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Chronic alcohol-related myopathy (CAM), characterized by muscle atrophy and weakness, arises from prolonged excessive ethanol (EtOH) intake. The precise mechanisms by which EtOH induces skeletal muscle atrophy are not fully understood. This article posits that the pathophysiology of CAM may be significantly influenced by how EtOH modifies lipid profiles and alters lipid composition and content in skeletal muscle. We review existing literature on lipid alterations in CAM-afflicted individuals and analogous animal models, discuss EtOH's direct and indirect effects on skeletal muscle lipids, and present specific instances where lipids contribute to muscle atrophy. This article advocates for a novel viewpoint, suggesting that lipid dysregulation may be the principal factor in EtOH-induced muscle wasting, offering a different angle to approach CAM research and treatment strategies. [ABSTRACT FROM AUTHOR]

Patients with schizophrenia exhibit functional impairments in their locomotory tasks, which decreases their quality of life. Due to the limited current research, the neuromuscular mechanisms behind the functional impairments in patients is not fully understood. Thus, this review aims to summarize the neuromuscular mechanisms that underlie these deficits in daily functioning. These deficits are speculated to stem from abnormalities at various levels from neurons through to the skeletal muscles. The neurological abnormalities are exhibited as lower motor neuron dysfunction whereas the skeletal muscle pathology is shown as increased muscle fibre (type 1 and type 2) atrophy, reduction in maximal force generation, and increased strength loss per decade. Although antipsychotics effectively reduce positive symptoms, functional impairments remain unresolved. Both endurance and resistance training have shown potential benefits in alleviating deficits in daily functioning by increasing muscular strength, increasing fat-free mass, and preserving neuromuscular properties from degradation. In summary, the review elucidates various possible mechanisms for the onset of functional impairment experienced by patients with schizophrenia and highlights the potential utility of endurance and resistance training to alleviate these deficits in daily functioning. [ABSTRACT FROM AUTHOR]

We report the results of a novel worldwide survey on how adequate are existing policy instruments (if any) across the 169 targets of the Sustainable Development Goals. By obtaining more than 130,000 responses about 146 countries from more than 7000 experts, a large‐scale picture of the existence and adequacy of policy instruments emerges. This survey provides the first dataset depicting the current state of the world according to how well prepared (in terms of instruments) are countries and regions to tackle the challenges posed by the 2030 Agenda. We combine these data with the official UN SDG indicators and identify targets that systematically exhibit weaknesses in their historical performance and the adequacy of the available policy instrument, revealing key policy issues that need to be prioritised through interventions that go beyond the allocation of financial resources. [ABSTRACT FROM AUTHOR]

Purpose: To establish the prevalence and agreement between reported and observed leg weakness in people with sciatica. To establish which factors mediate any identified difference between reported and observed leg weakness in people with sciatica. Methods: 68 people with a clinical diagnosis of sciatica, records from spinal service, secondary care NHS Hospital, England, UK reviewed. Primary outcome measures were the sciatica bothersome index for reported leg weakness and the Medical Research Council scale for observed weakness. Agreement was established with Cohen's Kappa and intraclass correlation coefficient. Potential factors that may mediate a difference between reported and observed weakness included leg pain, sciatica bothersome index sensory subscale, age, hospital anxiety and depression subscale for anxiety. Results: 85% of patients reported weakness but only 34% had observed weakness. Cohen's Kappa (0.066, 95% CI − 0.53, 0.186; p = 0.317)] and ICC 0.213 (95% CI − 0.26, 0.428, p = 0.040) both showed poor agreement between reported and observed weakness. The difference between reported and observed measures of weakness was mediated by the severity of leg pain (b = 0.281, p = 0.024) and age (b = 0.253, p = 0.042). Conclusion: There is a high prevalence of reported leg weakness in people with sciatica, which is not reflected in observed clinical measures of weakness. Differences between reported and observed weakness may be driven by the severity of leg pain and age. Further work needs to establish whether other objective measures can detect patient reported weakness. [ABSTRACT FROM AUTHOR]

Case: A 71-year-old man with a history of C5-7 anterior cervical discectomy and fusion (ACDF) sustained a C7 spinous process fracture after falling from a ladder. He was initially managed nonoperatively but developed anterolisthesis and kyphosis at C7-T1 with left hand weakness over the course of 11 days. Surgical treatment included spinous process wiring and C5-T3 posterior fusion. At 14-month follow-up, he demonstrated resolution of pain and returned motor function. Conclusion: The patient's ACDF likely created a longer lever arm, allowing the force of his fall to be concentrated at C7-T1. Patients with a suspected Clay-Shoveler's fracture require close follow-up. [ABSTRACT FROM AUTHOR]

Introduction/Aims: The single simple question (SSQ), "What percentage of normal (0%–100%) do you feel regarding your disease?" has proven feasible and valid in assessing myasthenia gravis and a heterogeneous spectrum of neuropathies. This study explores the utility of the SSQ in axonal polyneuropathies (PNPs), encompassing diabetic neuropathy, and evaluates its responsiveness to scale changes. Methods: A retrospective chart review of 150 patients with axonal PNP responding to the SSQ was performed. Patients underwent clinical and electrophysiological evaluations, and were evaluated by clinical and disability scales, including the Medical Research Council sum score, modified Toronto Clinical Neuropathy score (mTCNS), Overall Neuropathy Limitation Scale, and Rasch‐built Overall Disability Scale (RODS). Results: The SSQ total scores correlated moderately with both the RODS score (r =.59, p <.001) and the mTCNS symptom score (r = −.43, p <.001), maintaining significance after adjustment for multiple comparisons. Longitudinally, after adjusting for multiple comparisons, the change in mTCNS symptom score retained statistical significance (adjusted p =.048). The SSQ did not show any association with electrophysiological parameters or sensory symptoms, other than a lower score in those with pain (100% with SSQ <40%, 85% with SSQ 40%–70%, and 34% with SSQ >70%). Discussion: The SSQ is a feasible, valid scale that may be utilized to assess and follow patients with length‐dependent axonal PNPs. Given that the SSQ is not strongly associated with clinical and disability scales or electrophysiological findings, additional investigations are required for a comprehensive assessment of PNP. [ABSTRACT FROM AUTHOR]

Background: Intensive care unit (ICU) protein benchmarks are based on mortality and morbidity; whether these targets also support functional recovery is unknown. We assessed whether different protein doses influenced patients' functional capacity, measured by the Chelsea Physical Assessment score (CPAx). Methods: Single‐center retrospective cohort study on ICU survivors with length of stay ≥7 days admitted between October 2014 and September 2020. Eligible patients were divided according to protein intake (g/kg/day): low (<0.8), medium (0.8–1.19), high (1.2–1.5), and very high (>1.5). Protein dose effect on CPAx was assessed at ICU discharge with analysis of covariance adjusting for age, illness severity, hospital length of stay before ICU admission, time to start nutrition support, and mechanical ventilation duration. We also investigated effect modification by energy intake and nutrition status. Results: Enrolled patients (n = 531) were similar for age, nutrition status, and illness severity across groups. CPAxs were nonlinearly associated with protein doses and similar among low, medium, and very high groups. The CPAx for the high group was statistically different (P = 0.014), indicating that the data of three groups could be pooled. Mean CPAx difference remained statistically significant after adjusting for confounding variables (3.9 ± 1.8, P = 0.029 in the four‐group model, and 2.7 ± 0.9, P = 0.003 in the pooled two‐group model). Energy intake was equivalent between groups and did not modify CPAx. The high group had superior CPAx in both well‐nourished and malnourished patients, indicating nutrition status was not an effect modifier. Conclusion: Protein dose 1.2–1.5 g/kg/day was associated with superior functional capacity at ICU discharge compared with other doses. Neither energy intake nor nutrition status modified functional capacity across groups; therefore, the results appear to be influenced by 1.2–1.5 g/kg/day. [ABSTRACT FROM AUTHOR]

