The Modernist Sublime: Parenthood and the Intersubjective Sublime Subject in Faulkner, Forster, Lawrence, and Woolf

This project explores how the modern novel restructures traditional conceptions of the Romantic sublime through complex depictions of parenthood. Using related strategies of representation, William Faulkner, E.M. Forster, D.H. Lawrence, and Virginia Woolf rewrite the traditional sublime as an intersubjective experience, dependent upon the recognition of social objectification and an ethics of reciprocal sympathy between mothers and fathers. Ultimately, The Modernist Sublime contributes to modernist scholarship by exploring the dynamics of modernist representations of parenthood and by focusing attention on how modernist authors reconsider the function of the sublime in the modern world.;Juxtaposing traditional aesthetics and Slavoj iek\u27s concept of the sublime object of ideology with recent theoretical work regarding identity, I argue that these modern novelists construct what I term a sublime subject (or a person who functions in the space of the traditional sublime object) in order to reveal the possibility of a sublime experience that favors emotional connection over reason. These novelists critique the objectification of the other in favor of a sublime experience that reveals the subject-shattering power of empathy. Drawing on Agamben\u27s concept of homo sacer, in As I Lay Dying, Faulkner reveals the mother as mater sacer, a woman who both enacts and receives acts of violence that show the ideological rituals regarding the abject mother. Employing recent queer theoretical work on the heteronormative family, Forster\u27s Howards End reveals the possibility of a queer family only through the interaction of a sublime subject. Perhaps more than any other author in this study, Lawrence presents marriage and the creation of family as a radical experience that results in mutual intersubjective sublime experiences through the generational pairings in The Rainbow. Finally, Woolf promotes sublime interactions between women as part of a feminist polemic embedded in To the Lighthouse. Tracing a transatlantic pattern, British and American modern novelists explore the possibility of human connection in direct confrontation to the aesthetic practice of objectification in both the traditional sublime and the theoretical discourse surrounding early twentieth century poetics

Estimating the proportion of Medicaid-eligible pregnant women in Louisiana who do not get abortions when Medicaid does not cover abortion.

BackgroundTo estimate the proportion of pregnant women in Louisiana who do not obtain abortions because Medicaid does not cover abortion.MethodsTwo hundred sixty nine women presenting at first prenatal visits in Southern Louisiana, 2015-2017, completed self-administered iPad surveys and structured interviews. Women reporting having considered abortion were asked whether Medicaid not paying for abortion was a reason they had not had an abortion. Using study data and published estimates of births, abortions, and Medicaid-covered births in Louisiana, we projected the proportion of Medicaid births that would instead be abortions if Medicaid covered abortion in Louisiana.Results28% considered abortion. Among women with Medicaid, 7.2% [95% CI 4.1-12.3] reported Medicaid not paying as a reason they did not have an abortion. Existing estimates suggest 10% of Louisiana pregnancies end in abortion. If Medicaid covered abortion, this would increase to 14% [95% CI 12, 16]. 29% [95% CI 19, 41] of Medicaid eligible pregnant women who would have an abortion with Medicaid coverage, instead give birth.ConclusionsFor a substantial proportion of pregnant women in Louisiana, the lack of Medicaid funding remains an insurmountable barrier to obtaining an abortion. Forty years after the Hyde Amendment was passed, lack of Medicaid funding for abortion continues to have substantial impacts on women's ability to obtain abortions

Executive functioning in mild cognitive impairment, frontotemporal dementia, and Lewy body dementia

