bluuebunny/crossref_metadata_2025 huggingface dataset:
The Politics of Blood Hemophilia Activism in the AIDS Crisis
Authors: Kirp David
Published: November 2023

On a warm afternoon in the autumn of 1996, a limousine pulled up at the gates of the Bayer AG plant in Berkeley, California1. A handful of young men piled out of the car, megaphones to the ready. “We are here to take your name away!” they shouted. “I.G. Farben, I.G. Farben, Zyklon B, Zyklon B”—an unsubtle reference to the lethal gas manufactured by the German pharmaceutical house and used to devastating effect in the Holocaust—”4000 dead, 4000 dead, 4000 dead.” A cameraman recorded the scene, hoping to persuade local 1V stations to air this “great source tape.” “Demo by limo,” these demonstrators—”the wrecking crew ... the Northern California boys in the band,” as they called themselves—exulted in their Internet posting2. “How much more newsworthy can a story be?” Abruptly, however, the tone of the posting shifted and the demonstrators stood revealed as desperately sick, if still defiant, young men. “We might not be able to walk, but we can still demo!” During the late 1980s and early 1990s, AIDS activists launched similar “zaps” against drug companies. Those demonstrators were mainly gay men, members of ACT UP, expert practitioners in dramaturgical activism 3. The object of their animus was the alleged profiteering by pharmaceutical companies that put AZT and other drugs in the HIV arsenal out of the reach of many people with AIDS. By 1996, ACT-UP, with its “Silence=Death” insignia, had disappeared from public view.
The Agility Factor
Authors: Miller Richard
Published: November 2023

No matter ttow sizable or dramatic a soprano instrument, it needs to flexibly perform rapid movement. If a singer is unable to freely move the voice in swift melismas, there will be a corresponding lack of freedom in slow, sustained passages.
The Wedding of Emotion and Skill
Authors: Miller Richard
Published: November 2023

Can violetta manage technical control of her breath and accomplish the pyrotechnical aspects of her first-act aria while experiencing the high levels of emotion she is expected to convey? Can Butterfly undergo such an emotional crisis that she might be tempted to thrust the ceremonial sword into her torso, while at the same time producing appropriate registration modification and resonance balancing in high tessitura? Can Gilda ecstatically recall her lover while skillfully managing her melismas? What is the relationship between dramatic situation and technical prowess, between communication and physical control? How does one keep the text and the drama from robbing one of one’s voice?
Graceland
Authors: Williamson Joel
Published: November 2023

I first came to Graceland on a bitterly cold day in the winter of 1984. Elvis Presley had died in 1977, and the house and grounds where he lived the last twenty years of his life had been open to paying visitors for only some eighteen months. I bought my ticket in a frigid barnlike structure in the staging area across the street from the estate. I recall vividly the squat, early middleaged man behind the chest-high counter and his condescending manner. He had a proprietary air, as if he were allowing me a privilege rather than selling me a ticket. Dourfaced, colorless, and fish-eyed, he tossed my change on the counter with a gesture of irritation and dismissal as if my money was nothing compared to the value of the ticket he pushed toward me. I suspected from his lordly manner that he was an insider of some sort who had never before had a job he loved so much.
Poetic Profit
Authors: Dougherty Carol
Published: November 2023

And for these reasons, Theophrastus too praised him [Democritus of Abdera], because he gathered a greater collection of goods than Menelaus and Odysseus. For those men wandered and were not at all different from Phoenician merchants. They gathered goods and offered this as their excuse for traveling and sailing around.Aelian, MiscellanyAt the end of Book 5, Odysseus builds a raft to sail away from Calypso’s island and return home to Ithaca. In addition to enabling Odysseus to continue his homeward journey, this raft helps articulate the figurative association of ships and seafaring with poetic activity in the Odyssey. On many occasions, shipsthe manner of their construction and their ability to sail-represent the poetic process in Greek poetry, and the raft-building scene in Book 5 elaborates the terms and structure of this metaphor at work in the Odyssey. Read metaphorically, then, Odysseus’ ability to set sail once again prefigures his emergence as poet of the Odyssey once he arrives safely at Phaeacia. In building his raft, Odysseus proves that he has the necessary skills of a professional shipbuilder or poet, but also, and somewhat surprisingly, this hastily cobbled together raft is said to have the capacity to carry substantial cargo:
Odysseus Returned and Ithaca Re-founded
Authors: Dougherty Carol
Published: November 2023