Objectives: The burden of pain in middle‐aged and older adults is considerable and significantly increases healthcare expenditures. We aimed to investigate the roles of handgrip strength (HGS) weakness and asymmetry in predicting pain across four nationally representative cohorts. Methods: This longitudinal study utilized data from four major surveys: the Health and Retirement Study (HRS); the English Longitudinal Study of Ageing (ELSA); the Survey of Health, Ageing and Retirement in Europe (SHARE); and the China Health and Retirement Longitudinal Study (CHARLS). Multivariable cubic regression splines were employed to visually explore the nonlinear associations between HGS and pain in each cohort. The Cox proportional hazard model was applied to analyze the independent and combined relationship between HGS weakness and asymmetry and pain risk. Results: We included 41,171 participants in the final analysis, with a mean follow‐up period of 4.68 ± 2.61 years (50.7% female, mean age 64.3 ± 9.3 years). No nonlinear relationship was found between HGS and pain incidence (nonlinear p < 0.05 in ELSA and SHARE; >0.05 in CHARLS and HRS). After adjustment, the highest quartile groups had a significantly reduced risk of pain compared to the lowest quartile groups across all cohorts, with hazard ratios of 0.81 (0.74, 0.89) in CHARLS, 0.86 (0.77, 0.97) in HRS, 0.88 (0.77, 0.98) in ELSA, and 0.78 (0.73, 0.84) in SHARE. Participants with normal HGS had approximately 20% lower risk of pain compared to those with weak HGS. Each 5 kg increase in HGS was associated with decreased hazard ratios for pain: 0.95 (0.93, 0.97) in CHARLS, 0.97 (0.94, 0.99) in HRS, 0.96 (0.94, 0.99) in ELSA, and 0.94 (0.92, 0.95) in SHARE. The association between HGS asymmetry and pain risk was significant only in a few cohorts (HRS at 10%, 1.10 (1.03, 1.18); SHARE at 30%, 1.12 (1.05, 1.21)). No interaction effect between HGS weakness and asymmetry on pain risk was observed (all p‐values for interaction >0.05). Conclusions: Our findings suggest that HGS can be used as an independent predictor of pain in middle‐aged and older European, American, and Chinese populations. However, our results do not support the use of HGS asymmetry as an independent predictor of pain risk. It is necessary to establish appropriate criteria for HGS asymmetry across different populations. The use of both weak HGS and asymmetry as predictors of health outcomes requires further validation in more diverse populations. [ABSTRACT FROM AUTHOR]

The article analyzes the aesthetic properties of the genre of classical Chinese poetry Сi and the spiritual-moral basis of their formation from the point of view of the concept “The beauty of weakness as virtue”, put forward by the famous specialist in the field of classical Chinese poetry Ye Jiaying. The relevance of the topic is determined by the fact that, although many classical Chinese Ci poems have been translated into Russian, there is little research on the aesthetic properties of the genre itself, especially from the point of view of modern Chinese poetic theory. The article uses methods of description, interpretation, historical-cultural and contextual analysis. The article aims is to explain the aesthetic properties and the reason for their formation from the point of view of the concept “The beauty of weakness as a virtue”. It is ahown that the aesthetic properties of the Ci lie in the presence of a deeply hidden, inexhaustible understatement in poetry. Formally, this is created by alternating long and short verses; at the semantic level, the understatement in poetry appeared as a result of the forced transformation of the inexpressible feelings and emotions of the poet, who was in a weak position, but at the same time showed the quality of endurance, restraint and commitment to something good. The influence of the ideas of Confucianism on the formation of the aesthetic properties of Ci poetry allows us to speak not only about its artistic-aesthetic, but also its spiritual-moral significance. Altogether, it allows us to give a decent assessment of the Ci genre, which for a long time was perceived as a genre less valuable than the Shi genre.

Schizencephaly is a highly uncommon clinical condition characterized by a diverse range of symptoms stemming from its numerous anatomical manifestations. The disorder is characterized by abnormalities in brain structure resulting from disruptions in neuronal migration. This article presents a case of schizencephaly in an Ethiopian child. The child, displaying delayed walking and speech difficulty since birth, was brought to the pediatric outpatient department for examination. The physical assessment revealed left-sided hemiparesis and an inability to sit without assistance. Subsequent magnetic resonance imaging findings confirmed the presence of open-lip schizencephaly. Therefore, neurorehabilitation, specifically highlighting the crucial importance of early intervention in enhancing cognitive and motor functions was initiated. It is imperative to acknowledge that, while a permanent cure for schizencephaly may not currently exist, neuro-rehabilitation plays a pivotal role in enhancing the overall quality of life for individuals affected by this condition.

Abstract Objectives The burden of pain in middle‐aged and older adults is considerable and significantly increases healthcare expenditures. We aimed to investigate the roles of handgrip strength (HGS) weakness and asymmetry in predicting pain across four nationally representative cohorts. Methods This longitudinal study utilized data from four major surveys: the Health and Retirement Study (HRS); the English Longitudinal Study of Ageing (ELSA); the Survey of Health, Ageing and Retirement in Europe (SHARE); and the China Health and Retirement Longitudinal Study (CHARLS). Multivariable cubic regression splines were employed to visually explore the nonlinear associations between HGS and pain in each cohort. The Cox proportional hazard model was applied to analyze the independent and combined relationship between HGS weakness and asymmetry and pain risk. Results We included 41,171 participants in the final analysis, with a mean follow‐up period of 4.68 ± 2.61 years (50.7% female, mean age 64.3 ± 9.3 years). No nonlinear relationship was found between HGS and pain incidence (nonlinear p 0.05 in CHARLS and HRS). After adjustment, the highest quartile groups had a significantly reduced risk of pain compared to the lowest quartile groups across all cohorts, with hazard ratios of 0.81 (0.74, 0.89) in CHARLS, 0.86 (0.77, 0.97) in HRS, 0.88 (0.77, 0.98) in ELSA, and 0.78 (0.73, 0.84) in SHARE. Participants with normal HGS had approximately 20% lower risk of pain compared to those with weak HGS. Each 5 kg increase in HGS was associated with decreased hazard ratios for pain: 0.95 (0.93, 0.97) in CHARLS, 0.97 (0.94, 0.99) in HRS, 0.96 (0.94, 0.99) in ELSA, and 0.94 (0.92, 0.95) in SHARE. The association between HGS asymmetry and pain risk was significant only in a few cohorts (HRS at 10%, 1.10 (1.03, 1.18); SHARE at 30%, 1.12 (1.05, 1.21)). No interaction effect between HGS weakness and asymmetry on pain risk was observed (all p‐values for interaction >0.05). Conclusions Our findings suggest that HGS can be used as an independent predictor of pain in middle‐aged and older European, American, and Chinese populations. However, our results do not support the use of HGS asymmetry as an independent predictor of pain risk. It is necessary to establish appropriate criteria for HGS asymmetry across different populations. The use of both weak HGS and asymmetry as predictors of health outcomes requires further validation in more diverse populations.

