State of method: Unknowing

Within the assertive movements of inquiry and creation there dwells a quiet void of unknowing. Out of this abyss of infinite expansion the creative gesture is exhaled. Tracing a chaotic profusion of instances, images and inferences, this thesis is an exploratory delve into the active state of unknowing resident within the creative gesture. It is suggested that the non-discriminating and ubiquitous presence of unknowing conditions a method of doing and a mode of being that together become a state of method of unknowing. Commensurate with the subject, the thesis is presented not so much as a document, but as an activity: a formal emulation of the postulate that invites encounter. A way is opened into the nebulous territories of the unknown but arrival at any understanding is paradoxically dependent on the absence of a destination. The trajectory is therefore not, and must not be, conclusive. Divided into three parts, the thesis begins with a general appraisal of concepts and ideas which all manifest a tendency towards unknowing. Frequently this is by housing at their core some inscrutable and mysterious unknown element. This element is more often than not the very essence of the idea itself. These ideas or occurrences span nearly two and a half millennia of recorded thought in quite diverse and not necessarily related fields. The second part focuses on how the active principle of unknowing may reveal itself through methods of meaning making. The main vehicles of explication are those of poetics and hermeneutics. This is chiefly for reasons of attempting to demonstrate through the actual means employed, and in the case of a thesis, this is language. The third part introduces the archetypal image of a ruin as an aesthetic articulation of the state of method. The ruin is conceived of as an entity in a state of perpetual becoming and which, by means of this metaphysical topography, unveils the performing dynamics of unknowing as a state of method

A service evaluation of parent adherence with dysphagia management therapy guidelines: Reports from family carers supporting children with complex needs in Greece

Purpose: Many children with complex needs exhibit eating, drinking and/or swallowing disorders (dysphagia). These children often have associated learning needs, and require assistance from carers for daily tasks such as eating and drinking. The aim of this study was to identify which strategies to manage dysphagia were challenging for family carers, and reasons for any non-adherence. Method: In this service evaluation researchers observed carers during mealtimes, and investigated carer opinions of strategies used to minimise the risks of dysphagia. Eight children with complex needs aged 3.4 - 7.5 years and their primary family caregiver participated. Results: Adherence with speech and language pathologists’ dysphagia recommendations overall was over 50% in all but one case. For specific strategies, the highest adherence was observed for diet modifications of foods (89%), communication during the mealtime (83%), amount of food to present (81%) and the pacing of fluids and foods (81%). Lower levels of adherence were identified in relation to postural management (58%), environmental changes (58%), utensils (56%) and preparatory strategies (49%). Conclusion: Adherence with use of strategies to support mealtimes was over 50% in all but one case. Findings suggest that support is essential in order to promote safe mealtimes, reduce family carers’ stress and increase knowledge, confidence and adherence in implementing dysphagia guidelines in the family home

Too Many Cooks: Redesigning the English Program Website

The purpose of this project was to produce new content for the English Program webpages for Dr. Patterson’s course, ENGL 875 Seminar: Writing for the Web. Throughout all stages of this project, we consulted Janice Redish’s book Letting Go of the Words. The first stage of the project was to identify the webpages’ target audiences; this was achieved through the creation of personas that reflected the demographics of users. Through these personas, we developed a series of tasks for a preliminary usability test. Subsequently, we conducted the preliminary test on the existing English Program webpages using test subjects that reflected these audiences. The failing test results revealed issues with accessibility, consistency, and optimization. In response, we audited the existing content, which involved cataloging the information on each page. Next, we created new content that fit the parameters we developed. Finally, we assessed the effectiveness of this content through extended workshops. After finalizing the content, we created mock-up webpages to simulate the user experience. The final stage of our project was implementing the content into the program webpage. With this new webpage, we hope to improve the user experience and attract more students to not only the English Program but to the university at large

Harms and benefits associated with psychoactive drugs: Findings of an international survey of active drug users

There have been several recent efforts in the UK and the Netherlands to describe the harms of psychoactive substances based on ratings of either experts or drug users. This study aimed to assess the perceived benefits as well as harms of widely used recreational drugs, both licit and illicit, in an international sample of drug users. The survey was hosted at https://www.internationaldrugsurvey.org/ and was available in three languages. Residents reported their experience of 15 commonly used drugs or drug classes; regular users then rated their harms and benefits. In all, 5791 individuals from over 40 countries completed the survey, although the majority were from English speaking countries. Rankings of drugs differed across 10 categories of perceived benefits. Skunk and herbal cannabis were ranked consistently beneficial, whilst alcohol and tobacco fell below many classified drugs. There was no correlation at all between users’ harm ranking of drugs and their classification in schedules of the USA or ABC system in the UK. Prescription analgesics, alcohol and tobacco were ranked within the top 10 most harmful drugs. These findings suggest that neither the UK nor US classification systems act to inform users of the harms of psychoactive substances. It is hoped the results might inform health professionals and educators of what are considered to be both the harms and benefits of psychoactive substances to young people

