bluuebunny/crossref_metadata_2025 huggingface dataset:
The Interchurch World Movement and the Christening of the Open Shop
Authors: Drake Janine Giordano
Published: August 2023

If clerics of the Federal Council of Churches had previously argued that that they were workers’ mouthpiece, that their churches were nexuses of social justice, and that workers were entitled to a living wage, they now changed their tune considerably. In this postwar moment, ministers of the Federal Council used their nationwide church revival movement, the Interchurch World Movement, to distract from the union focus of the Great Steel Strike. The clergy argued that a nonunion workplace, characterized by a “Christian brotherhood” among workers and employees, would establish justice better than any union. They normalized a white Christian patriarchy and shifted the focus of their reform mission from the “worker” to the working-class “family.” This Protestant vision of postwar justice gambled on the expectation of clergy’s perpetual civic authority to persuade business leaders to do the right thing. As it turned out, their moral suasion would last only long enough to dismantle the Christian moral authority of unions.
The Birth of the Civil Police in London, 1829
Authors: Go Julian
Published: August 2023

This chapter examines the birth of the “civil police” model with the creation of the London Metropolitan Police in 1829. It illuminates how the racialization of crime and disorder, precipitated by the arrival of new Irish migrants to England’s shores, triggered the formation of this novel form. The inventors of the civil police, including Sir Robert Peel and Sir Charles Rowan, acted as imperial importers, drawing upon colonial forms and operations from the British Caribbean and Ireland as they created the new police, thereby bringing the colonial boomerang to London. This chapter further shows the birth of the associated civil police ideal. As creators of the police appropriated colonial forms for domestic policing, they made efforts to cover them up, performing “civility” to legitimate the new police.
First Sounds on the Neck/Mouthpiece
Authors: Adams Allison D. , Horner Brian R.
Published: August 2023

Chapter 5 guides students through their first sounds on the saxophone. To avoid the many obstacles presented by using the instrument as a whole, this first step uses the neck and mouthpiece.
Altissimo
Authors: Adams Allison D. , Horner Brian R.
Published: August 2023

Chapter 38 provides tips and exercises for learning to play in the saxophone’s altissimo register.
Saxophone Equipment
Authors: Adams Allison D. , Horner Brian R.
Published: August 2023

Chapter 44 contains information to help teachers advise students as they navigate the many brands of saxophones, mouthpieces, reeds, ligatures, and other gear.
From Wild Violence to Courtly Rituals
Authors: Drummond Hugh
Published: August 2023

When vertebrate infants grow up with siblings, they compete for food, and they may do this using diverse modes of aggression or by going directly for the food. The brown booby’s unconditional aggression and the blue-foot’s dominance-subordination with conditional aggression contrast with the cattle egret’s pairwise battles ending in concession by the younger chick. Oystercatcher chicks are mobile enough to mostly avoid the fierce aggression of higher-rank siblings. In crested ibis broods, nestlings take turns dominating their sibs with real and fake pecks and getting fed. The self-feeding chicks of game birds and waterfowl compete non-aggressively by going directly for the food on the substrate but establish dominance hierarchies. In birds and mammals, the factors that have shaped the evolution and expression of sibling aggression and hierarchy formation include infant locomotor ability, number of sibs, subordinates’ prospects of surviving, spatiotemporal distribution of food or teats, and capacity for individual recognition.
And the Lots Were Cast
Authors: Dailey E. T.
Published: August 2023

This chapter recounts the unfortunate turns of fate that Radegund experienced in her early years, and the manner in which she may have come to reconcile a series of tragedies with her belief in the omnipotent Christian God (and the texts that she may have used, perhaps second hand, in this process). After describing Radegund’s homeland of Thuringia, the chapter narrates the Frankish conquest of 531, taking a critical approach to the details of the account given by Gregory of Tours. The chapter cautiously raises the possibility that Radegund may have suffered from survivor’s guilt, before turning to her years as a captive of Chlothar, raised in his royal villa in Athies. It seeks to answer questions about her status, treatment, education, and religious formation. Finally, the chapter turns to her wedding with the king, deciphering an enigmatic passage in Fortunatus’s Life of Radegund, demonstrating how Radegund used the little leverage she had to ensure that she became a recognized queen, and detailing the challenges she faced from the other women in Chlothar’s life.
Oil in Oil-Poor States
Authors: Hansen Randall
Published: August 2023

The OPEC oil crisis destroyed import substitution industrialization and forced Arab states to embrace neoliberalism. Oil-price-driven inflation led to economic stagnation in Egypt, and Sadat, in response, embraced neoliberal capitalism. He entered a cynical partnership with political Islamists for support, but when his economic program resulted in poverty and inequality, criticism grew, and Sadat ended his alliance with the Islamists, repressing his former allies. Islamist opposition only expanded. When that resistance was violent, the state responded with more violence, creating a cycle of oppression, recruitment, violence, more oppression, and more violence that lasted into the 1990s.
Drunk on Oil and Gas
Authors: Hansen Randall
Published: August 2023

