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Intuitively, a speaker who uses slurs to refer to people is doing something morally objectionable even if no one is measurably affected by their speech. Perhaps they are only talking to themselves, or they are speaking with bigots who are already as vicious as they can be. This paper distinguishes between slurring as an expressive act and slurring as the act of causing a psychological effect. It then develops an expression-focused ethical account in order to explain the intuition that slurring involves an effect-independent moral wrong. The core idea is that the act of expressing a morally defective attitude is itself pro tanto morally objectionable. Unlike theories that focus only on problematic effects, this view is able to shift the moral burden of proof away from victims of slurring acts and onto speakers. It also offers moral guidance with respect to metalinguistic and pedagogical utterances of slurs.

New surgical procedures can expose patients to harm and should be carefully evaluated before widespread use. The InSpace balloon (Stryker, USA) is an innovative surgical device used to treat people with rotator cuff tears that cannot be repaired. We aimed to determine the effectiveness of the InSpace balloon for people with irreparable rotator cuff tears.We conducted a double-blind, group-sequential, adaptive randomised controlled trial in 24 hospitals in the UK, comparing arthroscopic debridement of the subacromial space with biceps tenotomy (debridement only group) with the same procedure but including insertion of the InSpace balloon (debridement with device group). Participants had an irreparable rotator cuff tear, which had not resolved with conservative treatment, and they had symptoms warranting surgery. Eligibility was confirmed intraoperatively before randomly assigning (1:1) participants to a treatment group using a remote computer system. Participants and assessors were masked to group assignment. Masking was achieved by using identical incisions for both procedures, blinding the operation note, and a consistent rehabilitation programme was offered regardless of group allocation. The primary outcome was the Oxford Shoulder Score at 12 months. Pre-trial simulations using data from early and late timepoints informed stopping boundaries for two interim analyses. The primary analysis was on a modified intention-to-treat basis, adjusted for the planned interim analysis. The trial was registered with ISRCTN, ISRCTN17825590.Between June 1, 2018, and July 30, 2020, we assessed 385 people for eligibility, of which 317 were eligible. 249 (79%) people consented for inclusion in the study. 117 participants were randomly allocated to a treatment group, 61 participants to the debridement only group and 56 to the debridement with device group. A predefined stopping boundary was met at the first interim analysis and recruitment stopped with 117 participants randomised. 43% of participants were female, 57% were male. We obtained primary outcome data for 114 (97%) participants. The mean Oxford Shoulder Score at 12 months was 34·3 (SD 11·1) in the debridement only group and 30·3 (10·9) in the debridement with device group (mean difference adjusted for adaptive design -4·2 [95% CI -8·2 to -0·26];p=0·037) favouring control. There was no difference in adverse events between the two groups.In an efficient, adaptive trial design, our results favoured the debridement only group. We do not recommend the InSpace balloon for the treatment of irreparable rotator cuff tears.Efficacy and Mechanism Evaluation Programme, a Medical Research Council and National Institute for Health and Care Research partnership.

We investigated the effects of two types of competition, races and tournaments (as well as an individual challenge and a do-your-best condition), on two different aspects of performance: effort and strategy. In our experiment, 100 undergraduate participants completed a simple cognitive task under four experimental conditions (in a repeated-measures design) based on different types of competitions and challenges. We used the Linear Ballistic Accumulator to quantify the effects of competition on strategy and effort. The results reveal that competition produced changes in strategy rather than effort, and that trait competitiveness had minimal impact on how people responded to competition. This suggests individuals are more likely to adjust their strategy in competitions, and the uncertainty created by different competition types influences the direction of these strategy adjustments.

This chapter, ‘Treatment planning’, covers the processes that are involved in the production of a patient specific treatment plan, ranging from simple single field palliative treatments through to complex radical treatments using volumetric modulated arc therapy (VMAT). The step-wise methodology for creating planning target volumes (PTVs) from gross tumour volumes (GTVs), taking into account uncertainties at each step is discussed as is the evaluation of treatment plans using isodose distributions and dose volume histograms. The processes of plan checking and patient specific checks for complex treatment plans are discussed. The basics of monitor unit calculations are described and sample calculations are presented. A new and relevant section in this edition of the book describes stereotactic treatments such as SRS (stereotactic radiosurgery) and SABR (stereotactic ablative body radiotherapy) and how evaluation of these plans differs from more conventional techniques. The chapter concludes with a short discussion on the more common dose calculation models (algorithms) implemented on treatment planning systems.

