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Disability is often defined as deviation from putative norms of physical, cognitive, or affective function. This definition is normatively laden, causing people with disabilities to be thought of as “different” and treated with pity. We address the predominant theme of this issue on “Disability Identity”: defining and imposing the category of “disability” and attempting to overcome it through medical intervention. The issue culminates in a call for courageous humility as the proper response to encounters with disability, providing medical professionals with the disposition to resist medicine’s inherent drive to fix what is perceived to be broken—that which strays from the norm. We hope that this issue might act as a clarion call to medical professionals to reevaluate how they see and interact with “disability” as a category, and ultimately with people with disabilities, especially with respect to what may be owed to persons with disabilities from society.

Arlie Hochschild’s theory of emotional labor (1983) has become a staple framework for understanding the tension that exists between outward emotional expression and inward emotional realities. In it, Hoschild (1983) introduces us to the idea of emotional management, the expectations that are put on us to manipulate the display of our emotions—act—in order to put the experiences of others first. Recently, however, several articles in popular media have used emotional labor to describe labor that deviates from Hochschild’s (1983) original definition. In doing so, popular discourse has highlighted a kind of labor that has historically gone unnamed in the academy. The implications of not naming this other form of labor and instead morphing Hochschild’s original definition yield many consequences if left unchecked. The purpose of this article is to step into the conversation on emotional labor, highlight the gap in language to describe the various types of labor performed by adult learners, and introduce the idea of gendered labor as a way to be better informed in serving adult learners in ongoing development.

Volcanism in compressional tectonic settings presents several unclear relations, especially between faulting, volcano locations, and local stress fields. The Central Andes comprise one of the most important volcanic provinces in the world, where these relations can be studied. We investigate the Miocene-Quaternary faulting and the tectonic stress evolution of the Western Cordillera of Chile, between 24 and 26°S, and how they dictate the orientation of magma feeding fractures, to understand the relations between deformation and volcanism. We calculated 68 new stress tensors from faults of recognized age and reconstructed magma paths by analyzing the morphostructural characteristics of 130 monogenetic and polygenetic volcanoes of known age. Moreover, we integrated the database with previously published data from the Western Cordillera to carry out a regional comparison. Results allow us to recognize three main volcano-tectonic events. The oldest occurred in the Early Miocene and was characterized by an E-W greatest principal stress (σ1) expressed by N-S-striking reverse faults and NW–SE left-lateral strike-slip faults. Volcanoes belonging to this stage show morphometric characteristics that indicate dominant N-S magma feeding systems. The second event, active during the Upper Miocene-Pliocene, was characterized by NW–SE to NNW-SSE σ1, WNW-ESE right-lateral strike-slip faults, and NW–SE preferential direction of volcanic feeding systems. The last event was active in the Upper Pliocene–Pleistocene, mainly in the northern part of the study area, with N-S to NE-SW normal and right-lateral strike-slip faults with NNE-SSW-trending least principal stress (σ3). Volcanism in this stage is characterized by NW–SE and N-S magma feeding systems. Our results suggest that volcano distribution has been mainly controlled by variations of the stress field related to the growth and collapse of the Puna Plateau. Magma emplacement was mainly guided by fractures parallel to the compression direction, irrespectively of the horizontal stress being σ3 or the intermediate principal stress σ2. Anyway, magma emplacement occurred also through fractures oblique to σ1, along strike-slip faults, or by exploitation of inherited weak structures, such as reverse faults.

BACKGROUND Non-compressible torso hemorrhage (NCTH) is the leading cause of potentially preventable death on the battlefield. Resuscitative endovascular balloon occlusion of the aorta (REBOA) aims to restore central blood pressure and control NCTH below the balloon, but risks ischemia-reperfusion injury to distal organs when prolonged. We tested a bilobed partial REBOA catheter (pREBOA), which permits some of the blood to flow past the balloon. METHODS Female swine (n = 37, 6 groups, n = 5-8/group), anesthetized and instrumented, were exponentially hemorrhaged 50% of estimated blood volume (all except time controls [TC]). Negative controls (NC) did not receive REBOA or resuscitation. Positive controls (PC) received retransfusion after 120 min. REBOA groups received REBOA for 120 min, then retransfusion. Balloon was fully inflated in the full REBOA group (FR), and was partially inflated in partial REBOA groups (P45 and P60) to achieve a distal systolic blood pressure of 45 mm Hg or 60 mm Hg. RESULTS Aortic occlusion restored baseline values of proximal mean arterial pressure, cardiac output, and carotid flow in pREBOA groups. Lactate reached high values during occlusion in all REBOA groups (9.9 ± 4.2, 8.0 ± 4.1, and 10.7 ± 2.9 for P45, P60, and FR), but normalized by 6 to 12 h post-deflation in the partial groups. All TC and P60 animals survived 24 h. The NC, PC, and P45 groups survived 18.2 ± 9.5, 19.3 ± 10.6, and 21.0 ± 8.4 h. For FR animals mean survival was 6.2 ± 5.8 h, significantly worse than all other animals (P

