Conceptual Clarity Research Articles

A new clinical entity bridging the cardiovascular system and the kidney: The Chronic Cardiovascular-Kidney Disorder.

Background The complex relationship between heart and kidney dysfunction has been a subject of medical inquiry since the 19th century. The term "cardio-renal syndrome" (CRS) was introduced in the early 2000s and has since become a focal point of research. CRS is typically categorized into five subtypes based on the sequence of cardiovascular and kidney disease events. Summary The Cardiovascular-Kidney-Metabolic (CKM) syndrome, as defined by the American Heart Association (AHA), describes a set of interrelated metabolic risk factors and their effects on the kidneys and cardiovascular system. This syndrome emphasizes the complexity of managing patients with combined conditions and identifies several knowledge gaps, including disease mechanisms, clinical phenotype variability, and the impact of social determinants of health. The Chronic Cardiovascular-Kidney Disorder (CCKD) framework proposes a shift from the term "syndrome" to "disorder," focusing on concurrent cardiovascular and kidney problems regardless of their sequence. Key messages • The CCKD concept calls for simplification and conceptual clarity, arguing that understanding the bidirectional acceleration of disease progression between heart and kidney dysfunction can lead to more effective treatment strategies. • Both CKM and CCKD share common pathophysiological mechanisms and risk factors, including hypertension, diabetes, obesity, and dyslipidemia. Managing these conditions requires a comprehensive approach that addresses the underlying risk factors and pathophysiological mechanisms. • Future directions include embracing precision medicine, public health strategies, interdisciplinary care models, and ongoing research and innovation. Both frameworks underscore the need for comprehensive, interdisciplinary care models and innovative treatment strategies to address the complex interplay between cardiovascular and kidney diseases.

Secretory pedicels? Development, morphology, and histochemistry of articulated pedicels in Neotropical Malveae (Malvaceae).

In the Malveae tribe (Malvaceae), the axis supporting the flower has a joint at the upper third. This axis can be considered as an articulated pedicel, peduncle, peduncle-pedicel, or anthopodium. Such disparity in terminology reveals a duality in interpretation since this structure is classified as part of the inflorescence or part of the flower. In an effort to reach a consensus, this study aims to evaluate axes supporting the flowers of species from the Malveae tribe through ontogenetic, morphological, and histochemical analyses, using light microscopy and scanning electron microscopy. Ontogenetic analyses indicated that the axis supporting the flower is an articulated pedicel, which is divided into proximal and distal parts owing to the presence of the constriction (joint). Simultaneously, the articulated pedicel arises from the floral meristem, along with the establishment of the calyx and androecium. As development progresses, we observed frequent abscissions of the floral bud, along with the distal portion of the pedicel, at the joint. After this, the remaining proximal portion of the pedicel becomes secretory, as an extrafloral nectary, often foraged by ants of the genus Wasmannia. Thus, this ontogenetic analysis of the articulated pedicel helps in understanding its functionality and morphological variability, highlighting the importance of standardized terminology since it would lead to conceptual clarity in different studies. Additionally, this study, for the first time, reveals the presence of extrafloral nectaries on articulated pedicels in Malveae, a previously undocumented feature in Malveae and Malvaceae.

“The illuminating quiet”: a metaphor analysis of autobiographical descriptions of inner speech in aphasia

