Tele-AAC Resolution.

Approximately 1.3% of all people, or about 4 million Americans, cannot rely on their natural speech to meet their daily communication needs. Telepractice offers a potentially cost-effective service delivery mechanism to provide clinical AAC services at a distance to the benefit of underserved populations in the United States and worldwide. Tele-AAC is a unique cross-disciplinary clinical service delivery model that requires expertise in both telepractice and augmentative and alternative communication (AAC) systems. The Tele-AAC Working Group of the 2012 ISAAC Research Symposium therefore drafted a resolution underscoring the importance of identifying and characterizing the unique opportunities and constraints of Tele-AAC in all aspects of service delivery. These include, but are not limited to: needs assessments; implementation planning; device/system procurement, set-up and training; quality assurance, client progress monitoring, and follow-up service delivery. Tele-AAC, like other telepractice applications, requires adherence to the ASHA Code of Ethics and other policy documents, and state, federal, and international laws, as well as a competent technological infrastructure. The Working Group recommends that institutions of higher education and professional organizations provide training in Tele-AAC service provision. In addition, research and development are needed to create validity measures across Tele-AAC practices (i.e., assessment, implementation, and consultation); determine the communication competence levels achieved by Tele-AAC users; discern stakeholders' perceptions of Tele-AAC services (e.g., acceptability and viability); maximize Tele-AAC's capacity to engage multiple team members in AAC assessment and ongoing service; identify the limitations and barriers of Tele-AAC provision; and develop potential solutions

Relationships of the Location and Content of Rounds to Specialty, Institution, Patient-Census, and Team Size

OBJECTIVE: Existing observational data describing rounds in teaching hospitals are 15 years old, predate duty-hour regulations, are limited to one institution, and do not include pediatrics. We sought to evaluate the effect of medical specialty, institution, patient-census, and team participants upon time at the bedside and education occurring on rounds. METHODS AND PARTICIPANTS: Between December of 2007 and October of 2008 we performed 51 observations at Lucile Packard Children's Hospital, Seattle Children's Hospital, Stanford University Hospital, and the University of Washington Medical Center of 35 attending physicians. We recorded minutes spent on rounds in three location and seven activity categories, members of the care team, and patient-census. RESULTS: Results presented are means. Pediatric rounds had more participants (8.2 vs. 4.1 physicians, p<.001; 11.9 vs. 2.4 non-physicians, p<.001) who spent more minutes in hallways (96.9 min vs. 35.2 min, p<.001), fewer minutes at the bedside (14.6 vs. 38.2 min, p = .01) than internal medicine rounds. Multivariate regression modeling revealed that minutes at the bedside per patient was negatively associated with pediatrics (-2.77 adjusted bedside minutes; 95% CI -4.61 to -0.93; p<.001) but positively associated with the number of non-physician participants (0.12 adjusted bedside minutes per non physician participant; 95% CI 0.07 to 0.17; p = <.001). Education minutes on rounds was positively associated with the presence of an attending physician (2.70 adjusted education minutes; 95% CI 1.27 to 4.12; p<.001) and with one institution (1.39 adjusted education minutes; 95% CI 0.26 to 2.53; p = .02). CONCLUSIONS: Pediatricians spent less time at the bedside on rounds than internal medicine physicians due to reasons other than patient-census or the number of participants in rounds. Compared to historical data, internal medicine rounds were spent more at the bedside engaged in patient care and communication, and less upon educational activities

Systematic and Controllable Negative, Zero, and Positive Thermal Expansion in Cubic Zr1–xSnxMo2O8

We describe the synthesis and characterization of a family of materials, Zr1–xSnxMo2O8 (0 < x < 1), whose isotropic thermal expansion coefficient can be systematically varied from negative to zero to positive values. These materials allow tunable expansion in a single phase as opposed to using a composite system. Linear thermal expansion coefficients, αl, ranging from −7.9(2) × 10–6 to +5.9(2) × 10–6 K–1 (12–500 K) can be achieved across the series; contraction and expansion limits are of the same order of magnitude as the expansion of typical ceramics. We also report the various structures and thermal expansion of “cubic” SnMo2O8, and we use time- and temperature-dependent diffraction studies to describe a series of phase transitions between different ordered and disordered states of this material

Androgen Receptor Functional Analyses by High Throughput Imaging: Determination of Ligand, Cell Cycle, and Mutation-Specific Effects

