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Greater motor output variability (MOV, inconsistency and unsteadiness) during submaximal tasks post stroke is associated with poorer motor performance. However, little is known about MOV during maximal tasks and relationships with clinical measures of motor performance among stroke survivors. This study determined inconsistency (across discrete attempts) and unsteadiness (within a single attempt) during knee extension maximal voluntary isometric contractions (MVICs) in stroke survivors and neurotypical controls. Forty‐three stroke survivors (28 female) and 31 age‐matched neurotypical controls (15 female) performed a minimum of five knee extension MVICs with paretic and non‐paretic legs (stroke) or dominant leg (controls). Inconsistency was calculated as coefficient of variation between maximal torque values of each MVIC. Unsteadiness was calculated as the average from coefficient of variation of the torque values during each MVIC. The paretic leg of stroke survivors had greater MVIC inconsistency (7.61 ± 4.31% vs. 4.94 ± 2.77%, p = 0.014) and unsteadiness (7.00 ± 3.16% vs. 3.44 ± 1.68%, p < 0.001) than the dominant leg of neurotypical controls. Greater MVIC inconsistency (rs = −0.374, p = 0.016) and unsteadiness (rs = −0.445, p = 0.004) of stroke survivors' paretic leg were associated with lower Fugl‐Meyer Assessment‐Lower Extremity motor scores. Stroke increases MOV during a single session of MVIC measurements with multiple attempts and is associated with poorer clinical measures of motor performance. Compared with neurotypical controls, stroke survivors had greater motor output variability (inconsistency and unsteadiness) during a single session of maximal voluntary isometric contractions of the paretic knee extensor muscles, highlighting the importance of using multiple attempts when assessing maximal muscle strength in stroke survivors.

Vitellogenesis is the process in which female oviparous vertebrates synthesize the protein vitellogenin to develop egg yolk. In some species, vitellogenin has been used to investigate reproductive status, as a biomarker of clutch size and nesting frequency, and as a biomarker of exposure to endocrine-disruptive chemicals. The Diamond-backed Terrapin (Malaclemys terrapin) is an obligate coastal species that in the northern extent of its range nests in the spring and summer months. Diamond-backed Terrapins serve as a key indicator species of coastal ecosystem health; thus, furthering our understanding of the endocrine control of reproduction may inform biologists of the health and status of coastal ecosystems. The objective of this study was to quantify baseline values of vitellogenin and testosterone in Diamond-backed Terrapins during the nesting season, in the northern part of their range. Blood samples were taken from adult female terrapins from two populations in coastal New Jersey from June–August. Enzyme-linked immunosorbent assays (ELISAs) were used to quantify vitellogenin (VTG) and testosterone (T) across the nesting season. VTG concentrations showed peak values in the earliest part of the nesting season, significantly declining through the summer before reaching basal values in August, with T showing a similar trend. This suggests that terrapins in New Jersey follow a similar reproductive cycle to other turtle species from temperate latitudes. Additionally, we found that larger females exhibited higher concentration of T and VTG than smaller females. This suggests that VTG and T are useful biomarkers of reproductive output in these animals. Lastly, we also noted that larger females tended to nest earlier in the nesting season than smaller females. We hypothesize that larger females may compete for resources more effectively and efficiently than smaller females, which may confer larger individuals a fitness advantage.

The purpose of this dissertation was to quantify the benefits of ischemic conditioning on reactive balance responses and gait adaptation during treadmill walking in chronic stroke survivors. Reactive balance and gait adaptations are believed to be limited in this population. Ischemic conditioning is an emerging adjunct to physical therapy that improves motor function post-stroke via improvements in strength, voluntary muscle activation, walking speed, and fatigability. Here, we quantified how ischemic conditioning could impact performance of a more complex task: altering gait to meet various perturbing conditions. Specifically, we quantified mediolateral margin of stability in response to lateral cable pulls (both random, in Aim 1, and repetitive, in Aim 2) at the waist and the number of steps taken to adapt the gait cycle to a split-belt treadmill paradigm (Aim 3). We hypothesized that ischemic conditioning would improve stroke survivors’ ability to alter their gait to meet environmental demands due to increases in voluntary muscle activation. In this series of studies, we observed that stroke survivors who were treated with ischemic conditioning were able to increase their margin of stability to a greater degree in response to both random and repetitive perturbations as compared to a group of individuals treated with a Sham treatment. This increase in margin of stability was accompanied by ischemic conditioning-induced increases in hip abductor muscle activity during perturbation responses. Additionally, we found increased voluntary activation of the knee extensors during maximal voluntary contractions. Finally, we found that IC decreased the number of steps an individual required to adapt their paretic stance time to a split-belt treadmill paradigm. Clinically, the results presented in this dissertation could have significant implications for physical rehabilitation paradigms for stroke survivors. Currently, standard of care paradigms do not effectively address the stroke-induced decrease in the ability to fully activate muscles of the extremities and ability to adapt a motor task, despite evidence that these contribute to overall disability status, muscle weakness, and independence. Ischemic conditioning can be used to address decreased muscle activation and rate of adaptation, ideally increasing functional gains made in a physical rehabilitation program.

