, if they're attacked, we have to come totally to their defense. And...that's a real problem."1 On the campaign trail, he repeatedly returned to the topic of Japan to note the lack of reciprocity in the security relationship. At a rally in Iowa on August 6, Trump claimed he was told that Japan pays 50% of the costs of basing U.S. troops there, but he then asked, "Why don't they pay 100%?"2These assertions, however, may have little to do with how the Trump administration manages the U.S. relationship with Japan. What may be most important is how it envisions U.S. interests in Asia and how it approaches the United States' relationship with Japan's neighbor, China.This essay will first discuss the likely changes in U.S. strategy toward Asia under Trump and the implications for U.S.-Japan relations. The next section will then offer several policy options for the Trump administration to consider, while the conclusion will assess the impact of Russia's relations with both the United States and Japan on the alliance.Changes in U.S. Strategy toward Asia and the Implications for JapanThe incoming Trump administration's approach will differ from the Obama administration's "rebalance" to Asia. Several broad areas of policy change seem likely. First, U.S. policy toward China will be more fraught, and the trade relationship is likely to be the first target of the new administration. Indeed, designating China as a currency manipulator was high on the list of what Trump stated he would do in the first hundred days of his presidency. But since the election, Trump has taken this idea of shaking up the relationship between the United States and the People's Republic of China (PRC) a step further by suggesting that he would be willing to abandon the one-China policy that has guided Washington's relationship with Beijing since normalization in the 1970s. Accepting a phone call from Taiwan's president Tsai Ing-wen on December 2 was the first departure, but his statements that followed were even more explicit about his intention to recalibrate the U.S. relationship with the PRC.Second, the Trump administration seems interested in building up U.S. military capabilities, including in the Asia-Pacific. Trump's Asia advisers have used President Ronald Reagan's "peace through strength" concept to advocate for a demonstration of U.S. military power. At face value, this strategy may not be all that alarming for allies such as Japan, who prefer that the United States maintain a strong military presence in Asia. How the incoming president intends to use those forces, however, could be more worrisome in the context of a far more contentious U.S.-PRC relationship.Finally, it seems unlikely that the incoming administration will prioritize the Asia-Pacific's annual multilateral gatherings to the same degree as its predecessor. Support for the Association of Southeast Asian Nations (ASEAN) and its related regional meetings, such as the East Asia Summit and the ASEAN Regional Forum, is likely to diminish. Prime Minister Shinzo Abe and President Barack Obama have been strong supporters of ASEAN's efforts to institutionalize a regional summit meeting, and their administrations have supported the ASEAN Regional Forum and the ASEAN Defence Ministers' Meeting-Plus that seek to find common ground between regional security and military leaders.These broad changes in the U.S. approach to the Asia-Pacific will shape President Trump's relationship with Japan. First, Washington's relationship with Beijing will have a significant impact on bilateral ties between Tokyo and Beijing. Should tensions with Beijing rise, Tokyo will feel the impact. A trade war with China would of course be a disaster for most of the Asia-Pacific economies, and Japan's economy would be badly affected. …