La automedicación puede ser definida de forma genérica como la administración por decisión propia, o por consejo no cualificado, de medicamentos para aliviar un síntoma o curar una enfermedad. La automedicación representa un problema más complejo ya que entran aspectos atribuibles a la población como la educación médica, la cultura, los usos y costumbres, que de alguna manera son influenciados por el gran aparato de la comercialización con que cuentan las empresas productoras de medicamentos. La investigación consideró determinar los factores relacionados a la automedicación en la población estudiantil de enfermería y obstetricia en la Universidad Privada de Huancayo. El diseño que se empleó responde a la de una investigación por objetivos tomando como referencia la naturaleza de la variable (causa - efecto), empleados en la formulación del problema planteado.De acuerdo a los resultados obtenidos se afirma que existe automedicación en la población estudiantil, siendo para la carrera de enfermería en un 96.83% y para obstetricia en un 94.12%. Los medicamentos que más se auto medican son los : antibióticos, analgésicos y antiinflamatorios en porcentajes de 69.04% en los alumnos que estudian enfermería y 66.18% en obstetricia , los procesos patológicos por los que se auto medican son Resfriado común y dolores corporales 47.62% en los alumnos de enfermería y 51.47% en obstetricia. Los medios de comunicación que influyeron en los alumnos de la Carrera Profesional de Enfermería para auto medicarse fueron: Televisión 64.28 % y para los alumnos de obstetricia en un 60.29%.

Satureja brevicalyx Epling crece en la parte sur andina del Perú (Ayacucho, Apurimac, Cuzco y Puno), entre las altitudes de 3300-3800 msnm, dentro de la composición química del aceite e s e n c i a l d e S a t u r e j a b r e v i c a l y x p o d e m o s encontrar varios constituyentes como mentonas, pulegonas, linalol. Tradicionalmente se ha usado como digestivo, contra la gastritis, flatulencia y antiespasmódica.OBJETIVO:Identificar la composición química del extracto etanólico,Hexano/etanol y acuoso de la Satureja brevicalyx Epling para conocer los metabolitos secundarios que sean de interés biológico en la terapeútica. MÉTODOS:Las hojas fueron exudadas y deshidratadas a temperatura ambiente, obteniéndose un polvo seco de color verdoso al cual se sometieron a extracciones sucessivas com solventes de polaridad creciente. A los extractos obtenidos se realizaron ensayos fitoquímicos de identificación. RESULTADOS:El tamizaje fitoquímico ,efectuado a los extractos etanólico, hexano/etanol y acuoso de la hojas,demostró la existencia de varias familias de meta bolitos secundarios de interés biológico y farmacológico, entre los que se destacan, por su significativa presencia las, quinonas, flavonoides, alcaloides ,fenoles , taninos. CONCLUSIONES : De acuerdo a la presencia de los metabolitos secundarios presentes en las hojas de la Satureja brevicalyx Epling , así como los efec tos farmacológicos reportados para el aceite esencial de la especie, sería importante efectuar nuevos estudios que sirvan como evidencias para avalar su empleo tradicional teniendo en cuenta la eficacia y seguridad de esta planta.

Although some scholars have explored the experiences of racially minoritized doctoral students in large research universities, few have studied the racial dynamics of doctoral education in smaller ...