In this pragmatic trial, patients with asthma who required first-line controller therapy or were already using an inhaled glucocorticoid and needed additional therapy received a leukotriene-receptor antagonist (LTRA) or an inhaled glucocorticoid as first-line treatment or an LTRA or a long-acting beta 2 -agonist as an add-on. Results of double-blind, randomized, controlled trials provide, appropriately, the bedrock of evidence in determining the efficacy of therapeutic interventions. Proof of efficacy in the trial setting of optimized adherence and follow-up for selective patient populations does not, however, guarantee that a particular therapy will be effective in the diverse patient populations seen in clinical practice. 1 – 3 In the case of asthma, for example, the eligibility criteria in most such trials exclude an estimated 95% of patients with a current diagnosis of asthma, including smokers and those who have “insufficient” bronchodilator reversibility or impaired pulmonary function. 4 , 5 Moreover, the design of . . .

Endothelial dysfunction precedes atherosclerosis and represents an important link between obesity and cardiovascular events. Strategies designed to prevent endothelial dysfunction may therefore reduce the cardiovascular complications triggered by obesity. We tested the hypothesis that deficiency of P-selectin glycoprotein ligand-1 (Psgl-1) would improve the endothelial dysfunction associated with obesity. Psgl-1-deficient (Psgl-1−/−) and wild-type (Psgl-1+/+) mice were fed standard chow or a high-fat, high-sucrose diet (diet-induced obesity [DIO]) for 10 weeks. DIO increased mesenteric perivascular adipose tissue (mPVAT) macrophage content and vascular oxidative stress in Psgl-1+/+ mice but not in Psgl-1−/− mice. Pressure myography using mesenteric arteries demonstrated that relaxation responses to acetylcholine were significantly impaired in DIO Psgl-1+/+ mice, whereas DIO Psgl-1−/− mice were protected from endothelial dysfunction with similar relaxation responses to Psgl-1+/+ or Psgl-1−/− mice fed standard chow. The superoxide scavenger 4-hydroxy-2,2,6,6-tetramethylpiperidinyloxy (TEMPOL) partially recovered impaired endothelial function induced by DIO. A neutralizing Psgl-1 antibody was also effective in preventing endothelial dysfunction and reducing mPVAT macrophage content induced by DIO. These results indicate that obesity in mice leads to PVAT inflammation and endothelial dysfunction that is prevented by Psgl-1 deficiency. Psgl-1 inhibition may be a useful treatment strategy for targeting vascular disease associated with obesity.

Understanding International Law through Moot Courts: Genocide, Torture, Habeas Corpus, Chemical Weapons, and the Responsibility to Protect consists of five sets of opposing legal briefs and judge’s decisions for five moot court cases held before the International Court of Justice and the International Criminal Court. Each moot court brief included in the book addresses contemporary controversies in international affairs; issues ranging from the application of the newly emerging Responsibility to Protect (R2P) doctrine, to the torture of detainees, to the derogation from international due process protections. These moot court briefs and case judgments help students formulate legal arguments that will be applicable to other similar cases. They also provide students with excellent sources of international and domestic law, as well as greater comprehension of topics ranging from jurisdictional disputes to matters of evidence. Chapter 1 of the book provides an overview of the book as well as instructions regarding the construction of a moot court. Chapter two, by George Andreopoulos discusses the interrelationship between human rights and international criminal law. Chapters 3 through 7 are the cases. The introduction to each chapter (and subsequently each case) lays out the facts of the case in question, discusses (where applicable) issues associated with the material and contextual elements of the crimes(s) in question, provides additional topics for classroom discussion, and also places the issues of contention between the parties within the broader context of foreign affairs and international relations. After each set of briefs and legal judgments is an appendix which includes an example moot court, as well as an appendix that includes a set of alterable facts that students and faculty could adopt to change the general legal argument of the particular case.