The Odysseus of the Odyssey justifies himself by his success as the refounder of his own house; he is ruthless, practical, inventive, self-seeking, and utterly committed to a few close loyalties. Such a man would surely have found ample play for his talents in the first great age of Greek entrepreneurial expansion, which was also the moment of the composition of the Odyssey. Home at last. After ten long years of battle at Troy and still ten more at sea, Odysseus has returned home at last. In his travels he has encountered seductive nymphs, cannibal monsters, destructive whirlpools, and Golden Age landscapes. He has gone to Hades and returned, survived the song of the Sirens, and rejected offers of immortality. He has built a raft and lost it. And after all these travels, all these experiences, all this suffering, he has now come home; in fact, his travels are precisely what has enabled Odysseus to return home successfully. Like the Swiss missionary-ethnographer, Jean de Lery, Odysseus has managed a return to the self-to his Greek self-through his travels among the other. In other words, he helps forge a new sense of Greek identity out of his experiences among the peoples and places overseas. In the first section of this book we looked at the ways in which Odysseus’ raft operates as a vehicle for articulating the poem’s ethnographic imagination. The raft, with its careful construction, its cargo-carrying capacity, and its ability to travel, serves as an emblem of the inextricable interconnection in the Odyssey of narrative, travel, and trade. It both represents the potential of the ethnographic imagination and transports Odysseus to the site of his New World tales. The second section then turned its focus to these brave new worlds, and in particular to the land of the Phaeacians. With a landscape that belongs in part to traditions of the Golden Age and in part to narratives of the New World, Phaeacia offers an ideal site for the ethnographic imagination.
The Cognitive And Behavioral Neurologic Examination
Authors: Taylor Michael Alan
Published: November 2023

The neuropsychiatric evaluation detailed in Chapters 2 and 3 provides information needed to make a DSM diagnosis and to identify dysfunctional systems in the brain. The relationship between diagnosis and treatment is obvious. Knowing which brain systems are involved is equally important for treatment because it (1) identifies specific syndromes now grouped together in the DSM “not otherwise specified” (NOS) categories; (2) identifies subgroups of patients who, despite meeting criteria for a DSM category, are still atypical in some way that suggests that they have a different underlying pathophysiologic process (i.e., they have a secondary syndrome); and (3) determines medication choices and areas needing rehabilitation. The following vignettes illustrate these points.
Depression
Authors: Taylor Michael Alan
Published: November 2023

Depression is common, affecting about 10% of adults in any one year. About 8% of women and 4% men are at lifetime risk for severe depression, and an additional 10% (about 15% overall) are at risk for less severe forms (e.g., adjustment disorders). Depression affects all social classes and all ethnic groups and Western and nonWestern societies. Most first depressions occur after puberty and before age 60 years, although childhood depression occurs and is of major clinical concern. The incidence (new cases) of depression increases in persons born more recently (period effect). The age of onset of the first depression is also getting younger (cohort effect). Thus, depression is more common in persons born in the last several decades than in persons born before World War II, and these depressions are occurring for the first time when people are younger. The explanations for these effects are unclear. About 15%-20% of private psychiatric hospital patients and about 10% of public psychiatric hospital patients are admitted for depression. Melancholia affects about 2% of the general population and represents about 20% of all depressions.
Epilepsy And Related Syndromes
Authors: Taylor Michael Alan
Published: November 2023

