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Identifying risk factors of individuals in a clinical-high-risk state for psychosis are vital to prevention and early intervention efforts. Among prodromal abnormalities, cognitive functioning has shown intermediate levels of impairment in CHR relative to first-episode psychosis and healthy controls, highlighting a potential role as a risk factor for transition to psychosis and other negative clinical outcomes. The current study used the AX-CPT, a brief 15-min computerized task, to determine whether cognitive control impairments in CHR at baseline could predict clinical status at 12-month follow-up.
Baseline AX-CPT data were obtained from 117 CHR individuals participating in two studies, the Early Detection, Intervention, and Prevention of Psychosis Program (EDIPPP) and the Understanding Early Psychosis Programs (EP) and used to predict clinical status at 12-month follow-up. At 12 months, 19 individuals converted to a first episode of psychosis (CHR-C), 52 remitted (CHR-R), and 46 had persistent sub-threshold symptoms (CHR-P). Binary logistic regression and multinomial logistic regression were used to test prediction models.
Baseline AX-CPT performance (d-prime context) was less impaired in CHR-R compared to CHR-P and CHR-C patient groups. AX-CPT predictive validity was robust (0.723) for discriminating converters v. non-converters, and even greater (0.771) when predicting CHR three subgroups.
These longitudinal outcome data indicate that cognitive control deficits as measured by AX-CPT d-prime context are a strong predictor of clinical outcome in CHR individuals. The AX-CPT is brief, easily implemented and cost-effective measure that may be valuable for large-scale prediction efforts.
A national need is to prepare for and respond to accidental or intentional disasters categorized as chemical, biological, radiological, nuclear, or explosive (CBRNE). These incidents require specific subject-matter expertise, yet have commonalities. We identify 7 core elements comprising CBRNE science that require integration for effective preparedness planning and public health and medical response and recovery. These core elements are (1) basic and clinical sciences, (2) modeling and systems management, (3) planning, (4) response and incident management, (5) recovery and resilience, (6) lessons learned, and (7) continuous improvement. A key feature is the ability of relevant subject matter experts to integrate information into response operations. We propose the CBRNE medical operations science support expert as a professional who (1) understands that CBRNE incidents require an integrated systems approach, (2) understands the key functions and contributions of CBRNE science practitioners, (3) helps direct strategic and tactical CBRNE planning and responses through first-hand experience, and (4) provides advice to senior decision-makers managing response activities. Recognition of both CBRNE science as a distinct competency and the establishment of the CBRNE medical operations science support expert informs the public of the enormous progress made, broadcasts opportunities for new talent, and enhances the sophistication and analytic expertise of senior managers planning for and responding to CBRNE incidents.
Leading-edge telescopes such as the Atacama Large Millimeter and sub-millimeter Array (ALMA), and near-future ones, are capable of imaging the same sky area at hundreds-to-thousands of frequencies with both high spectral and spatial resolution. This provides unprecedented opportunities for discovery about the spatial, kinematical and compositional structure of sources such as molecular clouds or protoplanetary disks, and more. However, in addition to enormous volume, the data also exhibit unprecedented complexity, mandating new approaches for extracting and summarizing relevant information. Traditional techniques such as examining images at selected frequencies become intractable while tools that integrate data across frequencies or pixels (like moment maps) can no longer fully exploit and visualize the rich information. We present a neural map-based machine learning approach that can handle all spectral channels simultaneously, utilizing the full depth of these data for discovery and visualization of spectrally homogeneous spatial regions (spectral clusters) that characterize distinct kinematic behaviors. We demonstrate the effectiveness on an ALMA image cube of the protoplanetary disk HD142527. The tools we collectively name “NeuroScope” are efficient for “Big Data” due to intelligent data summarization that results in significant sparsity and noise reduction. We also demonstrate a new approach to automate our clustering for fast distillation of large data cubes.
The aims of this study were twofold: (a) to explore whether specific components of shared decision making were present in consultations involving nurse prescribers (NPs), pharmacist prescribers (PPs) and general practitioners (GPs) and (b) to relate these to self-reported patient outcomes including satisfaction, adherence and patient perceptions of practitioner empathy.
There are a range of ways for defining and measuring the process of concordance, or shared decision making as it relates to decisions about medicines. As a result, demonstrating a convincing link between shared decision making and patient benefit is challenging. In the United Kingdom, nurses and pharmacists can now take on a prescribing role, engaging in shared decision making. Given the different professional backgrounds of GPs, NPs and PPs, this study sought to explore the process of shared decision making across these three prescriber groups.