Becoming known as the Primary Care Respiratory Society UK (PCRS UK) is intended to reflect a number of positive changes to the organisation: membership has grown as nurses have expanded their interest, roles and responsibilities in respiratory care; respiratory care is increasingly managed by multidisciplinary teams; the Society works across all areas of respiratory medicine in primary care, in particular chronic obstructive pulmonary disease (COPD), asthma and respiratory-related allergy.

Abstract Objective: To determine whether routine review by telephone of patients with asthma improves access and is a good alternative to face to face reviews in general practices. Design: Pragmatic, randomised controlled trial. Setting: Four general practices in England. Participants: 278 adults who had not been reviewed in the previous 11 months. Intervention: Participants were randomised to either telephone review or face to face consultation with the asthma nurse. Main outcome measures: Primary outcome measures were the proportion of participants who were reviewed within three months of randomisation and disease specific quality of life, as measured by the Juniper mini asthma quality of life questionnaire. Secondary outcome measures included the validated “short Q” asthma morbidity score, nursing care satisfaction questionnaire score, and length of consultation. Results: Of 137 people randomised to telephone consultation, 101 (74%) were reviewed, compared with 68 reviewed (48%) of the 141 people in the surgery group, a difference of 26% (95% confidence interval 14% to 37%; P<0.001; number needed to treat 3.8). Three months after randomisation the two groups did not differ in the Juniper score (risk difference −0.07 (95% confidence interval −0.40 to 0.27) or in satisfaction with the consultation (risk difference −0.07 (−0.27 to 0.13)). Telephone consultations were on average 10 minutes shorter than reviews held in the surgery (mean difference 10.7 minutes (12.6 to 8.8; P<0.001)). Conclusions: Compared with face to face consultations in the surgery, telephone consultations enable more people with asthma to be reviewed, without clinical disadvantage or loss of satisfaction. A shorter duration means that telephone consultations are likely to be an efficient option in primary care for routine review of asthma. What is already known on the topic Regular review of patients with asthma reduces morbidity and is endorsed as good practice by UK and international guidelines, but only about a third of patients attend for their annual review Most studies of telephone consultation in primary care have focused on consultations requested by patients rather than their use in the routine review of chronic disease What this study adds Telephone consultations enable more people with asthma to be reviewed Telephone consultations are shorter than face to face consultations, without any apparent clinical disadvantage Patients are satisfied with telephone consultations

This dissertation offers a historically-informed ethnographic account of evangelical Christian efforts to combat poverty on the south and west sides of Chicago. Through a case study of a year-long, residential urban volunteer program, and several faith-based social service agencies, I offer insight into the meanings and practices evangelicals associate with the term “social justice.” Chicago, I show, is an important center of evangelical anti-poverty organizations, the earliest of which emerged in response to the uprising that engulfed Madison Street immediately following the assassination of Martin Luther King, Jr. in 1968. Despite their earliest efforts, however, evangelicals have over the course of six decades increasingly turned away from systemic interventions. Evangelicals established volunteer programs rapidly throughout the 1980s, the same decade in which the United States government increasingly disinvested from urban communities of color. Following an uprising in Los Angeles in 1992, evangelicals rejected government solutions in favor of calls for racial reconciliation, of which voluntarism is now one manifestation. My ethnographic fieldwork demonstrates that evangelicals of the early twenty-first century are increasingly aware of the systemic causes of poverty; however, this knowledge does not result in increased political involvement. Rather, volunteer programs emphasize the personal transformations that take place in evangelical encounters with the poor. Evangelical engagement with urban poverty draws largely on neoliberal notions of the free market, private philanthropic aid, and the power of individual relationships to heal neighborhoods that have suffered from decades of private and public disinvestment.