Introduction to the Special Issue on Liminal Hotspots

This article introduces a special issue of Theory and Psychology on liminal hotspots. A liminal hotspot is an occasion during which people feel they are caught suspended in the circumstances of a transition that has become permanent. The liminal experiences of ambiguity and uncertainty that are typically at play in transitional circumstances acquire an enduring quality that can be described as a “hotspot”. Liminal hotspots are characterized by dynamics of paradox, paralysis, and polarization, but they also intensify the potential for pattern shift. The origins of the concept are described followed by an overview of the contributions to this special issue

Acting without being in control: Exploring volition in Parkinson's disease with impulsive compulsive behaviours.

BACKGROUND: Several aspects of volitional control of action may be relevant in the pathophysiology of impulsive-compulsive behaviours (ICB) in Parkinson's disease (PD). We aimed to explore multiple aspects of action control, assessing reward-related behaviour, inhibition (externally and internally triggered) and sense of agency in PD patients, with and without ICB compared to healthy subjects. METHODS: Nineteen PD patients with ICB (PD-ICB), 19 PD without ICB (PD-no-ICB) and 19 healthy controls (HC) underwent a battery of tests including: Intentional Binding task which measures sense of agency; Stop Signal Reaction Time (SSRT) measuring capacity for reactive inhibition; the Marble task, assessing intentional inhibition; Balloon Analog Risk Task for reward sensitivity. RESULTS: One-way ANOVA showed significant main effect of group for action binding (p = 0.004, F = 6.27). Post hoc analysis revealed that PD-ICB had significantly stronger action binding than HC (p = 0.004), and PD-no-ICB (p = 0.04). There was no difference between PD-no-ICB and HC. SSRT did not differ between PD groups, whereas a significant difference between PD-no-ICB and HC was detected (p = 0.01). No other differences were found among groups in the other tasks. CONCLUSIONS: PD patients with ICB have abnormal performance on a psychophysical task assessing sense of agency, which might be related to a deficit in action representation at cognitive/experiential level. Yet, they have no deficit on tasks evaluating externally and internally triggered inhibitory control, or in reward-based decision-making. We conclude that impaired sense of agency may be a factor contributing to ICB in PD patients

Molekular zielgerichtete Therapie

Zusammenfassung: Bis vor knapp 10Jahren stützte sich die Tumortherapie auf 3Säulen: die Chirurgie, die Strahlentherapie und die zytostatische Chemotherapie. Eine definitive Heilung im Bereich der soliden Tumoren versprach meist nur eine vollständige Entfernung des Tumors durch den Chirurgen. Radiotherapeuten und Onkologen konnten nur einem kleinen Teil ihrer Patienten langfristig helfen. Antikörpertherapien, Antitumorvakzinierungen oder gar genspezifische, individualisierte Therapieformen existierten zwar als Visionen, diese schienen Mitte der 90er-Jahre von einer klinischer Anwendung noch weit entfernt. Mit der Einführung des Antikörpers Rituximab (1997) und des Tyrosinkinaseinhibitors Imatinib (2001) in die klinische Praxis kamen 2 neuartige Substanzen auf den Markt, die Denken und Vorstellungen in der Onkologie grundsätzlich veränderten. Diese Therapeutika ließen aus Visionen Realitäten werden, die der Pharmaindustrie, den Klinikern und Patienten neue Perspektiven bezüglich Machbarkeit und kommender Möglichkeiten im Bereich der Tumortherapie eröffnet haben. Im Folgenden soll ein Überblick über die Entwicklung der 4.Säule der Tumortherapie, der sog. "targeted therapy", gegeben werde

Multicentric Castleman's disease as a cause for unclear febrile episodes in a 55-year-old HIV-infected man

Our case illustrates the difficulties involved in diagnosing multicentric Castleman's disease (MCD) in a human immunodeficiency virus-infected man with febrile episodes and malaise. In the absence of well-established treatment protocols, we have chosen a new treatment algorithm with rituximab, etoposide, and valganciclovir, which led to the remission of clinical symptoms. Yet, we advocate focused exploration for MCD in immunosuppressed patients with unclear febrile episodes, as recent advances in treatment are promisin

Online effects of beta-tACS over the left prefrontal cortex on phonological decisions

The left posterior inferior frontal gyrus in the prefrontal cortex is a key region for phonological aspects of language processing. A previous study has shown that alpha-tACS over the prefrontal cortex applied before task processing facilitated phonological decision-making and increased task-related theta power. However, it is unclear how alpha-tACS affects phonological processing when applied directly during the task. Moreover, the frequency specificity of this effect is also unclear since the majority of neurostimulation studies tested a single frequency only. The present study addressed the question whether and how 10 Hz online tACS affects phonological decisions. To this end, 24 healthy participants received tACS at 10 Hz or 16.18 Hz (control frequency) or sham stimulation over the left prefrontal cortex during task processing in three sessions. As an unexpected finding, 16.18 Hz significantly impaired task accuracy relative to sham stimulation, without affecting response speed. There was no significant difference in phonological task performance between 10 Hz and 16.18 Hz tACS or between 10 Hz and sham stimulation. Our results support the functional relevance of the left prefrontal cortex for phonological decisions and suggest that online beta-tACS may modulate language comprehension

Selective Intra-arterial Chemotherapy with Floxuridine as Second- or Third-Line Approach in Patients with Unresectable Colorectal Liver Metastases