Analysis of audio-recordings of consultations in primary care in South England between patients and GPs, NPs and PPs. Analysis of patient questionnaires completed post consultation.
A total of 532 consultations were audio-recorded with 20 GPs, 19 NPs and 12 PPs. Prescribing decisions occurred in 421 (79%). Patients were given treatment options in 21% (102/482) of decisions, the prescriber elicited the patient’s treatment preference in 18% (88/482) and the patient expressed a treatment preference in 24% (118/482) of decisions. PPs were more likely to ask for the patient’s preference about their treatment regimen (χ2=6.6, P=0.036, Cramer’s V=0.12) than either NPs or GPs. Of the 275 patient questionnaires, 192(70%) could be matched with a prescribing decision. NP patients had higher satisfaction levels than patients of GPs or PPs. More time describing treatment options was associated with increased satisfaction, adherence and greater perceived practitioner empathy. While defining, measuring and enabling the process of shared decision making remains challenging, it may have patient benefit.
The way in which identity is understood in contemporary society is the result of the application of a double perspective composed of figures which do not simply add up but instead present us with a set of tensions: a reflection on the crisis in the forms of media discourse as the principal locus of present-day identity, and the urgent need to construct experiential discourses that can suture the deficit of legitimation in the anonymous discourses which address us […]. Narratives of identity come up against the fact that they are constructions in which there is not merely some mechanical actuation of codes but also a production of meaning. This is why there can be no question of extolling situations of marginality or exoticism as reservoirs of such narratives, but rather of analysing the extent to which the very brokenness of classic models of identity itself generates new narratives, in which modes of integration and rebellion are negotiated.
(Marinas 1995: 75–78)
The return of identity and the exhaustion of storytelling
Breaking with the sterile cycle that leads from the affirmation of identity as an immutable essence to its negation in the supposed inevitability of homogenization, contemporary thought proposes identity as a construction which emerges through narration. This new way of thinking about identity aims to account both for the changes which traverse mono-identities and the emergence of multiculturalities which exceed ethnic, racial and national categories.
In this chapter I address the meaning and representativity of the term ‘Cuban popular culture’ through two rather different test-cases, the first of which is the film Aventuras de Juan Quinquín (1967) by the Cuban film director Julio García-Espinosa (b. 1926), and the second the religious social phenomenon of santería. In each case I ask the question of the extent to which the energy of popular culture is co-opted into a new (revolutionary) value-system or whether, ultimately, it escapes that hermeneutic net. It is legitimate to argue that García-Espinosa's films as much as santería as we nowadays understand the phenomenon came into being as a result of the Cuban Revolution. The experience of a revolution in Cuba in 1959 was as decisive for its generation as the French Revolution had been for European intellectuals in the 1790s. As Hobsbawm puts it: ‘It was now known that social revolution was possible; that nationals existed as something independent of states, peoples as something independent of their rulers, and even that the poor existed as something independent of the ruling classes’ (1962: 91). Hobsbawm's last point about the ‘poor’ existing ‘as something independent of the ruling classes’ is particularly relevant to the Cuban context. Hugh Thomas provides a sense of Fidel Castro's particular personal impact among the popular sectors of Cuban society soon after the Revolution:
A month after Batista's flight, Castro had established a personal hold over the Cuban masses such as no Latin American leader had ever had. […] Castro appeared so often on the television screen (the State Department was already beginning to curse the salesmen of those 400,000 sets) that he resembled less a De Gaulle or a Kennedy (others who used television to effect) than a kind of permanent confessor or a resident revolutionary medicine man. (1971: 1193)
It is the ‘inter’ – the cutting edge of translation and negotiation, the in-between space – that carries the burden of the meaning of culture. It makes it possible to begin envisaging national, anti-nationalist histories of the ‘people’ [, … to] elude the politics of polarity and emerge as the others of our selves.
(Bhabha 1994: 38–9)
It should not be enough to oppose to the elitism of those positions most critical of mass culture, simply their symmetrical inversion under the figure of a neo-populism seduced by the charms of industrial culture.