Epilepsy results from excessive neuronal electrical discharges that synchronize and spread (by recruiting more neurons) through parts or all of the brain, producing a focal or generalized electrical “storm” or seizure. For there to be a seizure, instability must occur or be induced in neuronal membrane voltage-dependent sodium and chloride channels that then produce high frequency potentials. These potentials spread, producing the seizure. Dopamine and GABA stabilize these channels and can prevent the high frequency potential spread and thus the seizure.
Daybreak
Authors: Sudhalter Richard M
Published: November 2023

Anyone wanting to drive from Indianapolis to Richmond, Indiana, these days simply picks up Interstate 70, which bisects the city, heads east, and steps on the gas. Provided the traffic is relatively light, the weather reasonable, and the police not too attentive, a driver can cover the seventythree miles in little more than an hour.
Big Town Blues
Authors: Sudhalter Richard M
Published: November 2023

The 1928 Book Nook “commencement” came and went, bigger and more elaborately choreographed than its predecessor. The old gang was still in attendance: Wad Allen, introduced as the “out-of-town speaker,” arrived in stovepipe hat and frock coat, a live white hen under his arm. Carmichael remembered his speech as “a marvelous thing … inspiring, yet completely senseless; as insanely futile as a Bent Eagle’s notion of posterity.”
A Poke in His Pocket
Authors: Sudhalter Richard M
Published: November 2023

Americans responded to the December 7, 1941, Japanese attack on Pearl Harbor in intense, often personal, ways but with an overall unity. The fractiousness that had tied up public debate over possible U.S. involvement in the century’s second “foreign” war seemed to evaporate overnight. As Time magazine put it: The war came as a great relief, like a reverse earthquake, that in one terrible jerk shook everything disjointed, distorted, askew back into place. Japanese bombs had finally brought national unity to the U.S.
Tide: Rise and Ebb
Authors: Sudhalter Richard M
Published: November 2023

The opening credits to Young Man With a Horn have hardly faded from the screen when the camera pans down and catches Hoagy Carmichael, seated at an old upright piano in a deserted ballroom. He glances up, as if acknowledging a visitor, then calmly lights a cigarette.
Loss
Authors: Sudhalter Richard M
Published: November 2023

Loss, progressive and pervasive, shadowed Hoagy Carmichael throughout the 1960s. His younger sister Martha, unable to regain her footing since the death of her husband, novelist John Bell Clayton, was the first casualty. Georgia, with whom she was staying at the Doheny Drive house, found her body on Sunday morning, August 6, 1961. The sisters and Hoagy Bix had dined together the previous evening, and Martha had excused herself early, saying she was tired and wanted to turn in early. She’d drunk a bit during dinner, and before going to bed had apparently taken a sleeping pill, from which she’d never awakened. Though no mention was made at the time, family suspicion lingered that her death had not been accidental.
Introduction
Authors: Ricketts Thomas c.
Published: November 2023

Rural health policy has taken an important place on the American political agenda due to changes within the health care system and the policy environment that affects rural America. The demographic, social, cultural and economic changes in rural and urban populations are different in many respects, yet policy does not always recognize those differences and sometimes causes harm when policies that do recognize a difference are implemented. The financing and delivery of health care in this nation has undergone a revolution in the past decade. This is apparent to even the most casual observer as well as to people directly involved in health policy making. The changes of the past 10 years have been almost overwhelming in their scope and impact.
Federal Programs and Rural Health
Authors: Ricketts Thomas C
Published: November 2023

The federal government has long been involved in the support of programs and projects that target rural populations and places. Although there is no comprehensive national rural policy (Bonnen, 1992) for the main sectors of economic development, agriculture, energy, communications, and transportation, there has been a concerted effort to coordinate policy and combine and coordinate programs in health policy. The establishment of the Office of Rural Health Policy (ORHP) in 1987 signaled a desire on the part of Congress and the Administration to bring together the various elements of federal rural health policy to eliminate duplication of effort and to apply policies consistently.
State Laws and Programs That Affect Rural Health Delivery
Authors: Slifkin Rebecca T
Published: November 2023

