Artificial Nutrition and Hydration for Infants with Life-Terminating Conditions: Rethinking the Catholic Position

Infants with life-terminating conditions (ILTCs) are those whose conditions prevent them from living more than two years. When these infants have difficulty assimilating food and fluids orally, doctors can provide nutrition and hydration through artificial means. While artificial nutrition and hydration (ANH) can provide benefits, it can also result in complications leading to pain and/or distress in addition to that which an ILTC may already be experiencing from one or more underlying conditions. Many medical experts maintain that withholding or withdrawing ANH can help a patient’s body produce its own analgesics. I consider four categories of ILTCs: 1) infants who receive prognoses of two weeks or less; 2) infants who will live longer than two weeks but no more than two years and who are not suffering or in distress; 3) infants who are not dying, but are in distress from the use of ANH; and 4) infants who are not dying, but are in distress from their conditions and/or ANH. I argue that in addition to providing natural analgesics, withholding or withdrawing ANH is a form of comfort care that prevents the occurrence of further complications requiring additional medical treatments and keeps ILTCs content. Under certain circumstances, the withholding or withdrawing of ANH should be obligatory. As it stands, the whole of Catholic teaching on ANH is inconsistent. Operating from the sanctity-of-life ethic, the Church teaches that ANH is an ordinary, therefore obligatory, form of care. But this position contradicts the view that any form of care presenting a grave burden to a patient and/or his family is extraordinary and therefore optional. In addition, by making ANH obligatory, the Catholic Church causes families to undergo heroic suffering (i.e., enduring more than what can be expected or asked of anyone), which the Church says is not required of everyone. I argue that rethinking the Catholic position on ANH will enable the Church to offer practical moral guidance for families to comfort ILTCs, help ILTCs and their families avoid heroic suffering, and provide spiritual care families of ILTCs need, all while still respecting the sanctity of life of every person

Distinguishing Between Empathy and Enabling: Dance/Movement Therapy for Family Members of People with Addiction

This theoretical inquiry investigates the experiences and needs of family members of people with addiction; a group which is rapidly growing in the United States, and one that has been largely neglected by health service providers and medical professionals. With more than 22 million Americans currently addicted to drugs and alcohol (Substance Abuse and Mental Health Services Administration, 2017), and 365 drug-related deaths occurring each day (Sheff, 2013), the scope of family member grief and suffering is immeasurable. Evidence-based research reveals that family members lose touch with their own basic needs and experience high rates of psychological and physical health disorders, and social and financial instability as a result of their loved one’s addiction and subsequent stigmatization from the wider culture. Despite the severity and urgency of family member needs and the mounting evidence that their wellness improves their loved one’s success in recovery, families have been given little to no therapeutic resources, let alone options. This inquiry concludes with a discussion of the existing resources, which offer conflicting approaches, and the suggestion of dance/movement therapy as an additional therapeutic treatment option that can improve family member coping. It is proposed that a body-based, psychotherapeutic approach would allow family members to notice important distinctions between thoughts and feelings, self and other, and to distinguish between popular addiction theories and individualized needs and preferences amidst the unpredictable course of a loved one’s addiction

The Role of Metastasis Suppressor CD82 in the Deactivation of the c-Met Signaling Pathway in Prostate Cancer

BACKGROUND AND PURPOSE: Prostate cancer is the second leading cause of cancer deaths among men in the United States. Metastasis plays a major role in patient prognosis and treatment options. One of the factors that influences metastasis is the activation of the c-Met signaling pathway. Activation of the growth factor c-Met results in cytoskeletal rearrangement, migration, and invasion. Previous studies have shown CD82 to act as an active metastatic suppressor in normal, healthy cells and is downregulated in various forms of cancer. When CD82 is re-expressed in cancer cells, the cells no longer express metastatic characteristics. The purpose of this study was to determine what effect, if any, re-expression of CD82 in prostate cancer cells had on c- Met mediated migratory characteristics. METHODS AND MATERIALS: Two prostate cancer cell lines were utilized for this project. PC3-29 cells have been engineered with a vector that expresses CD82 and PC3-5V carry an empty vector and were used as a control in this study. ANALYSES: Expression levels of CD82, c-Met, related migratory proteins, and the activation state of c-Met were determined via western blot analysis. Visualization of cytoskeletal changes was done by staining F-actin fibers and focal adhesions. RESULTS: Re-expression of CD82 in PC3-29 cells led to a decrease in c-Met activation. CD82 prevented the formation of F-actin fibers and focal adhesions needed for metastasis. CONCLUSIONS: CD82 directly impacts the activation of c-Met by preventing the phosphorylation of Rac1, inhibiting the cytoskeletal changes needed for metastasis to occur