A vocation to serving in severely medically under-resourced settings invariably means facing of our own weakness in realizing that vocation. Christian teaching proclaims that God’s strength in made perfect in weakness, which is both a comfort and a mystery to many in facing their weaknesses. Without diminishing the mystery, experience demonstrates several ways in which this promise plays out in reality, providing an imaginative stimulus for how it may also be true in ways where it is less understood. Believing such teaching forms part of a necessary theological framework for Christians serving in areas of immense suffering as well as encouraging transparency and vulnerability in regards to their own weaknesses.

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Botulism is a serious condition that carries with it a high rate of morbidity and mortality. This review highlights the pearls and pitfalls of botulism, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. Botulism is a neuromuscular disorder caused by toxin production of clostridium species bacteria and is a challenging diagnosis that mimics several other conditions. Children account for the majority of patients, with a foodborne source most common, followed by wound sources, typically from intravenous drug injection. Classically, patients with botulism develop bilateral cranial nerve palsies and symmetric, bilateral, descending paralysis. However, patients may initially present with vague symptomatology, such as weakness and dry mouth, which can make diagnosis challenging. A careful history elucidating exposures such as intravenous drug use or consumption of non-commercial canned products can help differentiate botulism from other disorders causing neuromuscular weakness. If suspected, the Centers for Disease Control should be notified to mobilize antitoxin for treatment as soon as the diagnosis is suspected even prior to confirmatory testing. Antibiotics should be avoided in these patients, as they can potentiate toxin release, unless there is a concomitant infection requiring antibiotic therapy. Patients with botulism can develop respiratory compromise requiring emergent airway management. Prolonged neuromuscular blockade from botulism will lead to a variety of symptoms that require comprehensive intensive care unit level care. An understanding of botulism and its many potential mimics can assist emergency clinicians in diagnosing and managing this deadly disease. [ABSTRACT FROM AUTHOR]

This article, based on network science, aims to contribute to overcoming its geometric and technological phases. The novelty consists in considering links of networks as linked by superimposed networks, termed here multiple superimposed soft networks (MSSN), which is introduced as a research issue. Such links of links (termed here as passive links) concern, for instance, correspondences, incompatibilities, and temporal synchronizations between the occurrences of pairs of active links of effective networks, such as those based on electrical and telecommunication. A possible constitutive mechanism of such passive linkage consists of linkage representations for practices and histories of use expressed by their validating statistical reoccurrences. We consider the possible emergent nature of the passive linkage. The reason for introducing the design and usage of MSSN properties as a research issue involves making new approaches to profile and manage networks available. Correspondence between active linkage and MSSN properties should be a matter for an experiential, machine-learning approach. Research issues relate their possible usage on the active linkage such as for classification, comparations, detection of criticalities, diagnosis, performance evaluation, and regulatory as weak forces. Furthermore, the possible identification of standard corresponding configurations of passive and active linkage is finalized to avoid their establishment or, conversely, in facilitating their establishment and keeping their replication in different contexts (or partially and in combinations) and identifying related standardized approaches (also for classes of configurations having significant levels of equivalence). This research project has methodological generalizing aspects of trans-disciplinarity. We conclude by mentioning related research issues. [ABSTRACT FROM AUTHOR]

The unforeseen consequences of a worldwide epidemic on higher education have compelled administrators, learners, and educators to reassess all elements of current systems, particularly in enhancing the efficacy and efficiency of technology utilisation in education. The transition to online classes--whether mixed or entirely virtual--can be executed swiftly; but, first studies indicate significant disparities in excellence, acceptability, completion rates, and learning outcomes. Therefore, it is essential to analyse the current studies on educational developments and procedures that use technology. This research investigates the contemporary technical, institutional, and educational trends and problems using a study. [ABSTRACT FROM AUTHOR]

Background: A nonvolitional diagnostic method based on FES‐Cycling technology has recently been demonstrated for mechanically ventilated patients. This method presents good sensitivity and specificity for detecting muscle dysfunction and survival prognosis, even in unconscious patients. As the clinical relevance of this method has already been reported, we aimed to evaluate its safety and feasibility. Methods: An observational prospective study was carried out with 20 critically ill, mechanically ventilated patients. The FES‐cycling equipment was set in a specific diagnostic mode. For safety determination, hemodynamic parameters and peripheral oxygen saturation were measured before and immediately after the diagnostic protocol, as well as venous oxygen saturation and blood lactate. The creatine phosphokinase level (CPK) was measured before and 24, 48, and 72 h after the test. The time taken to carry out the entire diagnostic protocol and the number of patients with visible muscle contraction (capacity of perceptive muscular recruitment) were recorded to assess feasibility. Results: Heart rate [91 ± 23 vs. 94 ± 23 bpm (p = 0.0837)], systolic [122 ± 19 vs. 124 ± 19 mm Hg (p = 0.4261)] and diastolic blood pressure [68 ± 13 vs. 70 ± 15 mm Hg (p = 0.3462)], and peripheral [98 (96–99) vs. 98 (95–99) % (p = 0.6353)] and venous oxygen saturation [71 ± 14 vs. 69 ± 14% (p = 0.1317)] did not change after the diagnostic protocol. Moreover, blood lactate [1.48 ± 0.65 vs. 1.53 ± 0.71 mmol/L (p = 0.2320)] did not change. CPK did not change up to 72 h after the test [99 (59–422) vs. 125 (66–674) (p = 0.2799) vs. 161 (66–352) (p > 0.999) vs. 100 (33–409) (p = 0.5901)]. The time taken to perform the diagnostic assessment was 11.3 ± 1.1 min. In addition, 75% of the patients presented very visible muscle contractions, and 25% of them presented barely visible muscle contractions. Conclusions: The FES cycling‐based muscular dysfunction diagnostic method is safe and feasible. Hemodynamic parameters, peripheral oxygen saturation, venous oxygen saturation, and blood lactate did not change after the diagnostic protocol. The muscle damage marker (CPK) did not increase up to 72 h after the diagnostic protocol. [ABSTRACT FROM AUTHOR]

