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Treating disability as an asset (not a limitation): A critical examination of disability inclusion through social entrepreneurship
No full textSocial enterprises play an increasing role in providing employment opportunities for disabled people. This paper examines the implications of social enterprises’ market-based approach to disability inclusion, which is characterized by viewing disability as an asset rather than a limitation. Taking our inspiration from critical disability scholars who have pointed out that inclusion agendas produce disability as a distinct social reality, we use a performative lens to examine how social enterprises variously “do disability,” for instance, by defining where the potentials of disabled people lie and how best to promote them. Drawing on an ethnographic study of Magic Fingers, a Nepal-based enterprise that employs blind people as massage therapists, we identify entrepreneurial “doings” of disability that were guided by ideals of empowerment but that ultimately produced new and subtle forms of exclusion. By closely examining the case organization’s founding phase, as well as its practices of advertising, recruitment, and day-to-day management, we show how Magic Fingers commodified disability in novel ways, reinforced the notion of disability as a negative condition that must be “overcome” through work, and introduced new market-oriented evaluative distinctions between “more able” and “less able” disabled individuals. By exploring and evaluating these effects, this paper draws attention to the ways in which social enterprises, while challenging deficit-oriented representations of disability, can paradoxically solidify disability as something profoundly “other.
Treatment success in cats with chronic enteropathy is associated with a decrease in fecal calprotectin concentrations
No full textFeline chronic enteropathies (FCE) are challenging to diagnose and monitor for progression and response to treatment. Fecal calprotectin might be a useful non-invasive marker to evaluate clinical endpoints of therapeutic monitoring in FCE. We evaluated fecal calprotectin concentrations in cats with FCE before and after initiation of treatment comprised of immunomodulation and/or dietary intervention. Included were 17 cats with FCE and 18 healthy controls. Clinical investigation of FCE cases included clinical severity grading (feline chronic enteropathy activity index, FCEAI) in all cats, abdominal ultrasonography in 15 cats, and gastrointestinal biopsies in 6 cats. Fecal calprotectin was measured in samples from 12 cats with FCE before treatment, all 17 FCE cats ≥6 weeks after treatment initiation, and all healthy controls. Fecal calprotectin concentrations in FCE cases before treatment (median: 61 μg/g) were significantly higher than after treatment initiation (median: 15 μg/g; p = 0.0098) and compared to controls (median: 6 μg/g; p = 0.0235) and correlated with the FCEAI scores (ρ = 0.54, p = 0.0316). Fecal calprotectin concentrations after treatment initiation were higher with more severe duodenal/proximal jejunal pathology (ρ = 0.83, p = 0.0427) and shorter intervals between sampling time points (ρ = −0.54, p = 0.0250). Relevant decreases in initially increased fecal calprotectin concentrations are seen in cats with FCE on varying treatment strategies that significantly improve or have remission of clinical signs. This supports the utility of fecal calprotectin as a surrogate biomarker to assess disease severity in FCE cases. Further studies need to evaluate fecal calprotectin concentrations longitudinally in relation to mucosal healing vs. clinical response
Regional climate change: consensus, discrepancies, and ways forward
No full textClimate change has emerged across many regions. Some observed regional climate changes, such as amplified Arctic warming and land-sea warming contrasts have been predicted by climate models. However, many other observed regional changes, such as changes in tropical sea surface temperature and monsoon rainfall are not well simulated by climate model ensembles even when taking into account natural internal variability and structural uncertainties in the response of models to anthropogenic radiative forcing. This suggests climate model predictions may not fully reflect what our future will look like. The discrepancies between models and observations are not well understood due to several real and apparent puzzles and limitations such as the “signal-to-noise paradox” and real-world record-shattering extremes falling outside of the possible range predicted by models. Addressing these discrepancies, puzzles and limitations is essential, because understanding and reliably predicting regional climate change is necessary in order to communicate effectively about the underlying drivers of change, provide reliable information to stakeholders, enable societies to adapt, and increase resilience and reduce vulnerability. The challenges of achieving this are greater in the Global South, especially because of the lack of observational data over long time periods and a lack of scientific focus on Global South climate change. To address discrepancies between observations and models, it is important to prioritize resources for understanding regional climate predictions and analyzing where and why models and observations disagree via testing hypotheses of drivers of biases using observations and models. Gaps in understanding can be discovered and filled by exploiting new tools, such as artificial intelligence/machine learning, high-resolution models, new modeling experiments in the model hierarchy, better quantification of forcing, and new observations. Conscious efforts are needed toward creating opportunities that allow regional experts, particularly those from the Global South, to take the lead in regional climate research. This includes co-learning in technical aspects of analyzing simulations and in the physics and dynamics of regional climate change. Finally, improved methods of regional climate communication are needed, which account for the underlying uncertainties, in order to provide reliable and actionable information to stakeholders and the media
Social class and moral judgment: a process dissociation perspective
No full textDo social classes differ in moral judgment? Previous research showed that upper-
class actors have a greater inclination toward utilitarian judgments than lower-
class actors and that this relationship is mediated by empathic concern. In this
paper, we take a closer look at class-based differences in moral judgment and use
the psychometric technique of process dissociation to measure utilitarian and
deontological decision inclinations as independent and orthogonal concepts.