‘Particles: electrons, protons, and neutrons’ provides the basis for understanding charged particle therapy. In photon radiotherapy, photons are deposited in tissue, their energy is imparted to electrons in tissue and these electrons then cause biological damage. In contrast, in charged particle radiotherapy it is the charged particles themselves that are deposited in tissue directly causing biological damage. The charged particles in routine clinical use are electrons, with proton therapy growing rapidly but still limited to specialist centres. Neutron therapy is no longer used, although photon beams can be contaminated with neutrons. This chapter describes particle interactions (soft collisions, hard collisions, and radiative interactions) and defines and explains stopping power and its link with radiobiology. The pattern of energy deposition of a charged particle beam in tissue, the Bragg peak and production of protons are also covered.

This chapter, ‘Quality in Radiotherapy’, demonstrates how the implementation and development of quality systems over the past 30 years has contributed to the radiotherapy process in the United Kingdom. The nomenclature surrounding quality systems is defined and the subtle differences between accuracy and precision are clarified, as are those between quality control (QC) and quality assurance (QA). Important developments in equipment technology highlight the significant quality improvements that have occurred in the delivery accuracy of radiotherapy through image-guided radiotherapy (IGRT). Significant radiotherapy incidents are used as learning points to demonstrate the consequences of quality failure.

This quantitative study was designed to investigate teacher preparation as an interactive system and examine whether individual approaches to preparation are associated with differential retention benefits across different teacher subgroups. Drawing on longitudinal data on mathematics teachers who entered teaching through the New York City Teaching Fellows (NYCTF) program, the study focused specifically on the first-school retention of two policy-relevant teacher subgroups, namely, (1) the graduates of very selective colleges and (2) Black and Latinx community-insiders. Whereas the latter all attended city high schools, the former generally did not. In part because the field lacks a well-substantiated theory of the relationship between teacher initial preparation and their retention, we drew on intersectionality theory and incorporated two-way interaction effects in quantitative models of the teachers’ first-school retention. We found significant relationships between NYCTF’s initial training and the teachers’ retention and, further, that single approaches to initial training appeared to bestow different retention benefits to different teacher subgroups. We also found that the Black and Latinx community-insiders exhibited significantly higher rates of first-school retention than the elite college graduates and, for that matter, other NYCTF mathematics teachers. This result has clear implications for teacher recruitment and training and, in particular, the promise of developing community-based mathematics teachers who resemble the students they teach.

Spontaneous combustion (SPONCOM) of coal is well known to be a serious threat to the safety of mineworkers, mining equipment and to the environment. It is also the biggest reason behind the coal mine fires. In this study, the influence of antioxidants on coal properties and SPONCOM liability of coal samples collected from South African coal mines was investigated. These antioxidants minimized SPONCOM but have effects on coal properties as confirmed under laboratory tests. As part of the design and test of a spray machine on two 60 T stockpiles using powdered gypsum as an antioxidant, the tests show an increase in the temperature distribution of the untreated stockpile compared to the treated stockpile. Gypsum, which has been used for the first time, proves to be an economically viable option compared to other antioxidants on both laboratory and medium-scale tests.

BACKGROUND: To date, we lack U.S. data on the effects of the long-used Russian tilt-table training protocol known as the Russian pre-launch tilt-table training protocol on internal jugular vein cross sectional area (IJV-CSA) in microgravity.CASE REPORT: A case study of a single healthy male astronaut volunteer was used for this study. The right IJV-CSA was measured using real time ultrasound at set times throughout the Russian pre-launch tilt-table training protocol, a method of physiological preparation for microgravity using tilt-table training. In microgravity, the subjects right IJV-CSA was measured again for comparison. The mean difference from in-flight right IJV-CSA for pre-tilt (0) was 0.438 cm2, for 15 was 0.887 cm2, for 30 was 0.864 cm2, for 50 was 1.15 cm2, and for post-tilt (0) the difference was 0.305 cm2.DISCUSSION: The cross-sectional areas of the subjects right IJV-CSA were significantly different between in-flight values and several angles of the Russian tilt-table protocol, except for the 0 measurement. In summary, this case-study represents the first time IJV-CSA has been compared between various angles of a tilt-table training protocol and microgravity in the same astronaut subject. The findings support prior cohort studies studying the same principles. Further investigation is merited; both to better describe the relationship between the cardiovascular effects of tilt-table simulations of microgravity and their correlating in-flight values, and to evaluate and study the Russian tilt-table protocol effects on cardiovascular physiology from a training and preparation perspective.David J, Scheuring RA, Morgan A, Olsen C, Sargsyan A, Grishin A. Comparison of internal jugular vein cross-section area during a Russian tilt-table protocol and microgravity. Aerosp Med Hum Perform. 2021; 92(3):207211.

