Step Backwards Research Articles

Abandon All.

Ad Libitum4 July 2017Abandon AllStanley Cohen, MDStanley Cohen, MDFrom Atlanta, Georgia.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-0409 Audio Reading - “Abandon All” Audio. Virginia L. Hood, MD, reads "Abandon All," by S. Cohen. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ER wastebaskets are fullof stethoscopes, theirthick tubes coiled, earpiecesand bells used only if nothingcan justify a CT scan, or after,to hear what Marcus Welbywould have diagnosed.CT done, lab filed in the chart,so it's safe to call an attendingor the referring doc,assure the familythe blood they sawwas real, the bruise expected,and the cough or painwill slowly dissipateunless it doesn't;in which case (theirs),they should come backto the same magazines. Author, Article, and Disclosure InformationAffiliations: From Atlanta, Georgia.Current Author Address: Stanley Cohen, MD, Children's Center for Digestive Health Care, 993D Johnson Ferry Road, #440, Atlanta, GA; e-mail, [email protected]com. PreviousarticleNextarticle Advertisement Audio Reading - “Abandon All” Audio. Virginia L. Hood, MD, reads "Abandon All," by S. Cohen. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics 4 July 2017Volume 167, Issue 1Page: 76KeywordsBloodChartsChild healthChildrenComputed axial tomographyHealth careLower back pain ePublished: 4 July 2017 Issue Published: 4 July 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Intensive Care.

Ad Libitum4 July 2017Intensive CareBrenda Butka, MDBrenda Butka, MDFrom Nashville, Tennessee.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-0257 Audio Reading - “Intensive Care” Audio. Virginia L. Hood, MD, reads "Intensive Care," by B. Butka. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Mr. Jones stands outside the glass, looks inat his foreign wife. Alien,her only language numbers, her only songvariations on an oscilloscope. The audiencerecognizes wild new rhythms:she is pushing back frontiers, shemarches forward.In this cool light,eight floors above the parking lot,she transforms.A bag of bone and water,flesh becomes irrelevant, she becomeswhat she was not.A silent grotesque, she sings her song.The room sighs, is more alive than this centerpiece.Her chest rises and falls in time with machines.As the sun warms an aqua morning sky,a hidden crescendo.Mr. Jones tells Mrs. Jones good-bye. Author, Article, and Disclosure InformationAffiliations: From Nashville, Tennessee.Current Author Address: Brenda Butka, MD; e-mail, brenda.[email protected]edu. PreviousarticleNextarticle Advertisement Audio Reading - “Intensive Care” Audio. Virginia L. Hood, MD, reads "Intensive Care," by B. Butka. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics 4 July 2017Volume 167, Issue 1Page: 65KeywordsBoneFallsThorax ePublished: 4 July 2017 Issue Published: 4 July 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Counterclockwise.

Ad Libitum4 July 2017CounterclockwiseVenetta Masson, RN, MAVenetta Masson, RN, MAFrom Washington, DC.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-0373 Audio Reading - “Counterclockwise” Audio. Virginia L. Hood, MD, reads "Counterclockwise," by V. Masson. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Lost in timeand the fog of bereavementI'm startled to see the handsof the clock by our bedrunning backwards.I confront it face to face,shake it, but resist unplugging.For days we track back(the clock and I)from now to then till suddenly I seewhat Zen and physics say is true—we live in a block universe,all things in all time.And with that, I unplug.I no longer use the clockbut keep it closeted—prophet in a cave—silent reminder thatthere's no such thing as a raceagainst time, no finish lineonly this human finitude. Author, Article, and Disclosure InformationAffiliations: From Washington, DC.Current Author Address: Veneta Masson, RN, MA; e-mail, veneta.[email protected]com. PreviousarticleNextarticle Advertisement Audio Reading - “Counterclockwise” Audio. Virginia L. Hood, MD, reads "Counterclockwise," by V. Masson. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics 4 July 2017Volume 167, Issue 1Page: 16KeywordsRacial and ethnic issuesRunning ePublished: 4 July 2017 Issue Published: 4 July 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Krebs Cycle.