The Soviet invasion of Afghanistan had multiple causes, but oil—and gas—were among them. Oil prices escalated once again following the Iranian Revolution, and they led to petromania in Moscow—a delusional belief that all difficulties could be overcome. At the same time, the Soviet Union feared that the collapse of a puppet regime in Kabul would lead to the loss of cheap—effectively stolen—Afghan gas. The Soviets invaded, leading to massive Afghan resistance. Moscow responded by drenching the countryside in bombs and mines, creating 6 million refugees. They fled to Iran and Pakistan, becoming cheap migrant labor in both and, in the latter, future recruits for the Taliban, al-Qaeda, and the latter’s still more violent and nihilistic offshoot, the Islamic State of Iraq and the Levant (ISIL).
How We Live
Authors: Hansen Randall
Published: August 2023

The year 1973 was a turning point in the demand for migrant domestic labor. As millions of educated women entered Western workforces, and demand for domestic labor exploded with oil prices in the Gulf States, households turned to migrant domestic laborers. Today, there are 75.6 million documented domestic workers worldwide; 76.2% of them are women. Over 13 million (17%) are migrants. The basic dynamic—a demand for low-skilled labor that cannot be filled by citizens, leading to cheap migrant labor—shares much with the other sectors examined in this book. There are, nonetheless, two differences. Unlike meatpacking, garment and textiles, retail, construction, and (briefly) agriculture, there was no golden age of unionization. There were very few domestic workers during the high point of American and European industrial unionization in the 1950s and 1960s. Migrant domestic workers have always had few rights and are, either because legislation enables it or because the private sphere is difficult to police, subject to extensive exploitation.
Conflicts in Relation to Private Law Administration
Authors: Smith Lionel
Published: August 2023

This chapter examines conflicts of interest: that is, conflicts of self-interest and duty to another in respect of an other-regarding power. It also addresses the related topic of conflicts between multiple duties in respect of other-regarding powers. A crucial part of the argument is that these rules are closely linked to the requirements of loyalty discussed in the preceding chapter: loyalty forbids the use of administrative powers for selfish ends, but conflicts make it impossible to know whether this is exactly what has happened. The argument here draws on long juridical suspicion of conflict situations, and also on recent psychological and ethical research to explain the link between the requirements of loyalty and the rules on conflicts. It goes on to distinguish actual and potential conflicts, as well as apparent and trivial conflicts; and to explore the legal consequences of acting while in a conflict and how conflicts can be managed.
Conclusion
Authors: Smith Lionel
Published: August 2023

The concluding chapter synthesizes and summarizes the argument and its implications. The argument that there are common principles governing other-regarding powers in public and private law implies that it is a mistake to draw too fundamental a distinction between private law and public law. These are deeply different domains of law, and yet, the argument goes, they are united under the application of the less well-known distinction between the law governing situations where we act for ourselves, and the law governing situations where we act for others. As explained in previous chapters, the fundamental difference between the public and private context lies in enforcement mechanisms.
Omnisubjectivity
Authors: Zagzebski Linda Trinkaus
Published: August 2023

This book explains and defends the idea that the God of the monotheistic religions has the property of omnisubjectivity, the property of perfectly grasping every conscious state of every conscious being from the first-person perspective of the subject. God not only knows all objective facts, such as the fact that someone is in pain, but God is present in the pain, grasping it the way the bearer of the pain grasps it. The book argues that this attribute is entailed by omniscience, omnipresence, divine love, and divine justice, and it is presupposed in common practices of prayer. Three models of omnisubjectivity are described: the empathy model, the perceptual model, and panentheism. The book then defends the idea that omnisubjectivity extends to the possible but non-actual conscious states of all possible conscious beings. God grasps all possible subjective states in his imagination. The book then shows how the Christian form of the attribute of omnisubjectivity affects the doctrines of the Trinity, the Incarnation, and the infusion of the Holy Spirit. The book concludes that subjectivity and intersubjectivity are deep in the universe, deeper than the universe as it is objectively described.
Interatomic Potentials with Electron Temperature
Authors: Moriarty John A.
Published: August 2023

In Chapters 7 and 8, the high temperature (T) properties of metals were treated in the conventional weak-coupling limit, where zero-T quantum-based interatomic (QBIPs) are applied to obtain the thermal components of thermodynamic properties in the solid as well as the liquid. In this chapter, we consider the alternative strong-coupling limit, where the ion and electron temperatures are treated on an equal footing, leading to explicit T-dependent QBIPs. Such a strong-coupling treatment can be important for narrow-band 3d and 4d transition metals near melt due to their high density of electronic states and corresponding large observed specific heats. Here the generalized pseudopotential theory (GPT) of QBIPs is first extended to finite electron temperature within the rigorous Mermin formulation of density functional theory. For a Mo prototype, T-dependent model-GPT potentials have then been developed for optimized noncanonical d bands and applied to the simulation of the high-pressure melt curve, a result that is found to be in excellent agreement with both experiment and full quantum molecular dynamics simulations.
Law and Social Practice: Foundations of the Leap of Faith
Authors: Thomas Jean
Published: August 2023