Many government programs and regulations, both state and federal, affect the health care infrastructure of rural areas. Unlike the federal government, states are in the unique position of being able to respond to the specific needs of their communities, and many of the new government programs that focus on improvement of the health of rural populations have been state-initiated. These initiatives have both a direct benefit to states, in terms of improvement of their populations’ health, and also an indirect benefit, as the presence of a health care delivery system is critical to the economic development of rural areas (McCloskey and Luehrs, 1990).
Hospitals in Rural America
Authors: Ricketts Thomas C , Heaphy Paige E
Published: November 2023

The role of hospitals in the American health care system is changing very rapidly. Indeed, there are some who see hospitals as disappearing from the scene, to be replaced by networks of professionals and institutions tied together through a variety of contractual arrangements to coordinate care and promote health-the so-called virtual hospital. For many rural communities, however, it is the hospital that has served as the focus of health care delivery in the community and that remains as the most prominent-and effective-institution to organize the delivery of health care.
Rural Maternal and Perinatal Health
Authors: Lishner Denise M , Larson Erich H , Rosenblatt Roger A , Clark Sarah J
Published: November 2023

Maternal and newborn care is a critical component of rural health services and integral to the health of the rural community (Council on Graduate Medical Education, 1997; Gavin and Leong, 1989). A high-quality system provides prenatal, obstetric, and neonatal services locally and, at the same time, an efficient system for linking higher-risk women and infants with nonlocal services when required. In the 1960s and 1970s, many rural areas lagged behind urban ones in terms of sentinel health outcomes such as infant mortality and rates of low birthweight (Sherman, 1992). Research on rural birth outcomes and the organization of maternal and neonatal services revealed that obtaining optimal birth outcomes required an accessible and efficiently used constellation of local and nonlocal services (Gortmaker et al., 1987; Hein and Lathrop, 1986). Efforts to build such regionalized systems of care substantially decreased the most glaring of rural/urban differentials in infant mortality.
Rural Children’s Health
Authors: Clark Sarah J , Savitz Lucy A , Randolph Randy K
Published: November 2023

This chapter presents a profile of rural children’s health in the 1990s, describing demographic changes, mortality patterns, health status indicators, health insurance, and the availability of health care providers and institutions. It utilizes recent, national data only; findings from small-area or single-state studies and from research conducted prior to 1990 are not included in statistical comparisons, although they are referenced occasionally to support or clarify statements about related issues. The purpose is to describe the current situation, suggest recent trends, and inform policy decisions concerning child and adolescent health in rural America.
Rural Mental Health and Substance Abuse
Authors: Hartley David , Bird Donna C , Dempsey Patricia
Published: November 2023

Current trends, including active consideration of parity for mental health benefits and the increasing role of managed care in the delivery of mental health services, may be breaking down some of the historic barriers between the mental and physical health care delivery systems. Unfortunately, the concerns of rural mental health and substance abuse service consumers and providers are often overlooked as these systems undergo financial and organizational changes. While system changes raise many concerns about quality, appropriateness, cost, and equity, this chapter will focus only on rural-specific issues with implications for policy, financing or organizational initiatives.
The Rural Elderly and Long-Term Care
Authors: Coburn Andrew F , Bolda Elise J
Published: November 2023

The aging of America will have dramatic implications for the health care system. Approximately one fifth of the elderly-defined as persons over the age of 65-reside in rural places, accounting for 8.2 million people in 1995. Although in the past rural areas have had higher concentrations of older people, this trend appears to be changing. The rural elderly differ in a number of important respects from the stereotypical image of the rural older person living in an idyllic home in a quaint country setting surrounded by a large multigenerational family. Compared with urban elders, the rural elderly have lower in comes, they are more likely to be poor, and they are less educated (Coward et al., 1994b). Although they are more likely to own their homes, those dwellings are more likely to substandard; that is, they are more likely to have inadequate heating and plumbing systems and to be in need of costly repairs (Coward et al., 1994b).
Importance of Alkenes in the Chemistry of Ozone Generation in the Urban Atmosphere
Authors: Calvert J G , Atkinson R , Kerr J A , Madronich S , Moortgat G K , Wallington, T J , Yarwood G
Published: November 2023

