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Views of physiotherapists on factors that play a role in ethical decision-making: an international online survey study

Availability of data and materials: The data that support the findings of this study are available on reasonable request from the corresponding author. The data are not publicly available due to ethical restrictions to protect the research participants who provided sensitive information.Supplementary Information: Additional file 1: Appendix 1. List of survey-items with underpinning or embedded factors in ethical decision-making including literature informing survey development. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9889242/bin/40945_2022_157_MOESM1_ESM.docx (23K) GUID: FA7F265B-87C8-45E3-824D-D8C69B94EE21 Additional file 2: Appendix 2. Drop-out analysis by gender, age, nationality (geographic/WP region), and religion. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9889242/bin/40945_2022_157_MOESM2_ESM.docx (17K) GUID: 35DC772B-739E-4799-8AE2-2E50FABF3767 .Archives of Physiotherapy is now published by AboutScience Sr. on behalf of Società Italiana di Fisioterapia. Authors contributing to Archives of Physiotherapy agree to publish their articles under the CC-BY-NC 4.0 license, which allows third parties to re-use the work without permission as long as the work is properly referenced and the use is non-commercial.Background: There is a lack of knowledge about the ways physiotherapists around the world learn about professional code of ethics and ethical decision-making frameworks. The profession has a gap in the understanding about physiotherapists’ views on factors that play a role in ethical decision-making and whether these views differ between World Physiotherapy regions. Methods: An online survey study in English was conducted from October 2018 to October 2019. Participants included 559 physiotherapists located in 72 countries. The self-designed survey questionnaire contained 13 items asking about demographic information and means of learning about ethical codes and decision-making frameworks. A further 30 items were presented which included statements underpinned with individual, organisational, situational and societal factors influencing ethical decision-making. Participants were asked to express their level of agreement or disagreement using a 5-point-Likert-scale. Results: Participants’ highest rated responses endorsed that the professional role of physiotherapists is linked to social expectations of ethical behaviour and that ethical decision-making requires more skills than simply following a code of ethics. A recognisable organisational ethical culture was rated as supporting good ethical decisions. Comparing responses by World Physiotherapy regions showed significant differences in factors such as culture, religion, emotions, organisational values, significant others, consequences of professional misconduct and professional obligations. Entry level education was not perceived to provide a solid base for ethical decision-making in every World Physiotherapy region. Participants reported multiple sources for learning about a professional code of ethics and ethical decision-making frameworks. What’s more, the number of sources differed between World Physiotherapy regions. Conclusions: Multiple factors play a role in physiotherapists’ ethical decision-making internationally. Physiotherapists’ ethical knowledge is informed by, and acquired from, several learning sources, which differ in both quality and quantity amongst World Physiotherapy regions. Easily accessible knowledge and education about professional codes of ethics and ethical decision-making can foster continuing professional development for physiotherapists. The establishment of constructive ethical cultures in workplaces can improve ethical decision-making, and should acknowledge the influence of individual, organisational, situational and societal factors. The establishment of collaborative learning environments can support knowledge translation which acknowledges practice-based methods of knowing and learning.This work was supported by the Department for Culture and Science of the Salzburg Government (Land Salzburg), Austria, under Grant number 20204-WISS/225/80-2018 (survey distribution)

Western ideals and global realities–physiotherapists’ views on factors that play a role in ethical decision-making: an international qualitative analysis

Data availability statement: The data that support the findings of this study are available on reasonable request from the corresponding author, AS. The data are not publicly available due to ethical restrictions to protect the research participants who provided sensitive information.Supplemental material is available online at: https://www.tandfonline.com/doi/full/10.1080/21679169.2022.2155240#supplemental-material-section .Background: There is a lack of knowledge about factors that play a role in ethical decision-making of physiotherapists internationally. The purpose of this study was to explore, describe and map factors in ethical decision-making of physiotherapists from around the globe. Methods: A descriptive research design and constructivist research paradigm was applied. Elements of both a coding reliability thematic analysis and a reflexive thematic analysis method were used deductively and inductively to analyse the content of responses to an optional open question in an internationally distributed online survey with 559 participants from 72 countries through several steps and cycles. Results: A spectrum of 43 factors was identified within 200 individual responses, allocated to five themes: individual factors (19 factors); relational factors (6 factors); organisational factors (6 factors); situational factors (6 factors); and societal factors (6 factors). The importance of context on organisational, situational and societal levels, interrelatedness of physiotherapists, individual characteristics and situatedness of patients/clients and physiotherapists, as well as aspects and features of the patient/client-physiotherapist relationship became apparent throughout analysis. Conclusions: To meet the emerging requirements for ethical physiotherapy practice, we advocate that both physiotherapy students and practicing physiotherapists internationally need to be trained as moral agents in integrated manners. Based on the results of this study we conclude that such training should embrace professionalism, professional values, ethical codes, ethical theories and ethical decision-making frameworks that acknowledge interrelatedness, epistemology and situatedness, self-reflective and communicative techniques, critical thinking, social/societal determinants of health, social responsibility, cultural competence and self-care techniques.This work was supported by the Department for Culture and Science of the Salzburg Government (Land Salzburg), Austria, under Grant number 20204-WISS/225/80-2018 (survey distribution) and 20204-WISS/225/193-2019 (open access publishing)