ABSTRACT Background Inner speech in aphasia is a rapidly expanding research area, but can be defined in numerous ways. Unlike behaviourally observable language processes such as overt word-production, inner speech is only directly available to introspection. Subjective experience thus grounds our understanding of inner speech and is a necessary starting point for investigating its definition. Descriptions of inner speech written by people with aphasia can make an important contribution to conceptual clarity in the literature. This important data source has not been systematically analysed. Our research addresses this gap. Aims This research aims to understand the subjective experience of impaired and preserved inner speech in aphasia, through analysis of the metaphors used in autobiographical accounts, and to interpret the findings in relation to the inner speech literature. Methods & Procedures This study carries out a metaphor-led discourse analysis of descriptions of inner speech in four autobiographical accounts of aphasia. Metaphorical expressions describing language processing were identified and coded, then systematic metaphors (i.e. the related concepts which are used consistently to describe a particular topic) were described. The metaphors used to describe inner speech were then analysed, with attention to patterns of use and contextual information. Results & Discussion 338 expressions made use of the main systematic metaphors which were used to describe inner speech. Two types of inner speech- Phonological Inner Speech and Dialogic Inner Speech – were described as distinct and dissociable experiences, and were described using different metaphors. Phonological Inner Speech, the internal activation of phonological representations, as used in mental repetition of a word or phrase, was described by two authors using the metaphors WORDS AS OBJECTS, MIND AS CONTAINER and INNER SPEECH AS HEARING WORDS. Dialogic Inner Speech, the use or awareness of linguistic inner reasoning or dialogue, was described by two different authors using the metaphors INNER SPEECH AS INNER VOICES/PERSONS/MONOLOGUE/DIALOGUE and APHASIA AS SILENCE/FLUID/SPIRITUAL EXPERIENCE. A double dissociation of these different definitions of inner speech is seen across two of the accounts. Different impacts on language processing and cognition were also described. Conclusions This research demonstrates that subjective accounts of inner speech can help clarify theoretical discussions and clinical implications. Although recent research within aphasiology has focused mainly on Phonological Inner Speech, we show that in these accounts the impairment of Dialogic Inner Speech was described as more salient and more explicitly as a “lack of inner voices”.

Networks for healthcare delivery: asystematic literature review.

Network configurations have been proposed as an efficient form of organisation and a promising area of research; however, a lack of conceptual clarity can be noted. The purpose of this review is to allow for a broad appreciation of network configurations and provide guidance for future studies of the concept. A systematic literature review was conducted based on the PRISMA method; Scopus, Web of Science, PubMed and the Cochrane Library were searched for conference proceedings and journal articles describing organisational networks to integrate resources aimed at care delivery. Around 80 articles were included in the final review and analysed thematically and by use of bibliographic coupling. The last decades have seen an increase in the frequency of articles describing networks for healthcare delivery. The most common contexts are care for multiple and/or long-term conditions. Three clusters of articles were found, corresponding to different conceptualisations of networks in healthcare: efficiency-enhancing cooperation, efficiency-enhancing integration and involvement for cocreation. To increase conceptual clarity and allow the research on network configurations in healthcare to produce meta-learnings and guidance to practice, scholars are advised to provide ample descriptions of studied networks and relate them to established network classifications. The current review has only included articles including networks as a key concept, which provides a focused overview of the use of network configurations but limits the insights into similar approaches not described explicitly as networks.

Ethical Theories Applied in the Field of Tourism

The paper aims to synthesise the main ethical theories that can be applied in any economic area in general and in the tourism field in particular. It is widely believed that each economic sector in which human interaction is principal, has a moral side. This moral side is translated into tourism through concepts such as ethical tourism, responsible tourism, and sustainable tourism. Three main ethical theories are described from a philosophical perspective. They can be applied in a concrete manner to real tourism processes and activities and will enable clarification of key concepts that form any applied ethics expert’s tool: values, principles, standards, ethics, and/or codes of conduct, etc. In the last part of the paper, among the main conclusions, future research directions are detailed.

Justicia constitucional y polarización política en EspañaConstitutional justice and political polarization in Spain

Abstract Established in 1980, the Spanish Constitutional Court displayed a pacifying function and remained in a discreet position, relatively immune to external polarization, during its first years of existence. Already in the first decade, certain signs of polarization began to appear. However, the last fifteen years have witnessed an increasing polarization around the Court. This is mainly due to exogenous causes, which have produced a change in the very self-understanding of the Court. The article begins with some conceptual clarifications, in order to highlight the inherent balance of Constitutional Justice. The author then devotes an epigraph to examine the practices that have contributed to polarization from the outside (distribution of appointments by quotas, transfer of social polarization, excessive recusals, political criticism and direct legislative disturbance of its peaceful functioning). Thirdly, he refers to the judicial practices that, as a consequence of the external intervention, seem to have fed back the polarization (leaks, delays, public exposure of the judges and overreaching of jurisdiction). The author concludes with some more general reflections on the relationship between the external and internal causes of polarization around the Court.

