Everything is Medicine : Burke’s Master Metaphor?

For Kenneth Burke, humans are part of a diseased and ailing society. Yet while the rest of us are under an anesthetic, too doped up to know what is going on, Burke is partially awake and sees through the fog, watching the surgery unfold. Burke’s mission is to elucidate the curative potential of language and literature. Paying particular attention to biographical influences, this article traces key lineages of the medical metaphor in Burke’s major works. I argue that scholars should take seriously the idea that “everything is medicine” to Burke by considering the way that medicine may function as a master metaphor, or a reading strategy, that allows us to more fully understand his theories of symbolic action, identification, and rhetorical demystification

(Im)mobile Metaphors: Toward an Intersectional Rhetorical History

Metaphors not only structure our experience but by organizing reality in particular ways, our selected metaphors also prescribe how we are to act. As the opening chapter of this volume notes, feminist scholars have long grappled with the figurative language of intersectionality in order to find the conceptual framing that best accounts for varied relationships between power, oppression, and privilege. Similarly, rhetorical historians have an obligation to think critically about the metaphors we use. One cluster of metaphors, in particular, characterizes both intersectional and rhetorical-historical research: the spatial and geographic. Moreover, critiques of both research approaches essentially point to the same problem; that the language of intersections and maps suggests a fixed location that does not fully account for the fluidity and shifting of human relationships. In her overview of feminist perspectives on the history of rhetoric, Kate Ronald notes that there has been an explosion of research in women\u27s rhetoric over the last decade and a half. Much of the early research in this area concentrated on the primary analytical category of woman in documenting, recovering, and interpreting rhetorical texts. Since then, major methodological debates have centered on the question of how best to ensure that feminist rhetorical historians do not focus too narrowly on a single axis of identity (woman) to the exclusion of others. This chapter uses common critiques of the metaphors of intersectionality and rhetorical history as a starting point to articulate a forward-looking vision for intersectional rhetorical history. To that end, I offer a way for communication scholars to animate our methodological and conceptual metaphors with an eye toward motion and mobility. In line with contemporary feminist theorizing that favors a coalitional (relational) rather than individual (locational) politics, I argue that an intersectional approach to rhetorical history should be concerned with shifting webs of relationships rather than singular articulations of identity in historical contexts. The first section identifies overlapping spatial and geographic language in key texts on intersectionality and feminist rhetorical history. I then suggest how metaphors that capture motion and mobility better address the relational complexity of the historical practices and people we study. Finally, I offer examples of the themes of coalitional belonging, movement, and travel in the life of politician Barbara Jordan to demonstrate the possibilities of intersectional rhetorical history. In taking mobile metaphors seriously, intersectionality can inform rhetorical-historical research, while feminist rhetorical history can explore innovative spaces for the extension of intersectionality studies

Effects of physiological arousal on speech motor control and speech motor practice in preschool-age children who do and do not stutter

Purpose: We examined the effects of physiological arousal on speech motor control and speech motor practice effects in preschool-age children who do (CWS) and do not stutter (CWNS). Method: Participants included 18 CWS (mean age 4 years, 5 months) and 18 age- and gender-matched CWNS. The participants repeated a phrase “buy bobby a puppy” interspersed with viewing pictures from the International Affective Picture System under two experimental conditions speaking after viewing pictures with (1) negative, and (2) neutral valence. Participants’ lip movements were tracked using Optotrak system. The spatio-temporal index (STI; Smith, Goffman, Zelaznik, Ying & McGillem, 1995) and mean utterance duration were calculated to examine speech motor control and speech motor practice effects. Skin conductance level was measured during the experimental conditions to assess participants’ physiological level of arousal. Results: Preschool-age CWS demonstrated greater speech movement variability across all conditions and trials than CWNS. Further, the younger participants produced more variable articulatory movements than the older participants. Participants’ speech movement variability did not significantly differ between the negative and neutral experimental conditions and the level of physiological arousal did not have a significant effect on it. There was a non-significant trend of decrease in speech movement variability across the repeated trials in both groups. Last, CWS and CWNS did not differ in their mean utterance duration, suggesting that their articulation rate was similar across all conditions and trials. Conclusions: Our findings indicate that, compared to preschool-age CWNS, CWS demonstrate less mature speech motor control. However, present findings do not support the hypothesis that CWS benefit less from motor practice relative to CWNS. Given that our conditions elicited similar levels of arousal in the participants, future research is needed to examine whether physiological arousal disrupts speech motor control in preschool-age children potentially contributing to disruptions of speech fluency and the development of stuttering

