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"Bruce, Richard M."
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استعادة التوازن : استراتيجية للشرق الأوسط برسم الرئيس الجديد
لا شك في أن الرئيس الرابع والأربعين للولايات المتحدة الأميركية سيجد في انتظاره سلسلة من التحديات الحاسمة، المعقدة والمتشابكة في الشرق الأوسط، التي تتطلب إيلاءها اهتماما عاجلا. ذلك أن النموذج الذي اعتمده جورج بدليو بوش القائم على تغيير أنظمة الحكم ونشر الديمقراطية بالقوة لم يعد يتلاءم والظروف المتغيرة التي ستواجه الإدارة الجديدة على الأرجح الحاجة ماسة إذن لأفكار جديدة، وتحليلات غير حزبية، وتوصيات حصيفة. والكتاب الذي بين أيديكم يفي بتلك الحاجة على أفضل وجه. في اتسعادة التوازن، تتضافر جهود الخبراء والمختصين بشؤون الشرق الأوسط من مجلس العلاقات الخارجية ومركز صبان لسياسة الشرق الأوسط بمعهد بروكنغز، لتطرح استراتيجية أميركية جديدة لمنظمة حيوية لكن متفجرة كالشرق الأوسط فبناء على أبحاث ميدانية معنقة، قام هؤلاء الخبراء ببلورة مجموعة من التوصيات السياسية برسم الرئيس الأميركي الجديد وقد قامت بفحصها وتمحيصها ونقدها هيئة من المختصين من كلا الحزبين يتمتعون بخبرة سياسية واسعة ومعرفة غنية بالمنطقة، هذا التمرين في تخطيط السياسات الذي استغرق سنة كاملة هو الأول من نوعه على الإطلاق، الذي يوحد جهود وقدرات العاملين في هاتين المؤسستين المحترمتين بالسياسة الخارجية لتنصب على درس وتحليل واحدة من أخطر وأهم مناطق العالم. وكل فصل من هذا الكتاب يستضيف اثنين أو أكثر من الباحثين في مجلس العلاقات الخارجية ومعهد بروكنغز لمعاينة واستعراض التحديات التي ستواجه الرئيس المقبل.
Book
Acute psychological and physiological benefits of exercising with virtual reality
Exercise is a powerful tool for disease prevention and rehabilitation. Commercially available virtual reality (VR) devices and apps offer an immersive platform to gamify exercise and potentially enhance physiological and psychological benefits. However, no work has compared immersive exercise to closely matched 2D screen-based equivalents with the same visual and auditory stimuli. This study aims to compare the acute effects of an exercise session using a commercial immersive VR workout to the same stimuli and workout presented on a screen. 17 healthy participants (male = 7, female = 10; aged 24.18±4.56 years), completed a 12-minute guided VR boxing exercise session in FitXR™ and a screen-based equivalent. Physiological responses were recorded continuously using a heart rate monitor and telemetricmetabolic cart system. Psychological and perceptual responses were measured using their ratings of perceived exertion, the physical activity enjoyment scale, and the physical activity affect scale. In the immersive VR participants chose to engage in more intense exercise (%VO2max;
p
= 0.044), showed higher levels of all enjoyment subscales
(p
<0.05) and reported higher positive affect (
p
= 0.003) and lower negative affect (
p
= 0.045) following exercise compared to the screen-based equivalent. However, the design here could not determine which elements of immersive VR contributed to the positive effects. Immersive VR may offer a more efficient alternative to other forms of screen based and exergaming workouts and could be offered as a gateway into exercise.
Journal Article
Assessment of Ventilatory Heterogeneity in Chronic Obstructive Pulmonary Disease Using the Inspired Sinewave Test
There is marked variability in the symptoms and outcomes of patients with chronic obstructive pulmonary disease (COPD) which are poorly predicted by spirometry/FEV
. Furthermore, as spirometry requires the performance of potentially distressing respiratory manoeuvres which are to some extent user-effort dependent, there is need for non-invasive and simple-to-perform techniques to identify subtypes of COPD which are more closely related to clinically relevant outcomes.
The inspired sinewave test (IST) sinusoidally modulates the inspired concentration of a tracer gas (N
O) over successive tidal breaths. A single-compartment tidal-ventilation lung model processes the amplitude/phase of the expired N
O sinewave and estimates cardiopulmonary variables including: effective lung volume and indices of ventilatory heterogeneity (VH; ELV
/FRC
and ELV
/ELV
). 83 COPD patients and 53 healthy controls performed the IST test, standard pulmonary function tests (Spirometry, body plethysmography and the single breath test of carbon monoxide uptake), and symptom severity questionnaires (COPD assessment test, CAT; mMRC dyspnoea-scale, mMRC-DS; Cough+Mucus score; C+M score).
