The Content of Usual Clinical Care for Youth with Primary Anxiety Problems

The current study was designed to describe usual clinical care for youth with primary anxiety problems in community mental health centers. The observer-rated Therapy Process Observational Coding System for Child Psychotherapy - Revised Strategies scale (TPOCS-RS), designed to assess therapeutic techniques from five theory-based domains, was used to code sessions (N = 403) from the usual clinical care group of two randomized effectiveness trials: (a) Youth Anxiety Study (YAS) with 21 youth (M age = 10.44 years, SD = 1.91; 49.2% Latinx; 46.6%, 53.4% male) and 16 clinicians (77.5% female; 43.8% White), and (b) Child STEPS Multisite Trial with 17 youth (M age = 10.00 years, SD = 1.87; 58.8% male; 41.2% White) and 13 clinicians (M age = 40.00 years; SD = 9.18; 76.9% female; 61.5% White). The average number of TPOCS-RS items observed per treatment session was more than 10, and multiple techniques were used together in each session. All TPOCS-RS items were observed at least once throughout a clinical case, and most items reoccurred (i.e., observed in two or more sessions). The dosage of TPOCS-RS in all items was below 5 on a 7-point scale. In conclusion, clinicians in both usual care samples used a wide range of techniques from several theory-based domains at a low to medium dose. However, the type and dosage of the techniques used did vary across the two samples.

Hub and spoke framework for study of surgical centralization within United States health systems

BACKGROUND

Hospital consolidation into health systems has mixed effects on surgical quality, potentially related to degree of surgical centralization at high-volume (hub) sites. We developed a novel measure of centralization and evaluated a hub and spoke framework.

METHODS

Surgical centralization within health systems was measured using hospital surgical volumes (American Hospital Association) and health system data (Agency for Healthcare Research and Quality). Hub and spoke hospitals were compared using mixed effects logistic regression and system characteristics associated with surgical centralization were identified using a linear model.

RESULTS

Within 382 health systems containing 3022 hospitals, system hubs perform 63% of cases (IQR 40-84%). Hubs are larger, in metropolitan and urban areas, and more often academically affiliated. Degree of surgical centralization varies ten-fold. Larger, multistate, and investor-owned systems are less centralized. Adjusting for these factors, there is less centralization among teaching systems (p ​< ​0.001).

CONCLUSIONS

A hub-spoke framework applies to most health systems but centralization varies significantly. Future studies of health system surgical care should assess the contributions of surgical centralization and teaching status on differential quality.

Using social network analysis in applied psychological research: A tutorial

Social network analysis (SNA) is a highly flexible research method that allows for novel exploration of a wide variety of research phenomena. Evidence from fields as disparate as public health, education, informatics, sociology, and medicine has demonstrated the importance of recognizing the complexity inherent in individuals' connections with others. In this article, we provide a brief conceptual overview of social network theory and methodology, and then demonstrate how to apply SNA to an applied psychological research context studying students embedded in classrooms. We also provide numerous supporting materials on our OSF page, including R code for all analyses, a dataset containing social network data, and a glossary of key terms in social network analysis. We conclude with a set of recommendations for researchers interested in applying SNA to their own contexts and content areas. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Emergency department presentations with suicide and self-harm ideation: a missed opportunity for intervention?

AIMS

Suicidal ideation constitutes a central element of most theories of suicide and is the defining facet separating suicide from other causes of death such as accidents. However, despite a high worldwide prevalence, most research has focused on suicidal behaviours, such as completed suicide and suicide attempts, while the greater proportion who experienced ideation, which frequently precedes suicidal behaviour, have received much less attention. This study aims to examine the characteristics of those presenting to EDs with suicidal ideation and quantify the associated risk of suicide and other causes of death.

METHODS

Retrospective cohort study was performed based on population-wide health administration data linked to data from the Northern Ireland Registry of Self-Harm and centrally held mortality records from April 2012 to December 2019. Mortality data, coded as suicide, all-external causes and all-cause mortality were analysed using Cox proportional hazards. Additional cause-specific analyses included accidental deaths, deaths from natural causes and drug and alcohol-related causes.