Significance Among the major health challenges for astronauts during prolonged space travel are loss of muscle mass and loss of bone mass. Here, we investigated the effects of targeting the signaling pathway mediated by the secreted signaling molecules, myostatin and activin A, in mice sent to the International Space Station. We show that targeting this signaling pathway has significant beneficial effects in protecting against both muscle and bone loss in microgravity, suggesting that this strategy may be effective in preventing or treating muscle and bone loss not only in astronauts on prolonged missions but also in people with disuse atrophy on Earth, such as in older adults or in individuals who are bedridden or wheelchair-bound from illness., Among the physiological consequences of extended spaceflight are loss of skeletal muscle and bone mass. One signaling pathway that plays an important role in maintaining muscle and bone homeostasis is that regulated by the secreted signaling proteins, myostatin (MSTN) and activin A. Here, we used both genetic and pharmacological approaches to investigate the effect of targeting MSTN/activin A signaling in mice that were sent to the International Space Station. Wild type mice lost significant muscle and bone mass during the 33 d spent in microgravity. Muscle weights of Mstn −/− mice, which are about twice those of wild type mice, were largely maintained during spaceflight. Systemic inhibition of MSTN/activin A signaling using a soluble form of the activin type IIB receptor (ACVR2B), which can bind each of these ligands, led to dramatic increases in both muscle and bone mass, with effects being comparable in ground and flight mice. Exposure to microgravity and treatment with the soluble receptor each led to alterations in numerous signaling pathways, which were reflected in changes in levels of key signaling components in the blood as well as their RNA expression levels in muscle and bone. These findings have implications for therapeutic strategies to combat the concomitant muscle and bone loss occurring in people afflicted with disuse atrophy on Earth as well as in astronauts in space, especially during prolonged missions.

Polypropylene as one of the world's top commodity polymers is also widely used in the textile industry. However, its non-polar nature and partially crystalline structure significantly complicate the process of industrial coloring of polypropylene. Currently, textiles made of polypropylene or with a significant proportion of polypropylene are dyed under quite harsh conditions, including the use of high pressures and temperatures, which makes this process energy intensive. This research presents a three-step synthesis of coloring agents, capable of adhering onto synthetic polypropylene yarns without harsh energy-consuming conditions. This is possible by encapsulation of organic pigments using trimethoxyphenylsilane, introduction of surface double bonds via modification of the silica shell with trimethoxysilylpropylmethacrylate and final attachment of highly adhesive anchor peptides using thiol-ene chemistry. We demonstrate the applicability of this approach by dyeing polypropylene yarns in a simple process under ambient conditions after giving a step-by-step guide for the synthesis of these new dyeing agents. Finally, the successful dyeing of the yarns is visualized, and its practicability is discussed.

Highlights • COVID-19 patients are at increased risk of thromboembolic complications. • Escalated-dose thromboprophylaxis may help reduce the rate of thromboembolic events. • The bleeding risk is highest for patients treated with therapeutic anticoagulation.

The COVID-19 pandemic has led to enormous practical and emotional challenges for healthcare workers globally, including NHS staff. Psychological support provisions have been established by an NHS healthcare trust in the North of England, including 1:1 psychological support provided by the in-house psychology team. This study sought to understand how staff experienced the service, what worked well and what could be improved. Five participants who had accessed the staff support service took part in semi-structured interviews. Data were analysed using Interpretative Phenomenological Analysis (IPA). Three main themes emerged from the data: 'The need for a flexible, responsive approach', 'Individual and group benefits' and 'The future of staff support: "we need to invest in staff mentally"'. Accessing the service was seen as personally and professionally rewarding for the NHS staff interviewed. These findings are discussed in relation to the relevant literature. Clinical implications, methodological limitations and directions for future research are discussed.

This paper builds on recent studies of institutional diversity in Australian tertiary education by modifying this model and using it to profile Australian pathway providers. The results offer insig...

An efficient process to synthesize Monobactam 1 from intermediates 2, 3, and 4 was developed. The process was initially enabled to deliver 500 g of 1 for exploratory toxicity studies and further im...