Women Debating Society: Negotiating Difference in Historical Argument Cultures

This dissertation explores the relationship between gender and argumentation, complicating narratives that cast debating as an exclusionary practice that solely privileges elite, educated, white men. Drawing on three case studies of women's participation in debate, I argue that debating societies functioned as venues for rhetorical education and performance. Each chapter aims to add to our understanding about debate within historical contexts, reveal insight about the women who debated, and develop or extend concepts within rhetorical and argumentation scholarship. The first case study traces the Ladies' Edinburgh Debating Society from 1865 to 1935. This community-based association balanced the desire to achieve ideal rational-critical debate with the need to accommodate and sustain involvement by "women of infinite variety," developing what I call an "intergenerational argument culture." The second case study explores the relationship between debate history and the history of rhetorical criticism by examining Marie Hochmuth Nichols's intercollegiate debate participation in Pittsburgh in the 1930's. Nichols's debate experience cultivated a sense of gendered rhetorical excellence and a sensibility toward criticism that she would later develop as a major figure in twentieth-century rhetorical studies. The final case study explores how the challenges of debating at a southern historically black college in the 1950's influenced Barbara Jordan's rhetorical strategies and political career. Debating allowed Jordan to recognize the importance of viewing the body as a rhetorical resource in negotiating and sustaining access to exclusionary spaces. Though these women came from different socioeconomic, educational, racial, and geographical backgrounds, all used the vehicle of debate to challenge prevailing social norms. They not only honed their critical thinking, writing, speaking, and reasoning abilities through debate participation; they also used their experiences in unexpected ways as they negotiated difference along the intersecting axes of gender, race, class, age, ability, and citizenship. The final chapter argues that the dominant conceptual metaphor of argument-as-war is insufficient in capturing the complex dynamics between gender and argumentation. Instead, I offer an alternative of argument-as-travel, a more flexible metaphor that acknowledges the range of diverse participation in debate and accounts for the methodological choices involved in doing feminist rhetorical historical scholarship

Trauma histories among justice-involved youth: findings from the National Child Traumatic Stress Network.

BackgroundUp to 90% of justice-involved youth report exposure to some type of traumatic event. On average, 70% of youth meet criteria for a mental health disorder with approximately 30% of youth meeting criteria for post-traumatic stress disorder (PTSD). Justice-involved youth are also at risk for substance use and academic problems, and child welfare involvement. Yet, less is known about the details of their trauma histories, and associations among trauma details, mental health problems, and associated risk factors.ObjectiveThis study describes detailed trauma histories, mental health problems, and associated risk factors (i.e., academic problems, substance/alcohol use, and concurrent child welfare involvement) among adolescents with recent involvement in the juvenile justice system.MethodThe National Child Traumatic Stress Network Core Data Set (NCTSN-CDS) is used to address these aims, among which 658 adolescents report recent involvement in the juvenile justice system as indexed by being detained or under community supervision by the juvenile court.ResultsAge of onset of trauma exposure was within the first 5 years of life for 62% of youth and approximately one-third of youth report exposure to multiple or co-occurring trauma types each year into adolescence. Mental health problems are prevalent with 23.6% of youth meeting criteria for PTSD, 66.1% in the clinical range for externalizing problems, and 45.5% in the clinical range for internalizing problems. Early age of onset of trauma exposure was differentially associated with mental health problems and related risk factors among males and females.ConclusionsThe results indicate that justice-involved youth report high rates of trauma exposure and that this trauma typically begins early in life, is often in multiple contexts, and persists over time. Findings provide support for establishing trauma-informed juvenile justice systems that can respond to the needs of traumatized youth

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Everything is Medicine : Burke’s Master Metaphor?

For Kenneth Burke, humans are part of a diseased and ailing society. Yet while the rest of us are under an anesthetic, too doped up to know what is going on, Burke is partially awake and sees through the fog, watching the surgery unfold. Burke’s mission is to elucidate the curative potential of language and literature. Paying particular attention to biographical influences, this article traces key lineages of the medical metaphor in Burke’s major works. I argue that scholars should take seriously the idea that “everything is medicine” to Burke by considering the way that medicine may function as a master metaphor, or a reading strategy, that allows us to more fully understand his theories of symbolic action, identification, and rhetorical demystification