RESULTS

There were 1,662,118 individuals aged over 10 years, of whom 15,267 presented to the ED with ideation during the study period. Individuals with ideation had a 10-fold increased risk of death from suicide (hazard ratio [HR_adj] = 10.84, 95% confidence interval [CI] 9.18, 12.80) and from all-external causes (HR_adj = 10.65, 95% CI 9.66, 11.74) and a threefold risk of death from all-causes (HR_adj = 3.01, 95% CI 2.84, 3.20). Further cause-specific analyses indicated that risk of accidental death (HR_adj = 8.24, 95% CI 6.29, 10.81), drug-related (HR_adj = 15.17, 95% CI 11.36, 20.26) and alcohol-related (HR_adj = 10.57, 95% CI 9.07, 12.31) has also significantly increased. There were few socio-demographic and economic characteristics that would identify which of these patients are most at risk of suicide or other causes of death.

CONCLUSIONS

Identifying people with suicidal ideation is recognized to be both important but difficult in practice; this study shows that presentations to EDs with self-harm or suicide ideation represent an important potential intervention point for this hard-to-reach vulnerable population. However, and unlike individuals presenting with self-harm, clinical guidelines for the management and recommended best practice and care of these individuals are lacking. Whilst suicide prevention may be the primary focus of interventions aimed at those experiencing self-harm and suicide ideation, death from other preventable causes, especially substance misuse, should also be a cause of concern.

Exploring control-value motivational profiles of mathematics anxiety, self-concept, and interest in adolescents

In this study, we identified multidimensional profiles in students' math anxiety, math self-concept, and math interest using data from a large generalizable sample of 16,547 9th grade students in the United States who participated in the National Study of Learning Mindsets. We also analyzed the extent that students' profile memberships are associated with related measures such as prior mathematics achievement, academic stress, and challenge-seeking behavior. Five multidimensional profiles were identified: two profiles which demonstrated relatively high levels of interest and self-concept, along with low math anxiety, in line with the tenets of the control-value theory of academic emotions (C-VTAE); two profiles which demonstrated relatively low levels of interest and self-concept, and high levels of math anxiety (again in accordance with C-VTAE); and one profile, comprising more than 37% of the total sample, which demonstrated medium levels of interest, high levels of self-concept, and medium levels of anxiety. All five profiles varied significantly from one another in their association with the distal variables of challenge seeking behavior, prior mathematics achievement, and academic stress. This study contributes to the literature on math anxiety, self-concept, and interest by identifying and validating student profiles that mainly align with the control-value theory of academic emotions in a large, generalizable sample.

Securing the Oral Endotracheal Tube in Patients With Facial Burns: A Critical Care Clinician Technique

Securing an endotracheal tube (ETT) in a patient with facial burns poses many challenges. There is no standard practice and the existing literature provides solutions to this problem with limited detail outlining the specifics of their techniques. The teeth offer a rigid point of fixation and are an adaptable method to secure the ETT. For their dental insight, oral and maxillofacial surgeons are often tasked with the procedure of fixing the ETT to the dentition. The aim of this technical note is to review the previously published methods of securing an ETT in burns patients and to present a logical technique to secure the ETT to the dentition for critical care clinicians without dental experience.

60 POWER-AGERS: IMPLEMENTING PROGRESSIVE RESISTANCE TRAINING TO MANAGE SARCOPENIA AMONG COMMUNITY DWELLING OLDER ADULTS

Background

The prevalence of sarcopenia among community dwelling older adults is between 10-40%. Progressive Resistance Training (PRT) improves sarcopenia and functional performance among older-adults. A PRT programme was introduced to a Day Hospital service as part of a sarcopenia management quality improvement initiative.

Methods

The PRT programme was implemented on a phased basis. Phase 1 evaluated the feasibility, safety and participant satisfaction. Phase 2 then collected pre and post outcome measures (gait-speed, grip strength and 5-Times-Sit-to-Stand [5TSTS]), and a patient perception questionnaire. The intervention consisted of a physiotherapist-lead PRT programme (weekly in phase 1 and biweekly in phase 2). Recent community dwelling Day Hospital attendees were recruited by the physiotherapist to participate. The class consisted of a circuit of 4-6 exercises targeting upper and lower limbs, along with an educational component. Exercises were progressively overloaded on an individual basis.

