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David Foster Wallace is regarded as one of the most important American writers of the twentieth and twenty-first centuries. This book introduces readers to the literary, philosophical and political contexts of Wallace's work. An accessible and useable resource, this volume conceptualizes his work within long-standing critical traditions and with a new awareness of his importance for American literary studies. It shows the range of issues and contexts that inform the work and reading of David Foster Wallace, connecting his writing to diverse ideas, periods and themes. Essays cover topics on gender, sex, violence, race, philosophy, poetry and geography, among many others, guiding new and long-standing readers in understanding the work and influence of this important writer.
The children's books of Dr. Seuss abound in words that the author invented. Inspection shows that these coinages are not arbitrary, raising the challenge of specifying the linguistic basis on which they were created. Drawing evidence from regression analyses covering the full set of Seuss coinages, I note several patterns, which include coinages that are phonotactically ill-formed, coinages meant to sound German and coinages that assist compliance with the meter. But the primary coinage principle for Seuss appears to have been to use words that include phonesthemes (Firth 1930), small quasi-morphemic sequences affiliated with vague meanings. For instance, the coinage Snumm contains two phonesthemes identified in earlier research, [sn-] and [-ʌm]. Concerning phonesthemes in general, I assert their affiliation with vernacular style, and suggest that phonesthemes can be identified in words purely from their stylistic effect, even when the affiliated meaning is absent. This is true, I argue, both for Seuss’s coinages and for the existing vocabulary.
We examine why science is important to applied psychology, even if one’s motivation to be a psychologist is primarily practical. Helping others takes knowledge and skill, and often applied psychologists face situations that do not produce immediate or clear outcomes. In such situations experiential learning can only do so much, and science is needed to be effective long term. When the history of training models in applied psychology is reviewed from the inception of the field to the present day, it is clear that students of applied psychology need to learn how to do research that will inform practice, how to assimilate the research evidence as it emerges, and how to incorporate empiricism into practice itself. We argue that the kind of knowledge needed by practitioners requires a focus on the needs of those served by psychologists, a more personalized and process-based research approach, and a laser-like focus on issues of broad importance. A scientist-practitioner is a consumer of research, but is also able to identify, acquire, develop, and apply empirically supported treatments and assessments to those in need, and to think about their own work with an empirical mind set.
Patients with bipolar disorder (BPD) are prone to engage in risk-taking behaviours and self-harm, contributing to higher risk of traumatic injuries requiring medical attention at the emergency room (ER).We hypothesize that pharmacological treatment of BPD could reduce the risk of traumatic injuries by alleviating symptoms but evidence remains unclear. This study aimed to examine the association between pharmacological treatment and the risk of ER admissions due to traumatic injuries.
Individuals with BPD who received mood stabilizers and/or antipsychotics were identified using a population-based electronic healthcare records database in Hong Kong (2001–2019). A self-controlled case series design was applied to control for time-invariant confounders.
A total of 5040 out of 14 021 adults with BPD who received pharmacological treatment and had incident ER admissions due to traumatic injuries from 2001 to 2019 were included. An increased risk of traumatic injuries was found 30 days before treatment [incidence rate ratio (IRR) 4.44 (3.71–5.31), p < 0.0001]. After treatment initiation, the risk remained increased with a smaller magnitude, before returning to baseline [IRR 0.97 (0.88–1.06), p = 0.50] during maintenance treatment. The direct comparison of the risk during treatment to that before and after treatment showed a significant decrease. After treatment cessation, the risk was increased [IRR 1.34 (1.09–1.66), p = 0.006].
This study supports the hypothesis that pharmacological treatment of BPD was associated with a lower risk of ER admissions due to traumatic injuries but an increased risk after treatment cessation. Close monitoring of symptoms relapse is recommended to clinicians and patients if treatment cessation is warranted.