This chapter locates legal normativity in social normative practice. Gardner’s jurisprudence points to the ‘Euthyphro’ gap between legal and moral points of view. This insight suggests that if one accepts both (1) law’s moral potential and (2) its social foundations, then our account of legal normativity ought to allow for the possibility of making the ‘leap’ from one point of view to the other—moving from a non-ideal case to one in which law fulfils its moral potential. Gardner suggests that the leap of faith enabling this lies in law’s source of validity. Whereas Gardner envisions that source in a presupposition, this chapter focuses on social normative practice. This requires that norms be transmitted socially. Social normative practice involves the transfer of the internal point of view itself from one person to another, and is possible because of the affective and associational ties people have to one another.
Gardner’s Pluralistic Virtue Jurisprudence
Authors: Amaya Amalia
Published: August 2023

John Gardner is not identified with virtue jurisprudence, even though his work provides important insights on virtue and law. This chapter focuses on one main tenet of his virtue jurisprudence, namely, the claim that virtues are foils to each other. Gardner’s virtues-as-foils view is an original thesis that illuminates important aspects of the nature, structure, and phenomenology of virtue. Nonetheless, it is also problematic. It is in tension with central tenets of virtue theory, that is, that virtues are constitutive components of the good life and that the virtuous person embodies a valuable normative ideal; it is also questionable from a phenomenological and developmental point of view; and it has troubling implications as an account of institutional virtue. Despite these problems, the virtues-as-foils thesis is of paramount importance for virtue-oriented work in law, in that it paves the way for the development of a pluralistic version of virtue jurisprudence.
Rape Trauma and Rape’s Wrongness
Authors: Greasley Kate
Published: August 2023

In a widely discussed article co-authored with Stephen Shute, John Gardner offered a persuasive argument to the effect that the core wrongness of rape is not, as it seems, a function of the harmfulness of rape, but of something else: the rapist’s sheer sexual use of the victim, which is potentially harmless. In subsequent writing, partly in response to criticisms, Gardner sought to restate and clarify his view about the role of rape trauma in rape’s wrongness. A guiding thought in both his earlier and his later work is that the reasonableness of distress and anguish as a response to rape suggests that those reactions respond to and evaluate a prior, harm-independent wrong, thus revealed as the more basic wrong of rape. More strongly, he argued, we must agree that rape trauma is only epiphenomenal to, or derivative of, rape’s basic wrongness, if we are to affirm the rationality of rape victims. In this reappraisal, I focus most attention on this intriguing argument. Drawing on a comparison with the wrong of emotional abuse, I interrogate this argument about reasonable reactions and consider how to soften the choice it presents between affirming the rationality of rape victims and allowing some role for rape trauma in grounding the distinctive wrongness of rape.
Origins of object concepts in infancy: A perceptual account
Authors: Johnson Scott P. , Gavin Bremner J. , Slater Alan M.
Published: August 2023

One prominent cognitive developmental theory proposed that concepts of objects as coherent, enduring, and stable are constructed as infants gain experience interacting with objects and observing the consequences of object-oriented actions. An alternative account of object knowledge in infancy is based on the assumption that infants possess innate core knowledge of objects with which they reason about observed events. Here, a perceptual account of development of object concepts is proposed. On the perceptual account, young infants’ perception of object unity and that of object persistence, two foundations of mature object concepts, are susceptible to perceptual constraints such that young infants require a combination of cues to perceive unity or persistence across occlusion. Young infants thus perceive object persistence only under limited conditions, and over the early months, perception of persistence becomes more robust. In the chapter, the authors argue that these perceptual developments within the first six postnatal months likely underpin the later development of cognitive principles, including object concepts, and present substantial empirical support for the perceptual account.
Smelling odours and tasting flavours: Distinguishing orthonasal smell from retronasal olfaction
Authors: Young Benjamin D.
Published: August 2023

The olfactory system contains two senses that share the same type of stimuli, sensory transduction mechanism, and processing centres. Yet, orthonasal and retronasal olfaction differ in their types of perceptible objects as individuated by their sensory qualities. What will be explored is how the account of orthonasal smell developed in the Molecular Structure Theory of smell can be expanded for retronasal olfaction. Surveying the differences between orthonasal and retronasal olfaction provides the basis for the central argument that the perceptible objects we refer to as smells and individuated on the basis of their olfactory qualities are only relative to orthonasal olfaction. Retronasal olfaction, it is speculatively concluded, might play an essential role in our perception of flavourful objects.
Visuo-haptic object processing in the multisensory brain
Authors: Lacey Simon , Sathian K.
Published: August 2023

It is now over 20 years since the old orthodoxy of the brain as organized around discrete sensory channels feeding into higher-order multisensory convergence zones was challenged by the concept of a ‘metamodal’ brain with an inherently multisensory, task-based organization. This chapter concentrates on interactions between vision and touch in object perception and recognition, and the neural bases of such interactions. The chapter discusses the evidence for a model of visuo-haptic object recognition that takes into account object familiarity and the idea that visual imagery comprises object and spatial dimensions, and the resulting inferences that can be drawn about the underlying representation of object shape.
Sensitivity auditing
Authors: Piano Samuele Lo , Sheikholeslami Razi , Puy Arnald , Saltelli Andrea
Published: August 2023