Glutamate, N-acetyl aspartate and psychotic symptoms in chronic ketamine users

Rationale: Ketamine, a non-competitive NMDA receptor antagonist, induces acute effects resembling the positive, negative and cognitive symptoms of schizophrenia. Chronic use has been suggested to lead to persistent schizophrenia-like neurobiological changes. Objectives: This study aims to test the hypothesis that chronic ketamine users have changes in brain neurochemistry and increased subthreshold psychotic symptoms compared to matched poly-drug users. Methods: Fifteen ketamine users and 13 poly-drug users were included in the study. Psychopathology was assessed using the Comprehensive Assessment of At-Risk Mental State. Creatine-scaled glutamate (Glu/Cr), glutamate + glutamine (Glu + Gln/Cr) and N-acetyl aspartate (NAA/Cr) were measured in three brain regions—anterior cingulate, left thalamus and left medial temporal cortex using proton magnetic resonance spectroscopy. Results: Chronic ketamine users had higher levels of subthreshold psychotic symptoms (p < 0.005, Cohen’s d = 1.48) and lower thalamic NAA/Cr (p < 0.01, d = 1.17) compared to non-users. There were no differences in medial temporal cortex or anterior cingulate NAA/Cr or in Glu/Cr or Glu + Gln/Cr in any brain region between the two groups. In chronic ketamine users, CAARMS severity of abnormal perceptions was directly correlated with anterior cingulate Glu/Cr (p < 0.05, r = 0.61—uncorrected), but NAA/Cr was not related to any measures of psychopathology. Conclusions: The finding of lower thalamic NAA/Cr in chronic ketamine users may be secondary to the effects of ketamine use compared to other drugs of abuse and resembles previous reports in individuals at genetic or clinical risk of schizophrenia

Brain volume in chronic ketamine users - Relationship to sub-threshold psychotic symptoms and relevance to schizophrenia

RATIONALE: Ketamine may model aspects of schizophrenia arising through NMDA receptor activity deficits. Although acute ketamine can induce effects resembling both positive and negative psychotic symptoms, chronic use may be a closer model of idiopathic psychosis. OBJECTIVES: We tested the hypotheses that ketamine users had lower brain volumes, as measured using MRI, and greater sub-threshold psychotic symptoms relative to a poly-drug user control group. METHODS: Ketamine users (n = 17) and poly-drug using controls (n = 19) were included in the study. All underwent volumetric MRI imaging and measurement of sub-threshold psychotic symptoms using the Comprehensive Assessment of At-Risk Mental State (CAARMS). Freesurfer was used to analyse differences in regional brain volume, cortical surface area and thickness between ketamine users and controls. The relationship between CAARMS ratings and brain volume was also investigated in ketamine users. RESULTS: Ketamine users were found to have significantly lower grey matter volumes of the nucleus accumbens, caudate nucleus, cerebellum and total cortex (FDR p \u3c 0.05; Cohen\u27s d = 0.36-0.75). Within the cortex, ketamine users had significantly lower grey matter volumes within the frontal, temporal and parietal cortices (Cohen\u27s d 0.7-1.31; FDR p \u3c 0.05). They also had significantly higher sub-threshold psychotic symptoms (p \u3c 0.05). Frequency of ketamine use showed an inverse correlation with cerebellar volume (p \u3c 0.001), but there was no relationship between regional brain volumes and sub-threshold psychotic symptoms. CONCLUSIONS: Chronic ketamine use may cause lower grey matter volumes as well as inducing sub-threshold psychotic symptoms, although these likely arise through distinct mechanisms

Acute effects of cannabinoids on addiction endophenotypes are moderated by genes encoding the CB1 receptor and FAAH enzyme