Clozapine is the only licenced medication for treating treatment-resistant schizophrenia. Previous studies have suggested unequal rates of clozapine treatment by ethnicity among individuals with schizophrenia-spectrum disorders. One previous review has investigated this topic but was restricted to studies from the USA. This current review aims to synthesise the international literature regarding ethnic disparities in clozapine prescription amongst individuals with schizophrenia-spectrum disorders. We searched CINAHL, PubMed, Medline, Embase, APA PsycINFO and Open Grey and reviewed studies reporting on the proportion of service-users prescribed clozapine separately for different ethnic groups, in individuals with a primary diagnosis of schizophrenia or any schizophrenia-spectrum disorders. A narrative synthesis was conducted to integrate information from included studies. The review was registered in PROSPERO (Number: CRD42020221731). From 24 studies, there is strong, consistent evidence that Black and Hispanic service-users in the UK and the USA are significantly less likely to receive clozapine than White/Caucasian service-users after controlling for multiple demographic and clinical potential confounders. In New Zealand, Māori service-users were reported to be more likely to receive clozapine than those of White/European ethnicity. There is mixed evidence regarding Asian service-users in the UK. The mentioned disparities were observed in studies with TRS and non-TRS cohorts. The results imply that access to clozapine treatment varies among ethnic groups. These findings raise an ethical concern as they suggest a compromise of the standards of care in schizophrenia treatment practices. Interventions are needed to reduce clozapine prescribing disparities among ethnic communities.
The transfer rate for patients from an Alternate Care Site (ACS) back to a hospital may serve as a metric of appropriate patient selection and the ability of an ACS to treat moderate to severely ill patients accepted from overwhelmed healthcare systems. During the coronavirus infectious disease 2019 (COVID-19) pandemic, hospitals worldwide experienced acute surges of patients presenting with acute respiratory failure. An ACS in Imperial County, California was re-established in November 2020 to help decompress two local hospitals experiencing surges of COVID-19 cases. The patients treated often had multiple comorbid illnesses and required a median supplemental oxygen of three liters per minute (LPM) on admission. Numerous interventions were initiated during a two-week period to improve clinical care delivery. The objectives of this retrospective observational study are to evaluate the impact of these clinical and staff interventions at an ACS on the transfer rate and to provide issues to consider for future ACS sites managing COVID-19 patients. The data suggest that continuous, real-time process-improvement interventions helped reduce the transfer rate back to hospitals from 36.7% to 14.5% and that an ACS is a viable option for managing symptomatic COVID-19 positive patients requiring hospital-level care when hospitals are overburdened.
The body of evidence regarding self-management programs (SMPs) for adult chronic non-cancer pain (CNCP) is steadily growing, and regular updates are needed for effective decision-making.
To systematically identify, critically appraise, and summarize the findings from randomized controlled trials (RCTs) of SMPs for CNCP.
We searched relevant databases from 2009 to August 2021 and included English-language RCT publications of SMPs compared with usual care for CNCP among adults (18+ years old). The primary outcome was health-related quality of life (HR-QoL). We conducted meta-analysis using an inverse variance, random-effects model and calculated the standardized mean difference (SMD) and associated 95% confidence interval (CI) and statistical heterogeneity using the I2 statistic.
From 8538 citations, we included 28 RCTs with varying patient populations, standards for SMPs, and usual care. No RCTs were classified as having a low risk of bias. There was no evidence of a significant improvement in overall HR-QoL, irrespective of pain type, immediately post-intervention (SMD 0.01, 95%CI −0.21 to 0.24; I2 57%; 11 RCTs; 979 participants), 1–4 months post-intervention (SMD 0.02, 95%CI −0.16 to 0.20; I2 48.7%; 12 RCTs; 1160 participants), and 6–12 months post-intervention (SMD 0.07, 95%CI −0.06 to 0.21; I2 26.1%; 9 RCTs; 1404 participants). Similar findings were made for physical and mental HR-QoL, and for specific QoL assessment scales (e.g., SF-36).
There is a lack of evidence that SMPs are efficacious for CNCP compared with usual care. Standardization of SMPs for CNCP and better planned/conducted RCTs are needed to confirm these conclusions.
Structured review of video laryngoscopy recordings from physician team prehospital rapid sequence intubations (RSIs) may provide new insights into why prehospital intubations are difficult. The aim was to use laryngoscope video recordings to give information on timings, observed features of the airway, laryngoscopy technique, and laryngoscope performance. This was to both describe prehospital airways and to investigate which factors were associated with increased time taken to intubate.
Sydney Helicopter Emergency Medical Service (HEMS; the aeromedical wing of New South Wales Ambulance, Australia) has a database recording all intubations. The database comprises free-text case detail, airway dataset, scanned case sheet, and uploaded laryngoscope video. The teams of critical care paramedic and doctor use protocol-led intubations with a C-MAC Macintosh size four laryngoscope and intubation adjunct. First-pass intubation rate is approximately 97%. Available video recordings and their database entries were retrospectively analyzed for pre-specified qualitative and quantitative factors.