Introduction Renal transplantation is the optimal renal replacement therapy. In Mexico, most of the kidney transplants are from living donors. It is essential to identify conditions that increase the risk of developing chronic kidney disease (CKD) in donors, such as metabolic syndrome (MS). Materials and methods In retrospect from January 2008 to December 2018, the donation protocols for renal transplantation of the Hospital Central Sur Alta Especialidad “Picacho” were reviewed, classifying all the cases of donors by nephrectomy or no nephrectomy and describing the demographic characteristics, prevalence of metabolic diseases, and cause of rejection of the protocol. Results A total of 178 donors were studied: 82 women (46%), 96 men (54%), mean age of 42 years, average body mass index (BMI) 27.9 kg/m2, glomerular filtration rate (GFR) by Chronic Kidney Disease Epidemiology Collaboration 99 mL/min, 59 patients with grade I and II obesity (BMI ≥ 30 kg/m2), and 1 patient with morbid obesity (BMI ≥ 40 kg/m2). A total of 39 patients (22%) underwent nephrectomy and 139 (78%) did not. The following characteristics and alterations were found: Of the 139 patients who did not undergo nephrectomy, 91 had metabolic disorders, 20 had low GFR, 21 had albuminuria, and 4 recipients received cadaveric transplants, 3 due to critical conditions of the recipient. The metabolic alterations in the rejected donors were as follows: MS 54 (59%), prediabetes 55 (39%), newly diagnosed hypertension 70 (76%), diabetes mellitus 20 (14%), obesity 47 (51.6%), dyslipidemia 76 (83%), hyperuricemia 17 (12%). Discussion The prevalence of MS in apparently healthy donors is similar to that of other studies in Mexico. Both MS and its components are independently associated with an increased risk of cardiovascular disease and CKD. It has been shown that these donors have a greater degree of glomerular and interstitial fibrosis; therefore, diagnosis, prevention, and timely treatment in this group are important.

OBJECTIVES:. Most high-fidelity medical simulation is of limited duration, used for education and training, and rarely intended to study medical technology. U.S. caregivers working in prehospital, resource-limited settings may need to manage patients for extended periods (hours to days). This “prolonged casualty care” occurs during military, wilderness, humanitarian, disaster, and space medicine. We sought to develop a standardized simulation model that accurately reflects prolonged casualty care in order to study caregiver decision-making and performance, training requirements, and technology use in prolonged casualty care. DESIGN:. Model development. SETTING:. High-fidelity simulation laboratory. SUBJECTS:. None. INTERVENTIONS:. We interviewed subject matter experts to identify relevant prolonged casualty care medical challenges and selected two casualty types to further develop our model: a large thermal burn model and a severe hypoxia model. We met with a multidisciplinary group of experts in prolonged casualty care, nursing, and critical care to describe how these problems could evolve over time and how to contextualize the problems with a background story and clinical environment with expected resource availability. Following initial scenario drafting, we tested the models with expert clinicians. After multiple tests, we selected the hypoxia model for refinement and testing with inexperienced providers. We tested and refined this model until two research teams could proctor the scenario consistently despite subject performance variability. MEASUREMENTS AND MAIN RESULTS:. We developed a 6–8-hour simulation model that represented a 14-hour scenario. This model of pneumonia evolved from presentation to severe hypoxia necessitating advanced interventions including airway, breathing, and shock management. The model included: context description, caregiver orientation scripts, hourly progressive physiology tracks corresponding to caregiver interventions, intervention/procedure-specific physiology tracks, intervention checklists, equipment lists, prestudy checklists, photographs of setups, procedure, telementor, and role player scripts, business rules, and data collection methods. CONCLUSIONS:. This is the first standardized, high-fidelity simulation model of prolonged casualty care described in the literature. It may be used to assess caregiver performance and patient outcomes resulting from that performance during a complex, 14-hour prolonged casualty care scenario. Because it is standardized, the model may be used to compare differences in the impact of new technologies upon caregiver performance and simulated patient outcomes..

Improving student success outcomes such as persistence and graduation rates remains a priority for higher education institutions, scholars, and advocates. Recent scholarly work argues for more qualitative work in this area to develop a deeper understanding of the issue and to identify more effective ways to increase college completion rates across all populations. This study examines student success by focusing on an understudied population in the literature: overachievers. We define overachievers as students who matriculate in the lowest quartile of an institution’s standardized test score range but are selected and persist as honors students after their first collegiate semester. This phenomenological study highlights the prevalence of a strong internal locus of control among overachievers. Using Bean and Eaton’s student success model as a framework, we explore how our participants operationalized an internal locus of control to achieve academic success in college and consider how higher education institutions can promote this mind-set and its related practices among students on their campuses.