How does a motor or cognitive dual-task affect our sense of upper limb proprioception?

Data Availability: The authors have no reservation with publicly sharing the data that supports our results. Accession numbers and/or DOIs will be made available upon acceptance of this manuscript. Researchers seeking to have access to our data may also contact the "Commissie Voor Medische Ethiek" Medical Ethics Committee from Ghent University, Belgian Registration Number of this study: 8670201940272. To contact the ethical committee: [email protected], or the lead investigation at [email protected] Daily upper limb activities require multitasking and our division of attention. How we allocate our attention can be studied using dual-task interference (DTi). Given the vital role proprioception plays in movement planning and motor control, it is important to investigate how conscious upper limb proprioception is impacted by DTi through cognitive and motor interference. Purpose To examine how dual-task interference impacts conscious upper limb proprioception during active joint repositioning tasks (AJRT). Methods Forty-two healthy participants, aged between 18 and 35, took part in this cross-sectional study. Participants completed two AJRT during three conditions: baseline (single task), dual-cognitive task (serial subtractions), and dual-motor task (non-dominant hand movements). The proprioceptive error (PE; difference between their estimation and targeted position) was measured using an AJRT of 75% and 90% of maximum internal rotation using the Biodex System IIITM and the Upper Limb Proprioception Reaching Test (PRO-Reach). To determine if PEs differed during dual-task interference, interference change scores from baseline were used with one sample t-tests and analyses of variance. Results The overall mean PE with the Biodex was 4.1̊ ± 1.9 at baseline. Mean change scores from baseline reflect a mean improvement of 1.5̊ ± 1.0 (p < .001) during dual-cognitive task and of 1.5̊ ± 1.2 (p < .001) during dual-motor task. The overall mean PE with the PRO-Reach was 4.4cm ± 1.1 at baseline. Mean change scores from baseline reflect a mean worsening of 1.0cm ± 1.1 (p < .001) during dual-cognitive task and improvement of 0.8cm ± 0.6 (p < .001) during dual-motor task. Analysis of variance with the Biodex PEs revealed an interference effect (p < .001), with the cognitive condition causing greater PEs compared to the motor condition and a criterion position effect (p = .006), where 75% of maximum IR produced larger PEs during both interference conditions. An interference effect (p = .022) with the PRO-Reach PEs was found highlighting a difference between the cognitive and motor conditions, with decreased PEs during the contralateral motor task. Conclusion Interference tasks did impact proprioception. Cognitive interference produced mixed results, whereas improved proprioception was seen during motor interference. Individual task prioritization strategies are possible, where each person may choose their own attention strategy when faced with dual-task interference.The author(s) received no specific funding for this work

Measuring upper limb active joint position sense: Introducing a new clinical tool - The Upper Limb Proprioception Reaching Test