(Sarlo 2001: 55)
‘Popular culture’ has always represented a fulcrum within social, cultural and anthropological discourses in Latin America. It has often been imagined as inhabiting interstitial and heterogeneous spaces that have represented a challenge to the dominant cultural paradigms of the ‘lettered city’ since at least Colonial times, and has repeatedly been mapped on to political, economic and even libidinal boundaries – between the country and the city, between the folk and the street, between the ‘masses’ and elite national/political structures. Yet since at least the turn of the millennium, concepts of the ‘folk’, the ‘mass', the ‘people’ and the ‘multitude’ have exploded in the face of new cultural and informational technologies, with cinematic, televisual, narrative, musical and cybernetic manifestations of popular culture at the forefront of social processes which mediate between the national and the global in a see-sawing climate of technocratic neoliberal economic ideology, financial crises marked by new and intensified social problems, boom and bust cycles in commodities and resource-extraction, and the rise of demagogic, mediatic neo-populisms.
In this chapter I would like to reflect on the ways in which the Magdalena river has figured both in the imaginary production of a Colombian national-popular body, and in its dissolution, and at key moments in Colombian history from the mid-nineteenth century to the beginning of the twenty-first. I do so not to reclaim the river and its landscape, in a Romantic vein, as the wellspring of some authentic national ‘spirit’. Instead I am more interested in how instances of the articulation of such a thing occur in both real and imagined spaces where the nation's integrity is most questionable and the porosity of its borders most conspicuous.
As the principal route for the traffic of people, ideas and capital between colonial times and the early twentieth century, the Magdalena was for a long time central to the construction of the nation. Even today, as flows of global capital and information have displaced the organic motif of the river as an index of historical time and of the nation's temporal unfolding (see Appadurai 1996; Castells 2000), the Magdalena retains an affectively loaded presence in works of Colombian art and literature. Thus, in texts such as Fernando Vallejo's El río del tiempo (1998), where nature's collapse mirrors the entropy of Colombian public life, or films such as Bolívar soy yo (Jorge Alí Triana 2002), where history dissolves into the two dimensionality of the spectacle, the Magdalena continues to perform a labour of figuration, albeit of the nation's destiny as pipedream or curse.
This chapter discusses the work of internationally acclaimed, influential mixed-and multimedia artists who may be situated between the introduction in the 1990s in Cuba of the policy that granted artists the right to receive payment in convertible currency as well as to promote their work abroad freely, the introduction of a parallel currency for foreign visitors and investors (peso cubano convertible) and the ironic taking stock of the effects that such liberalization and commerce had on visual art practice referenced by the exhibition Cubanos convertibles in 2008. Its reflections play on the slippage between ‘convertible’ currency and convertible vehicles in relation to the value assigned to convertibility in aesthetic and cultural paradigms. These artists' deconstructivist strategies have sought to critique globalization while dismantling the complicitous ‘impurities’ and incongruities of their own productivity, seen through the distorting mirror of frustrated consumerism at home and the voracity of the free market paragons abroad that promote and consume their wares. The twisted skein of the analysis aims to discuss an interestingly impersonal (although archival) reflexive trend in contemporary art that, fibred by notions of social responsibility, participatory spectatorship and dissent, has explored the notion of ‘recycling’ as broadly inclusive of material disjecta with attendant ideas of ingestion and reconversion. Pieces have been predicated on the shift of emphasis from the phenomenology of ‘beholding’ to the involvement of the public as recipient, correspondent, interlocutor or user, with attention focused on the body of the observer and on experience.
At the beginning of his seminal social history of the Revolution, Alan Knight describes Mexico on the eve of the outbreak of the civil war:
Mexico of 1910 was, borrowing Lesley Simpson's phrase, ‘many Mexicos’, less a nation than a geographical expression, a mosaic of regions and communities, introverted and jealous, ethnically and physically fragmented, and lacking common national sentiments; these sentiments came after the Revolution and were […] its offspring rather than its parents. (Knight 1986: vol. 1, 2; emphasis added)
The formation of national sentiments has become a key theme in the burgeoning critical literature devoted to the politics of popular culture in the post-revolutionary period. Commentators have analysed how, in the aftermath of the profound upheavals of a war in which peasants, workers and the middle classes made, albeit uneasy, common cause, they came to unite under the rubric of shared symbols, icons and discourses experienced as national (Vaughan and Lewis 2006). Culture, particularly those forms and practices designated as popular –folk artisanship and music, and mass media forms, such as the radio and cinema – participated in the transformation of Mexico from ‘a regionally, culturally fragmented country into a modern nation-state with an inclusive and compelling national identity’ (López 2010: 2). Far from being a top-down process, the cultural-political construct that emerged in this period ‘was shaped, resisted, and ultimately negotiated by a multitude of actors and interests, and lo mexicano came to serve counterhegemonic impulses as well as regime projects’ (Joseph et al. 2001: 8).
