Step Forward Research Articles

Cardiopulmonary exercise testing and heart failure: a tale born from oxygen uptake.

Since 50 years, cardiopulmonary exercise testing (CPET) plays a central role in heart failure (HF) assessment. Oxygen uptake (VO2) is one of the main HF prognostic indicators, then paralleled by ventilation to carbon dioxide (VE/VCO2) relationship slope. Also anaerobic threshold retains a strong prognostic power in severe HF, especially if expressed as a percent of maximal VO2 predicted value. Moving beyond its absolute value, a modern approach is to consider the percentage of predicted value for peak VO2 and VE/VCO2 slope, thus allowing a better comparison between genders, ages, and races. Several VO2 equations have been adopted to predict peak VO2, built considering different populations. A step forward was made possible by the introduction of reliable non-invasive methods able to calculate cardiac output during exercise: the inert gas rebreathing method and the thoracic electrical bioimpedance. These techniques made possible to calculate the artero-venous oxygen content differences (ΔC(a-v)O2), a value related to haemoglobin concentration, pO2, muscle perfusion, and oxygen extraction. The role of haemoglobin, frequently neglected, is however essential being anaemia a frequent HF comorbidity. Finally, peak VO2 is traditionally obtained in a laboratory setting while performing a standardized physical effort. Recently, different wearable ergo-spirometers have been developed to allow an accurate metabolic data collection during different activities that better reproduce HF patients' everyday life. The evaluation of exercise performance is now part of the holistic approach to the HF syndrome, with the inclusion of CPET data into multiparametric prognostic scores, such as the MECKI score.

Artificial Intelligence Applied to Colonoscopy: Is It Time to Take a Step Forward?

Growing evidence indicates that artificial intelligence (AI) applied to medicine is here to stay. In gastroenterology, AI computer vision applications have been stated as a research priority. The two main AI system categories are computer-aided polyp detection (CADe) and computer-assisted diagnosis (CADx). However, other fields of expansion are those related to colonoscopy quality, such as methods to objectively assess colon cleansing during the colonoscopy, as well as devices to automatically predict and improve bowel cleansing before the examination, predict deep submucosal invasion, obtain a reliable measurement of colorectal polyps and accurately locate colorectal lesions in the colon. Although growing evidence indicates that AI systems could improve some of these quality metrics, there are concerns regarding cost-effectiveness, and large and multicentric randomized studies with strong outcomes, such as post-colonoscopy colorectal cancer incidence and mortality, are lacking. The integration of all these tasks into one quality-improvement device could facilitate the incorporation of AI systems in clinical practice. In this manuscript, the current status of the role of AI in colonoscopy is reviewed, as well as its current applications, drawbacks and areas for improvement.

Made in Louisiana: The Story of the Acadian Accordion

Made in Louisiana: The Story of the Acadian Accordion

Nanomaterials in Cosmetics: An Outlook for European Regulatory Requirements and a Step Forward in Sustainability

The use of materials and products that improve appearance and provide comfort and well-being goes back to the beginning of civilization. Cosmetics is an evolving market that has increasingly focused on innovative technological approaches. Nanotechnology is one of the most revolutionary and promising fields for the development of novel and enhanced cosmetic products, owing to the remarkable multifunctional characteristics and effects of nanomaterials (NMs). Their application, however, also raises potential safety concerns. Some of these concerns can be addressed by determining the type of NMs used, as well as their stability, potential for skin absorption, route of exposure, and how they are formulated into cosmetic products. To guarantee such safety, cosmetic products containing NMs, must comply with European regulatory provisions, particularly the European Regulation (EC) n.° 1223/2009 of the European Parliament and of the Council. Hence, this review comprises all the particularities of NMs, their influence on human health, challenges towards environmental sustainability, and strategies to harmonize policies with the aim to normalize their application in cosmetics.

Fil-Thai Language exchange Program Experience: Exploring the Next Step Forward

Fil-Thai Language exchange Program Experience: Exploring the Next Step Forward

Leading with Compassion: A Discussion and Steps Forward for Behavior Analysts

The provision of applied behavior analytic (ABA) services is a highly efficacious intervention approach most often used to improve the lives of individuals with autism spectrum disorder (ASD)/Autistics. Given the advancement of the field, more nuanced skill sets of behavior analysts, such as compassionate care skills, are emerging as the focus of intervention as measurable, observable, and essential. As the field progresses, the identification, refinement, and assessment of more nuanced skills become crucial to the success of our interventions. Leading with a compassionate approach that balances habilitation with client happiness, assent, and engagement is of the utmost importance. This paper discusses the current trend in existing compassionate care literature and how those evaluations may potentially be extended to direct interventionists and Registered Behavior Technicians. In this paper, we argue that a behavioral framework should be used to conceptualize, train, and evaluate the demonstration of these skills in front line ABA practitioners.

