THE AMERICAN PRAGMATIC TRADITION: A USEFUL TOOLKIT FOR INTERNATIONAL RELATIONS? THE CASE OF THE OBAMA ADMINISTRATION AND ITS FOREIGN POLICY

Il presente lavoro di ricerca indaga i rapporti tra la disciplina delle Relazioni Internazionali (RI) e la tradizione filosofica americana del Pragmatismo (PP), focalizzandosi sui possibili contributi che quest’ultimo può fornire alle RI, guardando sia allo sviluppo del dibattito paradigmatico della disciplina sia alla dimensione delle politiche. In particolare, dopo aver fornito un quadro generale dei principi fondamentali del pragmatismo e averne evidenziato la positiva influenza sullo sviluppo della disciplina delle Relazioni Internazionali, il lavoro di ricerca si concentra sul tema del pragmatismo applicato alla dimensione della politica estera, qui concepita come sottolivello delle RI multifattoriale, multidisciplinare e nel quale l’agente/attore specifico assume un ruolo centrale. In linea con questa impostazione, la ricerca si concentra sull’elaborazione della politica estera del 44° Presidente americano, Barack Obama, mettendone in luce gli explanans, la cui applicazione viene poi testata nell’ambito di due casi-studio particolari: le relazioni degli Stati Uniti con Cuba, da un lato, e Israele, dall’altro. Attraverso l’analisi della letteratura esistente, in gran parte piuttosto recente, di documenti ufficiali rilasciati dall’Amministrazione Obama e dai discorsi ufficiali del Presidente stesso, il lavoro mira a dimostrare l’effettiva importanza del Pragmatismo sia per gli studiosi delle RI che per i policy-makers.This research work aims at addressing the relations between the discipline of International Relations (IR) and the American philosophical tradition of Pragmatism (PP), investigating the possible contributions PP can provide IR with, both at a theoretical and a policy level. In particular, once given an overview of the basic principles of PP and the positive inputs it can provide to the discipline of the IR, the research work addresses the issue of whether pragmatism can direct and explain the formulation of a foreign policy (FP) – conceived as the sublevel of IR which is actor-specific, agent-oriented, multifactorial, multilevel, and multidisciplinary. In order to do so, an interpretative actor perspective is adopted, and the foreign policy of former U.S. President Barack Obama is analyzed, focusing on the explanans of his foreign policy making and vision. Their application is then tested on two case-studies: U.S.-Cuba relations and U.S.-Israel relations, in the timeframe of the Obama Presidency. Through the analysis of the existing literature – some of which quite recent, official documents released by the Obama Administrations and speeches given by the President, the research work tries to demonstrate that PP can indeed constitute a useful tool-kit for both IR scholars and policy-makers

Depression, auditory-verbal hallucinations, and delusions in patients with schizophrenia: Different patterns of association with prefrontal gray and white matter volume

Structural brain abnormalities, including decreased gray matter (GM) and white matter (WM) volume, have been observed in patients with schizophrenia. These decrements were found to be associated with positive and negative symptoms, but affective symptoms (depression and anxiety) were poorly explored. We hypothesized that abnormalities in GM and WM volume might also be related to affective symptoms. GM and WM volumes were calculated from high-resolution T1 structural images acquired from 24 patients with schizophrenia and 26 healthy controls, and the associations of positive, negative, and affective symptoms with the brain volumes that showed significant reduction in patients were investigated. Patients demonstrated GM volume reductions in the bilateral prefrontal cortex, and WM volume reductions in the right frontal and left corpus callosum. Prefrontal cortex volume was significantly and inversely associated with both auditory-verbal hallucinations and depression severity. WM volume alterations, in contrast, were related to alogia, anhedonia, and delusions. The combined impact of auditory-verbal hallucinations and depression on similar sub-regions of the prefrontal cortex suggests that depression is involved in hearing voices. Further, this adverse impact of depression on prefrontal GM volume may underlie the impairment demonstrated by these patients in cognitive tasks that rely on executive processes

Comparison of the touch-screen and traditional versions of the Corsi block-tapping test in patients with psychosis and healthy controls

