Female Pleasure and Theories of Desire in Narrative Structure: Evolution, Futurity, and Species Survival in the Post-Human and Science Fiction Imaginary

This dissertation explores the complex relationship between an expanded narratological theory of narrative desire, inseparable in its relation to evolution and biological reproduction, and the future survival of humanity imagined across the narrative structures of three 21st-century works of dystopian science fiction. By examining the genre\u27s potential to address species survival specifically through female forms of desire identified as narrative recurrence, prolonged duration, and emotional resolution, this study concurrently develops a metatextual methodology that cultivates the overlooked liminal space of quiescence. This analytical framework emphasizes narrative structure over theme-based analysis to unlock the radical imagination present in the texts by highlighting the challenges of narrativizing a post-human future in Battlestar Galactica, Mass Effect 3, and Octavia Butler\u27s Parable of the Trickster. The reimagined television series Battlestar Galactica self-consciously poses questions regarding its own structural design. A moment of quiescence, positioned after the end and before the beginning of a narrative cycle in the epilogue, exists as a phase of unlimited potentiality beyond the activity of the diegetic text. In Mass Effect 3, the third installment of the massively successful video game franchise, the protests of dissatisfied gamers resulted in the creation of new ending options, revealing how quiescence can also be understood as the space surrounding the text as paratextual elements, existing adjacent to but separate from the main text, that directly influence interpretation and meaning. Finally, the archival materials of the unfinished book Parable of the Trickster, held at the Huntington Library and written by acclaimed science fiction author Octavia Butler, offers insights into quiescence as a location that exists akin to this pre-textual space. The archives reveal Butler’s struggle with severe writer’s block as a testament to the challenges and foreboding nature of envisioning humanity\u27s future as it pertains to evolution and species survival. By incorporating female sexuality into narrative desire, I propose that reviving this theory may offer value in contemporary structural analysis of plots, especially since the concept of quiescence allows us to explore aspects beyond the confines of the diegetic text in a world where narrative is becoming ever more interactive, multi-modal, intertextual, and transmedial. Science fiction during this era of convergence is also seeing a rapid transformation. As humanity increasingly faces existential threats such as artificial intelligence, pandemics, climate change, and nuclear apocalypse, innovative strategies and skills for survival must be developed that transcend our anthropocentric limitations. Although human reproduction is traditionally based on biological foundations that involve erotic desire, the reality of human survival - and reproduction - is rapidly evolving. The development of non-erotic desires such as scientific literacy, global cooperation, and ethical reasoning will become increasingly essential for species survival and, as this occurs, alterations to our human biology may fundamentally reshape our narrative constructs and forms of narrative desire. Ultimately, these texts reveal attempts at post-human forms of relationality within a genre of possibilities that self-consciously struggles to answer what form human survival may take in the future

Physicians' Attitudes Toward Complementary and Alternative Medicine and Their Knowledge of Specific Therapies: A Survey at an Academic Medical Center

The purpose of this study was to evaluate the attitudes of physicians at an academic medical center toward complementary and alternative medicine (CAM) therapies and the physicians' knowledge base regarding common CAM therapies. A link to a Web-based survey was e-mailed to 660 internists at Mayo Clinic in Rochester, MN, USA. Physicians were asked about their attitudes toward CAM in general and their knowledge regarding specific CAM therapies. The level of evidence a physician would require before incorporating such therapies into clinical care was also assessed. Of the 233 physicians responding to the survey, 76% had never referred a patient to a CAM practitioner. However, 44% stated that they would refer a patient if a CAM practitioner were available at their institution. Fifty-seven percent of physicians thought that incorporating CAM therapies would have a positive effect on patient satisfaction, and 48% believed that offering CAM would attract more patients. Most physicians agreed that some CAM therapies hold promise for the treatment of symptoms or diseases, but most of them were not comfortable in counseling their patients about most CAM treatments. Prospective, randomized controlled trials were considered the level of evidence required for most physicians to consider incorporating a CAM therapy into their practice. The results of this survey provide insight into the attitudes of physicians toward CAM at an academic medical center. This study highlights the need for educational interventions and the importance of providing physicians ready access to evidence-based information regarding CAM

New Insights into the Education of Children with Congenital Heart Disease with and without Trisomy 21

Background and Objectives: Patients with congenital heart disease (CHD), especially as a concomitant syndromal disease of trisomy 21 (T21), are at risk for impaired neurodevelopment. This can also affect these patients’ education. However, there continues to be a research gap in the educational development of CHD patients and T21 CHD patients. Materials and Methods: In total, data from 2873 patients from the German National Register for Congenital Heart Defects were analyzed. The data are based on two online education surveys conducted among patients registered in the National Register for Congenital Heart Defects (2017, 2020). Results: Of 2873 patients included (mean age: 14.1 ± 4.7 years, 50.5% female), 109 (3.8%) were identified with T21 (mean age: 12.9 ± 4.4 years, 49.5% female). T21 CHD participants had a high demand for early specific interventions (overall cohort 49.1%; T21 cohort 100%). T21 CHD children more frequently attended special schools and, compared to non-trisomy 21 (nT21) CHD patients, the probability of attending a grammar school was reduced. In total, 87.1% of nT21 CHD patients but 11% of T21 CHD patients were enrolled in a regular elementary school, and 12.8% of T21 CHD patients could transfer to a secondary school in contrast to 35.5% of nT21 CHD patients. Most of the T21 CHD patients were diagnosed with psychiatric disorders, e.g., learning, emotional, or behavioral disorders (T21 CHD patients: 82.6%; nT21 CHD patients: 31.4%; p < 0.001). Conclusions: CHD patients are at risk for impaired academic development, and the presence of T21 is an aggravating factor. Routine follow-up examinations should be established to identify developmental deficits and to provide targeted interventions