Selecting criteria for the evaluation of school counselors based on item discrimination power

This study was conducted for the purpose of identifying discriminating, reliable, and valid criteria for evaluating counselor perfermance which could be used by local schools in constructing a new or refining an existing evaluation instrument. Data were collected by having 1,004 principals/supervisors, teachers, and counselors complete a 74-item questionnaire to determine which criteria had the ability to separate high counselor performance from that of average and poor performance;Fifty-eight counselors from seven school districts located in Kansas, Texas, Indiana, and Virginia volunteered to participate in this research effort. Each of the 45 secondary and 13 elementary counselors were evaluated by 15 to 18 raters;The nature of a school counselor\u27s position calls for extensive confidentiality and one-to-one closed door conferencing with students, parents, teachers, and administrators. These factors add a great deal of complexity to counselor performance appraisal as many counselor behaviors are not observable to a large number of evaluators;Major findings of this study included: (1) Seventy-three of the 74 survey items discriminated or measured differences between the 58 counselors, (2) rater observability of the counselor performance criteria varied greatly, (3) two or more of the evaluator groups had significantly different means for 39 of the 73 items, (4) 47 of the 74 items on the questionnaire measured differences between the 13 elementary counselors, (5) 40 of the 74 items on the survey discriminated for the 45 secondary counselors, (6) all 74 items had discrimination values for both male and female raters, (7) a total of 73 items discriminated for male counselors and 72 items for female counselors, and (8) 62 of the 73 items on the questionnaire discriminated or measured differences between counselors based on school enrollment;It is recommended that separate evaluation instruments be used for elementary and secondary school counselors because of the difference in item discrimination values found for these positions. A list of 35 performance criteria for elementary and 35 for secondary counselor evaluation based on discrimination power, observability, and school size are included for local schools to consider

Design, fabrication and acoustic tests of a 36 inch (0.914 meter) statorless turbotip fan

The LF336/E is a 36 inch (0.914 meter) diameter fan designed to operate in a rotor-alone configuration. Design features required for modification of the existing LF336/A rotor-stator fan into the LF336/E statorless fan configuration are discussed. Tests of the statorless fan identified an aerodynamic performance deficiency due to inaccurate accounting of the fan exit swirl during the aerodynamic design. This performance deficiency, related to fan exit static pressure levels, produced about a 20 percent thrust loss. A study was then conducted for further evaluation of the fan exit flow fields typical of statorless fan systems. This study showed that through proper selection of fan design variables such as pressure ratio, radius ratio, and swirl distributions, performance of a statorless fan configuration could be improved with levels of thrust approaching the conventional rotor-stator fan system. Acoustic measurements were taken for the statorless fan system at both GE and NASA, and when compared to other lift fan systems, showed noise levels comparable to the quietest lift fan configuration which included rotor-stator spacing and acoustic treatment. The statorless fan system was also used to determine effects of rotor leading edge serrations on noise generations. A cascade test program identified the serration geometry based on minimum pressure losses, wake turbulence levels and noise generations

Reliability of Strength and Performance Testing Measures and Their Ability to Differentiate Persons with and without Shoulder Symptoms

BACKGROUND: Upper extremity physical performance measures exist but none have been universally accepted as the primary means of gauging readiness to return to activity following rehabilitation. Few reports have described reliability and/or differences in outcome with physical performance measures between individuals with and without shoulder symptoms. HYPOTHESES/PURPOSE: The purpose of this study was to establish the reliability of traditional upper extremity strength testing and the CKCUEST in persons with and without shoulder symptoms as well as to determine if the testing maneuvers could discriminate between individuals with and without shoulder symptoms. The authors hypothesized that strength and physical performance testing would have excellent test/re-test reliability for individuals with and without shoulder symptoms and that the physical performance maneuver would be able to discriminate between individuals with and without shoulder symptoms. METHODS: Male and female subjects 18-50 years of age were recruited for testing. Subjects were screened and placed into groups based on the presence (Symptomatic Group) or absence of shoulder symptoms (Asymptomatic Group). Each subject performed an isometric strength task, a task designed to estimate 1-repetition maximum (RM) lifting in the plane of the scapula, and the closed kinetic chain upper extremity stability test (CKCUEST) during two sessions 7-10 days apart. Test/re-test reliability was calculated for all three tasks. Independent t-tests were utilized for between group comparisons to determine if a performance task could discriminate between persons with and without shoulder symptoms. RESULTS: Thirty-six subjects (18/group) completed both sessions. Test/re-test reliability for each task was excellent for both groups (intraclass correlations ≥ .85 for all tasks). Neither strength task could discriminate between subjects in either group. Subjects with shoulder symptoms had 3% less touches per kilogram of body weight on the CKCUEST compared to subjects without shoulder symptoms but this was not statistically significantly different (p=.064). CONCLUSIONS: The excellent test/re-test reliability has now been expanded to include individuals with various reasons for shoulder symptoms. Traditional strength testing does not appear to be the ideal assessment method for making discharge and/or return to activity decisions due to the inability to discriminate between the groups. The CKCUEST could be utilized to determine readiness for activity as it was trending towards being discriminatory between known groups. LEVEL OF EVIDENCE: Basic Science Reliability Study, Level 3