Ad Libitum20 June 2017Krebs CycleVeneta Masson, RN, MAVeneta Masson, RN, MAFrom Washington, DC.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-0374 Audio Reading - “Krebs Cycle” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Krebs Cycle," by V. Masson. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail the sequence of reactions by whichliving cells generate energyI remember as if it were yesterdaycramming in the libraryhours before the examwhen, in a Zen-like flashthe Krebs cycle manifested itselfin stunning clarity.I rushed into classspilled out what I knewenergized, euphoriconly half-believing that a revelationof this magnitudehad been entrusted to me.I couldn't contain it for long.A curtain fellmy understanding cloudedonce again blurring the border ofscienceand mystery.Every few years I've cycled backtrying to recapture that thingI once grasped—... Author, Article, and Disclosure InformationAffiliations: From Washington, DC.Current Author Address: Veneta Masson, RN, MA; e-mail, veneta.[email protected]com. PreviousarticleNextarticle Advertisement Audio Reading - “Krebs Cycle” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Krebs Cycle," by V. Masson. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics 20 June 2017Volume 166, Issue 12Page: 911KeywordsBlindnessCellsLibraries ePublished: 20 June 2017 Issue Published: 20 June 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

The United States Leads Other Nations In Differences By Income In Perceptions Of Health And Health Care.

We examined income gaps in the period 2011-13 in self-assessments of personal health and health care across thirty-two middle- and high-income countries. While high-income respondents were generally more positive about their health and health care in most countries, the gap between them and low-income respondents was much bigger in some than in others. The United States has among the largest income-related differences in each of the measures we studied, which assessed both respondents' past experiences and their confidence about accessing needed health care in the future. Relatively low levels of moral discomfort over income-based health care disparities despite broad awareness of unmet need indicate more public tolerance for health care inequalities in the United States than elsewhere. Nonetheless, over half of Americans felt that income-based health care inequalities are unfair, and these respondents were significantly more likely than their compatriots to support major health system reform-differences that reflect the country's political divisions. Given the many provisions in the Affordable Care Act that seek to reduce disparities, any replacement would also require attention to disparities or risk taking a step backward in an area where the United States is in sore need of improvement.

Repealing Obama's healthcare act a massive step backwards?

Repealing Obama's healthcare act a massive step backwards?

This Is Why.

On Being a Doctor16 May 2017This Is WhyCassandraCassandraSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M16-1745 Audio Reading - “This Is Why” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "This Is Why," by Anonymous. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail I write this because I am afraid to write this.I write this because I am a fourth-year medical student typing on a small laptop in my closet in the dark. Because I am sitting on the floor with my back against the wall. Because to my left lies a pile of unsorted clothes and underneath a silver knife. Because in my senior year of college, I sat on the corner of my bed—on my bed, because back then my closet was overfull of skeletons and nightmares seeped in under door cracks and through the walls and there was nowhere ...

The Public Right to Float through Private Property in Utah: Conatser v. Johnson

In the summer of 2008, the Utah Supreme Court addressed the scope of the public’s easement in state waters. Specifically, the Court determined “whether the easement, which allows the public to engage in recreational activities in state waters, also allows the public the right to touch the privately owned beds below those waters.The Supreme Court ruled that “[t]he district court [had] incorrectly interpreted the scope of the public’s easement in state waters so as to limit the Conatsers’ rights to being upon the water and to touching the privately owned bed of the Weber River only in ways incidental to the right of floatation.” In its decision, the Supreme Court found that under Utah law, the public has the right to “engage in all recreational activities that utilize the water” and that this right is not limited to “activities that can be performed upon the water.” While riparian land owners may see the Conatser ruling as a major step backwards in the protection of their property rights, recreation enthusiasts are likely to view the holding in this case as the right interpretation of the public’s easement over state waters in Utah. As the Court emphasized in its Conatser ruling, by statute all waters in Utah are property of the public. Under such a “doctrine of public ownership,” the public has an “easement over the waters regardless of who owns the water bed beneath.” The Conatser ruling resolved two issues: first, whether it is criminal trespass for members of the public to float on state waters through private property; and second, whether recreational users who float through private property on the state waters and touch the beds and banks of these streams are subject to being dragged into court by riparian land owners and charged with civil liability.