ELV
/FRC
and ELV
/ELV
were significantly lower in patients with COPD vs healthy participants (0.34±0.11 vs 0.68±0.14 and 0.7±0.27 vs 0.98±0.15, respectively; P<0.05). Multivariable regression analysis demonstrated that ELV
/FRC
was a stronger and independent predictor of CAT, mMRC-DS and C+M score vs FEV
. ELV
/ELV
was a stronger and independent and better predictor of C+M score vs FEV
. Phenotyping patients, based upon ELV
/ELV
and FRC
, uncovered significant symptomatic differences between groups.
The IST indices of VH were superior and independent predictors of symptom severity vs FEV
and has potential as a non-invasive and simple-to-perform method to stratify patients into subgroups related to clinically relevant features of COPD.
Journal Article
The Continuing Multidisciplinary Needs of Adult Patients with Cleft Lip and/or Palate
Objective:
Babies born with cleft lip and/or palate are followed-up throughout their growth in childhood. During adulthood, they may require further functional and/or aesthetic treatment. Adult multidisciplinary cleft clinics have been in place in the West Midlands, U.K. since June 2000. The aim of this study was to review the number and nature of problems these adult patients had and the types of treatment they required.
Design:
All adult patients seen in 2004 were identified. Case notes were reviewed for patient epidemiology, problems at initial presentation, and interventions carried out until their last clinic visit in 2004.
Results:
In 2004, there were 145 patients seen in the adult cleft clinic. Of those, 55 patients attended as part of their continuing care. Ninety were newly referred as adults to the cleft service. Patients ranged in age from 15 to 70 years and had, on average, three clinical problems each. One hundred and sixteen patients were listed for surgery of varying types, nine patients had nonsurgical speech-related intervention, 21 patients had restorative dental intervention, and 16 patients needed an extended clinical psychology assessment.
Conclusion:
For some patients who have had a cleft lip and/or palate, problems continue into adulthood or arise later in life. These problems are often multiple and treatment often requires the input of more than one specialist. The results of this audit support the need for coordinated multidisciplinary care for adults who have had a cleft lip and/or palate.
Journal Article
Encountering chemotherapy 2.0
Hovey discusses his experience of undergoing chemotherapy for advanced metastasized prostate cancer. He states that it has been almost 4 years since his first round, and now he is learning to endure it again, both practically with the physical pain and ontologically with the emotional pain, as he becomes something of a stranger to himself. He does so as a person who was actively trying not to be disrupted by negative life events and was purposefully avoiding the conditions that might unsettle his life, which Heidegger refers to as \"thrownness.\" As he contends with cancer, he is open to new developments and possibilities and not attempt to escape or deny the reality of his situation. Although he has choices, he chose chemotherapy. He seeks to return to what is normal to him because this thrownness causes anxiety.
Journal Article
Cervical branch of the facial nerve in leprosy
This study demonstrates that the platysma is occasionally palsied in leprosy and that this only occurs when the facial nerve already has some other palsy. That there needs to be a facial palsy before there can be a platysma palsy is strongly suggested, in that there was no case of an isolated platysma palsy. Patients, regardless of age or other factors, could mimic a platysma contraction. This obviates the need for electrical testing to examine for a platysma palsy. It also means that a nonfunctioning platysma on clinical examination is, in fact, a palsied platysma. While lagophthalmos is regularly examined for, and any obvious facial paresis would be noticed, less severe forms of facial muscle paresis will only be found if formally examined for. The mechanism whereby the facial nerve is involved in leprosy is not clarified, but our findings suggest that proximal spread of a lesion that began in the zygomatico-temporal branches and reaches to the facial nerve trunk is more likely than new lesions developing de novo in other peripheral facial nerve branches. That the primary lesion is within the facial nerve trunk in all cases but we only see the frequent zygomatic sequelae due to secondary factors is not excluded.
Journal Article
Bayfront Parkway should be two lanes
A two-lane road is much friendlier to all pedestrians than a four-lane road, and it is an essential aspect that forms a thriving and successful downtown.
Newspaper Article
In defense of American higher education
The current era in higher education is characterized by increased need for accountability and fiscal constraint coupled with demands for increased productivity. Higher education is expected to meet the demand of changing student demographics, as well as requests for research and service from government and industry. To preserve the academy's ability to meet these demands, the editors and contributors to this volume argue that, while change is inevitable and desirable, any radical alterations to the practices that have established and upheld the excellence of higher education in the United States must be carefully considered.The editors and contributors cherish the best ideals of higher education: academic freedom, commitment to both inquiry and teaching, and preservation of an independence of mind and spirit in the face of external pressures. At the same time, the authors of these essays also reflect upon the failings of higher education, including problematic historical legacies such as racism, sexism, and anti-semitism. In Defense of American Higher Education is a careful analysis of what we have inherited, undertaken with a critical eye for constructive reform. It will be of interest to anyone concerned about the future of American higher education.
eBook