Background: Working memory (WM) refers to the capacity system for temporary storage and processing of information, which is known to depend on the integrity of the prefrontal cortex. Impairment in working memory is a core cognitive deficit among individuals with psychotic disorders. The Corsi block-tapping test is a widely-used instrument to assess visuospatial working memory. The traditional version is composed of 9 square blocks positioned on a physical board. In recent years, the number of digital instruments has increased significantly; several advantages might derive from the use of a digital version of the Corsi test. Methods: This study aimed to compare the digital and traditional versions of the Corsi test in 45 patients with psychotic disorders and 45 healthy controls. Both groups completed a neuropsychological assessment involving attention and working memory divided into the two conditions. Results: Results were consistent between the traditional and digital versions of the Corsi test. The digital version, as well as the traditional version, can discriminate between patients with psychosis and healthy controls. Overall, patients performed worse with respect to the healthy comparison group. The traditional Corsi test was positively related to intelligence and verbal working memory, probably due to a more significant effort to execute the test. Conclusions: The digital Corsi might be used to enhance clinical practice diagnosis and treatment.The digital version can be administered in a natural environment in real-time. Further, it is easy to administer while ensuring a standard procedure

Barriers to and Facilitators of Engagement With mHealth Technology for Remote Measurement and Management of Depression: Qualitative Analysis

BACKGROUND: Mobile technology has the potential to provide accurate, impactful data on the symptoms of depression, which could improve health management or assist in early detection of relapse. However, for this potential to be achieved, it is essential that patients engage with the technology. Although many barriers to and facilitators of the use of this technology are common across therapeutic areas and technology types, many may be specific to cultural and health contexts. OBJECTIVE: This study aimed to determine the potential barriers to and facilitators of engagement with mobile health (mHealth) technology for remote measurement and management of depression across three Western European countries. METHODS: Participants (N=25; 4:1 ratio of women to men; age range, 25-73 years) who experienced depression participated in five focus groups held in three countries (two in the United Kingdom, two in Spain, and one in Italy). The focus groups investigated the potential barriers to and facilitators of the use of mHealth technology. A systematic thematic analysis was used to extract themes and subthemes. RESULTS: Facilitators and barriers were categorized as health-related factors, user-related factors, and technology-related factors. A total of 58 subthemes of specific barriers and facilitators or moderators emerged. A core group of themes including motivation, potential impact on mood and anxiety, aspects of inconvenience, and ease of use was noted across all countries. CONCLUSIONS: Similarities in the barriers to and facilitators of the use of mHealth technology have been observed across Spain, Italy, and the United Kingdom. These themes provide guidance on ways to promote the design of feasible and acceptable cross-cultural mHealth tools. ©Sara Simblett, Faith Matcham, Sara Siddi, Viola Bulgari, Chiara Barattieri di San Pietro, Jorge Hortas López, José Ferrão, Ashley Polhemus, Josep Maria Haro, Giovanni de Girolamo, Peter Gamble, Hans Eriksson, Matthew Hotopf, Til Wykes, RADAR-CNS Consortium. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 30.01.2019

Blunted autonomic reactivity to mental stress in depression quantified by nonlinear cardiorespiratory coupling indices

In this study, differences in autonomic reactivity to mental stress between Major Depressive Disorder (MDD) patients and healthy control (HC) subjects are assessed by nonlinear cardiorespiratory coupling indices derived from the Real Wavelet Biphase. The degree and strength of Quadratic Phase Coupling (QPC) between interacting oscillations of Heart Rate Variability (HRV) and respiration are quantified before, during and after the execution of acognitive task. Results show that the QPC strength and QPC degree between the respiration and the respiratory sinus arrhythmia component of HRV were lower in HC compared to MDD during stress, suggesting that the parasympathetic branch was less inhibited in MDD patients. During recovery, only in HC group, this degree of QPC increased, while the respiratory rate was reduced, compared to the basal stage. The degree of QPC between the respiration and components of HRV in the low frequency band ([0.04, 0.15] Hz) increased in HC during stress, compared to the basal stage, while remained unchanged in MDD patients. These results imply that depression is associated with blunted autonomic reactivity to mental stres

Photoplethysmographic waveform analysis for autonomic reactivity assessment in depression

Objective: In the present study, a photoplethysmographic (PPG) waveform analysis for assessing differences in autonomic reactivity to mental stress between patients with Major Depressive Disorder (MDD) and healthy control (HC) subjects is presented. Methods: PPG recordings of 40 MDD and 40 HC subjects were acquired at basal conditions, during the execution of cognitive tasks, and at the post-task relaxation period. PPG pulses are decomposed into three waves (a main wave and two reflected waves) using a pulse decomposition analysis. Pulse waveform characteristics such as the time delay between the position of the main wave and reflected waves, the percentage of amplitude loss in the reflected waves, and the heart rate (HR) are calculated among others. The intra-subject difference of a feature value between two conditions is used as an index of autonomic reactivity. Results: Statistically significant individual differences from stress to recovery were found for HR and the percentage of amplitude loss in the second reflected wave ( A13 ) in both HC and MDD group. However, autonomic reactivity indices related to A13 reached higher values in HC than in MDD subjects (Cohen's d =0.81, AUC = 0.74), implying that the stress response in depressed patients is reduced. A statistically significant (p < 0.001) negative correlation (r = 0.5) between depression severity scores and A13 was found. Conclusion: A decreased autonomic reactivity is associated with higher degree of depression. Significance: Stress response quantification by dynamic changes in PPG waveform morphology can be an aid for the diagnosis and monitoring of depression