What we mean

In the twenty-first century, cyberspace and the ‘real world’ have become inseparable. The stability and security of cyberspace therefore affect, in increasingly profound ways, the economies, international reputations, national security, military capabilities and global influence of states. In their short history, operations in cyberspace have already been used extensively by states and their non-state supporters for many purposes. They are an inevitable aspect of contemporary international affairs while carrying significant risk. In this Adelphi book, Marcus Willett, a former deputy head of GCHQ, argues that there is no coherent or widely shared understanding of what cyber operations really are, how they are used and what they can do; or of their implications for strategic affairs and international law; or what their ‘responsible’ use really entails. The myths and misunderstandings that abound tend to dull the conceptual clarity needed by strategic policymakers and overseers, and they complicate the essential task in a liberal democracy of maintaining public consent for, and legitimisation of, the development and use of such capabilities. The book sheds light on these issues, exposing myths and clarifying misunderstandings.

The future

In the twenty-first century, cyberspace and the ‘real world’ have become inseparable. The stability and security of cyberspace therefore affect, in increasingly profound ways, the economies, international reputations, national security, military capabilities and global influence of states. In their short history, operations in cyberspace have already been used extensively by states and their non-state supporters for many purposes. They are an inevitable aspect of contemporary international affairs while carrying significant risk. In this Adelphi book, Marcus Willett, a former deputy head of GCHQ, argues that there is no coherent or widely shared understanding of what cyber operations really are, how they are used and what they can do; or of their implications for strategic affairs and international law; or what their ‘responsible’ use really entails. The myths and misunderstandings that abound tend to dull the conceptual clarity needed by strategic policymakers and overseers, and they complicate the essential task in a liberal democracy of maintaining public consent for, and legitimisation of, the development and use of such capabilities. The book sheds light on these issues, exposing myths and clarifying misunderstandings.

The strategic utility of cyber operations

In the twenty-first century, cyberspace and the ‘real world’ have become inseparable. The stability and security of cyberspace therefore affect, in increasingly profound ways, the economies, international reputations, national security, military capabilities and global influence of states. In their short history, operations in cyberspace have already been used extensively by states and their non-state supporters for many purposes. They are an inevitable aspect of contemporary international affairs while carrying significant risk. In this Adelphi book, Marcus Willett, a former deputy head of GCHQ, argues that there is no coherent or widely shared understanding of what cyber operations really are, how they are used and what they can do; or of their implications for strategic affairs and international law; or what their ‘responsible’ use really entails. The myths and misunderstandings that abound tend to dull the conceptual clarity needed by strategic policymakers and overseers, and they complicate the essential task in a liberal democracy of maintaining public consent for, and legitimisation of, the development and use of such capabilities. The book sheds light on these issues, exposing myths and clarifying misunderstandings.

The cyber dimension of the Russia–Ukraine war

In the twenty-first century, cyberspace and the ‘real world’ have become inseparable. The stability and security of cyberspace therefore affect, in increasingly profound ways, the economies, international reputations, national security, military capabilities and global influence of states. In their short history, operations in cyberspace have already been used extensively by states and their non-state supporters for many purposes. They are an inevitable aspect of contemporary international affairs while carrying significant risk. In this Adelphi book, Marcus Willett, a former deputy head of GCHQ, argues that there is no coherent or widely shared understanding of what cyber operations really are, how they are used and what they can do; or of their implications for strategic affairs and international law; or what their ‘responsible’ use really entails. The myths and misunderstandings that abound tend to dull the conceptual clarity needed by strategic policymakers and overseers, and they complicate the essential task in a liberal democracy of maintaining public consent for, and legitimisation of, the development and use of such capabilities. The book sheds light on these issues, exposing myths and clarifying misunderstandings.

Responsible cyber power

In the twenty-first century, cyberspace and the ‘real world’ have become inseparable. The stability and security of cyberspace therefore affect, in increasingly profound ways, the economies, international reputations, national security, military capabilities and global influence of states. In their short history, operations in cyberspace have already been used extensively by states and their non-state supporters for many purposes. They are an inevitable aspect of contemporary international affairs while carrying significant risk. In this Adelphi book, Marcus Willett, a former deputy head of GCHQ, argues that there is no coherent or widely shared understanding of what cyber operations really are, how they are used and what they can do; or of their implications for strategic affairs and international law; or what their ‘responsible’ use really entails. The myths and misunderstandings that abound tend to dull the conceptual clarity needed by strategic policymakers and overseers, and they complicate the essential task in a liberal democracy of maintaining public consent for, and legitimisation of, the development and use of such capabilities. The book sheds light on these issues, exposing myths and clarifying misunderstandings.