Effects of pre-conditioning on behavior and physiology of horses during a standardised learning task

Rein tension is used to apply pressure to control both ridden and unridden horses. The pressure is delivered by equipment such as the bit, which may restrict voluntary movement and cause changes in behavior and physiology. Managing the effects of such pressure on arousal level and behavioral indicators will optimise horse learning outcomes. This study examined the effect of training horses to turn away from bit pressure on cardiac outcomes and behavior (including responsiveness) over the course of eight trials in a standardised learning task. The experimental procedure consisted of a resting phase, treatment/control phase, standardised learning trials requiring the horses (n = 68) to step backwards in response to bit pressure and a recovery phase. As expected, heart rate increased (P = 0.028) when the handler applied rein tension during the treatment phase. The amount of rein tension required to elicit a response during treatment was higher on the left than the right rein (P = 0.009). Total rein tension required for trials reduced (P < 0.001) as they progressed, as did time taken (P < 0.001) and steps taken (P < 0.001). The incidence of head tossing decreased (P = 0.015) with the progression of the trials and was higher (P = 0.018) for the control horses than the treated horses. These results suggest that preparing the horses for the lesson and slightly raising their arousal levels, improved learning outcomes.

Active Versus Healthy Aging: a Step Backwards?

Active Versus Healthy Aging: a Step Backwards?

Analytics and Information: A Case for Performance Ratings

Schiemann and Ulrich's (2017) discussion of opportunities for industrial–organizational (I-O) psychology speaks directly to the growing movement of companies eliminating their performance ratings. One of the main issues that the focal article highlights is the need for strong analytics and measurement. A core domain of industrial psychology historically has been employee performance measurement. However, by some accounts, as of September 2015, at least 51 large companies were in the process of eliminating their performance ratings (Rock &amp; Jones, 2015). Whether eliminating performance ratings is a good idea is a subject of debate in the I-O psychology community. In addition to a focal article in the summer of 2016 edition of Industrial and Organizational Psychology (Adler, Campion, et al., 2016), several sessions addressed this topic at the 2016 Society for Industrial and Organizational Psychology convention (e.g., Adler, Colquitt, et al., 2016; Hettal, Garza, Levy, &amp; Cleveland, 2016; Hunt et al., 2016; Roch &amp; Gorman, 2016). The I-O psychology community appears to be divided on the value of performance ratings. In my opinion, the recent drive to abandon rigorous performance measurement appears to be a step backward rather than a step forward.

Jules and Augusta Dejerine: Crossing biographies

Jules and Augusta Dejerine: Crossing biographies

Protection of environment in armed conflicts: From progress to regress

The paper deals with the issue of environmental protection in armed conflicts. The article starts from the solutions contained in the Convention on the Prohibition of Military or Any Other Hostile Use of Environmental Modification Techniques (ENMOD Convention) and the Protocol I to the Geneva Conventions, which, for the first time, explicitly contained provisions on the protection of environment in armed conflicts. Then the author focuses on the content of Article 8 of the Rome Statute and gives a brief overview of theoretical statements of prominent authors. Comparing the solutions of Protocol I and Rome Statute, the author starts from the hypothesis that the solution of the Rome Statute represent a step backwards in the protection of the environment in armed conflicts in relation to the solutions of Protocol I. In addition to critical consideration of the aforementioned provisions of the Rome Statute, the author points out the differences in the standardization of ecological war crimes in the Rome Statute and the Serbian Criminal Code. After reviewing the normative solutions, the author presents the selected examples of environmental protection in armed conflicts in practice. The results of the research, by application of the legal dogmatic method, shows that there are many problems that hinder the implementation of relevant provisions of the instruments of environmental protection in armed conflicts in practice. Therefore, the aim of the author is, starting from the problems in this area, to offer de lege ferenda proposals for the amendment of existing solutions.

Hard populism and the challenge to incumbent parties in Greece: a step forwards or backwards?

ABSTRACTIt is often assumed that the rise of populism leads to political outcomes that threaten to undermine stable democratic politics and commitment to European integration. This article interrogates the relationship between increasing political polarisation including violent protests and the institutional trajectories followed by mainstream political parties. Through an analysis conceptually anchored on historical and sociological institutionalist approaches to change and resilience, the article examines the hypothesis that change in party structures can be accelerated by a hostile social and economic environment. Empirical evidence provided from the case study of Greece delineates how this change has occurred through the gradual development of discourse coalitions. Key findings include the introduction of novel structures and practices in party contestation and campaigning that differ from the existing national (domestic) model and can in part be attributed to EU impact. However, as innovations remain limited in scope and appeal in the short-term, they prove unable to constrain the populist surge and the associated counter-innovations or prevent the return to discarded national models.