A thorough description of cognitive functioning in individuals with dementia and those at risk of developing dementia is essential for early and accurate diagnosis. Executive functioning is one cognitive domain in which deficits have been reported in various types of dementia, including mild cognitive impairment (MCI, often a transitional stage between normal aging and Alzheimer's disease), frontotemporal dementia (FTD), and Lewy body dementia (LBD). This thesis contains two papers addressing executive functioning in these patient groups, the first comparing MCI patients to normal controls and the second comparing FTD and LBD patients. In each study, we examined executive functioning across multiple domains (working memory, inhibitory control, verbal fluency, and planning), and compared groups in terms of statistical differences, the pattern of the severity of clinical impairment, and the frequency of impairment. Results indicated that MCI patients performed worse than controls on all of the tests administered, were clinically impaired in all 4 domains, and that clinical impairment was frequent in each of the domains. FTD and LBD patients performed remarkably similarly across all domains in group comparisons, pattern of clinical impairment, and frequency of impairment, with only one test producing results that could potentially differentiate the groups. All three patient groups were disproportionately impaired on measures of inhibitory control in comparison to other tests of executive functioning. Implications of these results are discussed

Teaching Problem-Solving to Improve Family Functioning and Decrease Suicidality

Suicide is a leading cause of death among adolescents and young adults. Numerous risk factors have been identified in the literature, including poor problem-solving skills, poor family functioning, excessive risk-taking behaviors, legal difficulties, and school difficulties. Deficits in problem-solving skills and poor family functioning are typically reported together, indicating a relationship between the two. However, no previous studies have identified this relationship. The purpose of this study was to identify possible relationships between two known risk factors and suicidal ideation, to determine whether problem-solving skills taught in the experimental groups reduce suicidal ideation and improve perceptions of family relationships, and to establish if knowledge of problem-solving skills acts as a mediator between family functioning and suicidal ideation. Archival data of 285 adolescents who participated in up to 10 sessions dedicated to teaching the process of solving problems were analyzed. There was an unusually high attrition rate (64%), and so in some analyses, only data from 85 adolescents was reported. One empirically-validated questionnaire and three additional questionnaires were utilized to assess suicidal ideation, perception of family functioning, risky behaviors, and knowledge of steps in problem-solving. Knowledge of the problem solving process was shown to significantly improve over the course of the group. Although there were not significant improvements in suicidal ideation or family functioning, the change in scores was in the predicted direction. The results also found significant correlations between family functioning and problem solving and family functioning and suicidal ideation; however, no significant relationship was found between problem solving and suicidal ideation. Additionally, there were many significant correlations found between the outcome measures and many of the risk factors for suicide. Lastly, a mediator effect of problem-solving on the relationship between family functioning and suicidal ideation was found at pre-test only

EEG Coherence and Executive Function in Mild Cognitive Impairment and Alzheimer’s Disease: An Examination of Resting Coherence and Coherence During Executive Functioning Tasks

Deficits in executive functioning have been reported in the early stages of Alzheimer’s disease (AD) and in mild cognitive impairment (MCI); however, the neural underpinnings of these deficits remain unclear. It has been proposed that AD can be characterized as a disconnection syndrome, where functional connectivity between brain regions is compromised. Therefore, it may be hypothesized that altered functional connectivity may be related to executive functioning in MCI and AD. The research presented in this dissertation examined group differences for MCI and AD patients relative to controls for EEG coherence within a fronto-parietal network measured at rest (Study 1), during a Go/No-go inhibitory control task (Study 2), and during an N-back working memory task (Study 3). The relationships between coherence and measures of cognition and brain integrity (cortical thickness and PiB retention) were also explored. Results indicated that AD patients, but not MCI patients, had reduced resting coherence between cross-hemisphere parietal regions versus normal controls, and that MCI patients who later converted to dementia had higher resting fronto-parietal coherence versus MCI patients who remained stable. Furthermore, both AD and MCI patients showed altered coherence during task performance. During both tasks, AD patients showed reduced coherence and less of a task-related increase in coherence versus controls (for cross-hemisphere electrode pairs during the Go/No-go task and for cross-hemisphere and fronto-parietal pairs during the N-back task). In contrast, in comparison to controls, MCI patients had higher fronto-parietal coherence during the Go/No-go task and a larger task-related increase in fronto-parietal coherence for both tasks, but less of a task-related increase in cross-hemisphere frontal coherence for both tasks. Correlational analyses showed different relationships between EEG coherence and cognition and brain integrity across groups, with some evidence of a potential compensatory mechanism for higher coherence in controls and MCI patients in some conditions. These results demonstrate that functional connectivity within a fronto-parietal network is altered in AD patients and MCI patients during the performance of executive tasks. In AD patients, coherence is decreased, whereas MCI patients show a potential compensatory increase in fronto-parietal coherence. The implications of these findings and directions for future research are discussed