Providing decision makers and the investment community with transparent methods to value investments in resilience and adaptation measures to protect physical assets from climate change impacts is becoming increasingly critical. To address this need, this paper introduces and utilizes the decoupled net present value (DNPV) valuation methodology. DNPV is a robust method that can incorporate climate change risk into investment analyses. This paper also discusses how the widespread use of traditional valuation methods such as net present value combined with risk-adjusted discount rates introduces a pernicious time bias effect that magnifies stakeholders’ misaligned interests and investment horizons, leading investors, both public and private, to significantly underinvest in resilience and adaptation. Furthermore, because traditional valuation methods cannot correlate physical risks (e.g., loss of revenue due to physical damage or lost access to an asset) with discount rates, investments to reduce climate change risks are largely considered as expenses that make the investment less attractive. The DNPV method addresses this issue and offers a viable alternative that can consistently and transparently quantify all risks (market and non-market) in terms of cash flows. This allows investors and stakeholders to quantify in monetary terms the potential exposure of physical assets to climate-related hazards and assess the effect of decisions to invest in resilience and adaptation measures. With the aid of a simple numerical example, the DNPV method is used to illustrate how such actions can be treated as quantifiable risk reduction investment opportunities that result in better investment decisions.

This paper discusses the structure, particle morphology, and optical properties of un-doped ZnO and ZnO doped with Er3+ and Yb3+ lanthanide ion nanoparticles (NPs) through a process denominated sol-gel-hydrothermal. According to the pattern of X-ray diffraction, ZnO:Er and ZnO:Yb is formed by a single-phase wurtzite structure with crystallites sized ~65 nm on average, and Er or Yb dopant ions in the hexagonal structure of ZnO, specifically in its distorted lattice sites. The results also suggest the possible role of oxygen vacancies or Ox– (defects) in the energy transfer from ZnO to the Er or Yb ions with a decrease of 3.18 eV and 3.19 eV in bandgap values to a red shift.

Journal of catalysis 401, 1-34 (2021). doi:10.1016/j.jcat.2021.08.029, Efficient and sustainable optimization of heterogeneous catalytic processes requires a deep understanding of catalyst structure-activity relationships that occur inside catalytic reactors in space and time. Here we introduce a catalytic profile reactor capable of simultaneously measuring spatially-resolved temperature, concentration, and X-ray absorption spectroscopy (XAS) profiles through a catalytic fixed-bed. Using the oxidative dehydrogenation of ethane to ethylene over MoO$_3$/$��$-Al$_2$O$_3$ as a test reaction, we obtained a detailed picture of local catalyst structure and activity under realistic and well-defined reaction conditions. Concentration, temperature and XAS profiles were measured up to and beyond the point of complete O$_2$ consumption showing a distinct transition from oxidation reactions to steam reforming and water-gas shift. Profile data up to the point of complete O$_2$ consumption were used to develop a kinetic model for the oxidation chemistry. Structural data beyond the point of complete O$_2$ consumption were ideal for demonstrating the correlative approach but the kinetic data in the second part were not considered during modeling because industrial selective oxidation reactors are always operated at incomplete O$_2$ consumption. The fit of kinetic models to complete reactor profiles significantly speeds up the development and accuracy of kinetic models required for any reactor design. Further, the kinetic model considers the oxidation state of molybdenum as a dynamically changing and critical catalyst property. Hence, we could predict local catalyst oxidation states and validate our model experimentally with spatially-resolved XAS. This provides a quantitative link between catalyst structure and reactivity and allows including catalyst dynamics in reactor simulations. In the current work a widely applicable methodological approach is presented to understand and optimize heterogeneous catalytic processes, e.g. in selective oxidation., Published by Elsevier, Amsterdam [u.a.]

A renewed alignment with the church’s historic ministry of catechesis necessitates a comprehensive understanding of the God-centered, experiential, lifelong, communal, and mission-centered nature of catechesis. Ancient church practice of educating the affections, in contrast to post-Enlightenment intellectual indoctrination, requires mystagogical immersion of the human heart and life in the love of God. Mystagogical catechesis prevents the formation of superficial faith through pedagogical practices that: recognize the liturgical nature of faith and life; engage the whole person; aim for the heart; envision the journey; provoke wonder; and cultivate worship.