We find that upper-class actors do indeed have a greater inclination toward
decisions consistent with utilitarian principles, albeit only to a quite small extent.
Class-related differences are more pronounced with respect to deontological
judgments, in so far as upper-class actors are less inclined to judgments
consistent with deontological principles than lower-class actors. In addition, it
is shown that class-based differences in utilitarian judgments are mediated by
cognitive styles and not so much by empathic concern or moral identity. None
of these potential mediators explains class-based differences in the inclination
toward deontological judgments
The Clinical Applications of Left Atrial Strain: A Comprehensive Review
No full textLeft atrial (LA) strain imaging, which measures the deformation of the LA using speckle-tracing echocardiography (STE), has emerged recently as an exciting tool to help provide diagnostic and prognostic information for patients with a broad range of cardiovascular (CV) pathologies. Perhaps due to the LA’s relatively thin-walled architecture compared with the more muscular structure of the left ventricle (LV), functional changes in the left atrium often precede changes in the LV, making LA strain (LAS) an earlier marker for underlying pathology than many conventional echocardiographic parameters. LAS imaging is typically divided into three phases according to the stage of the cardiac cycle: reservoir strain, which is characterized by LA filling during systole; conduit strain, which describes LA deformation during passive LV filling; and booster strain, which provides information on the LA atrium during LA systole in late ventricular diastole. While additional large-population studies are still needed to further solidify the role of LAS in routine clinical practice, this review will discuss the current evidence of its use in different pathologies and explore the possibilities of its applications in the future
Passive leg raising test versus rapid fluid challenge in critically ill medical patients
No full textIm Rahmen der hämodynamischen Stabilisierung kritisch kranker Patienten ist die Volumenreagibilität eine therapierelevante Fragestellung. Der PLR-Test findet als eine einfache Methode mit reversiblem Effekt eine breite Anwendung. Das Manöver kann allerdings unter bestimmten Umständen falsch positive oder falsch negative Ergebnisse liefern. Bei bisherigen Vergleichen zwischen PLR-Test und VC wurden im Rahmen der VC sehr unterschiedliche Volumenmengen und ein breites Spektrum an Infusionsdauern verwendet. Neuere Erkenntnisse zeigen allerdings, dass sowohl die Infusionsdauer als auch eine an das Körpergewicht adaptierte Volumenmenge relevant für den hämodynamischen Effekt sind.
In der vorliegenden Arbeit wurde daher die Volumenreagibilität bei kritisch kranken internistischen Patienten mittels PLR-Testes und einer raschen Volumenchallenge (rapid fluid challenge, RFC) untersucht. Basierend auf aktuellen Erkenntnissen standardisierten wir die RFC als Bolusapplikation von 300 ml innerhalb von fünf Minuten, um möglichst nah an die physiologischen Merkmale des per PLR mobilisierten Volumens heranzukommen. Zusammenfassend zeigt die vorliegende Arbeit an Patienten mit hämodynamischer Instabilität eine relevante Diskrepanz zwischen den Ergebnissen des PLR-Tests und der RFC. Diese Diskrepanz sollte bei der individuellen Evaluation der Volumenreagibilität bei hämodynamisch instabilen Patienten berücksichtigt werden.