One Step Forward, One Step Back: The Micro-Level Impacts of Conflict on Women's Security

AbstractDespite conflict's violent and deleterious impacts, scholarship increasingly demonstrates that women's political rights at the macro-level increase after conflict. However, relatively less is understood about how conflict impacts women's security at the micro-level, especially regarding how it impacts men's and women's attitudes toward intimate partner violence. While conflict can challenge traditional gender roles that justify wife beating, it also promotes hypermasculinity, normalizes violence, and leads to backlash against women in an attempt to re-establish traditional gender hierarchies. International actors, particularly through aid, moderate the impact of conflict on attitudes toward wife beating by encouraging progressive gender roles and increasing socio-economic development. Using Demographic Health Survey data in Uganda, this analysis compares the influence of conflict and international aid at the microlevel on approval of wife beating. The results demonstrate that women exposed to both conflict and aid are relatively less likely to approve of wife beating relative to women exposed to conflict alone. In contrast, men exposed to violence and aid do not alter their justification of wife beating. This study clarifies how conflict impacts attitudes toward women's rights at the microlevel.

EU Copyright Exceptions and Limitations and the Three-Step Test: One Step Forward, Two Steps Back

Abstract The three-step test, by origin an international provision, restricts copyright exceptions and limitations. The three-step test was incorporated into multiple treaties and trade agreements after being first included in the Berne Convention. Despite some nuances regarding the test’s wording in these legal instruments, the essential part – i.e. the three criteria – has remained unchanged. The European Union (EU) legislator took a step forward by expressly implementing the international three-step test into EU law. Article 5(5) of the 2001 InfoSoc Directive provides for its own EU three-step test, and more recently, the test was included in the 2019 DSM Directive. However, two substantial issues remain. First, there is still uncertainty on the specific meaning of each of these steps, due to scarce case law at the international level. Second, the incorporation of this standard has led to an added discussion on the scope and addressee of the EU three-step test. Due to the InfoSoc Directive’s wording, the question arose whether the three-step test is solely addressed to national legislators, or whether the test can also be applied by national courts. This article features a detailed analysis of the European Court of Justice’s case law on the three-step test, highlighting differing tendencies in its rulings. The Court’s decisions bring little clarification regarding the question of the test’s addressee, leaving the issue unresolved and disputed in the legal literature.

The Roth Net at 40 years: celebrating the spirit of innovation

The Roth Net at 40 years: celebrating the spirit of innovation

A sport-health centre open to mental health

Physical activity is a determinant of the overall health and well-being of patients with mental disorders. The story of a clinical experience in a physical activity and sports center, recognized as a health and sports center, allows us to highlight the specific issues of adapted physical activity in psychiatry, oriented towards recovery and social integration. The opening of sport-health centres in mental health is an inclusive step forward that contributes to the improvement of care practices in psychiatry.

An Epic Step Forward: A Universal Pediatric Palliative Care Navigator Within an EHR to Improve Our Understanding of the Patient Narrative (FR201A)

An Epic Step Forward: A Universal Pediatric Palliative Care Navigator Within an EHR to Improve Our Understanding of the Patient Narrative (FR201A)

Have You Come a Long Way, Baby, Since 2008?: One Major Step Forward with Missteps Along the Way

ABSTRACT The 2020 American election saw a record-breaking number of women vying for the Democratic presidential nomination and ended with Kamala Harris shattering the second-highest, hardest glass ceiling—the vice presidency. This significant event should not be taken for granted, but it is a mistake to assume sexism is no longer prevalent in American politics. This essay furthers our 2009 analysis of media frames that applied Rosabeth Moss Kanter’s archetypes of women leaders—iron maiden, sex object, mother, pet—to coverage of women seeking the presidency and vice presidency since 2008. We find substantial evidence that the iron maiden and sex object are still common frames and evolved based on changing trends, specific women, and racial stereotypes. We conclude by arguing these frames have real-world implications for how women candidates are evaluated and how they might impact a woman’s chances to win the presidency.