Results

Ten participants attended the PRT programmes (phase 1 [n=5], phase 2 [n=5]). Most were female (n=6), mean age was 84 years. None had prior formal experience of PRT. The phase 1 PRT group was deemed feasible and safe in an outpatient setting. All phase 1 participants (n=5) felt it was beneficial and rated it 5/5. All phase 2 participants had improvements in sarcopenia markers (grip strength [range=1kg-9kg], gait-speed [range=0.04m/s-0.19m/s], and 5TSTS [range=5.1sec-11sec]). All participants reported that the programmes improved their confidence in PRT and that they were interested in continuing PRT in the future.

Conclusion

This supports that PRT a clinical setting with community dwelling older adults is safe, feasible and effective in improving sarcopenia markers. Furthermore, the high rate of satisfaction supports its use with this population. Further research is required to examine the impact of combined nutritional education with strength training as an intervention for older adults with sarcopenia.

43 EXPLORING STAFF PERCEPTIONS AND ATTITUDES TO CARE AND CAREBOTS: THE CASE OF AN ORIGINAL AIR-DISINFECTION ROBOT IN IRELAND

Background

The pandemic heightened the sense of security and safety in care settings, with cleanliness and infection control becoming an even more important aspect of care delivery. Although the impact of new welfare technology on health and social care has been discussed in recent years, few studies have reported the implementation processes or human-robot interactions in care facilities in different cultural settings. The aims of this interdisciplinary research therefore were to understand needs and aspects that have to be considered for implementing an assistive robot, and to explore user perceptions, and the process by which the robots are adopted in Ireland and Japan.

Methods

An original air-disinfection robot (V-Air) was developed by Akara Robotics, as part of research project “Harmonisation towards the establishment of Person-centred, Robotics-aided Care System” (Toyota Foundation, D18-ST-0005). Prior to its instalment in a rehabilitation centre in Dublin, semi-structured interviews were conducted, and observations carried out with seven care professionals, as they interacted with V-Air. The robot was then trialled for eight weeks (March-May 2022) in selected areas of the facility. After four weeks, the users filled out the System Usability Score and were asked questions at the end of the trial. Their scores and answers to the questions revealed staff perceptions and attitudes to care robots.

Results

Overall, the users had positive perceptions of V-Air and its usability. Initial differences existed in staff’s confidence levels, depending on prior experiences with technologies. Collective sensemaking was observed, particularly, around care delivery processes and robot functionalities. The adoption process was facilitated by several factors such as the timing of introduction, user-centred design, concept of care and organisational support.

Conclusion

The findings suggest that the introduction of care robots in care settings can offer an additional layer of organisational safety, while highlighting the significance of the iterative process in adopting assistive technologies.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Using Machine Learning to Predict Patterns of Employment and Day Program Participation

In this article, we demonstrate the potential of machine learning approaches as inductive analytic tools for expanding our current evidence base for policy making and practice that affects people with intellectual and developmental disabilities (IDD). Using data from the National Core Indicators In-Person Survey (NCI-IPS), a nationally validated annual survey of more than 20,000 nationally representative people with IDD, we fit a series of classification tree and random forest models to predict individuals' employment status and day activity participation as a function of their responses to all other items on the 2017-2018 NCI-IPS. The most accurate model, a random forest classifier, predicted employment outcomes of adults with IDD with an accuracy of 89 percent on the testing sample, and 80 percent on the holdout sample. The most important variable in this prediction was whether or not community employment was a goal in this person's service plan. These results suggest the potential machine learning tools to examine other valued outcomes used in evidence-based policy making to support people with IDD.

Optimizing Outcomes With the 1550/1927 nm Dual Wavelength Non-Ablative Fractional Laser: Experienced User Recommendations

BACKGROUND

Fractional laser treatment was introduced in 2004 as a non-invasive technique to treat sun-damaged and aging skin. Since then, numerous ablative and non-ablative photothermolysis technologies and devices have been introduced, increasing the options for clinicians and patients but also increasing the complexity regarding which system to use and the techniques to optimize outcomes. No two devices are the same and the user-manuals preset dosimetry does not address many clinical situations, which can create confusion for new and inexperienced users.