Die vorliegende Arbeit hat einige Limitationen. Zum einen sind ausschließlich kritisch kranke internistische Patienten eingeschlossen. Dennoch bildet die Kohorte die Problematik der hämodynamischen Stabilisierung gut ab. Zum anderen konnte eine kontinuierliche HZV-Messung nicht bei allen Patienten etabliert werden. Dennoch zeigt die Arbeit die Realität im Alltag der intensivmedizinischen Versorgung, in der solche Entscheidungen häufig schnell erfolgen müssen und die Etablierung invasiver und kostenintensiver Messverfahren nicht überall sofort realisierbar ist.:INHALTSVERZEICHNIS
ABKÜRZUNGSVERZEICHNIS 2
EINLEITUNG 4
PROLOG 4
GRUNDLAGEN DER HÄMODYNAMIK 5
Der Frank-Starling-Mechanismus 7
Das Herzzeitvolumen 8
Der Gefäßwiderstand 8
Der Perfusionsdruck 9
Das Sauerstoffangebot 10
HÄMODYNAMISCHE INSUFFIZIENZ 11
Schockformen 12
Diagnostik der hämodynamischen Insuffizienz 12
Bestimmung der Volumenreagibilität 13
Der Passive-Leg-Raising Test 14
Die Volumenchallenge 18
Therapie der hämodynamischen Insuffizienz 18
AUFGABENSTELLUNG 19
PUBLIKATION 20
ZUSAMMENFASSUNG DER ARBEIT 28
LITERATURVERZEICHNIS 31
ANLAGEN 36
SELBSTSTÄNDIGKEITSERKLÄRUNG 36
EIGENER WISSENSCHAFTLICHER BEITRAG ZUR PUBLIKATION 37
LEBENSLAUF 38
DANKSAGUNG 4
Cognitive Behavioral Therapy for Late-Life Depression (CBTlate): Results of a Multicenter, Randomized, Observer-Blinded, Controlled Trial
No full textIntroduction: Different psychotherapeutic interventions for late-life depression (LLD) have been proposed, but their evaluation in large, multicenter trials is rare. Objective: The present study evaluated the efficacy of a specific cognitive behavioral therapy (CBT) for LLD (LLD-CBT) in comparison with a supportive unspecific intervention (SUI), both administered in a specialist psychiatric outpatient setting. Methods: In this randomized, controlled, parallel group trial, we recruited participants (≥60 years) with moderate to severe depression at 7 trial sites in Germany. Participants were randomly assigned to the LLD-CBT or SUI group. The primary outcome was depression severity at the end of treatment measured by change on the Geriatric Depression Scale (GDS). Secondary outcomes included change in observer-rated depression, anxiety, sleep ratings, and quality of life throughout the treatment phase and at 6-month follow-up. Results: Between October 1, 2018, and November 11, 2020, we randomly assigned 251 patients to either LLD-CBT (n = 126) or SUI (n = 125), of whom 229 provided primary-outcome data. There was no significant between-group difference in the change in GDS scores at the end of treatment (estimated marginal mean difference: −1.01 [95% CI: −2.88 to 0.86]; p = 0.287). Secondary analyses showed significant improvements in several outcomes after 8 weeks and at follow-up in both treatment arms. Conclusions: Our data suggest that LLD-specific CBT and a supportive unspecific treatment both provide clinical benefit in patients with moderate to severe LLD without evidence for superiority of LLD-CBT
Far-right digital memory activism: Transnational circulation of memes and memory of Yugoslav wars
No full textThe terrorist attacks in Norway in 2011 and New Zealand in 2019 have revealed that the far-right worldwide uses the memory of the Yugoslav wars for online mobilization. Scholars working on memory activism usually deal with the liberal, self-critical memory emerging from the bottom-up activism of human rights groups while neglecting the activism of the far-right. This article fills the gap by addressing the global circulation of two memes, Remove Kebab and Pepe the Frog, as examples of far-right memory activism. In order to address the transnational circulation of memes as memory activism, this article employs the concept of ‘traveling memory’ while relying on multimodal discourse analysis to unveil the processes of memetic transformation, imitation, iconization and narrativization. The analysis reveals an alternative memory of Yugoslav wars that depicts Serbia as the first case of ‘white genocide’ in Europe, reversing the roles of war criminals and victims while propagating violence and celebrating genocide. The article argues that memory studies can no longer ignore memory production of far-right communities and, at the same time, outlines the method for examining far-right digital memory activism, revealing a whole set of mnemonic practices developed among the anonymous fringe communities of the far-right
How Do Perceived Instructors’ Mindset Beliefs Influence STEM Students’ Belonging Uncertainty and Dropout Intentions?: An Intersectional Analysis of Students’ Gender and Immigrant Background