Prehospital RSI video recordings were available for 385 cases from January 2018 through July 2020. Timings revealed a median of 58 seconds of apnea from laryngoscope entering mouth to ventilations. Median time to intubate (laryngoscope passing lips until tracheal tube inserted) was 35 seconds, interquartile range 28-46 seconds. Suction was required prior to intubation in 29% of prehospital RSIs. Fogging of the camera lens at time of laryngoscopy occurred in 28%. Logistic regression revealed longer time to intubate was associated with airway soiling, Cormack-Lehane Grade 2 or 3, multiple bougie passes, or change of bougie.
Video recordings averaging 35 seconds for first-pass success prehospital RSI with an adjunct give bed-side “definitions of difficulty” of 30 seconds for no glottic view, 45 seconds for no bougie placement, and 60 seconds for no endotracheal tube placement. Awareness of apnea duration can help guide decision making for oxygenation. All emergency intubators need to be cognizant of the need for suctioning. Improving the management of bloodied airways and bougie usage may reduce laryngoscopy duration and be a focus for training. Video screen fogging and missed recordings from some patients may be something manufacturers can address in the future.
Antipsychotic polypharmacy (APP) occurs commonly but it is unclear whether it is associated with an increased risk of adverse drug reactions (ADRs). Electronic health records (EHRs) offer an opportunity to examine APP using real-world data. In this study, we use EHR data to identify periods when patients were prescribed 2 + antipsychotics and compare these with periods of antipsychotic monotherapy. To determine the relationship between APP and subsequent instances of ADRs: QT interval prolongation, hyperprolactinaemia, and increased body weight [body mass index (BMI) ⩾ 25].
We extracted anonymised EHR data. Patients aged 16 + receiving antipsychotic medication at Camden & Islington NHS Foundation Trust between 1 January 2008 and 31 December 2018 were included. Multilevel mixed-effects logistic regression models were used to elucidate the relationship between APP and the subsequent presence of QT interval prolongation, hyperprolactinaemia, and/or increased BMI following a period of APP within 7, 30, or 180 days respectively.
We identified 35 409 observations of antipsychotic prescribing among 13 391 patients. Compared with antipsychotic monotherapy, APP was associated with a subsequent increased risk of hyperprolactinaemia (adjusted odds ratio 2.46; 95% CI 1.87–3.24) and of registering a BMI > 25 (adjusted odds ratio 1.75; 95% CI 1.33–2.31) in the period following the APP prescribing.
Our observations suggest that APP should be carefully managed with attention to hyperprolactinaemia and obesity.
This chapter engages with the tensions between periphery and centre that are displayed by all forms of world crime fiction but that are especially telling in crime fiction in French. The notion of ‘French crime fiction’ is analysed, including the tensions inherent in Frenchness itself (the Francophone debate) and those between literature and genre fiction. Case studies include the nouveau roman, especially Michel Butor’s Passing Time, which stages the rules of crime fiction while simultaneously mapping them overseas; the nexus formed by Albert Camus’ The Outsider and Kamal Daoud’s The Meursault Investigation; the territorial and literary double spaces of Didier Daeninckx’s Murder in Memoriam; and questions of decapitation in Georges Simenon’s Maigret and the Headless Corpse and Marguerite Duras’s L’Amante anglaise. Additionally, the relationship between France, the Caribbean and Québec is traced in the genre-bending works of Maryse Condé, Patrick Chamoiseau, Fred Vargas and Anne Hébert. Through these texts, their points of intersection and their generic and geographical movements, crime fiction in French will be shown to exemplify the mobilities of world crime fiction.
Conquering CHD, formerly known as the Pediatric Congenital Heart Association (PCHA), is the leading congenital heart disease (CHD) patient advocacy organisation in the United States of America, and places high priority on patient engagement in the research process. Participatory design is an approach to problem-solving that utilises the knowledge and opinions of groups of people to generate plans and new ideas. Utilising this mode of patient engagement, patients and families engaged with Conquering CHD assisted in developing a list of research priorities which was then distributed to the larger membership with instructions to rank the priorities in order of importance. Upon completion, these items were compared to the current scientific literature to assess correlation with current publications. This cross-sectional study and literature review aimed to assess the priorities of patients and families in CHD research and to determine the reflection of these areas in the current body of scientific literature.