Organic compounds are important trace constituents of the atmosphere that originate from many different natural and man-made sources. The atmospheric reactions of organic compounds influence other atmospheric trace constituents. In particular, reactions of volatile organic compounds (VOCs) with nitrogen oxides (NOx) in the presence of sunlight can lead to the formation of ozone and other oxidants, commonly referred to as “smog” or “ground-level ozone” (see, e.g., Warneck, 1988; Finlayson-Pitts and Pitts, 1986). In many urban areas, emissions of VOCs and NOx, when combined under meteorological conditions that favor smog formation, can lead to the formation of ground-level ozone at harmful levels. In some cases, such as the eastern United States, ground-level ozone is a “regional-scale” as well as an “‘urban-scale” problem because significant atmospheric transport of ozone (and/or ozone precursors) occurs from urban to rural areas, or between neighboring urban areas.
Reactions of Alkenes with the N03 Radical
Authors: Calvert J G , Atkinson R , Kerr J A , Madronich S , Moortgat G K , Wallington, T J , Yarwood G
Published: November 2023

Kinetic data for the NOrradical reactions with the alkenes are less extensive than those for OH radical, but a great deal has been learned about the mechanism; for example, see Atkinson (1991, 1994, 1997b) and the references therein. The existing data show that the reactivity of the NO3 radical with alkenes is much greater than that for the corresponding alkanes (see table III-A-I). Introduction of a double bond in the C2 alkane (ethane) to form the C2 alkene (ethene) causes at least a 50- fold increase in the reactivity. This increase is even more dramatic when alkyl groups are attached to the double bond as in 2-butenes; here, the reactivity increases over that of n-butane by a factor of over 5000. With four alkyl groups about the double bond, as in 2,3-dimethyl-2-butene, the ratio of rate coefficient is increased from that for 2,3-dimethylbutane by a factor of over 105. The dienes show a similar but somewhat less dramatic effect; with alkyl-group substitution, the reaction rate coefficient is over a thousand times that for the alkane with the structurally equivalent carbon chain.
Experiments in Conservatism
Authors: Levinger Matthew
Published: November 2023

“The people will never attain maturity,” declared Otto von Voß-Buch in January 1821.1 This statement, as clearly as any other, signaled the end of the era of reform in Prussia. Dismissed from the Prussian ministry in 1809 because of his bitter opposition to Stein and Hardenberg, Voß reentered the inner circle of the king’s advisers in the autumn of 1820. Upon Hardenberg’s death in November 1822, Voß became the new head of the Prussian ministry—though he died within two months of assuming his new post.2
Power Analysis and Experimental Design
Authors: Steidl Robert J , Thomas Len
Published: November 2023

Ecologists conduct research to gain information about ecological patterns and processes (chapter 1). An underlying, fundamental goal for all research, therefore, is to generate the maximum amount of information from a given input of effort, which can be measured as time, money, and other similarly limited resources. Consequently, after we develop a clear set of questions, objectives, or hypotheses, the most critical aspect of ecological research is design.
The Bootstrap and the Jackknife: Describing the Precision of Ecological Indices
Authors: Dixon Philip M
Published: November 2023

Quantitative ecology uses many indexes and coefficients, including diversity indices (Magurran 1988), similarity indices (Goodall 1978), competition coefficients (Schoener 1983), population growth rates (Lenski and Service 1982), and measures of size hierarchy (Weiner and Solbrig 1984). All of these indices are statistics, calculated from a sample of data from some population and used to make conclusions about the population (chapter 1). To help a reader interpret these conclusions, good statistical practice includes reporting a measure of uncertainty or precision along with a statistic. Although it is easy to calculate the values of many ecological statistics, it is often difficult to estimate their precision.
Enabling Democratic Deliberation: How Managed Care Organizations Ought to Make Decisions about Coverage for New Technologies
Authors: Daniels Norman
Published: November 2023