Mathematical models that draw inference from real systems are often used to inform policy-making processes. However, system complexity and uncertainties require effective tools to ensure the credibility of a model. Critical aspects include acknowledging the conditionality of model-based knowing and refraining from overinterpreting the results. We show that sensitivity auditing, an extension of sensitivity analysis to the entire cycle of model framing and building, is an effective means to scrutinize policy-relevant modelling activities, including forms of quantifications such as metrics, indicators, and rankings. Sensitivity auditing, that is also inspired by the epistemology of post-normal science, calls on modellers to examine the assumptions during model construction and operation, including those relating to the identification of the nature of the problem and of the policy context. In this contribution, we present four real-world applications of sensitivity auditing in public health, education, human–water systems, and food provision systems.
Mathematical modelling, rule-making, and the COVID-19 pandemic
Authors: Xu Ting
Published: August 2023

The COVID-19 pandemic brought to light the need to rethink the ways in which rules and decisions are made and what rule-making can achieve under conditions of uncertainty. Among the recommendations put forward by a recent Manifesto is to ‘pay attention to the unknowns’. This forces us to examine three interrelated questions: what is the nature of mathematical modelling? What kinds of uncertainty are there in the contested arena of science for rule-making? What ideas and approaches can help us better address the interaction between mathematical modelling and rule-making under conditions of uncertainty? This chapter addresses these three questions in detail.
Mechanism of ozone alleviation of malignant ascites in hepatocellular carcinoma through the inhibition of neutrophil extracellular traps
Authors: Han Feng , Guo Jiayou , Mu Mingchen , Bian Ka , Cui Zhenting , Duan Qiong , Ma Jianxin , Jin Lai , Liu Wentao , Chen Fanghong
Published: August 2023

Malignant ascites in hepatocellular carcinoma is usually a sign of advanced disease and poor prognosis and is also thought to be associated with chronic inflammation mediated by neutrophil extracellular trap (NET) networks. Although ozone, a strong oxidant, has significant antibacterial and anti-inflammatory effects, its effectiveness in treating malignant liver ascites is unclear. We first measured the levels of NETs in the peripheral blood of patients with liver cancer and healthy individuals. Next, we constructed the H22 tumor-bearing mouse model and observed the abdominal girth, body weight, survival rate, and survival time in each group; we marked the proteins associated with NETs in mouse intestinal tissues by immunofluorescence; cf-DNA and cytokines in ascites such as: tumor necrosis factor alpha (TNF-α), vascular endothelial growth factor (VEGF), interleukin 6 (IL-6), matrix metalloprotein 9 (MMP-9), and interferon gamma (IFN-γ) levels in ascites were measured by enzyme-linked immunosorbent assay. The expression levels of phosphorylated adenylate-activated protein kinase (P-AMPK) and scavenger receptor-A (SR-A) were detected by immunocytochemistry in the intestinal tissues of each group of mice. We further examined the expression of P-AMPK and SR-A proteins in ascites deposits by Western blotting. The results show, the plasma levels of NETs were higher in patients with hepatocellular carcinoma than in normal subjects (P < 0.01). Abdominal girth and body weight were significantly reduced in the ozone-treated group compared with the model group, while survival and survival time were dose dependently increased (both P < 0.05). NET-associated guanine histone H3 and myeloperoxidase were abundantly expressed at neutrophil aggregates in the intestinal tissues of the model mice, whereas their expression was significantly reduced in the ozone-treated group. The levels of cf-DNA, IL-6, IFN-γ, MMP-9, VEGF, and TNF-α were dose dependently increased in the ascites of H22 tumor-bearing mice in the ozone-treated group compared with the model group (all P < 0.01), while the expression of P-AMPK and SR-A proteins was increased in the ozone-treated group compared with the model group. Ozone showed significant antiperitoneal fluid production properties in H22 tumor-bearing mice, and ozone reduced peritoneal fluid production by activating AMPK and up-regulating SR-A phagocytosis damage-associated molecular patterns to reduce the production of NETs. This suggests that ozone could be used as a new drug for the treatment of malignant ascites in hepatocellular carcinoma.
The tobacco quitline setting as a teachable moment: The Educating Quitline Users About Lung (EQUAL) cancer screening randomized trial
Authors: Webster Marguerite , Whealan Julia , Williams Randi M , Eyestone Ellie , Le Ariel , Childs Jack , Kao Jen-Yuan , Martin Maria , Wolfe Sara , Yang Felice , Hung Pei-Yao , Lau Yan Kwan , Luta George , Tammemagi Martin , Meza Rafael , Taylor Kathryn L
Published: August 2023