METHODS

An online survey addressing use of a 1550 nm /1927 nm dual wavelength, non-ablative, fractional laser was sent to eight (8) US board certified dermatologists with extensive experience in the use of the device. The survey included 39 questions, addressing experience, best practices and recommendations for use.

RESULTS

The survey data suggests that the device can be used to treat patients of all ages and skin types for indications including photoaging and photodamage, periorbital wrinkles, freckles, (ephelides), solar lentigines, poikiloderma, scarring due to acne or surgery. It can be used on both facial and non-facial areas, including neck, chest, hands, arms, abdomen, legs, and buttocks. Unexpected and adverse effects were rarely reported and those that did were mild and transient.

CONCLUSIONS

This position paper provides practical real-world guidelines resulting from a small survey of experienced users, for new and early uses of the novel 1550 nm /1927 nm dual wavelength, non-ablative, fractional laser. J Drugs Dermatol. 2021;20(11):1150-1157. doi:10.36849/JDD.6181.

1458 Compliance of Abdominal X-ray Requesting with iRefer Guidelines in CDDFT

Aim

100% of Abdominal x-ray (AXR) requests in the trust should be compliant with iRefer guidelines. Therefore, with this audit we hope to evaluate the compliance of our hospitals with said guidelines.

Method

This audit was retrospective with AXRs taken between 23 – 29th of November 2020 being analysed for compliance creating our first loop. On the 1st of December we placed our intervention. This came in the form of educational posters in the four areas that request the majority of AXRs. Following this, a further weeks’ worth of AXRs were assessed for compliance between 2nd – 8th of December 2020.

Results

Between 23-29/11/20 there were 67 AXRs requested. Eight of these were excluded according to our exclusion criteria, leaving a total of 59 AXRs to be assessed. After reviewing the request cards for these AXRs, 17 were non-compliant (28.8%). Following the intervention, AXR requests were re-audited. Between 2-8/12/20 there were 69 AXRs requested. Six were excluded leaving a total of 63 AXRs to be assessed. After review, 22 were non-compliant (34.9%)

Conclusions

In both loops of this audit, the standard of 100% compliance with iRefer guidelines was not met. There was a high percentage of non-compliance in both loops with a rate of 28.8% and 34.9% respectively – a decrease in compliance. One possible reason to account for this was due the changeover of Junior Doctors within the trust on 2/12/20. Our interventional posters were placed in only half of the Trusts hospitals which may also account for the decrease in compliance.

On spatial conditional extremes for ocean storm severity

We describe a model for the conditional dependence of a spatial process measured at one or more remote locations given extreme values of the process at a conditioning location, motivated by the conditional extremes methodology of Heffernan and Tawn. Compared to alternative descriptions in terms of max-stable spatial processes, the model is advantageous because it is conceptually straightforward and admits different forms of extremal dependence (including asymptotic dependence and asymptotic independence). We use the model within a Bayesian framework to estimate the extremal dependence of ocean storm severity (quantified using significant wave height, H S ) for locations on spatial transects with approximate east-west (E-W) and north-south (N-S) orientations in the northern North Sea (NNS) and central North Sea (CNS). For H S on the standard Laplace marginal scale, the conditional extremes "linear slope" parameter α decays approximately exponentially with distance for all transects. Furthermore, the decay of mean dependence with distance is found to be faster in CNS than NNS. The persistence of mean dependence is greatest for the E-W transect in NNS, potentially because this transect is approximately aligned with the direction of propagation of the most severe storms in the region.