I will sketch a sympathetic addition to the house that Amy Gutmann and Dennis Thompson build in Democratic Disagreement. Because they are fearful that democratic deliberation theory has put all of its effort into thinking about foundations, or constitutional issues, they design a structure to occupy “middle democracy,” a space where much more of the action in our political lives takes place. My addition expands that living space to include certain nonpublic, nondemocratic organizations and the role they can play in enabling a broader, if not formal, democratic deliberation. In designing the addition, I pay more attention to functional detail than the original. That is, I focus more specifically on how constraints on deliberation in these institutions might actually affect the process of deliberation. In contrast, Gutmann and Thompson pay less attention to institutional function and design and instead provide us with an instructor’s manual showing how we might reconstruct, deconstruct, and sometimes resolve controversies of the sort originally raised in their case book Ethics and Politics in light of their principles.
Everyday Talk in the Deliberative System
Authors: Mansbridge Jane
Published: November 2023

What I will call “everyday talk” does not meet all of the criteria implicit in the ordinary use of the word “deliberation.” It is not always self-conscious, reflective, or considered. But everyday talk, if not always deliberative, is nevertheless a crucial part of the full deliberative system that democracies need if citizens are, in any sense, to rule themselves. Through talk among formal and informal representatives in designated public forums, talk back and forth between constituents and elected representatives or other representatives in politically oriented organizations, talk in the media, talk among political activists, and everyday talk in formally private spaces about things the public ought to discuss-all adding up to what I call the deliberative system—people come to understand better what they want and need, individually as well as collectively. The full deliberative system encompasses all these strands.
Model for Estimation of Survival in Patients with Far-Advanced Cancer
Authors: Maltoni Marco , Nanni Oriana , Scarfi Emanuela , Pirovano, Marco , Amadori Dino
Published: November 2023

Research aimed at identifying prognostic factors of survival in a population of far-advanced and terminal cancer patients is a very delicate and risky matter. It involves a variety of implications and consequences that we deem necessary to examine and discuss, though briefly, at the very start.
Cancer Pain as a Model for the Training of Physicians in Palliative Care
Authors: Weissman David E
Published: November 2023

From the standpoint of medical education, cancer pain has received far greater attention over the past 10 years than all other topics in palliative care. This is undoubtedly due to the widespread acceptance of a standardized assessment approach and well-accepted treatment algorithms, combined with the tremendous attention that cancer pain has received on a national and international basis. During this time, consensus statements, curriculum guides, and cancer pain teaching materials have been developed and published.
The Palliative Care Consultation Team as a Model for Palliative Care Education
Authors: Abrahm Janet L
Published: November 2023

In the best circumstances, dying can be a peaceful time during which important memories are shared. In Fred Chappell’s novel Farewell, I’m Bound to Leave You, a beloved grandmother is dying, and for her family, “The wind had got into the clocks and blown the hours awry.” The grandson asks his father,”‘ ... what are we going to do?’ ‘We will watch the clocks at their strange antics’, my father said. ‘We will listen to the wind whisper and weep and tell again those stories of women that your mother and grandmother needed for you to hear.”‘ When the telling is done the father explains, “Not long from now there will come an icy cold into this room.
Prophylactic Anticoagulant Therapy in the Terminally Ill Cancer Patient
Authors: Levine Mark N
Published: November 2023

Thromboembolism commonly occurs in cancer patients and complicates their management. The etiology of thrombosis in malignancy is multifactorial; mechanisms include release of procoagulants by tumor cells, co-morbid predisposing factors (e.g., surgery, bed rest, infection), and anticancer drugs (chemotherapy, hormones). Acute pulmonary embolism can result in increased mortality, and the symptoms of pulmonary embolism (e.g., dyspnea) and deep vein thrombosis (pain and swelling) can have a substantial impact on the patient’s quality of life.
Intraspinal Analgesic Therapy in Palliative Care: Evolving Perspective
Authors: Du Pen Stuart L , Du Pen Anna R
Published: November 2023