Purpose: Survival rates for children diagnosed with acute lymphoblastic leukemia (ALL) have increased significantly over recent decades, and thus attention shifted toward understanding the adverse effects of cancer treatment. Chemotherapy has side effects that could affect muscle state and diminish motor performance. This scoping review was conducted to map the breadth of evidence for different tools used in fine motor skills assessment, the extent of upper extremity strength, and fine motor performance, highlighting the potential risk factors that may influence these skills. Methods: In March 2023, full-text studies that examined fine motor performance and/or upper extremity strength were identified via searches in PubMed, Science Direct, Scopus, Web of Science, and PEDro databases. The titles and abstracts of selected studies were screened according to the inclusion and exclusion criteria. Results: The search yielded initial 418 citations and 26 peer-reviewed articles were finally included in the review. Considerable heterogeneity was observed regarding the methods of evaluating fine motor skills. The results of this review indicate that children and adolescents with ALL experienced fine motor limitations and upper extremity weakness either during or after cessation of treatment. Conclusion: This scoping review presents a broad overview of the literature addressing fine motor difficulties in the pediatric population with ALL. Results accentuate the need to incorporate strengthening and occupational therapy training to preserve muscle strength and minimize future fine motor problems along the course of chemotherapeutic treatment. Little evidence was reported regarding the risk factors that may impair muscle strength and motor performance. [ABSTRACT FROM AUTHOR]

Faced with the ecological crisis, environmental scientists are asking what else besides providing evidence can they do to steer needed processes of substantive change. We argue that such an exploration should start by recognizing their weakness regarding the forces aiming at slowing down the pace of change. Recognizing this weakness should lead scientists to a change of tactics, embracing forms of strategic action used for centuries by groups on the weaker side of power struggles: that is, guerrilla strategies. Avoiding simplistic celebrations of guerrillas—historically a form of warfare that has produced as much pain as gain—an appraisal of some of its strategic tenets could help scientists to sketch alternative forms of engagement with the ecological crisis. Instead of grand gestures and direct confrontations, they could focus on carrying out epistemic strategic actions, or initiatives centered on the strategic usage of environmental knowledge and knowledge infrastructures to reduce, neutralize, and/or redress the impact of the organizations and regulations blocking, diverting, or slowing down decisive action regarding the ecological crisis. These actions could involve producing novel forms of knowledge, exposing facts that are currently hidden, refusing to engage in the production of contentious knowledge or, in extreme cases, disrupting specially damaging knowledge infrastructures. Please refer to Supplementary Material for a full text Spanish version of this article. Ante la gravedad de la crisis ecológica, científicos de distintas áreas se están preguntando qué más podemos hacer -además de aportar evidencia- para motivar procesos sustantivos de transformación socioambiental. En este artículo, sostenemos que la exploración de formas alternativas de acción debería empezar por reconocer la posición de debilidad de los científicos frente a las fuerzas que buscan ralentizar o frenar los procesos de transformación. Reconocer esta debilidad debería llevarnos a un cambio de táctica, adoptando formas de acción estratégica utilizadas durante siglos por grupos en el lado más débil de las luchas de poder: las guerrillas. Evitando una celebración simplista de la guerrilla -históricamente una forma de conflicto armado que ha producido más dolor que logros- analizamos cómo algunos de sus principios estratégicos nos pueden servir para desde las ciencias esbozar formas alternativas de acción en relación con la crisis ecológica. En lugar de declaraciones públicas y enfrentamientos directos, los científicos deberíamos desarrollar novedosas acciones epistémicas estratégicas, es decir, iniciativas centradas en el uso estratégico del conocimiento ambiental y sus infraestructuras para reducir, neutralizar y/o corregir el impacto de organizaciones y normativas que bloquean, desvían o ralentizan las transformaciones urgentes en relación con la crisis ecológica. Estas acciones podrían implicar la producción de formas novedosas de conocimiento, la exposición de conocimiento actualmente oculto, la negativa a participar en la producción de conocimiento controversial o, en casos extremos, la disrupción de infraestructuras o procesos de conocimiento especialmente dañinos. La versión en español de este artículo se puede encontrar en Material Suplementarias.

Introduction: Weakness is a common symptom that within itself does not indicate a specific diagnosis. Recreational inhalant use such as nitrous oxide (NO) may not often be disclosed. Additionally, professional or occupational history, such as being a dentist or dental assistant, should be determined because of higher reported rates of NO misuse.1 Nitrous oxide can cause vitamin B12 deficiency and resulting neuropathy. Nitrous oxide toxicity can have a wide variation of presentations with or without laboratory abnormalities or remarkable imaging findings, which can further complicate a diagnosis of weakness secondary to NO use. Case Report: A 33-year-old female presented to the emergency department with progressive bilateral leg numbness and objective weakness after repeated recreational NO use. After an extensive workup, she was found to have vitamin B12 deficiency and an electromyography study consistent with myeloneuropathy, despite normal imaging. She was prescribed high-dose vitamin B12 therapy and stopped using NO. One year after diagnosis, our patient maintained NO sobriety and had near-complete resolution of prior neurologic deficits. Conclusion: The use of recreational inhalant and the patient’s occupation should be considered when a patient presents with weakness. Obtaining vitamin B12 and methylmalonic acid levels should be considered for diagnosis. However, NO-induced neuropathy can be seen in patients with normal vitamin B12 and methylmalonic levels and patients do not always have abnormal imaging findings. The healthcare team should consider the varied presentations and findings of substance-induced conditions such as NO toxicity.

Chronic alcohol-related myopathy (CAM), characterized by muscle atrophy and weakness, arises from prolonged excessive ethanol (EtOH) intake. The precise mechanisms by which EtOH induces skeletal muscle atrophy are not fully understood. This article posits that the pathophysiology of CAM may be significantly influenced by how EtOH modifies lipid profiles and alters lipid composition and content in skeletal muscle. We review existing literature on lipid alterations in CAM-afflicted individuals and analogous animal models, discuss EtOH’s direct and indirect effects on skeletal muscle lipids, and present specific instances where lipids contribute to muscle atrophy. This article advocates for a novel viewpoint, suggesting that lipid dysregulation may be the principal factor in EtOH-induced muscle wasting, offering a different angle to approach CAM research and treatment strategies.

Accompanied by the continuous growth of China′s demand for seafood and the increasing number of problems arising from offshore aquaculture, the deep-sea aquaculture industry came into being, becoming a new industry in the process of structural adjustment and industrial upgrading of China′s mariculture industry, accelerating the transformation and upgrading of aquaculture methods, and forming a new pattern of development of the marine aquaculture model. Currently, China′s deep-sea aquaculture industry has the industrial characteristics of high dependence on advanced technology, strong interconnectivity between industrial chains, and occupying market share with unique product positioning. This paper is based on the current development status of aquaculture scale, aquaculture equipment and aquaculture mode in the deep-sea industry, introduces the definition of deep-sea aquaculture, compares the development mode of foreign countries, analyzes the weakness of China′s deep-sea aquaculture industry in detail, and puts forward suggestions to improve the risk early warning mechanism, broaden the aquaculture industry chain, overcome the key technical problems, introduce preferential policies and enhance the level of scientific breeding, etc., to provide references to the high-quality development of China′s deep-sea aquaculture mode. The analysis also provides recommendations on improving the risk warning mechanism, broadening the aquaculture industry chain, attacking key technical problems, introducing preferential policies and improving the level of scientific breeding, so as to provide reference for the high-quality development of China′s deep-sea aquaculture model.