A short history of cyber operations

In the twenty-first century, cyberspace and the ‘real world’ have become inseparable. The stability and security of cyberspace therefore affect, in increasingly profound ways, the economies, international reputations, national security, military capabilities and global influence of states. In their short history, operations in cyberspace have already been used extensively by states and their non-state supporters for many purposes. They are an inevitable aspect of contemporary international affairs while carrying significant risk. In this Adelphi book, Marcus Willett, a former deputy head of GCHQ, argues that there is no coherent or widely shared understanding of what cyber operations really are, how they are used and what they can do; or of their implications for strategic affairs and international law; or what their ‘responsible’ use really entails. The myths and misunderstandings that abound tend to dull the conceptual clarity needed by strategic policymakers and overseers, and they complicate the essential task in a liberal democracy of maintaining public consent for, and legitimisation of, the development and use of such capabilities. The book sheds light on these issues, exposing myths and clarifying misunderstandings.

Strategic risks

In the twenty-first century, cyberspace and the ‘real world’ have become inseparable. The stability and security of cyberspace therefore affect, in increasingly profound ways, the economies, international reputations, national security, military capabilities and global influence of states. In their short history, operations in cyberspace have already been used extensively by states and their non-state supporters for many purposes. They are an inevitable aspect of contemporary international affairs while carrying significant risk. In this Adelphi book, Marcus Willett, a former deputy head of GCHQ, argues that there is no coherent or widely shared understanding of what cyber operations really are, how they are used and what they can do; or of their implications for strategic affairs and international law; or what their ‘responsible’ use really entails. The myths and misunderstandings that abound tend to dull the conceptual clarity needed by strategic policymakers and overseers, and they complicate the essential task in a liberal democracy of maintaining public consent for, and legitimisation of, the development and use of such capabilities. The book sheds light on these issues, exposing myths and clarifying misunderstandings.

Maintaining balance

In the twenty-first century, cyberspace and the ‘real world’ have become inseparable. The stability and security of cyberspace therefore affect, in increasingly profound ways, the economies, international reputations, national security, military capabilities and global influence of states. In their short history, operations in cyberspace have already been used extensively by states and their non-state supporters for many purposes. They are an inevitable aspect of contemporary international affairs while carrying significant risk. In this Adelphi book, Marcus Willett, a former deputy head of GCHQ, argues that there is no coherent or widely shared understanding of what cyber operations really are, how they are used and what they can do; or of their implications for strategic affairs and international law; or what their ‘responsible’ use really entails. The myths and misunderstandings that abound tend to dull the conceptual clarity needed by strategic policymakers and overseers, and they complicate the essential task in a liberal democracy of maintaining public consent for, and legitimisation of, the development and use of such capabilities. The book sheds light on these issues, exposing myths and clarifying misunderstandings.

The UK model

In the twenty-first century, cyberspace and the ‘real world’ have become inseparable. The stability and security of cyberspace therefore affect, in increasingly profound ways, the economies, international reputations, national security, military capabilities and global influence of states. In their short history, operations in cyberspace have already been used extensively by states and their non-state supporters for many purposes. They are an inevitable aspect of contemporary international affairs while carrying significant risk. In this Adelphi book, Marcus Willett, a former deputy head of GCHQ, argues that there is no coherent or widely shared understanding of what cyber operations really are, how they are used and what they can do; or of their implications for strategic affairs and international law; or what their ‘responsible’ use really entails. The myths and misunderstandings that abound tend to dull the conceptual clarity needed by strategic policymakers and overseers, and they complicate the essential task in a liberal democracy of maintaining public consent for, and legitimisation of, the development and use of such capabilities. The book sheds light on these issues, exposing myths and clarifying misunderstandings.