Availability of data materials: All authors consent to all data being openly public and accessible.Supplementary data are available online at: https://www.sciencedirect.com/science/article/pii/S2468781223001145?via%3Dihub#appsec1 .Background: Proprioception is our sense of body awareness, including the sub-category of active joint position sense (AJPS). AJPS is fundamental to joint stability and movement coordination. Despite its importance, there remain few confident ways to measure upper limb AJPS in a clinic. Objective: To assess a new AJPS clinical tool, the Upper Limb Proprioception Reaching Test (PRO-Reach; seven targets), for discriminant validity, intra-rater and absolute reliability. Design: Cross-sectional measurement study. Methods: Seventy-five healthy participants took part in a single session with 2 consecutive evaluations (E1 and E2) (within-day reliability). Twenty participants were randomly selected to perform a dominant shoulder fatigue protocol (discriminant validity), whereafter a third evaluation was repeated (E3). The PRO-Reach was analyzed with paired t tests (discriminant validity), intra-class correlation coefficients (ICCs) and minimal detectable change [MDC]) (intra-rater: within-day and between-trial relative and absolute reliability). Results: The PRO-Reach supports moderate (mostly superior targets) to excellent (mostly inferior targets) reliability. Between-trial ICCs (T1/T2/T3) varied between 0.72 and 0.90, and within-day (E1/E2) ICCs between 0.45 and 0.72, with associated MDC95 values (3.9–5.0 cm). The overall scores (seven targets) supported the strongest within-day reliability (ICC = 0.77). The inferior targets demonstrated the highest between-trial and within-day reliability (ICCs = 0.90 and 0.72). A fatigue effect was found with the superior and superior-lateral targets (P <.05). Conclusions: The inferior targets and overall scores demonstrate the strongest reliability. The use of the PRO-Reach tool may be suitable for clinical use upon further psychometric testing amongst pathological populations. Level of evidence: Level III cross-sectional study.Financial support was provided by the Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris) and Université Laval in Québec City, Canada in the form of a student bursary

Photocatalyzed hydrogen evolution from water by a composite catalyst of NH2-MIL-125(Ti) and surface nickel(II) species

A composite of the metal–organic framework (MOF) NH2-MIL-125(Ti) and molecular and ionic nickel(II) species, catalyzed hydrogen evolution from water under UV light. In 95 v/v¿% aqueous conditions the composite produced hydrogen in quantities two orders of magnitude higher than that of the virgin framework and an order of magnitude greater than that of the molecular catalyst. In a 2 v/v¿% water and acetonitrile mixture, the composite demonstrated a TOF of 28 mol H2 g(Ni)-1 h-1 and remained active for up to 50 h, sustaining catalysis for three times longer and yielding 20-fold the amount of hydrogen. Appraisal of physical mixtures of the MOF and each of the nickel species under identical photocatalytic conditions suggest that similar surface localized light sensitization and proton reduction processes operate in the composite catalyst. Both nickel species contribute to catalytic conversion, although different activation behaviors are observed.Peer ReviewedPostprint (author's final draft

Can a conservative rehabilitation strategy improve shoulder proprioception? A systematic review

Context: Proprioception deficits contribute to persistent and recurring physical disability, particularly with shoulder disorders. Proprioceptive training is thus prescribed in clinical practice. It is unclear whether nonsurgical rehabilitation can optimize shoulder proprioception. Objectives: To summarize the available evidence of conservative rehabilitation (ie, nonsurgical) on proprioception among individuals with shoulder disorders. Evidence Acquisition: PubMed, Web of Science, and EBSCO were systematically searched, from inception until November 24, 2019. Selected articles were systematically assessed, and the methodological quality was established using the Dutch Cochrane Risk of Bias Tool and the Newcastle-Ottawa Quality Assessment Scale. The Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were utilized for this review. The conservative treatments were categorized as follows: (1) conventional therapy, (2) proprioceptive training, (3) elastic kinesiology tape, and (4) other passive therapies. Evidence Synthesis: Twelve articles were included, yielding 58 healthy control shoulders and 362 shoulders affected by impingement syndrome, glenohumeral dislocations, nonspecific shoulder pain, rotator cuff dysfunction, or subluxation poststroke. The level of agreement between the evaluators was excellent (84.9%), and the studies were evaluated to be of fair to excellent quality (risk of bias: 28.5%–100%). This review suggests, with moderate evidence, that proprioceptive training (upper-body wobble board or flexible foil training) can improve proprioception in the midterm. No decisive evidence exists to suggest that conventional therapy is of added value to enhance shoulder proprioception. Conflicting evidence was found for the improvement of proprioception with the application of elastic kinesiology tape, while moderate evidence suggests that passive modalities, such as microcurrent electrical stimulation and bracing, are not effective for proprioceptive rehabilitation of the shoulder. Conclusions: Proprioceptive training demonstrates the strongest evidence for the effective rehabilitation of individuals with a shoulder proprioceptive deficit. Elastic kinesiology tape does not appear to affect the sense of shoulder proprioception. This review suggests a possible specificity of training effect with shoulder proprioception.This project did not receive funding from any sources

A zinc oxide-modified hydroxyapatite-based cement facilitated new crystalline-stoichiometric and amorphous apatite precipitation on dentine.