Although lung cancer screening (LCS) using low-dose CT is recommended for high-risk individuals, screening adherence remains low. We conducted a randomized trial to compare two methods of providing LCS education to Maryland Tobacco Quitline (MTQ) callers in order to assess whether this setting may serve as a teachable moment for LCS-eligible individuals. MTQ callers (50–80 years, 20+ pack-years, prior LCS ≥12 months) completed the baseline and were randomized to the Print- or Web-based version of ShouldIScreen.com. Participants completed 1- and 4-month follow-up assessments to evaluate intervention engagement and LCS-related outcomes. Participants (Print = 152, Web = 146) were 61.7 (SD = 6.3) years old and reported 63.5 pack-years (SD = 36.0). Most identified as Black (54.2%), female (66.1%), having internet access (78.9%), completing other recommended cancer screenings (86.3%), and that they would undergo LCS if recommended by their provider (91.3%). By 4 months, significantly more Print (75.0%) than Web (61.6%) participants had read the materials (P = .01). Most reported the interventions contained “the right amount” of information (92.6%) and prepared them to talk with their doctor (57.2%). Regarding screening-related outcomes, 42.8% (Print) and 43.8% (Web) had scheduled or completed a low-dose CT scan or a shared decision-making visit (P = .86). In a racially diverse sample of LCS-eligible quitline callers, offering LCS educational materials resulted in high intervention engagement and screening-related appointments. As >20% did not have internet access, providing participants’ preferred modality (web/print) may improve intervention engagement and knowledge. Improving LCS awareness represents an important opportunity to increase screening among eligible but unscreened quitline callers.
Individual, socioeconomic and healthcare access factors influencing the delays in leprosy presentation, diagnosis and treatment: a qualitative study
Authors: de Oliveira Serra Maria Aparecida Alves , da Silva Regiane Aquino Alves , Monari Flavia Ferreira , Silva Julianna Oliveira e , de Sá Junior Jurandir Xavier , Silva Roberta de Araújo e , Fontoura Iolanda Graepp , Neto Marcelino Santos , de Araújo Márcio Flávio Moura
Published: August 2023

Background

This study investigated the factors influencing the presentation, diagnosis and treatment of leprosy in primary healthcare.

Methods

Qualitative research was conducted on patients undergoing treatment in a priority hyperendemic region for leprosy control in northeastern Brazil. Interviews were conducted between September and December 2020 at primary healthcare centers. Data were analysed based on the basic interpretive qualitative structure according to Andersen and Newman's model of healthcare utilisation.

Results

Knowledge of leprosy symptoms influenced patients' search for a diagnosis. Unfavorable socioeconomic conditions experienced by patients made diagnosis and treatment difficult. Incorrect evaluations by health professionals caused difficulties and delays in obtaining a diagnosis of leprosy. Perceptions about the disease, such as non-acceptance of the disease and the adverse effects of the medications, affected treatment seeking and treatment continuity.

Conclusions

Patients with leprosy faced delays and healthcare access barriers related to knowledge of the disease, socioeconomic conditions and the structure of healthcare services, which must be considered when creating care plans, surveillance and control actions against leprosy. Appropriate interventions are necessary to reduce delays and better control the disease.
The significance of a forum selection agreement as an indicator of the implied choice of law in international contracts: a global comparative perspective
Authors: Okoli Chukwuma Samuel Adesina
Published: August 2023

Where the parties to an international contract fail to specify the choice of law, a forum selection agreement is one of the most, if not the most, significant factors to consider in implying the choice of law in many international, supranational, regional instruments, and national jurisdictions. However, it is an ill-defined, notoriously complex, and hotly debated issue as to the weight that should be attached to a forum selection agreement in implying the choice of law. Hence, this article is devoted to discussing this topic from a comparative perspective, in order to propose a guide to global uniform criteria. To achieve this, the article covers all relevant international, regional, and supranational instruments, and selected legal systems in Africa, Asia, Australasia, Europe, the Middle East, and North and South America. The legal systems compared include those from the global North and global South, including common law, civil law, and mixed legal systems. The article’s core proposal is that an exclusive forum selection agreement should be a key factor in implying the choice of law. However, except in such cases as where a forum is chosen on a neutral basis, there should be a general requirement of corroboration with at least one other factor of significance. The aim of the proposal is to contribute to greater uniformity, predictability, and certainty in the global community in this field of law.
Change in Peak Oxygen Uptake Predicted by the Moderate 1-km Treadmill Walking Test After Walking Training in Outpatients With Cardiovascular Disease
Authors: Raisi Andrea , Bernardi Eva , Myers Jonathan , Piva Tommaso , Zerbini Valentina , Masotti Sabrina , Menegatti Erica , Caruso Lorenzo , Mazzoni Gianni , Grazzi Giovanni , Mandini Simona
Published: August 2023

Purpose:

The purpose of this study was to determine the ability of the moderate 1-km treadmill walking test (1km-TWT) to predict changes in peak oxygen uptake (V˙O2peak) in patients with stable cardiovascular disease (CVD) during an exercise-based secondary prevention program.