Developmental trajectories regarding the age onset of violence and offending have not routinely considered the role of major mental illness (MMI). In parallel, despite several studies investigating the relationship between MMI, violence and offending, fewer have identified motivational processes that may link illness to these outcomes in a more direct and proximal manner. This study investigates whether subtypes of forensic psychiatric patients deemed Not Criminally Responsible on account of Mental Disorder ( N = 91) can be identified based on the age onset of mental illness and offending behavior, and whether information on motivational influences for offending—elicited both from the patient directly and detailed collateral information—contributes to the clinical utility of this typology. Results indicated that most patients reported engaging in violence (51%) or antisocial behaviors (72%) prior to the onset of MMI, but that the index offense(s) resulting in forensic admission were predominantly psychotically motivated. In contrast to patients for whom the onset of MMI occurred prior to offending, patients exhibiting premorbid violence had higher levels of risk and criminogenic need; they were more likely to be diagnosed with personality and substance use disorders, and to have conventional (i.e., non-illness-related) motivations ascribed to their index offense. Findings are consistent with the existing literature regarding subgroups of mentally disordered offenders, but provide new information regarding proximal risk factors for violence through better identification of motivational processes.

Dystonia is a chronic and incurable movement disorder. This qualitative study aimed to enhance understanding of the condition by exploring the experience of living with dystonia.Interpretative phenomenological analysis was used to analyse data gathered through semi-structured interviews. Eight participants were recruited via a UK-based dystonia charity.Three superordinate themes emerged from the data: (1) dealing with ignorance and uncertainty: navigating health services with a rare, poorly understood condition; (2) the challenge of social isolation: overcoming barriers to positive social identity; and (3) fear of psychological explanations: the impact of stigmatised attitudes towards psychological explanations for dystonia symptoms.Coping with a rare and chronic condition led to participants feeling isolated and stigmatised by health care services and their communities. Participants were able to overcome this challenge to their identities through the use of social support, particularly from other people with dystonia. Recommendations for reducing the stigmatising experiences of people with dystonia can help to ease the process of adjustment to the illness and enable people to pursue meaningful lives and positive identities. Recommendations for research are aimed at increasing knowledge about these processes.IMPLICATIONS FOR REHABILITATIONDystonia has a pervasive, negative impact on the lives of people with the condition.The struggle for diagnosis marks the beginning of a period of psychological adjustment, the difficulty of which is compounded by social isolation and stigma.Support groups and peer interaction help people to integrate dystonia into their concept of a meaningful life and identity.Health professionals should play a pivotal role in assisting patients during the process of adjustment and on-going self-management through sensitive communication and signposting to wider support services.

Uveal melanoma (UM) survivors can experience significant emotional distress, although the factors underpinning this are poorly understood. Systematic reviews of distress in UM only include cross-sectional studies, thereby limiting our understanding of causal factors. This review identified prospective clinical, demographic, social and psychological predictors of distress in UM survivors. A systematic search of the literature for English language prospective studies was conducted. Thirteen papers, reporting data from seven unique datasets were included in a narrative synthesis of the results. Younger age (3 studies from 3 datasets), physical health (including visual impairment, ocular symptoms, and other UM-related factors; 3 studies from 3 datasets), and psychological factors (mainly baseline distress; 3 studies from 3 datasets and worry about recurrence; 2 studies from 2 datasets), significantly predicted distress. There was no consistent evidence for other demographic, clinical or social variables (significant in50% of datasets). Generally, the quality of the papers was adequate. However, attrition rates were high or not reported in over half of the included studies. The findings of this review emphasise the importance of attempts to prevent and recognise distress immediately post-diagnosis of UM. Particular focus should be given to younger patients, those with physical and psychological health difficulties at the time of diagnosis, and those who develop adverse treatment symptoms during survivorship. More research into potential social and psychological variables and their role in predicting distress in survivors is recommended.摘要: 葡萄膜黑色素瘤 (UM) 的幸存者可能会经历严重的情绪困扰, 尽管支持这一论点的因素尚不清楚。对UM患者情绪低落的系统评价仅包括横断面研究, 因此限制了我们对因果因素的理解。本综述确定了UM幸存者心理痛苦的临床、人口统计学、社会和心理的前瞻性预测因子。本文系统性检索了英文前瞻性研究文献。对13篇论文来自7个独特数据集的数据进行了综合性报道。较年轻 (3个数据集的3项研究) 、身体健康 (包括视力障碍、眼部症状和其他UM相关因素；3个数据集的3项研究) 和心理因素 (主要是痛苦基线值；3个数据集的3项研究和复发的顾虑；2个数据集的2项研究) 是预测患者心理痛苦的显著性预测指标。其他人口统计学、临床或社会变量没有一致的证据 (在数据集中的显著性50) 。纳入的所有论文质量达标。然而, 在超过一半的研究中, 患者失访率率较高或没有报告。本综述的研究结果强调了在确诊UM后立即预防和识别UM心理痛苦的重要性。我们应特别关注年轻患者、诊断时生理和心理健康障碍的患者以及在生存期间出现不良症状的患者。本文建议对潜在的社会和心理变量及其在预测幸存者痛苦中的作用进行更多研究。.