In recent years there has been a veritable explosion in Internet use in Latin America; according to recent statistics, in South America alone there are over 143 million Internet users, or 36.5 per cent of the population, representing an increase of over 900 per cent between 2000 and 2009.1 Alongside this growth in Internet use there has been a concomitant growth in literary, socio-cultural and artistic works which make use of the new medium, including blogs, hypertext novels, hypermedia fiction, net.art, online performance art, hacktivism and tactical media, among many others. From the first forays of the Zapatistas into the uses of new media technologies for oppositional purposes, giving rise to the term ‘digital Zapatismo’ (Domínguez c.1998), to the complex negotiations of on- and offline activism of the self-styled Chicano ‘cyberpunk media artist’ Fran Ilich, through to the multiple uses of digital technologies in by the now large and growing community of net.artists in Latin America, new media technologies in Latin America have been put to use in innovative and challenging ways by local practitioners, and frequently involve a consideration for the socio-political consequences of such technologies and their potentially resistant reworking.
While the wide range of tactical media projects, net.art, game art, hacktivism and other genres within Latin American digital culture cannot be subsumed into one universal model, one striking feature that is common to many of them is the way in which they involve a critical engagement with the on/offline interface, and the resistant reuse of (globalized) digital technologies, two notions which will be explored in more depth below.
The philosopher Bernard Stiegler argues that the ever-increasing technologization of memory is complicit with the shift in the nature of power towards a ‘society of control’. Stiegler borrows this term from Gilles Deleuze who, in his essay of 1990 entitled ‘Postscript on a Society of Control’, himself borrowed the term from William Burroughs to describe a nightmarish extension of the logic of Foucauldian discipline that parallels a shift towards a social logic governed by the flexibility and mobility afforded by digital technologies. Rather than rely on Deleuze's definition of the term (which emphasizes the crisis of the spaces of disciplinary enclosure described by Michel Foucault in Discipline and Punish and their replacement by a flexible logic of ‘control’ or ‘modulation’) Stiegler argues that the society of control is characterized by the total automation of consumption. Rather than just the means of production, in the control society consumption and the network of desires and affective intensities that drive consumption have become automated.
Stiegler argues that the fundamental interdependence of memory and technology is the crucial battleground on which the transition towards the nightmarish vision of the control society is negotiated and contested. He starts from the premise that the externalization of memory in technological tools is constitutive of humanity. As Stiegler explains in his essay ‘Memory’, which introduces ideas explored in greater detail in his three-volume Technics and Time, he uses the term ‘hypomnesis’ to describe the technical exteriorization of memory, which he opposes to the act of embodied memory ‘anamnesis’.
In the last ten years there has been a surge in films about Brazilian favelas for domestic and international markets, led by Kátia Lund's and Fernando Meirelles's blockbuster Cidade de Deus (City of God, 2002). Most of those films focus on the violence generated by drug trafficking: this is most famously the case with Cidade de Deus, but it also true of José Padilha's Tropa de Elite (Elite Squad, 2007) and Tropa de Elite 2 (Elite Squad 2, 2010), which offer an implicit response to Cidade de Deus by showing the drug war from the point of view of the police; and M.V. Bill's and Celso Athayde's documentary Falcão: Meninos do Tráfico (Falcão: Traffic Boys, 2006), which also responds to Cidade de Deus by presenting a view from within the favela. Other works, such as Matt Mochary's and Jeff Zimbalist's documentary Favela Rising (2005), concentrate on youth music and social initiatives that are presented as alternatives to drug trafficking – that is, they are films that, without focusing on drug violence per se, have it as the motivation for the artistic endeavours they document. An exception to this violence-centred cinematic view of favelas is Tata Amaral's Antônia (2006), where the violence caused by the traffic of drugs and illegal weapons is simply not present. Yet the favela where the action of Antônia takes place, Vila Brasilândia on the north side of São Paulo, is, like Cidade de Deus in Rio, notorious for being a violent, drug-ridden place that has seen many prolonged shoot-outs between the PCC and the police.