Weidman, Twale and Stein’s (2001) model of graduate student socialization has served as a theoretical starting point for understanding the experiences of doctoral students. Although a number of scholars have critiqued the model for failing to account for the unique experiences of different student groups, none has specifically approached the model with Evangelical Christian doctoral students in mind. Building on the literature on Evangelical Christian students in secular higher education, this article offers a reconceptualization of Weidman et al.’s (2001) model that accounts for the unique experiences of Evangelical Christian doctoral students in secular higher education. This revised model, called reconciliatory socialization, serves as a conceptual framework by which to conduct empirical research on the experiences of Evangelical Christian doctoral students in secular settings.

Equipping the saints for ministry is a primary work of the local church. However, the task of constructing equipping ministries requires theological and contextual reflection. This article argues that as theological educators, we must teach our students to exercise practical theological methods in order to develop an effective ministry of equipping. The article will first explore the underpinnings of practical theology, culminating in a closer look at the model posited by Richard Osmer. Engaging Osmer's model, the article will engage a case study to show how practical theology aids the congregational leader in formulating theologically faithful and contextually relevant equipping ministries.

The stability of a reinforced embankment relies on the contribution of the soil shear strength as well as the reinforcement tensile strength. Typical geotechnical monitoring programmes implemented ...

Inorganic phosphors based on monoclinic Y2WO6 doped with Eu3+ ions were prepared via conventional solid-state reactions at high temperature. A total of five samples were obtained with different Eu3+ concentrations (0–9%). The purity of the as-prepared phases was checked by powder X-ray diffraction (PXRD). Through the Rietveld refinement, at low concentrations Eu3+ ions are found to occupy preferentially the Y2 (2f) sites in the host compound. However, for higher dopant concentrations, the occupancy of the (2e) and (4g) sites becomes relevant. The excitation, emission, and time-resolved emission spectra were examined in detail. Efficient energy transfer from the (WO6)6− groups to the Eu3+ activators was observed. The decay curves for the Eu3+ 5D0 → 7F4 transition show a non-exponential behavior that is enhanced with increasing Eu3+ concentration. The experimental decay curves were fitted to the Inokuti–Hirayama model to gain some insight into the mechanism of the interaction between the Eu3+ ions in these phosphors.

BACKGROUND Acute respiratory distress syndrome (ARDS) is a severe form of acute lung injury with a mortality rate of up to 40%. Early management of ARDS has been difficult due to the lack of sensitive imaging tools and robust analysis software. We previously designed an optical coherence tomography (OCT) system to evaluate mucosa thickness (MT) after smoke inhalation, but the analysis relied on manual segmentation. The aim of this study is to assess in vivo proximal airway volume (PAV) after inhalation injury using automated OCT segmentation and correlate the PAV to lung function for rapid indication of ARDS. METHODS Anesthetized female Yorkshire pigs (n = 14) received smoke inhalation injury (SII) and 40% total body surface area thermal burns. Measurements of PaO2-to-FiO2 ratio (PFR), peak inspiratory pressure (PIP), dynamic compliance, airway resistance, and OCT bronchoscopy were performed at baseline, postinjury, 24 hours, 48 hours, 72 hours after injury. A tissue segmentation algorithm based on graph theory was used to reconstruct a three-dimensional (3D) model of lower respiratory tract and estimate PAV. Proximal airway volume was correlated with PFR, PIP, compliance, resistance, and MT measurement using a linear regression model. RESULTS Proximal airway volume decreased after the SII: the group mean of proximal airway volume at baseline, postinjury, 24 hours, 48 hours, 72 hours were 20.86 cm (±1.39 cm), 17.61 cm (±0.99 cm), 14.83 cm (±1.20 cm), 14.88 cm (±1.21 cm), and 13.11 cm (±1.59 cm), respectively. The decrease in the PAV was more prominent in the animals that developed ARDS after 24 hours after the injury. PAV was significantly correlated with PIP (r = 0.48, p < 0.001), compliance (r = 0.55, p < 0.001), resistance (r = 0.35, p < 0.01), MT (r = 0.60, p < 0.001), and PFR (r = 0.34, p < 0.01). CONCLUSION Optical coherence tomography is a useful tool to quantify changes in MT and PAV after SII and burns, which can be used as predictors of developing ARDS at an early stage. LEVEL OF EVIDENCE Prognostic, level III.