This article critically examines the question of whether a prophetic Hadith can be considered weak if it conflicts with intellect. The research employs analytical and library research methods, drawing on a range of scholarly works including books, academic articles, and writings by Muslim scholars spanning both the classical and contemporary eras.This study reveals that when the authenticity of a Hadith is uncertain and it contradicts intellect, it can be deemed weak. However, if a Hadith is deemed authentic by Hadith scholars despite its contradiction with intellect, two distinct theories emerge among Muslim scholars. The first theory, supported by many classical scholars and their contemporary followers, argues that a correct Hadith never opposes the intellect. According to this perspective, a sound and clear intellect will never contradict an authentic Hadith. In contrast, the second theory, advocated by modern Muslim scholars and some classical scholars, posits that a prophetic Hadith should be considered weak if it conflicts with intellect.The findings of this paper indicate that a prophetic Hadith, when narrated through a strong chain of narrators tracing back to the Prophet Muhammad, cannot inherently contradict the intellect. However, if a Hadith contradicts sound intellect, it can serve as a valid reason to question its authenticity and consider it weak. Through a comprehensive analysis of the scholarly discourse surrounding this topic, this study provides a deeper understanding of the complex relationship between prophetic Hadith and intellect. It underscores the importance of rigorous authentication processes, emphasizing the need to consider the reliability of the Hadith chain and the principles of intellectual reasoning when assessing the strength or weakness of a prophetic Hadith

Abstract A 38‐year‐old pathologist developed multiple evanescent white dot syndrome (MEWDS). He documented his visual impairment in detail utilizing a light microscope for pathological diagnosis. Notably, the subjective defects illustrated by the patient were in good spatiotemporal agreement with diagnostic outcomes. The present report enhances the understanding of visual impairment associated with MEWDS through a comparative analysis of subjective experiences and objective clinical findings.

ABSTRACT:Emphysematous pyelonephritis (EPN) is a rare and life-threatening sequalae of a urinary tract infection marked by a gas-producing necrotizing infection of the renal parenchyma requiring prompt treatment. It has been found to be correlated with uncontrolled diabetes mellitus and is more common in females due to their increased susceptibility to urinary tract infections. Early recognition and treatment of EPN are essential to improve the patient's prognosis and prevent further complications. In this case we highlight a progressive case of pyelonephritis complicated by emphysematous abscess formation requiring surgical management. A 49-year-old female with a history of diabetes, hypertension, asthma, and lupus who presented to the emergency department (ED) for evaluation of generalized weakness. Lactate was elevated and urinalysis was suggestive of infection. A computed tomography (CT) scan of the abdomen and pelvis revealed a large subcapsular fluid collection with multiple gas and air-fluid levels along the right kidney, as well as another suspected fluid collection adjacent to the upper pole of the right kidney. The findings suggested complicated pyelonephritis with emphysematous abscess formation. Urology was consulted and they suggested a perinephric drain be placed by interventional radiology (IR). The patient progressed well and was ultimately discharged days later in stable condition. Despite its rarity, healthcare providers should consider infectious processes such as EPN in the differential for generalized weakness and promptly initiate appropriate diagnostic and therapeutic measures.Topics: Weakness, sepsis, urology, CT scan.

Key points Mitochondrial dysfunctions are thought to contribute to muscle atrophy and weakness that develop during ageing and mechanical unloading caused by immobilization, bed rest and microgravity. Older adults are at greater risk of developing muscle and mitochondrial dysfunctions in response to unloading. Although exercise is well known to promote muscle and mitochondrial health, its protective effect during mechanical unloading in older adults remains largely unexplored. Here, we investigated the impact of 14 days of head‐down tilt bed rest (HDBR) with and without a multimodal exercise countermeasure in older men and women (55–65 years). Leg muscle volume was assessed using magnetic resonance imaging. Biopsies of the vastus lateralis were performed to assess markers of mitochondrial content, respiration, reactive oxygen species (ROS) production and calcium retention capacity (mCRC). Indices of mitochondrial quality control (MQC), including markers of fusion (MFN1 and 2), fission (Drp1), mitophagy (Parkin) and autophagy (p62 and LC3I and II) were measured using immunoblots. Muscle cross‐sections were stained for neural cell adhesion molecule (NCAM, a marker of denervation). HDBR triggered muscle atrophy, decreased mitochondrial content and respiration and increased mitochondrial ROS production. HDBR had no impact on mCRC or MQC markers but increased markers of autophagy and denervation. Exercise prevented the deleterious effects of HDBR on leg muscle volume, mitochondrial ROS production and markers of autophagy and denervation. Exercise also increased mitochondrial content and respiration without altering mCRC and MQC markers. Collectively, our results indicate that an exercise countermeasure that can be performed in bed is effective in protecting muscle and mitochondrial health during HDBR in older adults. Conditions associated with muscle unloading, such as immobilization, bed rest or microgravity, result in muscle atrophy and weakness, particularly in older adults. Mitochondrial dysfunctions are thought to contribute to muscle atrophy caused by unloading and ageing. However, whether exercise can counteract the deleterious effects of unloading in older adults remains largely unexplored. Here, we report that older adults exposed to 14 days of head‐down tilt bed rest (HDBR) displayed upper leg muscle atrophy, a decrease in mitochondrial content and respiration, an increase in H2O2 emission, and an increase in autophagy and denervation markers. No impact of HDBR on mitochondrial quality control was observed. A multimodal exercise countermeasure prevented the deleterious effects of HDBR on upper leg muscle volume, mitochondrial reactive oxygen species emission, and markers of autophagy and denervation and increased mitochondrial content and respiration. These findings highlight the effectiveness of exercise in promoting muscle and mitochondrial health in older adults undergoing bed rest. [ABSTRACT FROM AUTHOR]

In this paper, we explore the price dynamics of 16 representative records of USA Education Group stocks, encompassing two non-overlapping periods (before, during, and after COVID-19). Based on information theory and cluster analysis techniques, our study provides insights into disorder, predictability, efficiency, similarity, and resilience/weakness, considering the most diverse financial stakeholders. Our findings contribute significantly to understanding price dynamics in the education sector, encompassing non-crisis and crisis periods, and provide valuable information for financial risk management, highlighting the importance of considering financial assets' efficiency and resilience/weakness during economic turbulence, such as the COVID-19 crisis. [ABSTRACT FROM AUTHOR]