Understanding genetic factors that contribute to cannabis use disorder (CUD) is important, but to date, findings have been equivocal. Single‐nucleotide polymorphisms (SNPs) in the cannabinoid receptor 1 gene (CNR1; rs1049353 and rs806378) and fatty acid amide hydrolase (FAAH) gene (rs324420) have been implicated in CUD. Their relationship to addiction endophenotypes such as cannabis‐related state satiety, the salience of appetitive cues, and craving after acute cannabinoid administration has not been investigated. Forty‐eight cannabis users participated in a double‐blind, placebo‐controlled, four‐way crossover experiment where they were administered treatments in a randomized order via vaporization: placebo, Δ9‐tetrahydrocannabinol (THC) (8 mg), THC + cannabidiol (THC + CBD) (8 + 16 mg), and CBD (16 mg). Cannabis‐related state satiety, appetitive cue salience (cannabis and food), and cannabis craving were assessed each day. Participants were genotyped for rs1049353, rs806378, and rs324420. Results indicated that CNR1 rs1049353 GG carriers showed increased state satiety after THC/THC + CBD administration in comparison with placebo and reduced the salience of appetitive cues after THC in comparison with CBD administration; A carriers did not vary on either of these measures indicative of a vulnerability to CUD. CNR1 rs806378 CC carriers showed greater salience to appetitive cues in comparison with T carriers, but there was no evidence for changes in state satiety. FAAH rs324420 A carriers showed greater bias to appetitive cues after THC, in comparison with CC carriers. FAAH CC carriers showed reduced bias after THC in comparison with CBD. No SNPs modulated craving. These findings identify candidate neurocognitive mechanisms through which endocannabinoid system genetics may influence vulnerability to CUD

Subacute Rehabilitation Does Have Benefits for Patients With Advanced Cancer

© 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. This manuscript version is made available under the CC-BY-NC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/ This author accepted manuscript is made available following 12 month embargo from date of publication (Oct 2017) in accordance with the publisher’s archiving policyTo the Editor: It is with concern that we read a recent Letter to the Editor by Desai et al.,1 that stated “people with gastrointestinal cancer did not benefit from the admission to subacute rehabilitation,” concluding that inpatient rehabilitation could do more harm than good. People with advanced cancer may not always achieve physical gains after rehabilitation but to state there is no benefit is an oversimplification. This was a very small sample size (n = 22), one-third of whom had metastatic pancreas cancer where rapid functional decline is seen in the last weeks of life. Is this a sufficient sample on which to base the letter's conclusions? Careful individualized screening of people with advanced cancer to determine who may benefit from rehabilitation is essential when planning care. The outcomes used in this study to measure rehabilitation success (survival, further chemotherapy) do not capture rehabilitation gains. Limiting outcomes to these measures ignores functional outcomes of importance to patients and caregivers such as maintaining independence for as long as possible.2,3 Patient-driven palliative rehabilitation goals focus on maintenance of function and participation,4 not whether they can have further chemotherapy. Rehabilitation, which includes caregiver education and training, optimizes patient function, reduces caregiver burden, and facilitates supported discharge home.2,3,5 A growing body of evidence demonstrates that palliative rehabilitation can maintain and optimize functional ability.5–8 Rehabilitation is highly valued by patients with advanced disease4,9–11 and serves to improve patient confidence to actively participate in everyday activities.4,12,13 It enables patients to regain hope through exerting control over valued activities, even in the face of progressive physical deterioration.5,11,12 Psychosocial support during rehabilitation can be invaluable to facilitate adjustment to functional decline and enhance quality of life.10–13 It is dangerous to flag potential harms of rehabilitation without discussing the potential benefits. Inadequate communication about goals of care can be harmful, but discussing the scope including potential and limitations of rehabilitation is considered clinical care. Effective communication is essential in all clinical practices, and potential harms caused by unrealistic hope may be mitigated by clear, truthful communication delivered in a sensitive manner. When prognosis is openly discussed with patients, rehabilitation clinicians working with palliative care patients can agree on realistic goals of care. Of note, rehabilitation physicians have been found to be less likely to consider prognosis as a barrier to rehabilitation than oncologists14 while palliative care physicians' understanding of the potential benefits of rehabilitation varies.15 The specialties of oncology, palliative care, and rehabilitation bring different skill sets and perspectives that all contribute to optimizing patient function over the disease trajectory.16 Functional decline is inevitable for people with advanced cancer, and not all patients will benefit from palliative rehabilitation. However, a narrative that highlights potential harms of rehabilitation without exploring potential benefits is misleading. Importantly, the potential of palliative rehabilitation to optimize function warrants further investigation, irrespective of prognosis