Mechanistic Study of Enhanced Protonation by Chromium(III) in Electrospray Ionization: A Superacid Bound to a Peptide.

Addition of trivalent chromium, Cr(III), to solutions undergoing electrospray ionization (ESI) enhances protonation and leads to formation of [M + 2H]2+ for peptides that normally produce [M + H]+. This effect is explored using electronic structure calculations at the density functional theory (DFT) level to predict the energetics of various species that are potentially important to the mechanism. Gas- and solution-phase reaction free energies for glycine and its anion reacting with [Cr(III)(H2O)6]3+ and for dehydration of these species have been predicted, where glycine is used as a simple model for a peptide. For comparison, calculations were also performed with Fe(III), Al(III), Sc(III), Y(III), and La(III). Removal of water from these complexes, as would occur during the ESI desolvation process, results in species that are highly acidic. The calculated pKa of Cr(III) with a single solvation shell is -10.8, making [Cr(III)(H2O)6]3+ a superacid that is more acidic than sulfuric acid (pKa = -8.8). Binding to glycine requires removal of two aqua ligands, which gives [Cr(III)(H2O)4]3+ that has an extremely acidic pKa of -28.8. Removal of additional water further enhances acidity, reaching a pKa of -84.7 for [Cr(III)(H2O)]3+. A mechanism for enhanced protonation is proposed that incorporates computational and experiment results, as well as information on the known chemistry of Cr(III), which is substitutionally inert. The initial step involves binding of [Cr(III)(H2O)4]3+ to the deprotonated C-terminus of a peptide. As the drying process during ESI strips water from the complex, the resulting superacid transfers protons to the bound peptide, eventually leading to formation of [M + 2H]2+.

Technology Implementation and Curriculum Engagement for Children and Youth Who Are Deafblind.

The authors discuss the research of education professionals concerned with children and youth with deafblindness, presenting three theoretical frameworks and models useful for integrating technology into learning environments: (a) UDL (universal design for learning; Meyer, Rose, & Gordon, 2014), (b) SETT (student, environment, task, tools; Zabala, 2005), (c) SAMR (substitution, augmentation, modification, redefinition; Puentedura, 2014). Although the promise of technology in teaching children and youth with deafblindness is undisputed, a review of the extant research shows that little guidance is available on what technology tools may be efficacious and how these tools should be implemented. In the absence of research and in an age of rapid technological innovation, the authors suggest that all students with deafblindness will benefit if professionals use assistive and instructional technology frameworks to provide these children and youth access to and engagement in equitable learning experiences in inclusive settings.

Mass casualty following unprecedented tornadic events in the Southeast: natural disaster outcomes at a Level I trauma center.

On April 27, 2011, an EF4 (enhanced Fujita scale) tornado struck a 48-mile path across northwest Georgia and southeast Tennessee. Traumatic injuries sustained during this tornado and others in one of the largest tornado outbreaks in history presented to the regional Level I trauma center, Erlanger Health System, in Chattanooga, TN. Patients were triaged per mass casualty protocols through an incident command center and triage officer. Medical staffing was increased to anticipate a large patient load. Records of patients admitted as a result of tornado-related injury were retrospectively reviewed and characterized by the injury patterns, demographics, procedures performed, length of stay, and complications. One hundred four adult patients were treated in the emergency department; of these, 28 (27%) patients required admission to the trauma service. Of those admitted, 16 (57%) were male with an age range of 21 to 87 years old and an average length of stay of 10.9 ± 11.8 days. Eleven (39%) patients required intensive care unit admissions. The most common injuries seen were those of soft tissue, bony fractures, and the chest. Interventions included tube thoracostomies, exploratory laparotomies, orthopedic fixations, soft tissue reconstructions, and craniotomy. All 28 patients admitted survived to discharge. Nineteen (68%) patients were discharged home, six (21%) went to a rehabilitation hospital, and three (11%) were transferred to skilled nursing facilities. Emergency preparedness and organization are key elements in effectively treating victims of natural disasters. Those victims who survive the initial tornadic event and present to a Level I trauma center have low mortality. Like in our experience, triage protocols need to be implemented to quickly and effectively manage mass injuries.

Errors in administrative-reported ventilator-associated pneumonia rates: are never events really so?

Ventilator-associated pneumonia (VAP) is a common problem in an intensive care unit (ICU), although the incidence is not well established. This study aims to compare the VAP incidence as determined by the treating surgical intensivist with that detected by the hospital Infection Control Service (ICS). Trauma and surgical patients admitted to the surgical critical care service were prospectively evaluated for VAP during a 5-month time period. Collected data included the surgical intensivist's clinical VAP (SIS-VAP) assessment using Centers for Disease Control and Prevention (CDC) VAP criteria. As part of the hospital's VAP surveillance program, these patients' medical records were also reviewed by the ICS for VAP (ICS-VAP) using the same CDC VAP criteria. All patients suspected of having VAP underwent bronchioalveolar lavage (BAL). The SIS-VAP and ICS-VAP were then compared with BAL-VAP. Three hundred twenty-nine patients were admitted to the ICU during the study period. One hundred thirty-three were intubated longer than 48 hours and comprised our study population. Sixty-two patients underwent BAL evaluation for the presence of VAP on 89 occasions. SIS-VAP was diagnosed in 38 (28.5%) patients. ICS-VAP was identified in 11 (8.3%) patients (P < 0.001). The incidence of VAP by BAL criteria was 23.3 per cent. When compared with BAL, SIS-VAP had 61.3 per cent sensitivity and ICS-VAP had 29 per cent sensitivity. VAP rates reported by hospital administrative sources are significantly less accurate than physician-reported rates and dramatically underestimate the incidence of VAP. Proclaiming VAP as a never event for critically ill for surgical and trauma patients appears to be a fallacy.