A Tale of Two Constitutions: Métis Nationhood and Section 35(2)’s Impact on Interpretations of Daniels

Spurious claims to “Métisness,” or those claiming a Métis identity, have been on the rise since the Daniels decision, wherein the Supreme Court determined some measure of federal responsibility to Métis people. Yet the justices in the decision neither confirmed nor denied that people making claims to Métisness (often) on the basis of distant Indigenous ancestry, are people for whom federal responsibility extends. This is due to (what appears on the surface to be) a lack of clarity around the definition of Métis as it exists in section 35 of the Canadian Constitution of 1982. In light of this, this article offers a brief discussion of the Powley case, the first major Supreme Court decision pertaining to Métis rights and the first that sought to offer a pathway for determining who is Métis in the context of section 35(2) “Aboriginal rights.” It then takes a chronological step backwards to the time of constitutional negotiations to discuss the situation of Métis within the category of Aboriginal peoples. The article then ties this discussion into the recent Supreme Court decision in Daniels v. Canada. I argue that political activists put forth a specific definition of Métis rooted in an understanding of Métis nationhood that was not formally entrenched in the 1982 Constitution; this definition should be embraced and acknowledged to appropriately narrow the meaning of Métis in section 35. This would in turn have implications for Daniels and the federal government’s responsibility to the Métis Nation.

Las Armas de Destrucción Masiva y la Estrategia Global de Seguridad de la Unión Europea

The proliferation of weapons of mass destruction (WMD), nuclear, biological and chemical (NBC) is one of the main security challenges facing the international community today. However the new Global Security Strategy of 2016 raises the question of non-proliferation of WMD only as an incidental matter, not addressing directly the threat, a fundamental threat in the regional and global security. This is a clear step backwards for the European common security.

Comment on “A Historical Review of Induced Earthquakes in Texas” by Cliff Frohlich, Heather DeShon, Brian Stump, Chris Hayward, Matt Hornbach, and Jacob I. Walter

Researchers (Frohlich et al. , 2016) from the University of Texas at Austin and Southern Methodist University recently developed a new question‐based system for categorizing Texas earthquakes as either natural or man‐made. Unfortunately, this new test is a significant step backward. Frohlich et al. (2016) appears to reject the science‐based, integrated subsurface engineering and geomechanics approach as advocated by more than 80 national and international subject matter experts. The test also runs counter to the approach recommended by the National Academies and the U.S. Environmental Protection Agency (EPA), and it arbitrarily skews the conclusion away from natural causes. This article will explore these shortcomings and provide some recommendations for improvements. A question‐based system, where researchers answer conditional questions to determine if an earthquake may be man‐made, is a useful tool for exploring an inherently complicated subject. An earlier question‐based system developed by Davis and Frohlich (1993) focused on downhole pressure and fluid pathways: The premier U.S. scientific organization has also articulated the importance of subsurface factors. In its comprehensive 2013 report, the National Research Council of the National Academies concluded: Increase of pore pressure above ambient value due to injection of fluids and decrease in pore pressure below ambient value due to extraction of fluids have the potential to produce seismic events. For such activities to cause these events, a certain combination of conditions has to exist simultaneously …