No full textWe examined how undergraduate STEM students’ (N = 389) perceptions of their instructors’ beliefs that intelligence is malleable (growth mindsets) or unchangeable (fixed mindsets) influence their uncertainty about belonging and, in turn, their dropout intentions. Taking an intersectional research perspective, we focused on students’ gender and immigrant background to better understand the distinct and combined impact of these social categories on students’ academic experiences. Our results show that male students who perceived their instructors to hold more fixed mindsets reported fewer dropout intentions. In contrast, female students’ dropout intentions were unaffected by their perceived instructors’ mindset beliefs. Belonging uncertainty predicted students’ dropout intentions regardless of their gender and immigrant background, but did not serve as a mediator in the relationship between perceived instructors’ mindset beliefs and dropout intentions. Overall, our findings suggest the predominance of students’ gender in the examined context rather than definitive evidence of intersectional effects with their immigrant background.Wir untersuchten, wie die durch MINT-Studierende (N = 389) wahrgenommenen Überzeugungen ihrer Dozierenden, dass Intelligenz veränderbar (growth mindset) oder unveränderbar (fixed mindset) ist, ihre Zugehörigkeitsunsicherheit und schließlich ihre Studienabbruchsintentionen beeinflusst. Von einer intersektionalen Forschungsperspektive ausgehend, untersuchten wir die sozialen Kategorien Geschlecht und Migrationshintergrund der Studierenden, um den individuellen und kombinierten Einfluss, die diese sozialen Kategorien auf die akademischen Erfahrungen von Studierenden haben können, besser zu verstehen. Unsere Ergebnisse zeigen, dass männliche Studierende, die die Mindsets ihrer Dozierenden eher als „fixed“ wahrnahmen, weniger Studienabbruchsintentionen berichteten, während die wahrgenommenen Dozierendenmindsets für die Studienabbruchsintentionen von weiblichen Studierenden nicht prädiktiv waren. Die Zugehörigkeitsunsicherheit sagte die Studienabbruchsintentionen von Studierenden unabhängig ihres Geschlechts und Migrationshintergrundes vorher, wirkte jedoch nicht als Mediator zwischen wahrgenommenen Dozierendenmindsets und Studienabbruchsintentionen. Insgesamt deuten unsere Ergebnisse eher auf die Dominanz des Geschlechts der Studierenden im untersuchten Kontext hin als auf eindeutige Belege für intersektionale Effekte mit ihrem Migrationshintergrund
Teacher Stereotypes and Teacher Expectations at the Intersection of Student Gender and Socioeconomic Status
No full textGender and family socioeconomic status (SES) are central dimensions of educational inequality and may interact in shaping inequality. This study addresses teacher expectations and stereotypes that possibly contribute to intersectional inequality. The study relies on two samples of teachers and students in German primary schools (sample 1: NTeachers=69, 94 % female, NStudents= 1,049 (German language)/1,027 (mathematics), 48 % female; sample 2: NTeachers= 698 (German language)/614 (mathematics), 94 % female; NStudents= 4,732 (German language)/4,117 (mathematics), 51 % female). Two-level regression analyses revealed additive gender and socioeconomic bias in teacher expectations in German language and mathematics but no intersectional bias (i. e., constant gender bias along family SES and similar socioeconomic bias for girls and boys). Further, teachers with more traditional gender stereotypes showed stronger gender bias, while SES-related stereotypes were unrelated to teacher expectations. We discuss how additive teacher expectation biases relate to the broader concept of intersectionality, potentially shaping unique educational experiences at the intersection of gender and SES.Geschlecht und sozioökonomischer Hintergrund sind zentrale Dimensionen bildungsbezogener Ungleichheiten, die Bildungsungleichheiten wechselseitig prägen können. Die vorliegende Studie untersucht Erwartungen und Stereotype von Lehrkräften, die zu intersektionalen Bildungsungleichheiten beitragen können. Die Studie basiert auf zwei Stichproben von Lehrkräften und Schüler_innen in Grundschulen in Deutschland (Stichprobe 1: NLehrkräfte=69, 94 % weiblich, NSchüler_innen=1,049 (Deutsch)/1,027 (Mathematik), 48 % weiblich; Stichprobe 2: NLehrkräfte=698 (Deutsch)/614 (Mathematik), 94 % weiblich; NSchüler_innen=4,732 (Deutsch)/4,117 (Mathematik), 51 % weiblich). Zwei-Ebenen-Regressionsanalysen zeigten additive Verzerrungen der sprachlichen und mathematischen Leistungserwartungen in Abhängigkeit vom Geschlecht und sozioökonomischen Hintergrund, jedoch keine intersektionalen Verzerrungen (d. h., geschlechtsbezogene Verzerrungen unabhängig vom sozioökonomischen Hintergrund und vergleichbare Verzerrungen in Abhängigkeit vom sozioökonomischen Hintergrund für Mädchen und Jungen). Zudem zeigten Lehrkräfte mit traditionelleren Geschlechterstereotypen stärker nach dem Geschlecht verzerrte Leistungserwartungen, während sozioökonomische Stereotype nicht bedeutsam mit Verzerrungen zusammenhingen. Wir diskutieren, inwiefern additive Erwartungsverzerrungen mit der generellen Idee von Intersektionalität übereinstimmen, da sie spezifische Bildungserfahrungen an der Schnittstelle von Geschlecht und sozioökonomischem Status generieren können