Bimetallic cobalt catalysts promoted by La2O3 for the production of high-calorie synthetic gas

A new catalytic route for the production of a high-calorie synthetic gas (40–60 MJ/Nm3), composed by C1-C4 hydrocarbons, has industrial interest for gas applications and locations with high heating requirements. In this work, a series of bimetallic Co-X (X = Ni, Pt and Fe) catalysts supported on La2O3 promoted Al2O3 micro-spheres were evaluated using both CO2 and CO carbon sources under mild temperature (T = 200–300 °C), moderate pressure (P = 10 bar·g) and relatively high gas hourly space velocity (40,000 N mL/gcat·h). Experimental results proved that the incorporation of nickel as a second metal is beneficial for high-calorie gas application. Besides, catalytic results showed that the utilization of CO as carbon source is beneficial in both conversion and C1-C4 hydrocarbon selectivities. Co-Ni presented the most interesting results, leading to a heating value of 57.9 MJ/Nm3 (40.01 % CH4 and 50.04 % C2-C4 hydrocarbon) at 250 °C through CO hydrogenation. The enhanced catalytic performance achieved over bimetallic Co-Ni was attributed to CoNi alloy catalytic activity, high reducibility (73.82 %), active metal content (9.65x10-4 mmol/g) and appropriate acid-basic sites for COx activation. In contrast, the conversion of CO2 to high-calorie gas was found to be more challenging and lower gas heating values were achieved (39.73 MJ/Nm3). In this case, an adapted reactor concept using a dual bimetallic catalyst and different reaction conditions is hereby proposed to shift selectivity towards the targeted products. This findings represent a step forwards in catalytic engineering for the development of high-calorie synthetic gas reactors.

Annals for Educators - February 2023.

Annals for Educators - February 2023.

Validating angiographically derived FFR in the NSTEMI patient: An important step forward.

Key Points Despite concerns of altered physiology impacting fractional flow reserve (FFR) values in acute coronary syndrome, angiographic FFR compared with wire‐based FFR in patients with NSTEMI demonstrated excellent correlations. Limits to the accuracy of FFRangio include the need for optimal angiographic angles to avoid vessel overlap and assumptions for myocardial resistance, mass, and blood flow. Clinical outcome studies will be required before FFRangio becomes a standard of care.

Manuscript Map of Illyricum, 1663, in the Pontifical Croatian College of St Jerome

In the Pontifical Croatian College of St. Jerome in Rome, a manuscript geographic map of Illyricum is kept, drawn in 1663 by the architect and geographer, Pietro Andrea Buffalini of Rome. Cartographic analysis of this map has been carried out on several occasions, and the ecclesiastico-legal and historico-geographic context of its origin analysed. As contribution to previous research on the 1663 map of Illyricum, the depiction of the coast on that map is cartometrically compared with that on geographic maps and nautical charts from the late 16th century and the first half of the 17th. On the basis of these analyses it is confirmed that, with the 1663 map of Illyricum, a qualitative step forward was taken in depicting the northeast coast of the Adriatic. In addition, on the basis of research into available written data sources, it is concluded that Ivan Lučić made a key (co)authorial contribution to the shaping of the geographic content of this manuscript map.

Control of internal affairs bodies by citizens: a step forward

Control of internal affairs bodies by citizens: a step forward

Understanding Core Native Human Effective Components in Crisis Management Is a Step Forward Towards Increasing Resiliency and Decreasing Stress Especially in Sudden Crises as a Sustainable Development Framework

Background: In different crises without any exception, especially sudden emergencies, the role of human effective components (HECs), native human effective components (NHECs) (belonging to a specific space and location), and especially core native human effective components (CNHECs); and among CNHECs, level of management skills, ignorance, and manager’s mind bandwidth are of vital importance in crisis management. These three specified CNHECs can affect crisis management and managers as well as the level of latency in planning, strategy, and management, and as such through a complexity of reactions (i.e. A. affective, B. behavioral, and C. cognitive reactions) to increase resiliency and decrease distress in metropolitan urban areas. The time limitation is also an important issue to be considered. Materials and Methods: The type of review method has been integrative review. For a better review process, 200 articles during an approximately 50-year time (1972-2021) period during 3 years of the review process were studied and for the selection method, the well-known scientific databases and universities, the search terms, and inclusion/exclusion criteria were selected, analyzed, and summarized through a review protocol. Results: We aim to shed light on HECs preparation of NHECs and CNHECs in disaster management which will generate a good understanding to increase the resiliency and decrease the distress in crisis managers in times of sudden emergencies in metropoles as a sustainable development framework for the future. Conclusion: By creating the proposed taxonomy and classification of CNHECs in crisis management (managers), at first a better understanding will be obtained which in times of sudden crisis can increase resiliency and decrease distress generating a sustainable development framework.

Organic Weed Management: A Step Forward Towards Sustainability

Organic Weed Management: A Step Forward Towards Sustainability

Blended Learning in Animal Biotechnology during Pre-COVID-19, COVID-19 and Post COVID-19 Recovery Phase Periods across the Globe: a Step Forward or Backward?

Blended Learning in Animal Biotechnology during Pre-COVID-19, COVID-19 and Post COVID-19 Recovery Phase Periods across the Globe: a Step Forward or Backward?