Methods:

Sixty-four male outpatients with stable CVD (age 64 [41-85] yr) performed the 1km-TWT before and after an 8-wk walking training program. Patient V˙O2peak was estimated using a sex-specific equation including age, body mass index, 1km-TWT performance time, and heart rate (V˙O2peakEST). Forty-one patients completed a maximal cardiopulmonary treadmill test (CPX) for direct V˙O2peak determination (V˙O2peakMEAS). The training prescription consisted of moderate-to-high intensity supervised walking for 30-40 min/session, and an additional 2-4 times/wk of unsupervised home moderate walking sessions between 20-60 min at the end of the program. The walking intensity was based on the results of the 1km-TWT.

Results:

Patients participated in an average of 14 of the 16 supervised sessions. An overall significant improvement in V˙O2peakMEAS and weekly recreational physical activity levels were observed. No differences were observed between V˙O2peakMEAS and V˙O2peakEST. Compared with CPX results, the 1km-TWT underestimated the V˙O2peak increase after the exercise intervention (mean difference −0.3 mL/kg/min, P > .05).

Conclusions:

The 1km-TWT provides a reasonably accurate and simple tool to predict changes in V˙O2peak due to moderate walking training in male outpatients with CVD. These findings contribute to the growing body of evidence supporting the use of the 1km-TWT for exercise testing and training purposes in the context of cardiac rehabilitation/secondary prevention programs.
Travel nurses and patient outcomes
Authors: Vander Weerdt Candice , Peck Jessica A. , Porter Tracy
Published: August 2023

Background

The unprecedented use of travel and temporary nurses in recent years requires further investigation of the impact on patient care.

Purpose

We conducted a systematic review of empirical research investigating the relationship between travel nurses and patient care to identify if consistent significant associations exist and how structural and process variables may influence such associations.

Methods

A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of six databases resulted in the identification of 21 relevant articles.

Results

The existing research of travel nurse use differs widely in terms of the definition of travel nurse, study design, and included controls. The literature has failed to establish a consistent relationship between travel nurses and patient outcomes. Adverse associations between travel nursing and patient care may reflect staffing levels or work environments rather than the specific care by the travel nurses themselves.

Practice Implications

Underlying structural and process variables, such as staffing levels and the practice work environment, may be confounding associations between travel nurse usage and quality patient care. Administrators and managers are urged to assess staffing and the work environment when employing travel nurses.
Validation Testing of a New Crutch Tip Biofeedback Device for Prescribed Lower Extremity Weight-Bearing
Authors: Brueilly Kevin E. , Feller Amanda M. , Ahearn Jonathan M. , Goodwin Jonathan S.
Published: August 2023

Introduction:

Modified weight-bearing recommendations are commonly prescribed after surgical intervention for injuries to the lower extremity to reduce the risk of nonunion and delayed healing associated with load bearing through the injured limb and to combat the deleterious effects of immobility. The physical therapist (PT) in the acute care setting is likely to instruct patients after lower extremity injury in weight-bearing-restricted ambulation. A new device is now available for use in the training of weight-bearing status. The study examines whether the ComeBack Mobility crutch tip reporting weight-bearing on the lower extremity is a reliable and valid tool in determining force when compared with the gold standard force plate measurement of lower extremity weight-bearing.

Review of Literature:

Previous studies have shown that patients are often not able to adequately learn or adhere to restrictive weight-bearing modifications. This may be due to an inability to provide immediate and ongoing feedback on weight-bearing. The new ComeBack Mobility crutch tip system is now available for the acute care PT to use in instruction and for patients to receive real-time feedback throughout their rehabilitation process.

Subjects:

A sample of convenience of 6 able-bodied PTs was used.

Methods:

Each subject performed 30 trials of axillary crutch-assisted weight-bearing ambulation using the new device. The weight-bearing reported by the device was compared with the weight-bearing measured through force plates via correlations, t tests, and Bland-Altman plot.

Results:

The new device demonstrated moderate-good reliability in the measurement of non-weight-bearing and 50% partial weight-bearing in trials completed.

Discussion and Conclusion:

The ComeBack Mobility crutch tip system could be useful and should be considered for clinical use as a reliable and valid tool in providing auditory feedback for compliance to a prescribed weight-bearing protocol. The system could be useful in the training of patients in the first use of crutches such as prior to discharge from an acute care hospital. Further research is needed with clinical populations as well as with varied weight-bearing protocols.
The Effect of a Biofeedback-Based Integrated Program on Improving Orthostatic Hypotension in Community-Dwelling Older Adults
Authors: Han Jeonghwa , Park Jooyeon , Kang Hyunwook , Lee Hyung , Kim Nahyun
Published: August 2023

Background

Orthostatic hypotension (OH) is prevalent among community-dwelling older adults and is associated with multiple negative health outcomes. Older adults are susceptible to developing OH because aging alters autonomic nervous system function. Biofeedback is a noninvasive, nonpharmacological intervention that can modulate autonomic nervous system dysfunction in older adults.

Objectives

Our aim in this study was to examine the effect of a biofeedback-based integrated program on community-dwelling older adults with OH.