The older population is growing exponentially causing greater demands on healthcare. Malnutrition, dysphagia, sarcopenia and weakness are highly prevalent diseases in the older population. Previous research (Byun et al. in BMC Geriatr 19(356):1–7, 2019; Fujishima et al. in Geriatr Gerontol Int 19:91–97, 2019; Hernandez et al. in Nutr Hosp 32(4):1830–1836, 2015; Nagano et al. in J Nutr Health Aging 23(3):256–265.5, 2019; Nishioka et al. in Clin Nutr 36(4):1089–1096, 2017; Robinson et al. in Clin Nutr 37(4):1121–1132, 2018, https://doi.org/10.1016/j.clnu.2017.08.016) has shown that these disorders are frequently associated, in many cases, preventable using screenings and intervention. This study utilized the National Hospital Discharge Survey of 2008 from the National Center of Health Statistics as secondary data to examine the associations amongst these four variables as well as possible correlations with age, days of care in the acute care hospital setting and frequency of rehabilitative and nutritional interventions received by these patients. Out of 165,630 cases, a sample size of 59,029 cases ages 65 and above were filtered by the researchers for desired diagnoses and procedure codes. After this, all neurological diagnoses were filtered and excluded by the researchers, resulting in 2458 cases. Using the Chi square test of independence, findings revealed significant associations between the variables of malnutrition and dysphagia (χ2 (1) = 1882.618, p = 0.001), dysphagia and weakness (χ2 (1) = 21.069, p = 0.001) and malnutrition weakness (χ2 (1) = 88.434, p = 0.001). The point biserial correlation coefficient was calculated to examine possible associations between these four conditions and age as well as days of care. A significant negative correlation was found between malnutrition and age (rpb (2456) = − 0.043, p = 0.05). In addition, days of care were significantly correlated with malnutrition (r(2456) = 0.138, p = 0.001) and inversely significantly correlated with dysphagia (r(2456) = − 110, p = 0.001), weakness (r(2456) = − 0.060, p = 0.001) and sarcopenia (r(2456) = − 0.041, p = 0.05). Lastly, the study found a large disparity between cases that received rehabilitative and nutritional intervention and those that didn't. [ABSTRACT FROM AUTHOR]

The weakness of the tibialis anterior remains to be a controversial topic. There has been no study that used electrophysiological assessment of the function of the lumbar and sacral peripheral motor nerves. The aim is to evaluate surgical outcomes in patients with weakness of the tibialis anterior using neurological and electrophysiological assessments. We enrolled 53 patients. Tibialis anterior weakness was quantified by muscle strength, as assessed using a manual muscle test on a scale of 1 through 5, with scores <5 indicating weakness. Postoperative improvement in muscle strength was classified as excellent (5 grades recovered), good (more than one grade recovered), or fair (less than one grade recovered). Surgical outcomes for tibialis anterior function were categorized as "excellent" in 31, "good" in 8, "fair" in 14 patients. Significant difference in outcomes were observed depending on diabetes mellitus status, type of surgery, and the compound muscle action potentials amplitudes of the abductor hallucis and extensor digitorum brevis (p < 0.05). Surgical outcomes were classified into two groups, patients with excellent and good outcomes (Group 1) and patients with fair outcome (Group 2). Using the forward selection stepwise method, sex and the compound muscle action potentials amplitudes of the extensor digitorum brevis were identified as significant factors for their positive association with Group 1 status. The diagnostic power of the predicted probability was as high as 0.87 in terms of area under curve of the receiver operating characteristic curve. There was a significant correlation between the prognosis of tibialis anterior weakness and sex and the compound muscle action potentials amplitude of extensor digitorum brevis, suggesting that recording the compound muscle action potentials amplitude of extensor digitorum brevis will aid the outcome assessment of future surgical interventions for tibialis anterior weakness. [ABSTRACT FROM AUTHOR]

A 38‐year‐old pathologist developed multiple evanescent white dot syndrome (MEWDS). He documented his visual impairment in detail utilizing a light microscope for pathological diagnosis. Notably, the subjective defects illustrated by the patient were in good spatiotemporal agreement with diagnostic outcomes. The present report enhances the understanding of visual impairment associated with MEWDS through a comparative analysis of subjective experiences and objective clinical findings. [ABSTRACT FROM AUTHOR]

In the context of theological interpretations of disabilities, I am arguing for the concept of "strength in weakness." So far, a "theology of weakness," which portrays people with disabilities as pointedly illustrating universal human weakness, has played a very prominent role in the field. I argue that this theological interpretation of disabilities should not be the dominant one. I trace the alternative model of "strength in weakness" in discussing writings by the apostle Paul and describe how it is supported by the anthropological concept of intercorporeality. Yet first, the article discusses Stanley Hauerwas's theology of disability, which is not only a very pointed theology of weakness but also repeatedly associates disabilities with suffering. Since at least the latter aspect is in contrast with widespread self-perceptions among people with disabilities, a theology of weakness amounts to a "narrative prosthesis" (David Mitchell and Sharon Snyder). By contrast, Paul suggests that weakness can allow for distinct strengths. To flesh out distinctive competences of people with intellectual disabilities, I then discuss Maurice Merleau-Ponty's concept of intercorporeality. Intercorporeality denotes a human competence more generally, but I suggest that it is often partly eclipsed by social norms. However, people with intellectual disabilities often pay less attention to social norms, which helps explain a distinctive intercorporeal competence among people with intellectual disabilities. Reduced attention to social norms can imply a distinctive strength. [ABSTRACT FROM AUTHOR]

Background Older adults have the highest rates of head injury and are at the greatest risk for subsequent dysfunction, yet research on subsequent physical decline is limited. We sought to examine cross-sectional and prospective associations of head injury with physical functioning and frailty among older adults. Methods A total of 5 598 Atherosclerosis Risk in Communities Study participants from Visit 5 (2011–13) underwent assessments of physical functioning (Short Physical Performance Battery [SPPB], comprised of gait speed, chair stands, and balance) and frailty (defined using established criteria) were followed through Visit 7 (2018–19). Head injury was self-reported or based on ICD-9 codes. Adjusted linear and multinomial logistic regression models were used to estimate associations. Prospective models incorporated inverse probability of attrition weights to account for death or attrition. Results Participants were a mean age of 75 years, 58% were women, 22% were Black, and 27% had a prior head injury. Compared to individuals without head injury, individuals with head injury had worse physical functioning (SPPB total score, β-coefficient = −0.22, 95% CI: −0.35 to −0.09) and were more likely to be pre-frail (OR = 1.19, 95% CI: 1.04 to 1.35) or frail (OR = 1.40, 95% CI: 1.08 to 1.80) compared to robust. Prospectively, head injury was associated with a 0.02 m/s greater decline (95% CI: −0.04 to −0.01) in gait speed over a median of 5 years. Among baseline robust individuals (n  = 1 847), head injury was associated with increased odds of becoming pre-frail (OR = 1.32, 95% CI: 1.04 to 1.67) or frail (OR = 1.92, 95% CI: 1.05 to 3.51) compared to robust. Conclusions Older adults with prior head injury had worse physical functioning and greater frailty at baseline and were more likely to become frail and walk slower over time, compared to individuals without head injury. [ABSTRACT FROM AUTHOR]

Objective To analyze the risk factors of bleeding after subcutaneous injection of low-molecular-weight heparin in elderly patients with unstable angina pectoris and weakness. Methods Elderly patients with unstable angina pectoris and weakness who were hospitalized in the Department of Geriatrics and the Department of Cardiology of Nanjing Hospital Affiliated to Nanjing Medical University(Nanjing First Hospital) from June 2020 to June 2023, they were randomly divided into subcutaneous hemorrhage group(n=90) and control group(n=90) according to whether subcutaneous hemorrhage occurred.General data such as age, gender, body mass index(BMI), as well as combined diseases and injection methods were compared between the two groups.Multivariate logistic regression was performed to analyze the risk factors for subcutaneous hemorrhage after subcutaneous injection of low-molecular-weight heparin. Results The BMI, proportion of patients who underwent compression after injection of low-molecular-weight heparin, and subcutaneous fat thickness of patients in the subcutaneous hemorrhage group were significantly lower than those in the control group, with statistical significance(P

