IntroductionExertional dyspnoea is the primary diagnostic symptom for chronic cardiopulmonary disease populations. Whilst a number of exercise tests are used, there remains no gold standard clinical measure of exertional dyspnoea. The aim of this review was to comprehensively describe and evaluate all types of fixed-intensity exercise tests used to assess exertional dyspnoea in chronic cardiopulmonary populations and, where possible, report the reliability and responsiveness of the tests.MethodsA systematic search of five electronic databases identified papers that examined 1) fixed-intensity exercise tests and measured exertional dyspnoea, 2) chronic cardiopulmonary populations, 3) exertional dyspnoea reported at isotime or upon completion of fixed-duration exercise tests, and 4) published in English.ResultsSearches identified 8785 papers. 123 papers were included, covering exercise tests using a variety of fixed-intensity protocols. Three modes were identified, as follows: 1) cycling (n=87), 2) walking (n=31) and 3) other (step test (n=8) and arm exercise (n=2)). Most studies (98%) were performed on chronic respiratory disease patients. Nearly all studies (88%) used an incremental exercise test. 34% of studies used a fixed duration for the exercise test, with the remaining 66% using an exhaustion protocol recording exertional dyspnoea at isotime. Exertional dyspnoea was measured using the Borg scale (89%). 7% of studies reported reliability. Most studies (72%) examined the change in exertional dyspnoea in response to different interventions.ConclusionConsiderable methodological variety of fixed-intensity exercise tests exists to assess exertional dyspnoea and most test protocols require incremental exercise tests. There does not appear to be a simple, universal test for measuring exertional dyspnoea in the clinical setting.
This article argues that sexual violation can take both ‘chronic’ and ‘acute’ forms. The latter, encapsulated by the offences of rape and sexual assault, refers to a discrete incident in which a victim’s sexual autonomy is violated. By contrast, the article articulates an original concept of ‘chronic sexual violation’, in which the victim’s autonomy is gradually eroded over a longer period of time, for example in an abusive relationship. In such a case it may be difficult to identify specific sexual encounters as non-consensual, and yet the victim is left with little or no control over whether and on what terms they engage in sexual activity. This conceptualisation builds on Evan Stark’s theory of coercive control, and is grounded in survivor accounts of the lived experience of sexual violation within ongoing relationships drawn from existing studies of abusive relationships, my own empirical interview data, and case law. The article contends that the limitations of law and policy responses to sexual violation within relationships can be partly explained by the illegibility of chronic sexual violation within a legal framework premised on the notion that a crime is a discrete incident. The concept of chronic sexual violation offers a way forward for crafting legal responses to this specific and pervasive form of harm, while resisting hierarchical constructions of sexual violation within intimate relationships as less serious than ‘real rape’.
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