The Relationship between Major Depression Symptom Severity and Sleep Collected Using a Wristband Wearable Device: Multi-centre Longitudinal Observational Study

Research in mental health has implicated sleep pathologies with depression. However, the gold standard for sleep assessment, polysomnography, is not suitable for long-term, continuous, monitoring of daily sleep, and methods such as sleep diaries rely on subjective recall, which is qualitative and inaccurate. Wearable devices, on the other hand, provide a low-cost and convenient means to monitor sleep in home settings. The main aim of this study was to devise and extract sleep features, from data collected using a wearable device, and analyse their correlation with depressive symptom severity and sleep quality, as measured by the self-assessed Patient Health Questionnaire 8-item. Daily sleep data were collected passively by Fitbit wristband devices, and depressive symptom severity was self-reported every two weeks by the PHQ-8. The data used in this paper included 2,812 PHQ-8 records from 368 participants recruited from three study sites in the Netherlands, Spain, and the UK.We extracted 21 sleep features from Fitbit data which describe sleep in the following five aspects: sleep architecture, sleep stability, sleep quality, insomnia, and hypersomnia. Linear mixed regression models were used to explore associations between sleep features and depressive symptom severity. The z-test was used to evaluate the significance of the coefficient of each feature. We tested our models on the entire dataset and individually on the data of three different study sites. We identified 16 sleep features that were significantly correlated with the PHQ-8 score on the entire dataset. Associations between sleep features and the PHQ-8 score varied across different sites, possibly due to the difference in the populations

Relationship Between Major Depression Symptom Severity and Sleep Collected Using a Wristband Wearable Device:Multicenter Longitudinal Observational Study

BACKGROUND: Sleep problems tend to vary according to the course of the disorder in individuals with mental health problems. Research in mental health has associated sleep pathologies with depression. However, the gold standard for sleep assessment, polysomnography (PSG), is not suitable for long-term, continuous monitoring of daily sleep, and methods such as sleep diaries rely on subjective recall, which is qualitative and inaccurate. Wearable devices, on the other hand, provide a low-cost and convenient means to monitor sleep in home settings. OBJECTIVE: The main aim of this study was to devise and extract sleep features from data collected using a wearable device and analyze their associations with depressive symptom severity and sleep quality as measured by the self-assessed Patient Health Questionnaire 8-item (PHQ-8). METHODS: Daily sleep data were collected passively by Fitbit wristband devices, and depressive symptom severity was self-reported every 2 weeks by the PHQ-8. The data used in this paper included 2812 PHQ-8 records from 368 participants recruited from 3 study sites in the Netherlands, Spain, and the United Kingdom. We extracted 18 sleep features from Fitbit data that describe participant sleep in the following 5 aspects: sleep architecture, sleep stability, sleep quality, insomnia, and hypersomnia. Linear mixed regression models were used to explore associations between sleep features and depressive symptom severity. The z score was used to evaluate the significance of the coefficient of each feature. RESULTS: We tested our models on the entire dataset and separately on the data of 3 different study sites. We identified 14 sleep features that were significantly (P<.05) associated with the PHQ-8 score on the entire dataset, among them awake time percentage (z=5.45, P<.001), awakening times (z=5.53, P<.001), insomnia (z=4.55, P<.001), mean sleep offset time (z=6.19, P<.001), and hypersomnia (z=5.30, P<.001) were the top 5 features ranked by z score statistics. Associations between sleep features and PHQ-8 scores varied across different sites, possibly due to differences in the populations. We observed that many of our findings were consistent with previous studies, which used other measurements to assess sleep, such as PSG and sleep questionnaires. CONCLUSIONS: We demonstrated that several derived sleep features extracted from consumer wearable devices show potential for the remote measurement of sleep as biomarkers of depression in real-world settings. These findings may provide the basis for the development of clinical tools to passively monitor disease state and trajectory, with minimal burden on the participant