Methods

We conducted a controlled pilot study. Community-dwelling older adults 65 years or older who had nonneurogenic OH were eligible. Data from 51 participants, comprising 27 in the intervention group and 24 in the control group, were analyzed. Weekly biofeedback-based integrated program consisting of biofeedback training along with group education about behavioral modification, physical activities, and telephone counseling was provided for 12 weeks. Orthostatic hypotension was evaluated by measuring the drop in systolic and diastolic blood pressure after postural changes. Autonomic nervous system function was measured using heart rate variability.

Results

Among the indicators of heart rate variability, total power (P = .037) and low frequency (P = .017) increased significantly, suggesting that autonomic function improved. Severity of orthostatic symptoms (P < .001) and drops in systolic (P = .003) and diastolic (P = .012) blood pressure after postural changes decreased significantly in the intervention group.

Conclusion

Biofeedback-based integrated program was effective in improving autonomic nervous system function and alleviated OH. Therefore, biofeedback-based integrated program should be tested in a larger randomized controlled study with long-term follow-up.
Renal Glomerular Expression of WT-1, TGF-β, VEGF, and ET-1 Immunostains in Murine Models of Focal and Segmental Glomerulosclerosis
Authors: Husain Sufia
Published: August 2023

Primary focal segmental glomerulosclerosis (FSGS) is a type of chronic renal disease that commonly progresses to renal failure as the treatments are not particularly effective. Glomerular podocyte injury and loss are pivotal to the pathogenesis of FSGS. This study aims to explore the glomerular immunohistochemistry stain expression of Wilms tumor-1 (WT-1) (podocyte-specific protein), transforming growth factor beta (TGF-β) (cytokine protein), vascular endothelial growth factor (VEGF) (angiogenic protein), and endothelin-1 (ET-1) (profibrotic growth factor), in rats with adriamycin nephropathy, which represents the murine model of human FSGS. By the end of 8 and 12 weeks, the kidneys of adriamycin-treated rats and control rats were harvested and the histomorphology was studied. Both 8- and 12-week test groups developed proteinuria, and hypoalbuminemia and showed FSGS on hematoxylin and eosin–stained slides. The renal tissue samples were also treated with immunostains for WT-1, TGF-β, VEGF, and ET-1. The glomeruli in all the FSGS kidneys showed loss of WT-1 expression with a concomitant notable increased expression of TGF-β, VEGF, and ET-1 immunostains. These results demonstrate that as FSGS evolves, the WT-1-expressing podocytes are lost and it correlates inversely with the overexpression of TGF-β, VEGF, and ET-1, suggesting that during the pathogenesis of FSGS, podocyte damage triggers the activation of these proteins. The findings in the current study echo the theory hypothesized in world literature that TGF-β, VEGF, and ET-1 play an integral part in the evolution of FSGS. More research is needed to further detail the pathogenic role of these proteins as it may open routes to more targeted and effective treatment modalities.
The Peritumoral CD8+/FOXP3+ Cell Ratio Has Prognostic Value in Triple-negative Breast Cancer
Authors: Aldrees Rana , Siegal Gene P. , Wei Shi
Published: August 2023

Compelling data has demonstrated the prognostic significance of tumor-infiltrating lymphocytes (TILs) in triple-negative breast cancer (TNBC), a subtype generally associated with a poor clinical outcome but highly heterogeneous in nature. There have been limited studies investigating the importance of subsets of T cells in TILs. Further, the significance of intratumoral versus peritumoral TILs remains controversial. We examined the prognostic value of tumor-associated CD8+ cytotoxic T cells and FOXP3+ regulatory T cells in 35 chemotherapy-naive TNBC cases with a tumor-host interface in the tissue sections. The CD8+ and FOXP3+ cell count was expressed by immunoreactive cells per high-power field in an average of 10 high-power fields. There was a wide range of CD8+ and FOXP3+ T cells within the peritumoral and intratumoral stroma. Both CD8+ and FOXP3+ TILs were significantly higher at the former location as compared with the latter (P<0.0001 and 0.003, respectively). The numbers of CD8+ and FOXP3+ T cells, either within peritumoral or intratumoral stroma, were not significantly associated with distant relapse-free or disease-specific survival. However, the peritumoral CD8+/FOXP3+ ratio of TILs was significantly associated with prolonged relapse-free survival (P=0.04) and disease-specific survival (P=0.02). This association was not observed with the CD8+/FOXP3+ ratio of intratumoral TILs. These observations suggest that the immunologic balance in the tumor microenvironment might determine antitumor immunity. Further, the peritumoral TILs appear to play a more important role in the progression of TNBC when compared with the intratumoral TILs, thus reaffirming the necessity of revisiting the method for the assessment of TILs.
Improving access to prosthetic limbs in Germany: An explorative review
Authors: Baumann Martina F. , Maria Maia
Published: August 2023

Background:

Meeting the needs of users when it comes to accessing prosthetic limbs is an important factor in the acceptance and use of a prosthesis; the cost of such prosthetics also constitutes a potential financial challenge.

Objectives:

The aim of this study was to investigate potential hurdles to accessing limb prosthetics in the German health care system, including organizational, social, economic, and regulatory issues, and to provide food for thought about ethical implications.