Triple correlation for detection of damage-related nonlinearities in composite structures

Nonlinear effects in vibration responses are investigated for the undamaged composite plate and the composite plate with a delamination. The analysis is focused on higher harmonic generation in vibration responses for various excitation amplitude levels. This effect is investigated using the triple correlation technique. The dynamics of composite plate was modelled using two-dimensional finite elements and the classical lamination theory. The doubled-node approach was used to model delamination area. Mode shapes and natural frequencies were estimated based on numerical models. Next, the delamination divergence analysis was used to obtain relative displacements for delaminated plies. Experimental modal analysis test was carried out to verify the numerical models. The two strongest vibration modes as well as two vibration modes with the smallest and largest motion level of delaminated plies were selected for nonlinear vibration test. The Fisher criterion was employed to verify the effectiveness and confidence level of the proposed technique. The results show that the method can be used not only to reveal nonlinearities, but also to reliably detect impact damage in composites. These results are confirmed using the statistical analysis

Calculation of Resistive Loads for Elastic Resistive Exercises

Context: What is the correct resistive load to start resistive training with elastic resistance to gain strength? This question is typically answered by the clinician\u27s best estimate and patient\u27s level of discomfort without objective evidence. Objective: To determine the average level of resistance to initiate a strengthening routine with elastic resistance following isometric strength testing. Design: Cohort. Setting: Clinical. Participants: Thirty-four subjects (31±13yrs, 73±17kg, 170±12cm). Interventions: The force produced was measured in Newtons (N) with an isometric dynamometer. The force distance was the distance from center of joint to location of force applied was measured in meters to calculate torque that was called Test Torque for the purposes of this report. This torque data was converted to Exercise Load in pounds based on the location where the resistance was applied, specifically the distance away from the center of rotation of the exercising limb. The average amount of exercise load as percentage of initial Test Torque for each individual for each exercise was recorded to determine what the average level of resistance that could be used for elastic resistance strengthening program. Main Outcome Measures: The percentage of initial test torque calculated for the exercise was recorded for each exercise and torque produced was normalized to body weight. Results: The average percentage of maximal isometric force that was used to initiate exercises was 30 ± 7% of test torque. Conclusions: This provides clinicians with an objective target load to start elastic resistance training. Individual variations will occur but utilization of a load cell during elastic resistance provides objective documentation of exercise progression

Nonoperative Management of Shoulder Instability

Non-operative management following a shoulder dislocation or subluxation remains a challenging and complex task. Accurate diagnosis of the condition, and shared decision-making regarding operative and non-operative management, as well as timing of return to play is required. This clinical concept paper introduces a shoulder instability framework that addresses these fundamental clinical dilemmas. Valid clinical prognostic tools which can predict recurrent shoulder instability are reviewed. The process of shared decision-making within the realm of shoulder instability is also presented. Finally, a framework for progressive rehabilitation that addresses deficits in motor control, strength, and endurance in scapula and shoulder musculature is presented to guide patients from an initial instability event, through to return to play

The role of the stratospheric polar vortex for the austral jet response to greenhouse gas forcing

Future shifts of the austral midlatitude jet are subject to large uncertainties in climate model projections. Here we show that, in addition to other previously identified sources of inter-model uncertainty, changes in the timing of the stratospheric polar vortex breakdown modulate the austral jet response to greenhouse gas forcing during summertime (December-February). The relationship is such that a larger delay in vortex breakdown favors a more poleward jet shift, with an estimated 0.7-0.8-degree increase in jet shift per 10 days delay in vortex breakdown. The causality of the link between the timing of the vortex breakdown and the tropospheric jet response is demonstrated through climate modeling experiments with imposed changes in the seasonality of the stratospheric polar vortex. The vortex response is estimated to account for about 30% of the inter-model variance in the shift of the summertime austral jet, and about 45% of the mean jet shift