Acceptance and commitment therapy for symptom interference in metastatic breast cancer patients: a pilot randomized trial

PURPOSE: Breast cancer is the leading cause of cancer mortality in women worldwide. With medical advances, metastatic breast cancer (MBC) patients often live for years with many symptoms that interfere with activities. However, there is a paucity of efficacious interventions to address symptom-related suffering and functional interference. Thus, this study examined the feasibility and preliminary efficacy of telephone-based acceptance and commitment therapy (ACT) for symptom interference with functioning in MBC patients. METHODS: Symptomatic MBC patients (N = 47) were randomly assigned to six telephone sessions of ACT or six telephone sessions of education/support. Patients completed measures of symptom interference and measures assessing the severity of pain, fatigue, sleep disturbance, depressive symptoms, and anxiety. RESULTS: The eligibility screening rate (64%) and high retention (83% at 8 weeks post-baseline) demonstrated feasibility. When examining within-group change, ACT participants showed decreases in symptom interference (i.e., fatigue interference and sleep-related impairment; Cohen's d range = - 0.23 to - 0.31) at 8 and 12 weeks post-baseline, whereas education/support participants showed minimal change in these outcomes (d range = - 0.03 to 0.07). Additionally, at 12 weeks post-baseline, ACT participants showed moderate decreases in fatigue and sleep disturbance (both ds = - 0.43), whereas education/support participants showed small decreases in these outcomes (ds = - 0.24 and - 0.18 for fatigue and sleep disturbance, respectively). Both the ACT and education/support groups showed reductions in depressive symptoms (ds = - 0.27 and - 0.28) at 12 weeks post-baseline. Group differences in all outcomes were not statistically significant. CONCLUSIONS: ACT shows feasibility and promise in improving fatigue and sleep-related outcomes in MBC patients and warrants further investigation

Improving Community Advisory Board Engagement In Precision Medicine Research To Reduce Health Disparities

Community Advisory Boards (CABs) are used in efforts to reduce health disparities; however, there is little documentation in the literature regarding their use in precision medicine research. In this case study, an academic-CAB partnership developed a questionnaire and patient educational materials for two precision smoking cessation interventions that involved use of genetic information. The community-engaged research (CEnR) literature provided a framework for enhancing benefits to CAB members involved in developing research documents for use with a low-income, ethnically diverse population of smokers. The academic partners integrated three CEnR strategies: 1) in-meeting statements acknowledging their desire to learn from community partners, 2) in-meeting written feedback to and from community partners, and 3) a survey to obtain CAB member feedback post-meetings. Strategies 1 and 2 yielded modifications to pertinent study materials, as well as suggestions for improving meeting operations that were then adopted, as appropriate, by the academic partners. The survey indicated that CAB members valued the meeting procedure changes which appeared to have contributed to improvements in attendance and satisfaction with the meetings. Further operationalization of relevant partnership constructs and development of tools for measuring these aspects of community-academic partnerships is warranted to support community engagement in precision medicine research studies

Early diagnosis of mild cognitive impairment and Alzheimer’s with event-related potentials and event-related desynchronization in N-back working memory tasks