Attacking the issue

In the twenty-first century, cyberspace and the ‘real world’ have become inseparable. The stability and security of cyberspace therefore affect, in increasingly profound ways, the economies, international reputations, national security, military capabilities and global influence of states. In their short history, operations in cyberspace have already been used extensively by states and their non-state supporters for many purposes. They are an inevitable aspect of contemporary international affairs while carrying significant risk. In this Adelphi book, Marcus Willett, a former deputy head of GCHQ, argues that there is no coherent or widely shared understanding of what cyber operations really are, how they are used and what they can do; or of their implications for strategic affairs and international law; or what their ‘responsible’ use really entails. The myths and misunderstandings that abound tend to dull the conceptual clarity needed by strategic policymakers and overseers, and they complicate the essential task in a liberal democracy of maintaining public consent for, and legitimisation of, the development and use of such capabilities. The book sheds light on these issues, exposing myths and clarifying misunderstandings.

From curriculum to clinic: a qualitative study of junior doctors’ perceptions of global health and sustainable development

IntroductionThe role of global health and sustainable development in medical education is often debated. However, research regarding medical doctors’ views on the application of their global health knowledge in the...

Scarcity of resources and distributive justice

This article contributes to the discourse on global justice as it pertains to resources and the just distribution of resources. The focus is on the concept of scarcity. In examining different understandings of scarcity through the use of analogies and examples, a distinction is made between absolute scarcity and relative scarcity. I examine the conceptual understanding of scarcity of resources in the context of distributive justice. Conceptual clarity is necessary to ensure that scarcity is properly referred to in the discourse so that scarcity is not erroneously used when justifications are sought for material deprivation and consequent human suffering. The field of distributive justice arguably requires a full comprehension of scarcity of resources, and this can only be achieved by properly examining the concept of scarcity.

Concept Analysis of Psychosocial Distress Among African American and Latine Men Who Have Sex With Men: Implications for HIV Care.

The aim of this study is to provide conceptual clarity on psychosocial distress among African American and Latine men who have sex with men living with human immunodeficiency virus. Concept analysis. The 8-step Walker and Avant framework guided the concept analysis of psychosocial distress tailored to this patient population. A literature review was conducted using the research databases PubMed/Medline, PsycINFO, the Cumulated Index of Nursing and Allied Health Literature and Scopus with the selected search terms. A total of 7 articles were retrieved and analysed to explicate the antecedents, attributes, and consequences of psychosocial distress in this population. Four cases were developed to further clarify the concept of psychosocial distress; a model case, borderline case, related case and contrary case. As experienced by African American and Latine men who have sex with men living with human immunodeficiency virus, psychosocial distress is defined as a state of suffering due to uncontrollable structural and/or social factors that threaten the individual's existence and/or livelihood based on their social identity as a racial/ethnic, sexual minority. The concept analysis of psychosocial distress can be useful to guide future theory and measurement development to enhance disease-specific and general health outcomes for sexual and racial/ethnic minoritised men who have sex with men. Not applicable. No patient or public contribution.

Response assessment in pediatric neurooncology (RAPNO) criteria revisited: a practical navigation guide for neuroradiologists.

The Response Assessment in Pediatric Neuro-Oncology (RAPNO) Working Group is an international, collaborative network of experts dedicated to pediatric central nervous system (CNS) tumors that was created in 2011. Since then, six RAPNO articles with imaging guidelines for response assessment in diverse pediatric tumor subgroups have been published, namely: 1) medulloblastomas and leptomeningeal seeding tumors (2018), 2) pediatric high-grade gliomas (2020), 3) pediatric low-grade gliomas (2020), 4) diffuse intrinsic pontine gliomas (2020), 5) pediatric intracranial ependymomas (2022) and 6) pediatric craniopharyngiomas (2023). The purpose of this article is to review all current available RAPNO criteria using a systematized and comparative approach centered on the role of neuroradiologists and supported by neuroimaging examples. Special emphasis will be placed on clarification of core concepts as well as practical adoption aspects of the RAPNO guidelines, namely how and when to image the brain and/or the spine; how to interpret the imaging findings; which other clinical, therapeutic and laboratory variables to consider; and finally how to apply the information to attribute the final appropriate response assessment classification.