This cross-sectional study utilised a survey asking participants to rank the importance of research items within categories including “Technology Advances,” “Genetic and Cellular Research,” “Broad Understanding of CHD,” and “Psychosocial Outcomes” which was distributed through social media and email to 43,168 accounts across all platforms. Respondents were asked to place each item in a ranked order in each category, with the value “1” representing the most preferred for each participant. Anyone engaged with Conquering CHD was eligible to complete the study, including patients and families. Subsequently, a literature review of the largest medical databases including PubMed, Scopus, and ScienceDirect was undertaken to determine the number of articles published per each topic which was then assessed to determine if there is a correlation between patient-ranked priorities and the current body of literature.
The study generated a total response of 527 participants. Regarding “Technology Advances,” valve replacement was the preferred topic (mean rank 2.07, IQR 2). Stem cell research was the favoured topic in “Genetic and Cellular Research” (mean rank 2.53, IQR 2). Access to care was the priority in the “Broadening Understanding of CHD” (mean rank 1.24, IQR 1). Pertaining to “Psychosocial Outcomes”, psychological/emotional effects was the highest ranked topic (mean rank 1.46, IQR 1). The literature review returned a total of 135,672 articles in the areas of interest. For “Valve Replacement”, 8361 articles resulted reflecting a proportion of 0.097 of total articles. For “Stem Cell Research”, 9921 articles resulted reflecting a proportion of 0.115 of total articles. For “Access to Care”, 7845 articles resulted reflecting a proportion of 0.091 of total articles. For “Psychological/Emotional Effects”, 6422 articles resulted reflecting a proportion of 0.074 of total articles. A Spearman’s correlation demonstrated no correlation between the preferred domain of CHD research and the number of articles published for that domain (rs = 0.02, p = 0.94).
This process demonstrates the effectiveness of participatory design, using a patient and family network to determine the research items of concern to those affected by CHD. The cross-sectional survey was effective in assessing patient and family priorities but was limited by access to reliable internet and delivery only in English. Though the study had a large response rate, it was limited to patients already engaged with Conquering CHD. For these reasons, it may not completely reflect the opinions of the total population affected by CHD. However, this offers valuable insight into patient-determined priorities and reveals that the current scientific literature does not correlate with these items. These data serve to inform individual and institutional research agendas to better reflect the needs and desires of this population.
Experiences of felt presence (FP) are well documented in neurology, neuropsychology and bereavement research, but systematic research in relation to psychopathology is limited. FP is a feature of sensorimotor disruption in psychosis, hypnagogic experiences, solo pursuits and spiritual encounters, but research comparing these phenomena remains rare. A comparative approach to the phenomenology of FP has the potential to identify shared and unique processes underlying the experience across these contexts, with implications for clinical understanding and intervention.
We present a mixed-methods analysis from three online surveys comparing FP across three diverse contexts: a population sample which included people with experience of psychosis and voice-hearing (study 1, N = 75), people with spiritual and spiritualist beliefs (study 2, N = 47) and practitioners of endurance/solo pursuits (study 3, N = 84). Participants were asked to provide descriptions of their FP experiences and completed questionnaires on FP frequency, hallucinatory experiences, dissociation, paranoia, social inner speech and sleep. Data and code for the study are available via OSF.
Hierarchical linear regression analysis indicated that FP frequency was predicted by a general tendency to experience hallucinations in all three studies, although paranoia and gender (female > male) were also significant predictors in sample 1. Qualitative analysis highlighted shared and diverging phenomenology of FP experiences across the three studies, including a role for immersive states in FP.
These data combine to provide the first picture of the potential shared mechanisms underlying different accounts of FP, supporting a unitary model of the experience.
The authority of Abū Jaʿfar al-ʿAmrī, the second in the canonical sequence of envoys, emerged around the time when the old guard agents of the eleventh Imam were dying, two decades after the Imam’s death. The process of back-projection of the envoy paradigm to the earliest phase of the Occultation has obscured details of Abū Jaʿfar’s life, but we can piece together, in Chapter 5, some details from reports of opposition to Abū Jaʿfar from both skeptical agents and rival charismatic bābs. He established his authority through his father’s prestige, by forging alliances with other agents, by repudiating doubters, and issuing rescripts (tawqīʿāt) in the name of the hidden Imam. He also attempted to maintain revenues, giving concessions and dispensations for alms taxes, while asserting the legitimacy of the Imamic agents to continue revenue-collection, particularly from waqf endowments and Imamic estates. Through these activities he established the office of envoy firmly enough to survive him.