A persistent lack of international representation on editorial boards in environmental biology

The scholars comprising journal editorial boards play a critical role in defining the trajectory of knowledge in their field. Nevertheless, studies of editorial board composition remain rare, especially those focusing on journals publishing research in the increasingly globalized fields of science, technology, engineering, and math (STEM). Using metrics for quantifying the diversity of ecological communities, we quantified international representation on the 1985–2014 editorial boards of 24 environmental biology journals. Over the course of 3 decades, there were 3,827 unique scientists based in 70 countries who served as editors. The size of the editorial community increased over time—the number of editors serving in 2014 was 4-fold greater than in 1985—as did the number of countries in which editors were based. Nevertheless, editors based outside the “Global North” (the group of economically developed countries with high per capita gross domestic product [GDP] that collectively concentrate most global wealth) were extremely rare. Furthermore, 67.18% of all editors were based in either the United States or the United Kingdom. Consequently, geographic diversity—already low in 1985—remained unchanged through 2014. We argue that this limited geographic diversity can detrimentally affect the creativity of scholarship published in journals, the progress and direction of research, the composition of the STEM workforce, and the development of science in Latin America, Africa, the Middle East, and much of Asia (i.e., the “Global South”).

Microbial source tracking in shellfish harvesting waters in the Gulf of Nicoya, Costa Rica

Current microbial water quality monitoring is generally limited to culture-based measurements of fecal indicator bacteria (FIB). Given the many possible sources of fecal pollution within a watershed and extra-intestinal FIB reservoirs, it is important to determine source(s) of fecal pollution as a means to improve water quality and protect public health. The principal objective of this investigation was to characterize the microbial water quality of shellfish harvesting areas in the Gulf of Nicoya, Costa Rica during 2015. In order to achieve this objective, the specificity and sensitivity of 11 existing microbial source tracking (MST) PCR assays, associated with cows (BacCow), dogs (BacCan, DogBac), domestic wastewater (PMMoV), general avian (GFD), gulls (Gull2), horses (HorseBac, HoF), humans (HF183, HPyV), and pigs (PF), were evaluated using domestic wastewater and animal fecal samples collected from the region. The sensitivity of animal-associated assays ranged from 13 to 100%, while assay specificity ranged from 38 to 100%. The specificity of pepper mild mottle virus (PMMoV) and human polyomavirus (HPyV) was 100% for domestic wastewater, as compared to 94% specificity of the HF183 Bacteroidales marker. PMMoV was identified as a useful domestic wastewater-associated marker, with concentrations as high as 1.1 × 10⁵ copies/ml and 100% sensitivity and specificity. Monthly surface water samples collected from four shellfish harvesting areas were analyzed using culture-based methods for Escherichia coli as well as molecular methods for FIB and a suite of MST markers, which were selected for their specificity in the region. While culturable E. coli results suggested possible fecal pollution during the monitoring period, the absence of human/domestic wastewater-associated markers and low FIB concentrations determined using molecular methods indicated sufficient microbial water quality for shellfish harvesting. This is the first study to our knowledge to test the performance of MST markers in Costa Rica as well as in Central America. Given the lack of wastewater treatment and the presence of secondary sources of FIB, this study highlights the importance of an MST toolbox approach to characterize water quality in tropical regions. Furthermore, it confirms and extends the geographic range of PMMoV as an effective tool for monitoring domestic wastewater pollution.

Assessment of morbidity following insertion of fixed preoperative orthopedic appliance in infants with complete cleft lip and palate

OBJECTIVE

To examine physiologic and behavioral indicators of pain within the first 24 hours following insertion of the fixed presurgical orthopedic appliance (FPOA) under general anesthesia in infants with unilateral and bilateral complete cleft lip and palate.

METHODS

The study sample included 109 infants who had either a dentomaxillary appliance (DMA) or an elastomeric chain premaxillary retraction (ECPR) appliance. Vital signs and FLACC (Face, Legs, Activity, Cry, Consolability) scores were used to measure the outcomes.

RESULTS

There was an initial postoperative increase in the median heart rate. Heart rate returned to the median baseline level by 8 hours. The median systolic blood pressure increased postoperatively and remained elevated throughout the time of evaluation. The median respiratory rate remained below that at baseline throughout the study period. The highest mean change in FLACC measurements was observed approximately 2 hours postoperatively. By 3 hours postoperatively, the scores decreased.

CONCLUSIONS

Although there was a large individual variability, the FLACC scores became reduced after 3 hours following surgical insertion of the DMA and the ECPR appliance.