Microcephaly is associated with impaired educational development in children with congenital heart disease

Objectives This study aims to evaluate the school careers of patients with congenital heart disease (CHD) and microcephaly. Methods An exploratory online survey was conducted on patients from a previous study on somatic development in children with CHD in 2018 (n = 2818). A total of 750 patients participated in the online survey (26.6%). This publication focuses on 91 patients (12.1%) diagnosed with CHD and microcephaly who participated in the new online survey. Results Microcephaly was significantly associated with CHD severity (p < 0.001). Microcephalic patients suffered from psychiatric comorbidity two times as often (67.0%) as non-microcephalic patients (29.8%). In particular, the percentage of patients with developmental delay, intellectual debility, social disability, learning disorder, or language disorder was significantly increased in microcephalic CHD patients (p < 0.001). A total of 85.7% of microcephalic patients and 47.6% of non-microcephalic patients received early interventions to foster their development. The school enrollment of both groups was similar at approximately six years of age. However, 89.9% of non-microcephalic but only 51.6% of microcephalic patients were enrolled in a regular elementary school. Regarding secondary school, only half as many microcephalic patients (14.3%) went to grammar school, while the proportion of pupils at special schools was eight times higher. Supportive interventions, e.g., for specific learning disabilities, were used by 52.7% of microcephalic patients and 21.6% of non-microcephalic patients. Conclusion Patients with CHD and microcephaly are at high risk for impaired educational development. Early identification should alert clinicians to provide targeted interventions to optimize the developmental potential

Activated mutant NRasQ61K drives aberrant melanocyte signaling, survival, and invasiveness via a rac1-Dependent mechanism

Around a fifth of melanomas exhibit an activating mutation in the oncogene NRas that confers constitutive signaling to proliferation and promotes tumor initiation. NRas signals downstream of the major melanocyte tyrosine kinase receptor c-kit and activated NRas results in increased signaling via the extracellular signal–regulated kinase (ERK)/MAPK/ERK kinase/mitogen-activated protein kinase (MAPK) pathways to enhance proliferation. The Ras oncogene also activates signaling via the related Rho GTPase Rac1, which can mediate growth, survival, and motility signaling. We tested the effects of activated NRasQ61K on the proliferation, motility, and invasiveness of melanoblasts and melanocytes in the developing mouse and ex vivo explant culture as well as in a melanoma transplant model. We find an important role for Rac1 downstream of NRasQ61K in mediating dermal melanocyte survival in vivo in mouse, but surprisingly NRasQ61K does not appear to affect melanoblast motility or proliferation during mouse embryogenesis. We also show that genetic deletion or pharmacological inhibition of Rac1 in NRasQ61K induced melanoma suppresses tumor growth, lymph node spread, and tumor cell invasiveness, suggesting a potential value for Rac1 as a therapeutic target for activated NRas-driven tumor growth and invasiveness

Vital lines drawn from books: difficult feelings in Alison Bechdel’s Fun Home and Are You My Mother?

This article examines the representation of a transnational archive of queer books in Alison Bechdel’s graphic memoirs Fun Home and Are You My Mother? for the insights it provides into role of reading in making sense of the often difficult “felt experiences” of lesbian life. In both memoirs, books serve an important narrative function in the portrayal of Alison’s lesbian identification and its complex emotional entanglements with the lives of parents who are trapped – killed even, in the case of the father – in the wastelands of patriarchy and heterosexual expectation. The article argues that in this complex family dynamic in which “sexual identity” itself is a problem and emotions remain largely unspoken, books act as fragile conduits of feelings, shaping familial relationships even as they allow Alison to contextualise her life in relation to historical events and social norms. Reading books allows her to understand the apparently U.S.-specific history of her family in relation to a wider queer history in the West

Association of early imaging for back pain with clinical outcomes in older adults

IMPORTANCE: In contrast to the recommendations for younger adults, many guidelines allow for older adults with back pain to undergo imaging without waiting 4 to 6 weeks. However, early imaging may precipitate interventions that do not improve outcomes. OBJECTIVE: To compare function and pain at the 12-month follow-up visit among older adults who received early imaging with those who did not receive early imaging after a new primary care visit for back pain without radiculopathy. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort of 5239 patients 65 years or older with a new primary care visit for back pain (2011-2013) in 3 US health care systems. We matched controls 1:1 using propensity score matching of demographic and clinical characteristics, including diagnosis, pain severity, pain duration, functional status, and prior resource use. EXPOSURES: Diagnostic imaging (plain films, computed tomography [CT], magnetic resonance imaging [MRI]) of the lumbar or thoracic spine within 6 weeks of the index visit. PRIMARY OUTCOME: back or leg pain-related disability measured by the modified Roland-Morris Disability Questionnaire (score range, 0-24; higher scores indicate greater disability) 12 months after enrollment. RESULTS: Among the 5239 patients, 1174 had early radiographs and 349 had early MRI/CT. At 12 months, neither the early radiograph group nor the early MRI/CT group differed significantly from controls on the disability questionnaire. The mean score for patients who underwent early radiography was 8.54 vs 8.74 among the control group (difference, -0.10 [95% CI, -0.71 to 0.50]; mixed model, P = .36). The mean score for the early MRI/CT group was 9.81 vs 10.50 for the control group (difference,-0.51 [-1.62 to 0.60]; mixed model, P = .18). CONCLUSIONS AND RELEVANCE: Among older adults with a new primary care visit for back pain, early imaging was not associated with better 1-year outcomes. The value of early diagnostic imaging in older adults for back pain without radiculopathy is uncertain

A molecular insight into algal-oomycete warfare : cDNA analysis of Ectocarpus siliculosus infected with the basal oomycete Eurychasma dicksonii

Peer reviewedPublisher PD