Background: An outcome assessment was performed of patients with unresectable colorectal liver metastases (CRLM) treated in second or third line with floxuridine (FUDR)-based hepatic artery infusion (HAI). Methods: Twenty-three patients who were pretreated with systemic (immuno)chemotherapy received FUDR-HAI alone or combined with systemic chemotherapy. We reviewed patient charts and our prospective patient database for survival and associated risk factors. Results: Patients received FUDR-HAI for unresectable CRLM from January 2000 to September 2010. Twelve patients (52%) received concurrent systemic chemotherapy. Median overall survival (OS), progression-free survival (PFS), and hepatic PFS were 15.6months (range, 2.5-55.7months), 3.9months (range, 0.7-55.7months), and 5.5months (range, 1.6-55.7months), respectively. The liver resection rate after HAI was 35%. PFS was better in patients undergoing secondary resection than in patients without resection (hazard ratio [HR] 0.21; 95% confidence interval [95% CI] 0.07-0.66; P=0.0034), while OS showed a trend toward improvement (HR 0.4; 95% CI 0.13-1.2; P=0.09). No differences were observed in OS (P=0.69) or PFS (P=0.086) in patients who received FUDR-HAI alone compared with patients treated with combined regional and systemic chemotherapy. No statistically significant differences were seen in patients previously treated with one chemotherapy line compared with patients treated with two lines. Presence of extrahepatic disease was a negative risk factor for PFS (liver-only disease: HR 0.03; 95% CI 0.0032-0.28; P<0.0001). Toxicities were manageable with dose modifications and supportive measures. Conclusions: FUDR-HAI improves PFS and results in a trend toward improved OS in selected patients able to undergo liver resection after tumor is downsize

Interdisciplinary evidence-based recommendations for the follow-up of testicular cancer patients: a joint effort

Detailed recommendations for the treatment of testicular cancer exist and due to the stringent application of the standard therapies, most patients can nowadays be cured. Moreover in the treatment of early stage disease, active surveillance is now a cornerstone of treatment. Hence there is a clear need for recommendations regarding the long term follow-up of these young patients. These have to be safe, feasible and the intensity of procedures have to reflect the known risk of recurrence. Different proposals have been published but they differ widely especially in terms of frequency and modality of imaging. In the last few years, new evidence has become available regarding the relapse pattern of different disease stages of testicular cancer, the use of imaging in follow-up and the risks of excessive radiation due to imaging, in particular with CT scans. In this article, an interdisciplinary, multinational working group has reviewed the evidence and based on this has formulated practical recommendations for the follow-up of patients with testicular cancer

Surface Rupture and Slip Distribution of the Denali and Totschunda Faults

The 3 November 2002 Denali fault, Alaska, earthquake resulted in 341 km of surface rupture on the Susitna Glacier, Denali, and Totschunda faults. The rupture proceeded from west to east and began with a 48-km-long break on the previously unknown Susitna Glacier thrust fault. Slip on this thrust averaged about 4 m (Crone et al., 2004). Next came the principal surface break, along 226 km of the Denali fault, with average right-lateral offsets of 4.5–5.1 m and a maximum offset of 8.8 m near its eastern end. The Denali fault trace is commonly left stepping and north side up. About 99 km of the fault ruptured through glacier ice, where the trace orientation was commonly influenced by local ice fabric. Finally, slip transferred southeastward onto the Totschunda fault and continued for another 66 km where dextral offsets average 1.6–1.8 m. The transition from the Denali fault to the Totschunda fault occurs over a complex 25-km-long transfer zone of right-slip and normal fault traces. Three methods of calculating average surface slip all yield a moment magnitude of Mw 7.8, in very good agreement with the seismologically determined magnitude of M 7.9. A comparison of strong-motion inversions for moment release with our slip distribution shows they have a similar pattern. The locations of the two largest pulses of moment release correlate with the locations of increasing steps in the average values of observed slip. This suggests that slipdistribution data can be used to infer moment release along other active fault traces.PublishedS23–S52reserve

An Exploration of Community Palliative Care Clinical Nurse Specialists Experiences of Working as Independent Prescribers: Part 2

The Department of Health has recently reiterated its commitment to the improvement in the quality of end of life care and emphasized the importance of all patients having rapid access to medication. The aim of this study was to explore the lived experiences of clinical nurse specialists who are able to prescribe independently in their role in providing support for patients with palliative care needs within the community setting. Interpretive phenomenology was employed in order to understand and interpret the experiences of six nurse independent prescribes employed as community palliative care clinical nurse specialists. This purposive sampling was preferred with semi-structured interviews as the most appropriate data collection technique. Participants interviewed reported that being able to prescribe enabled them to provide seamless, holistic care which facilitated faster access to medicines for their patients. This was particularly apparent at weekends when the patient's usual general practitioner (GP) was unavailable. Several benefits of nurse independent prescribing were also highlighted. However, the main barrier identified by most participants was the difficulty in accessing the patient's records. The overwhelming conclusion was that independent prescribing by community nurse specialists is beneficial for patients in the palliative care phase of their life and those deemed important to them as they are being cared for at home. Such benefits can also impact on other aspects of the patient's life including prompt availability of medicines, effective symptom control and consequently, an improved or enhanced quality of life for the patients and job satisfaction for the prescribing specialists nurses