Attitudinal barriers to participation in oncology clinical trials: factor analysis and correlates of barriers

Patient participation in cancer clinical trials is low. Little is known about attitudinal barriers to participation, particularly among patients who may be offered a trial during an imminent initial oncology consult. The aims of the present study were to confirm the presence of proposed subscales of a recently developed cancer clinical trial attitudinal barriers measure, describe the most common cancer clinical trials attitudinal barriers, and evaluate socio-demographic, medical and financial factors associated with attitudinal barriers. A total of 1256 patients completed a survey assessing demographic factors, perceived financial burden, prior trial participation and attitudinal barriers to clinical trials participation. Results of a factor analysis did not confirm the presence of the proposed four attitudinal barriers subscale/factors. Rather, a single factor represented the best fit to the data. The most highly-rated barriers were fear of side-effects, worry about health insurance and efficacy concerns. Results suggested that less educated patients, patients with non-metastatic disease, patients with no previous oncology clinical trial participation, and patients reporting greater perceived financial burden from cancer care were associated with higher barriers. These patients may need extra attention in terms of decisional support. Overall, patients with fewer personal resources (education, financial issues) report more attitudinal barriers and should be targeted for additional decisional support.

Malignant otitis externa with skull base osteomyelitis

Malignant otitis externa associated with skull base osteomyelitis is a condition seen classically in the elderly, diabetic patient. This disease is difficult to manage, often requiring long-term antibiotic therapy. Here we present such a case, seen in a 74- year-old lady. Initially, she was treated for a number of years in the outpatient department with intermittent ear complaints, but eventually required a hospital admission that lasted for 6 months due to a severe malignant otitis externa complicated by skull base osteomyelitis. We will discuss the clinical features, diagnostic criteria, imaging and management of this life-threatening clinical entity.

Neuropeptide signaling sequences identified by pyrosequencing of the American dog tick synganglion transcriptome during blood feeding and reproduction

Ticks are important vectors of numerous pathogens that impact human and animal health. The tick central nervous system represents an understudied area in tick biology and no tick synganglion-specific transcriptome has been described to date. Here we characterize whole or partial cDNA sequences of fourteen putative neuropeptides (allatostatin, insulin-like peptide, ion-transport peptide, sulfakinin, bursicon alpha/beta, eclosion hormone, glycoprotein hormone alpha/beta, corazonin, four orcokinins) and five neuropeptide receptors (gonadotropin receptor, leucokinin-like receptor, sulfakinin receptor, calcitonin receptor, pyrokinin receptor) translated from cDNA synthesized from the synganglion of unfed, partially fed and replete female American dog ticks, Dermacentor variabilis. Their homology to the same neuropeptides in other taxa is discussed. Many of these neuropeptides such as an allatostatin, insulin-like peptide, eclosion hormone, bursicon alpha and beta and glycoprotein hormone alpha and beta have not been previously described in the Chelicerata. An insulin-receptor substrate protein was also found indicating that an insulin signaling network is present in ticks. A putative type-2 proprotein processing convertase was also sequenced that may be involved in cleavage at monobasic and dibasic endoproteolytic cleavage sites in prohormones. The possible physiological role of the proteins discovered in adult tick blood feeding and reproduction will be discussed.

Improving the Relevance of Speech-Language Pathology & Audiology Research and Practice

No abstract available.

Molecular modeling studies of the binding characteristics of phosphates to sevelamer hydrochloride--assessing a novel technique to reduce phosphates contamination

Recent advances in the use of polymeric materials for the remediation of phosphate from aqueous systems, including biological environments, have prompted the use of computational techniques to determine which methods are feasible to model such complex systems and to model the mechanism of binding action. In particular, Sevelamer Hydrochloride (Renagel®) is used as our model polymer. A relatively simple system is constructed with a dimer of Sevelamer Hydrochloride and four phosphate ions used for capture. This work reports on molecular dynamics and Monte Carlo simulations used to determine average structure, and points of intermolecular interaction, and calculate changes in volume after the successful capture of phosphate in our model. Our resulting volume changes are of the order of 20–25%, in comparison to experimental swelling measurements on similar systems, which have an average swelling of 50–60% in aqueous media.