This study employs a case study approach in the Batu City Region, East Java Province, Indonesia. Over time, Batu City has undergone a significant transformation, particularly in the tourism sector, leading to the growth of a large service industry. This study aims to propose a comprehensive development strategy for the Batu City area integrating economic, social, and environmental elements into the spatial layout of Batu City, with the ultimate goal of establishing an environmentally friendly Tourism City. Strengths, weaknesses, opportunities, threats analysis and analytic hierarchy process were employed to assess data from interviews, questionnaires, and agency sources. The stages of analysis are as follows: 1) data collection, 2) analysis, and 3) strategic prioritizing. This study recommends the main priority strategy for the development of a sustainable environmentally friendly tourism city is committing to implementing the principles of sustainable urban development and environmentally friendly tourism citiy through Regional Regulations. Considering the unique attributes of each city, such us their economy, resources, policies, and environment, among other factors, this paper considers contextual relevance issues. By doing so, it assists cities in developing sustainable cities based on their own strengths, weaknesses, opportunities, and threats.

The application of the concept of asymmetry in the domain of security enables a comprehensive overview of the strategic relations between the opposing parties, as well as the methods used by the adversaries in an effort to turn this type of inequality into a permanent strategic advantage. As a process, asymmetry can most often be reduced to the creation or exploitation of power inequality between adversaries, with the ultimate goal of generating strategic or political asymmetry. By skilfully exploiting the political and security asymmetry that arose after the NATO aggression in 1999, Pristina and its allies constantly constantly built statehood of the so-called "Republic of Kosovo". At the same time, they undertook various political, security and economic activities in order to reduce the effectiveness of the instruments of power of the Republic of Serbia in Kosovo and Metohija and neutralize Serbia's influence in the southern Serbian province. In addition to building institutions and developing various instruments of power, the Albanian political elite in Kosovo and Metohija worked intensively on building internal and external legitimacy. The key results of such activities of Pristina certainly represent: the extortion of the international community foreign policy attitude on the irreversibility of Kosovo's independence, the support of the USA, the EU and NATO members to the self-proclaimed independence, the relocation of Belgrade-Pristina negotiations outside the UN and the mediation of the European Union, the pressure of its international allies on Belgrade to "normalize" relations and stop the "de-recognition" campaign, in order to maintain the foreign policy asymmetry in international relations. In the domain of internal politics, Prishtina constantly exploits Serbia's key weakness, which is its inability to ensure security and normal living conditions for the local Serbian population in Kosovo and Metohija. A large part of the concessions that the Albanian side received, through a series of agreements with Belgrade, were achieved with combination of US and EU pressure on Serbia and internal political, security and socio-economic pressure on the Serbian population in the southern Serbian province. The above-mentioned activities of Pristina were especially intensified after the beginning of the war in Ukraine. Increasingly frequent instrumentalization of violence and demonstration of force and the undertaking of unilateral and provocative moves are evident. The authorities in Pristina are obviously counting on the preoccupation of the USA, the EU and NATO with the war in Ukraine. Albanian political elite from Kosovo and Metohija are actively exploiting US and EU efforts to prevent the aforementioned conflict from spilling over into the Balkan region. The analysis of Prishtina's actions so far, shows the implementation of the their's attrition strategy towards the USA, the European Union and Belgrade. At the same time they are gradually strengthening the institutions of the new Albanian state and establishing the new political order in the entire territory of the Kosovo and Metohija, with intention to strengthen the internal and build external legitimacy of the so-called "Republic of Kosovo". In this long-term process, violence is skilfully used to exploit the weaknesses of the policies of the European Union and the USA in the region and to reduce and neutralize the influence of the Republic of Serbia in Kosovo and Metohija. The strategy of the so-called "Republic of Kosovo" is not basically different from the rebel strategies of other non-state actors. The longterm goal of Pristina's strategy is to gradually build its own legitimacy and state institutions, while at the same time reducing the legitimacy and destroying political order of its opponents. In the last phase of this strategy, from the second half of 2023, the so-called "Kosovo Government", following Western counterinsurgency models, openly engaged on the complete dismantling of the "parallel" political system in the north of Kosovo and Metohija, using various instruments of political, security and economic coercion. Considering the weak reaction of the USA and the European Union, even more robust and energetic action by the government of the so-called "Republic of Kosovo" can be expected in order to completely remove any presence and influence of Serbia in the north of Kosovo. On the other hand, in the short term, Prishtina strives to make the concessions to the Serbian side as small and symbolic as possible. The formation of the Community/Association of Serbian Municipalities in Kosovo and Metohija with symbolic powers and responsibilities for them is a condition for the de-facto recognition of the so-called "Republic of Kosovo". In the long term, the constant and irreversible outflow of the Serbian population from Kosovo and Metohija, indicates that the actions of the so-called "Republic of Kosovo" on the ground are gradual assimilation, constant segregation and narrowing of the socio-economic and cultural space for Serbs, so that they would "voluntarily" leave Kosovo and Metohija and thus solve the Serbian problem according to the "Croatian model".

Background: Evidence suggests that COVID-19 infection can cause lasting health consequences. Multidisciplinary rehabilitation services have been recommended to reduce the sequalae. However, the effectiveness of physical exercise interventions remains insufficiently documented. The aim of this study was to develop and implement a specific and well-tolerated protocol-based intervention to reduce muscle weakness in older adults impacted by COVID-19. Methods: Forty-six older adults were randomized into intervention and control groups. Isometric and isokinetic strength assessments were conducted for selected muscle groups using a JBA Staniak® torquemeter and Biodex System 3 dynamometer. Functional abilities were evaluated with the Time Up and Go test and Chair Stand Tests. Results: Men in the intervention group demonstrated a significant improvement in static conditions for knee flexors (KFs), trunk extensors (TEs) and trunk flexors (TFs) and in dynamic conditions for knee extensors (KEs). Women in the intervention group showed a significant improvement in static conditions for EFs, KFs, TEs and TFs and in dynamic conditions for a KE and a KF. The interaction GROUP × TESTING SESSION was significant for the Chair Test (s) and Chair Test (n). Conclusions: Our results demonstrate the effectiveness of a well-tolerated, protocol-based approach that can be used to diminish long-lasting functional deficits in post-COVID survivors. [ABSTRACT FROM AUTHOR]