In the mid-twentieth century, the hospice movement in England epitomized the “death with dignity’’ philosophy-the picture of the patient with a peaceful, rapturous countenance attended at home by a modem Florence Nightingale. Nowhere did the anesthesiologist in scrubs appear, with catheters, needles, and infusion pumps. Later, in the United States, the Diagnosis Related Groups atmosphere of the 1970s and 1980s gave way to a growing adversarial relationship between hospice enthusiasts, for whom no invasive (and costly) technologies were ever deemed appropriate, and the infant subspecialty of anesthesia pain management, for which the hospice represented a deplorable sisterhood of euthanasia activists. Thankfully, a more well-defined middle ground has taken shape over the last several years for intraspinal analgesia in palliative care.
Care of the Elderly with Advanced Diseases: Caregiver Issues
Authors: Borneman Tami , Ferrell Betty
Published: November 2023

In many ways, family members caring for the elderly with an advanced disease experience a solitary journey. While some have been down this road before, many are not prepared for the journey. Throughout history, family members have assumed responsibility for caring for their own sick with more deaths occurring in the home rather than in the hospital setting. In the 1940s, a shift occurred with more deaths occurring in hospitals. Over the last 2 decades, there has been a shift in care back to the home setting along with an increase in deaths.
Truth-Telling and Reciprocity in the Doctor-Patient Relationship: A North American Perspective
Authors: Fins Joseph J
Published: November 2023

During a visit to a bioethics program in Europe, I recognized how far North American practice has strayed from global norms. In talking about truth-telling and the importance of providing patients with diagnostic information that would allow them to make important life decisions, I was asked how information about a grave diagnosis could possibly be helpful to a dying patient. After being accused of being a proponent of a cruel and brutal North American ethic, based more on patient autonomy than physician beneficence, I was proudly told of an act of deception to spare a dying patient the truth.
Economic Outcomes and Palliative Care
Authors: Smith Thomas J , Lyckholm Laurie
Published: November 2023

The cost of cancer care is rising because of increasing age, more cancer cases, increased demand for treatment, and new expensive technologies. Our limited resources must be rationed wisely so that we can provide both curative and palliative care. The ethical implications of using economic and management outcomes rather than traditional health outcomes include shifting emphasis from helping at all cost to helping at a cost society can afford, how much society is willing to pay, the value of care to the dying versus those with curable illnesses, and tolerance of suboptimal care.
Opioid Tolerance: A Clinical Perspective
Authors: Nghiemphu Leia Phioanh , Portenoy Russell K
Published: November 2023

Although opioids play a central role in the treatment of chronic pain, under treatment continues to be common. In part, under treatment can be traced to persistent fears and misconceptions about opioid properties, such as tolerance. To optimize the use of these drugs, the mechanisms and clinical relevance of tolerance must be understood. The disparities between experimental research and clinical observations must be highlighted and can help inform future research.
Dose Ratios Among Different Opioids: Underlying Issues and an Update on the Use of the Equianalgesic Table
Authors: Lawlor Peter , Pereira Jose , Bruera Eduardo
Published: November 2023

In patients with cancer pain, a change of opioid is recognized as a useful strategy in the management of either opioid toxicity alone or the combination of opioid toxicity and failure to achieve adequate analgesia with an existing opioid.1--J Terms such as opioid rotation, sequential opioid trials,4 or opioid substitution5·6 are used to describe this strategy. The frequency of opioid rotation varies in different centers with rates as high as 40%.
Intraspinal Pain Therapy in Palliative Care
Authors: Sjöberg Magnus , Rawal Narinder
Published: November 2023