Target color and shape can control contextual saccadic adaptation

Saccade adaptation is a form of motor learning that maintains saccade accuracy when facing new sensorimotor contingencies. Researchers have shown that distinct saccade gain states can be adapted simultaneously in a double-step paradigm depending on contexts acting on the motor command (e.g. velocity or direction of target motion, head tilt, orbital eccentricity, or vergence). However, purely visual cues such as target color or shape consistently failed to drive different gain states during saccadic adaptation. Since Deubel's work in 1995, this question has remained unsolved despite extensive research in both human and non-human participants. The present work investigates whether this lack of contextual control might be due to a lack of relevance of the contextual cue to the saccadic system. We modified the conventional intrasaccadic step paradigm by displaying a distractor at the back-stepped location when the target stepped forward and vice-versa. In a first experiment the pre-saccadic target color (red or green) indicated its intra-saccadic step (backward or forward) and a distractor (green or red) was displayed after the saccade landed (at the forward-stepped or back-stepped location). We observed contextual control of saccade adaptation, which did not occur when the distractor was not displayed. In two other experiments we found the same effect using shape or shape and color as contextual features. We conclude that feature-based selection of the target promotes contextual adaptation. Three additional experiments further confirmed that i) when two features of the context cues are conflicting, contextual adaptation is blocked, ii) the spatial reference provided by the distractor is not responsible for our contextual adaptation and iii) removing the distractor during the adaptation phase induces a progressive decrease in adaptation. These results indicate that any context could potentially control contextual saccadic adaptation provided that the relation between the context cue and the saccadic response is made relevant. Meeting abstract presented at VSS 2016

Expanding on Successful Concepts, Models, and Organization.

In her letter to the editor1 regarding our recent Feature Article “Completing the Link between Exposure Science and Toxicology for Improved Environmental Health Decision Making: The Aggregate Exposure Pathway Framework” 2, Dr. von Goetz expressed several concerns about terminology, and the perception that we propose the replacement of successful approaches and models for exposure assessment with a concept. We are glad to have the opportunity to address these issues here. If the goal of the AEP framework was to replace existing exposure models or databases for organizing exposure data with a concept, we would share Dr. von Goetz concerns. Instead, the outcome we promote is broader use of an organizational framework for exposure science. The framework would support improved generation, organization, and interpretation of data as well as modeling and prediction, not replacement of models. The field of toxicology has seen the benefits of wide use of one or more organizational frameworks (e.g., mode and mechanism of action, adverse outcome pathway). These frameworks influence how experiments are designed, data are collected, curated, stored and interpreted and ultimately how data are used in risk assessment. Exposure science is poised to similarly benefit from broader use of a parallel organizational framework, whichmore » Dr. von Goetz correctly points out, is currently used in the exposure modeling community. In our view, the concepts used so effectively in the exposure modeling community, expanded upon in the AEP framework, could see wider adoption by the field as a whole. The value of such a framework was recognized by the National Academy of Sciences.3 Replacement of models, databases, or any application with the AEP framework was not proposed in our article. The positive role broader more consistent use of such a framework might have in enabling and advancing “general activities such as data acquisition, organization…,” and exposure modeling was discussed in some detail. Like Dr. von Goetz, we recognized the challenges associated with acceptance of the terminology, definitions, and structure proposed in the paper. To address these challenges, an expert workshop was held in May, 2016 to consider and revise the “basic elements” outlined in the paper. The attendees produced revisions to the terminology (e.g., key events) that align with terminology currently in use in the field. We were also careful in our paper to acknowledge a point raised by Dr. von Goetz, that the term AEP implies aggregation, providing these clarifications: “The simplest form of an AEP represents a single source and a single pathway and may more commonly be referred to as an exposure pathway,”; and “An aggregate exposure pathway may represent multiple sources and transfer through single pathways to the TSE, single sources and transfer through multiple pathways to the target site exposure (TSE), or any combination of these.” These clarifications address the concern that the AEP term is not accurate or logical, and further expands upon the word “aggregate” in a broader context. Our use of AEP is consistent with the definition for “aggregate exposure”, which refers to the combined exposures to a single chemical across multiple routes and pathways.3 The AEP framework embraces existing methods for collection, prediction, organization, and interpretation of human and ecological exposure data cited by Dr. von Goetz. We remain hopeful that wider recognition and use of an organizing concept for exposure information across the exposure science, toxicology and epidemiology communities advances the development of the kind of infrastructure and models Dr. von Goetz discusses. This outcome would be a step forward, rather than a step backward.« less

Teaching Domestic Violence Online: A Step Forward or a Step Backward?

With the increasing number of courses and degree programs available online, faculty may be interested in developing an online course on domestic violence. This article analyzes the similarities and differences involved in teaching about domestic violence online versus face-to-face. Highlights of course activities and notable online resources are identified including YouTube videos, webinars, online training modules, and websites. The limitations and challenges of teaching domestic violence in an asynchronous online course and recommendations for future teaching are discussed.