Aim: To evaluate the remineralization ability of two dentin canal sealer cements. Methodology: Dentin surfaces were subjected to: i) 37% phosphoric acid (PA) or ii) 0.5 M ethylenediaminetetraacetic acid (EDTA) conditioning prior to the application of two experimental hydroxyapatite-based cements, containing sodium hydroxide (calcypatite) or zinc oxide (oxipatite), respectively. Samples were stored in simulated body fluid during 24 h or 21 d. Remineralization of the dentin surfaces were studied by Raman spectroscopy, mapping with K-means cluster and hierarchical cluster analysis were done. Nano-roughness and collagen fibrils width measurements were performed by means of an atomic force microscopy. Results: PA+oxipatite promoted both the highest dentin mineralization and crystallographic maturity at the dentin surface. Non-crystalline amorphous-like apatites were also formed. Dentin treated with PA+calcypatite attained the roughest surface with minimal fibril width. Crosslinking of collagen only raised in the group PA+oxipatite, after 21 d. The maximum relative mineral concentration and structure of collagen referred to amide I and ratio amide III/AGEs was achieved after using PA+calcypatite at 21 d time point. EDTA produced a lower stoichiometric hydroxyapatite with decreased maturity, at the expense of the carbonate band widening, though it favored the nucleation of carbonated calcium phosphate. Conclusions: Surfaces treated with PA+oxipatite attained the highest dentin remineralization with both crystalline-stoichiometric and amorphous apatites, at long term. EDTA conditioning facilitated amorphous-bulk mineral precipitation. This amorphization, more intense after using oxipatite, provided an ion-rich environment favoring in situ dentin remineralization.This work was supported by the Ministry of Economy and Competitiveness (MINECO) [Project MAT2014-52036-P] and European Regional Development Fund (FEDER)

Identification of Nonfunctional Alternatively Spliced Isoforms of STING in Human Acute Myeloid Leukemia

UNLABELLED: Lack of robust activation of Stimulator of Interferon Genes (STING) pathway and subsequent induction of type I IFN responses is considered a barrier to antitumor immunity in acute myeloid leukemia (AML). Using common human AML cell lines as in vitro tools to evaluate the efficacy of novel STING agonists, we found most AML lines to be poor producers of IFNs upon exposure to extremely potent agonists, suggesting cell-intrinsic suppression of STING signaling may occur. We observed unexpected patterns of response that did not correlate with levels of STING pathway components or of known enzymes associated with resistance. To identify a genetic basis for these observations, we cloned and sequenced STING from the cDNA of human AML cell lines and found both frequent mutations and deviations from normal RNA splicing. We identified two novel spliced isoforms of STING in these lines and validated their expression in primary human AML samples. When transduced into reporter cells, these novel STING isoforms exhibited complete insensitivity to agonist stimulation. These observations identify alternative splicing as a mechanism of STING pathway suppression and suggest that most AML silences the STING pathway through direct modification rather than through engagement of external inhibitory factors. SIGNIFICANCE: We find that AML acquires resistance to innate immune activation via the STING pathway through aberrant splicing of the STING transcript including two novel forms described herein that act as dominant negatives. These data broaden understanding of how cancers evolve STING resistance, and suggest that the AML tumor microenvironment, not the cancer cell, should be the target of therapeutic interventions to activate STING

Mineral maturity and crystallinity index are distinct characteristics of bone mineral

The purpose of this study was to test the hypothesis that mineral maturity and crystallinity index are two different characteristics of bone mineral. To this end, Fourier transform infrared microspectroscopy (FTIRM) was used. To test our hypothesis, synthetic apatites and human bone samples were used for the validation of the two parameters using FTIRM. Iliac crest samples from seven human controls and two with skeletal fluorosis were analyzed at the bone structural unit (BSU) level by FTIRM on sections 2–4 lm thick. Mineral maturity and crystallinity index were highly correlated in synthetic apatites but poorly correlated in normal human bone. In skeletal fluorosis, crystallinity index was increased and maturity decreased, supporting the fact of separate measurement of these two parameters. Moreover, results obtained in fluorosis suggested that mineral characteristics can be modified independently of bone remodeling. In conclusion, mineral maturity and crystallinity index are two different parameters measured separately by FTIRM and offering new perspectives to assess bone mineral traits in osteoporosis