Background and Objective: In this study we investigate whether or not event-related potentials (ERP) and/or event-related (de)synchronization (ERD/ERS) can be used to differentiate between 27 healthy elderly (HE), 21 subjects diagnosed with mild cognitive impairment (MCI) and 15 mild Alzheimer’s disease (AD) patients. Methods: Using 32-channel EEG recordings, we measured ERP responses to a three-level (N-back, N = 0,1,2) visual working memory task. We also performed ERD analysis over the same EEG data, dividing the full-band signal into the well-known delta, theta, alpha, beta and gamma bands. Both ERP and ERD analyses were followed by cluster analysis with correction for multicomparisons whenever significant differences were found between groups. Results: Regarding ERP (full-band analysis), our findings have shown both patient groups (MCI and AD) with reduced P450 amplitude (compared to HE controls) in the execution of the non-match 1-back task at many scalp electrodes, chiefly at parietal and centro-parietal areas. However, no significant differences were found between MCI and AD in ERP analysis whatever was the task. As for sub-band analyses, ERD/ERS measures revealed that HE subjects elicited consistently greater alpha ERD responses than MCI and AD patients during the 1-back task in the match condition, with all differences located at frontal, central and occipital regions. Moreover, in the non-match condition, it was possible to distinguish between MCI and AD patients when they were performing the 0-back task, with MCI presenting more desynchronization than AD on the theta band at temporal and fronto-temporal areas. In summary, ERD analyses have revealed themselves more valuable than ERP, since they showed significant differences in all three group comparisons: HE vs. MCI, HE vs. AD, and MCI vs. AD. Conclusions: Based on these findings, we conclude that ERD responses to working memory (N-back) tasks could be useful not only for early MCI diagnosis or for improved AD diagnosis, but probably also for assessing the likelihood o

Factors underlying metastatic breast cancer patients' perceptions of symptom importance: a qualitative analysis

The symptom literature in cancer has primarily examined symptom severity, frequency and distress. Assessing cancer patients' perceptions of symptom importance-how important it is for them to see improvement in a symptom following an intervention-and factors influencing these judgments would also inform patient-centred care, but this analysis has not been undertaken. This qualitative study aimed to identify factors underlying perceptions of symptom importance among 25 symptomatic metastatic breast cancer (MBC) patients. Participants were recruited from a cancer centre in the Midwestern USA. Semi-structured interviews focused on patients' rationale for considering common symptoms (i.e., anxiety, sadness, sleep problems, pain or fatigue) to be important. Thematic analyses revealed five interrelated factors underlying MBC patients' perceptions of symptom importance: activity restriction, concentration difficulties, exacerbation of other physical symptoms, symptom-related long-term health concerns and negative impact on their relationships with others. Patients most frequently stated that a physical or psychological symptom was important because of the resulting activity restriction. Additionally, some patients considered pain to be important because it signalled potential long-term health concerns, such as worsening metastatic disease. Findings suggest that clinicians should take into account MBC patients' perceptions of symptom importance and factors underlying these judgments when making shared treatment decisions

Symptom experiences in metastatic breast cancer patients: relationships to activity engagement, value-based living, and psychological inflexibility

OBJECTIVE: This study examined symptom-based subgroups of metastatic breast cancer (MBC) patients and the extent to which they differed across key constructs of acceptance and commitment therapy (ACT). METHODS: Eighty women with MBC completed self-report surveys assessing 10 common symptoms and several ACT variables (ie, activity engagement, psychological inflexibility, value obstruction, and value progress) during a single time point. RESULTS: A cluster analysis yielded 3 patient subgroups: low symptoms, low-moderate symptoms, and moderate-high symptoms. Relative to the subgroup with low symptoms, the other subgroups reported less activity engagement. In addition, compared with patients with low symptoms, the subgroup with moderate-high symptoms reported greater psychological inflexibility (ie, avoidance of unwanted internal experiences) and greater difficulty living consistently with their values. CONCLUSIONS: Women with MBC show heterogeneity in their symptom profiles, and those with higher symptom burden are more likely to disengage from valued activities and avoid unwanted experiences (eg, thoughts, feelings, and bodily sensations). Findings are largely consistent with the ACT model and provide strong justification for testing ACT to address symptom interference in MBC patients