The tempo of relationship progression among low-income couples.

This paper examines the factors associated with the tempo of low-income couples' relationship progression into sexual involvement and coresidence. Data come from a recently-collected survey, the Marital and Relationship Survey (MARS) that obtained information from low- to moderate-income married and cohabiting couples. Over one-fifth of male and female respondents reported becoming sexually involved with their current partner within the first week of dating. Entrance into shared living was also quite rapid; about one-third of respondents moved in with their partner within 6 months. Furthermore, about two-thirds of married respondents initially cohabited with their partners. Indicators of family disadvantage accelerated entrance into sexual involvement and coresidence; these effects are more pronounced for women than men. Our results also suggest that the pace of relationship progression, into sexual involvement as well as shared living, has accelerated among unions formed more recently.

The window, the river, and the novel: examining adolescents' conceptions of the past, the present, and the future.

Time perspective refers to thoughts and attitudes toward the past, the present, and the future and may underlie adolescents' decisions and behaviors about school and work. To develop a greater understanding of the topic we used focus group methodology to examine how adolescents conceptualized the past, the present, and the future. Nineteen adolescents aged 13 to 17 participated in six focus groups. Results from qualitative analyses suggested several patterns in adolescents' conceptualizations of the past, the present, and the future including absolute and fluid definitions, relations among temporal dimensions, and affective qualities. Further, responses were similar between genders, and included unsolicited mention of the relationship between socioeconomic status and time perspective. Findings are discussed in light of extant literature and directions are proposed for research on adolescent time perspective.

Exploring the elements of narrative that emerge in the interactions between an 8-year-old child who uses an AAC device and her teacher.

Narrative abilities have been identified as a link to successful school achievement and, in particular, to the acquisition of literacy. Children who use AAC may be at risk of impaired narrative facility due to the differences in their language learning experiences, limitation of their AAC systems, and limitations from constrained access to physical and social environments. In this study, the elements of narrative that emerged in the interactions between an 8-year-old child who used an AAC device and her teacher are described. This assessment was achieved through use of the Narrative Assessment Profile (Bliss, McCabe, & Miranda, 1998) in the context of five tasks designed to elicit a spectrum of narrative features. Results indicate that the interactions between the child and her teacher made it difficult to assess whether or not the child had control of certain features of narrative. From a purely structural analysis, most narrative discourse dimensions appeared to be severely compromised and therefore in need of immediate intervention. Discussion includes aspects of narrative intervention and suggested topics for further research.

Analysis of narratives produced by four children who use augmentative and alternative communication.

UNLABELLED: The ability to narrate a story is fundamental to the development of overall communicative competence and involves the coordination of a variety of knowledge structures and linguistic abilities. In this study, the narrative discourse abilities of four children who use AAC are described in the context of five tasks designed to elicit a spectrum of narrative skills. Assessment was achieved through application of the Narrative Assessment Profile tool [Bliss, L. S., McCabe, A., & Miranda A. E. (1998). Narrative assessment profile: Discourse analysis for school-age children. Journal of Communication Disorders, 31, 347-362.] and analysis of seven major story elements. Our results indicate that most narrative discourse dimensions in our participating children appeared to be compromised and in need of intervention. Discussion includes aspects of narrative intervention and suggested topics for further research. LEARNING OUTCOMES: The reader will be able to: (1) create a list of issues involved in the development of narrative abilities of children who depend on augmentative and alternative communication systems (AAC) and (2) describe the issues involved in assessing the narrative skills of children who use AAC.

The vulvodynia guideline.

OBJECTIVE: To provide a review of the literature and make known expert opinion regarding the treatment of vulvodynia. MATERIALS AND METHODS: Experts reviewed the existing literature to provide new definitions for vulvar pain and to describe treatments for this condition. RESULTS: Vulvodynia has been redefined by the International Society for the Study of Vulvovaginal Disease as vulvar discomfort in the absence of gross anatomic or neurologic findings. Classification is based further on whether the pain is generalized or localized and whether it is provoked, unprovoked, or both. Treatments described include general vulvar care, topical medications, oral medications, injectables, biofeedback and physical therapy, dietary changes with supplementations, acupuncture, hypnotherapy, and surgery. No one treatment is clearly the best for an individual patient. CONCLUSIONS: Vulvodynia has many possible treatments, but very few controlled trials have been performed to verify efficacy of these treatments. Provided are guidelines based largely on expert opinion to assist the patient and practitioner in dealing with this condition.