Background: Intensive care acquired muscle weakness is a common feature in critically ill patients. Beyond the therapeutic uses, FES‐cycling could represent a promising nonvolitional evaluation method for detecting acquired muscle weakness. Objectives: To assess whether FES‐cycling is able to identify muscle dysfunctions, and to evaluate the survival rate in patients with detected muscle dysfunction. Methods: A prospective observational study was carried out, with 29 critically ill patients and 20 healthy subjects. Maximum torque and power achieved were recorded, in addition to the stimulation cost, and patients were followed up for six months. Results: Torque (2.64 [1.53 to 4.81] vs 6.03 [4.56 to 6.73] Nm) and power (3.31 [2.33 to 6.37] vs 6.35 [5.22 to 10.70] watts) were lower and stimulation cost (22 915 [5069 to 37 750] vs 3411 [2080 to 4024] μC/W) was higher in patients compared to healthy people (p < 0.05). Surviving patients showed a nonsignificant difference in power and torque in relation to nonsurvivors (p > 0.05), but they had a lower stimulation cost (4462 [3598 to 11 788] vs 23 538 [10 164 to 39 836] μC/W) (p < 0.05). In total, 34% of all patients survived during the six months of follow‐up. Furthermore, 62% of patients with a stimulation cost below 15 371 μC/W and 7% of patients with a stimulation cost above 15 371 μC/W survived. Conclusions: FES‐cycling has good sensitivity and specificity for detecting muscle disorders. Critical patients have low torque and power and a high stimulation cost. Stimulation cost is related to survival. A low stimulation cost was related to a 3 times greater chance of survival. [ABSTRACT FROM AUTHOR]

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According to Spinoza, "... if we suppose that a person perceives his own lack of power because he recognizes that something is more powerful than himself... then we conceive that the person is simply understanding himself distinctly... " (Ethics IV, Demonstration to Proposition 53, my italics). What does Spinoza mean by 'something' here? Given that there are two kinds of adequate cognition for Spinoza, which one is at stake when we understand that something is more powerful than ourselves? This paper addresses these underexamined questions by considering different ways of conceiving our weakness against the backdrop of Spinoza's epistemological and metaphysical commitments. [ABSTRACT FROM AUTHOR]

Background: Aging is an unavoidable process characterized by a progressive decline in body organs and skeletal muscle. Sarcopenia is defined as low muscle mass and function; it is diagnosed according to the working group of sarcopenia definition; also, it can predict the adverse disability outcome and subsequent functional deterioration. Objectives: This study aims to estimating the prevalence of sarcopenia in old Iraqi adults and determines some sociodemographic factors that may be related. Methods: A descriptive cross-sectional study was conducted on 500 elderly aged ≥60 years in a community-dwelling and senior citizen center in Baghdad. The data were obtained from a questionnaire (sociodemographic and behavioral data) in addition to anthropometry measurements. The cut-off point score was derived from the European Working Group on Sarcopenia in Older People 2. Results: Sarcopenia was present in 15%, 21.5% in males and 8.2% in females. It was positively associated with aging, significantly associated with males, marital state, retirement, nonsmoker, alcoholic, fall history, normal body mass index, and elderly. While it was negatively related to educational level and physical activity. Conclusions: Sarcopenia prevalence was presented with a considerable prevalence among old adults, as well as had a great association with all behavioral and lifestyle variants studied. [ABSTRACT FROM AUTHOR]

Introduction: The outbreak of Coronavirus Disease-19 (COVID19) was a global disaster that greatly impacted the education system. The Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis can be used to identify favourable and unfavourable factors and conditions in offline and e-learning systems, and to address problems in a targeted manner. Aim: To evaluate the understanding and perception of students regarding the online learning system through SWOT analysis. Materials and Methods: This cross-sectional study was conducted at a tertiary care teaching hospital in the Department of Pharmacology at a tertiary care teaching hospital in Tamil Nadu, India for a duration of one month in October 2021. The study included 589 undergraduate students from medical, dental, and allied health sciences. A preformed questionnaire using Google Forms was used to assess the students’ perception of the online teaching methodology during the COVID-19 pandemic. Data was assessed using a five-point Likert scale, and results were expressed as numbers and percentages. Results: The present study reported that 52.46% of the study participants had a strong positive opinion about the convenience and flexibility of online learning methods, as they can be accessed from anywhere and at any time. However, 214 (36.33%) participants agreed that monitoring students during online teaching was more difficult compared to classroom teaching. During the pandemic, when all educational institutions were closed, 412 (69.95%) students felt that completing a course within a stipulated period was made possible by the online method. On the other hand, 401 (68.08%) students believed that some countries do not recognise certificates from online learning systems, as they may not provide sufficient practical experiences compared to classroom teaching. Conclusion: The current study showed that more than half of the study participants had a very favourable assessment of the portability and adaptability of online learning techniques. However, they also strongly felt that it was more challenging to keep track of students during online learning compared to traditional classroom methods. Online learning has both benefits and drawbacks, and it is important for individuals to decide how best to utilise it for their own gain while avoiding any negative side effects. Based on the experiences of the pandemic, it is crucial to find innovative solutions that are appropriate for different learning contexts.

Abstract There is increasing evidence that neurodegenerative disorders including the Parkinsonian syndromes are associated with impaired skeletal muscle health, manifesting as wasting and weakness. Many of the movement problems, lack of muscle strength and reduction in quality of life that are characteristic of these syndromes can be attributed to impairments in skeletal muscle health, but this concept has been grossly understudied and represents an important area of unmet clinical need. This review describes the changes in skeletal muscle health in idiopathic Parkinson's disease and in two atypical Parkinsonian syndromes, the most aggressive synucleinopathy multiple system atrophy, and the tauopathy progressive supranuclear palsy. The pathogenesis of the skeletal muscle changes is described, including the contribution of impairments to the central and peripheral nervous system and intrinsic alterations. Pharmacological interventions targeting the underlying molecular mechanisms with therapeutic potential to improve skeletal muscle health in affected patients are also discussed. Although little is known about the mechanisms underlying these conditions, current evidence implicates multiple pathways and processes, highlighting the likely need for combination therapies to protect muscle health and emphasizing the merit of personalized interventions for patients with different physical capacities at different stages of their disease. As muscle fatigue is often experienced by patients prior to diagnosis, the identification and measurement of this symptom and related biomarkers to identify early signs of disease require careful interrogation, especially for multiple system atrophy and progressive supranuclear palsy where diagnosis is often made several years after onset of symptoms and only confirmed post‐mortem. We propose a multidisciplinary approach for early diagnosis and implementation of personalized interventions to preserve muscle health and improve quality of life for patients with typical and atypical Parkinsonian syndromes.

Spinal epidural abscess is a rare but serious condition with poor outcomes. It's classic triad of new back pain, neurological deficit and fever is only present in 15% of cases at presentation and is initially misdiagnosed in 75-89%. 6,7 Delaying treatment is associated with worse outcomes. Delirium is itself a risk factor for mortality but the disturbance in cognition and memory can also complicate clinical assessment. 1-5 We present a case of delirium caused by, and obscuring, a spinal epidural abscess. This case highlights the difficulties in diagnosing spinal epidural abscesses, the need for a high index of suspicion for the condition and timely action to minimise morbidity. In addition, it demonstrates the value of treating unexplained delirium as an emergency and the danger of diagnostic premature closure. Finally, the importance of persistent clinical examination of the confused and non-cooperative patient. [ABSTRACT FROM AUTHOR]