Methods:

Sixteen German users of limb prosthetics with upper-limb and/or lower-limb amputation were recruited by means of purposive sampling. Semistructured interviews were performed, with the guiding question being as follows: “What were your experiences with the German prosthetic care and reimbursement system?” Ten stakeholders (insurance representatives, prosthetic technicians, medical service representatives, a law expert, and a lawyer) were asked about the issues they encounter in their work related to prosthetic care and reimbursement, and about ways to ameliorate these issues. A qualitative content analysis method was used to analyze the data.

Results:

Half of the interviewed service users experienced hurdles to gaining a suitable prosthetic device, such as waiting times and pressure to negotiate their need for a certain prosthesis. Some of the views expressed about the issues relating to prosthetic reimbursement in Germany were common to all stakeholders, whereas some conflicted with the views of others.

Conclusions:

Equitable access to prostheses and the efficient distribution of prosthetic innovations could be improved by organizational and regulatory measures. Furthermore, a user-centered design of prostheses, a health technology assessment, monitoring of prosthetic care pathways, and a societal discussion about rationing in health care should be considered as parts of a broader approach to tackle this issue.
Barriers and facilitators of receiving prosthetic services in people with lower limb amputation during Covid-19 pandemic: A qualitative study in a developing country
Authors: Nabizadeh Samira , Jalali Maryam , Kamali Mohammad , Shahabi Saeed , Babaee Taher
Published: August 2023

Purpose:

This study investigated the barriers, challenges, and facilitators in receiving prosthetic services in people with lower limb amputation during Covid-19 pandemic.

Materials and methods:

In this qualitative study, we conducted in-depth semistructured face-to-face interviews with individuals with lower limb amputation who needed prosthetic services during Covid-19 pandemic. We discussed about challenges and barriers that the participants had encountered during this period. The collected data were analyzed using a conceptual framework.

Results:

Six broad themes of availability, accessibility, acceptability, affordability, accommodation, and awareness emerged from the analysis. Staff shortage, lack of remote services, accommodation, insurance and governmental support, and cost of services were the main concerns. Moreover, long waiting lists, postponed referrals, noncompliance with Covid-19 protocols and preventive measures, and lockdowns were the other important concerns that were noted. In addition, unsatisfactory services in hometown, distance to capital, transportation permit in lockdowns, traffic jam, and public transport problems were other reasons of service not being accessible. The positive aspects were the facilitators such as having home visits, social work and charity, and using private drive services.

Conclusion:

It seems that after the beginning of Covid-19 pandemic, people with lower limb amputation have faced more drastic challenges in accessing and receiving prosthetic services than in the prepandemic situations.
Redefining Hemodynamic Imaging in Stroke: Perfusion Parameter Map Generation from TOF-MRA using Artificial Intelligence
Authors: Kossen Tabea , Madai Vince I , Lohrke Felix , Aydin Orhun Utku , Behland Jonas , Hilbert Adam , Mutke Matthias A , Bendszus Martin , Sobesky Jan , Frey Dietmar
Published: August 2023

Background

Perfusion assessment in cerebrovascular disease is essential for evaluating cerebral hemodynamics and guides many current treatment decisions. Dynamic susceptibility contrast (DSC) magnetic resonance imaging (MRI) is of great utility to generate perfusion parameter maps, but its reliance on a contrast agent with associated health risks and technical challenges limit its usability. We hypothesized that native Time-of-flight magnetic resonance angiography (TOF-MRA) can be used to generate perfusion parameter maps with an artificial intelligence (AI) method, called generative adversarial network (GAN), offering a contrast-free alternative to DSC-MRI.

Methods

We propose an adapted 3D pix2pix GAN that generates common perfusion maps from TOF-MRA images (CBF, CBV, MTT, Tmax). The models are trained on two datasets consisting of 272 patients with acute stroke and steno-occlusive disease. The performance was evaluated by the structural similarity index measure (SSIM), for the acute dataset we calculated the Dice coefficient for lesions with a time-to-maximum (Tmax) >6s.

Findings

Our GAN model showed high visual overlap and high performance for all perfusion maps on both the acute stroke dataset (mean SSIM 0.88-092) and data including steno-occlusive disease patients (mean SSIM 0.83–0.98). For lesions of Tmax>6, the median Dice coefficient was 0.49.

Interpretation

Our study shows that our AI model can accurately generate perfusion parameter maps from TOF-MRA images, paving the way for clinical utility. We present a non-invasive alternative to contrast agent-based imaging for the assessment of cerebral hemodynamics in patients with cerebrovascular disease. Leveraging TOF-MRA data for the generation of perfusion maps represents a groundbreaking approach in cerebrovascular disease imaging. This method could greatly impact the stratification of patients with cerebrovascular diseases by providing an alternative to contrast agent-based perfusion assessment.

Funding

This work has received funding from the European Commission (Horizon2020 grant: PRECISE4Q No. 777107, coordinator: DF) and the German Federal Ministry of Education and Research (Go-Bio grant: PREDICTioN2020 No. 031B0154 lead: DF).