Understanding how androgen receptor (AR) function is modulated by exposure to steroids, growth factors or small molecules can have important mechanistic implications for AR-related disease therapies (e.g., prostate cancer, androgen insensitivity syndrome, AIS), and in the analysis of environmental endocrine disruptors.We report the development of a high throughput (HT) image-based assay that quantifies AR subcellular and subnuclear distribution, and transcriptional reporter gene activity on a cell-by-cell basis. Furthermore, simultaneous analysis of DNA content allowed determination of cell cycle position and permitted the analysis of cell cycle dependent changes in AR function in unsynchronized cell populations. Assay quality for EC50 coefficients of variation were 5–24%, with Z' values reaching 0.91. This was achieved by the selective analysis of cells expressing physiological levels of AR, important because minor over-expression resulted in elevated nuclear speckling and decreased transcriptional reporter gene activity. A small screen of AR-binding ligands, including known agonists, antagonists, and endocrine disruptors, demonstrated that nuclear translocation and nuclear “speckling” were linked with transcriptional output, and specific ligands were noted to differentially affect measurements for wild type versus mutant AR, suggesting differing mechanisms of action. HT imaging of patient-derived AIS mutations demonstrated a proof-of-principle personalized medicine approach to rapidly identify ligands capable of restoring multiple AR functions.HT imaging-based multiplex screening will provide a rapid, systems-level analysis of compounds/RNAi that may differentially affect wild type AR or clinically relevant AR mutations

Morphology of the Faial Island shelf (Azores): the interplay between volcanic, erosional, depositional, tectonic and mass-wasting processes

[1] The extents of volcanic island shelves result from surf erosion, which enlarges them, and volcanic progradation, which reduces them. However, mass‐wasting, tectonics and sediment deposition also contribute to their morphology. In order to assess the relative significance of these various processes, we have mapped in detail Faial Island's shelf in the Azores archipelago based on interpretation of geophysical and geological data. The nearshore substrates of the island, down to 30–50 m depth, are rocky and covered by volcaniclastic boulder deposits formed by surf action on now‐submerged lava flows. Below those depths, sandy and gravel volcaniclastic beds dominate, building clinoforms up to the shelf edge. In some sectors of the coast, prograding lava has narrowed the shelf, but, in contrast to nearby Pico Island, we find fewer submarine‐emplaced lavas on the shelf. In this island, we interpret the distance between the coastline and the shelf edge as almost entirely a result of a straightforward competition between surf erosion and lava progradation, in which erosion dominates. Therefore shelf width can be used as a proxy for coastline age as well as for wave energy exposure. The stratigraphy of shelf deposits in boomer seismic data is examined in detail to assess the roles of different sediment sources, accommodation space and wave exposure in creating these deposits. We also show evidence of mass‐wasting at the shelf edge and discuss the possible origins of slope instability. Finally, we discuss the contributing role of tectonics for the development of the shelf.publishe

Evolution of Negative Thermal Expansion and Phase Transitions in Sc_1‑xTi_<i>x</i>F₃

The cubic ReO₃-type material ScF₃ exhibits strong isotropic negative thermal expansion (NTE) over a wide temperature range while remaining cubic. Control of its thermal expansion was investigated by forming Sc_1‑<i>x</i>Ti_<i>x</i>F₃ solid solutions, which were characterized by synchrotron powder diffraction at ambient pressure from 100 to 500 K. TiF₃ is fully soluble in ScF₃ at a synthesis temperature of 1338 K. The temperature for the cubic-to-rhombohedral phase transition in Sc_1‑<i>x</i>Ti_<i>x</i>F₃ varies linearly with composition (above 100 K), and, at large <i>x</i>, the transition is clearly first-order. The rhombohedral phase for each composition examined exhibits strongly positive thermal expansion, while the expansion of the cubic phase (between 420 and 500 K) is negative for all Sc_1‑<i>x</i>Ti_<i>x</i>F₃

Instrument accuracy in reactor vessel inventory tracking systems

Instrumentation needs for detection of inadequate core cooling. Studies of the Three Mile Island accident identified the need for additional instrumentation to detect inadequate core cooling (ICC) in nuclear power plants. Industry studies by plant owners and reactor vendors supported the conclusion that improvements were needed to help operators diagnose the approach to or existence of ICC as well as to provide more complete information for operator control of safety injection flow to minimize the consequences of such an accident. In 1980, the US Nuclear Regulatory Commission (NRC) required further studies by the industry and described ICC instrumentation design requirements that included human factors and environmental considerations. On December 10, 1982, NRC issued to Babcock and Wilcox (B and W) licensees orders for Modification of License and transmitted to pressurized water reactor licensees Generic Letter 82-28 to inform them of the revised NRC requirements. The instrumentation requirements include upgraded subcooling margin monitors (SMM), upgraded core exit thermocouples (CET), and installation of a reactor coolant inventory tracking system. NRC Regulatory Guide 1.97, which covers accident monitoring instrumentation, was revised (Rev. 3) to be consistent with the requirements of item II.F.2 of NUREG-0737