It has been suggested that the guidelines for treatment of cancer pain established by the World Health Organization1 can control more than 90% of cancer-related pain syndromes. The oral and parenteral routes of opioid therapy are favored for their simplicity and lower cost. Some patients do not respond adequately to these approaches, however, and more invasive techniques are needed.
Trophic Interactions, Community Organization, and the Kluane Ecosystem
Authors: Sinclair A R E , Krebs Charles J
Published: November 2023

The conservation of biodiversity depends on functioning natural ecosystems and com­ munities. There are various scientific reasons for conserving natural ecosystems. One is that we need to retain representative portions of the natural world as base line controls for human impacts elsewhere. Another is that we need to preserve species that may later be of benefit to humans. To conserve natural systems, however, we have to understand how disturbances affect natural systems and whether those effects will cause irreversible changes. Alternatively, in human-dominated systems, we need to understand how changes will affect our own livelihood through the stability of the system.
Snowshoe Hare Demography
Authors: Hodges Karen E , Krebs Charles J , Hik Davids. , Stefan Carol I , Gillis Elizabeth A , Doyle Cathy E
Published: November 2023

Snowshoe hares, Lepus americanus, exhibit continent-wide cyclic fluctuations in abundance. Peak densities occur every 8-11 years, and densities fluctuate 5 to 25-fold during a cycle. Snowshoe hares are typically the dominant herbivore in boreal forests, and their cyclic fluctuations have widespread ramifications for the shrubs and trees that they eat, for the transient and resident predators that eat them, and for the other forest herbivores that may compete with hares for food or that may serve as alternative prey for predators (Elton 1924, Finerty 1980, Keith 1990, Krebs et al. 1992, Royama 1992).
Other Herbivores and Small Predators: Arthropods, Birds, and Mammals
Authors: Smith James N M , Folkard Nicholas F G
Published: November 2023

In this chapter, we discuss the responses of three groups of animals in the center of the Kluane food web (figure 2.8) to the snowshoe hare cycle, to the experimental addition of NPK fertilizer, and to an unexpected natural event, a large outbreak of bark beetles. None of these animals was studied intensively every year, either because we did not expect them to be central players in the drama of the snowshoe hare cycle or because they were rare. The first group, arthropods, are usually the most diverse and abundant animals in terrestrial food webs (Daly et al. 1998), including the boreal forest (Danks and Footit 1989). Lepidopteran larvae can be dominant consumers of vegetation in temperate forests, re­ moving foliage from almost the entire forest canopy (Myers 1993), and severe defoliation can have large impacts on ecological performance of trees (Kaitaniemi et al. 1999). De­ foliating species may generate strong interactions in boreal food webs, including effects on passerine birds (Enemar et al. 1984, Neuvonen 1989). Wood-boring insects, particularly bark beetles (order Coleoptera, family Scolytidae), can kill many species of forest trees (Daly et al. 1998; see below).
Great Horned Owls
Authors: Rohner Christoph , Doyle Frank I , Smith James N M
Published: November 2023

Great homed owls (Bubo virginianus Gmelin) are large, long-lived, generalist predators. Diets of great homed owls are extremely variable and include a wide variety of species (ranging in size from insects to lagomorphs; Donazar et al. 1989), although the average prey size of great horned owls is larger than for smaller owl species (Marti 1974). Great horned owls typically ambush their prey from elevated perches and may be most successful in a mix of open and forested habitat ( Johnson 1993, Rohner and Krebs 1996). Nevertheless, they are widely distributed in most landscapes across North and South America, including the whole range of boreal forest (Voous 1988, Houston et al. 1998; See figure 2.7). Great homed owls form lasting pair bonds and defend territories year­ round (Petersen 1979, Rohner 1996). Great horned owls are the largest avian predators occurring widely at high densities in the boreal forest (body mass in June: 18 female adults, 1.61 :::’:: 0.26 kg, 4 male adults, 1.23 :::’:: 0.07 kg; C. Rohner, unpublished data).
Trophic Mass Flow Models of the Kluane Boreal Forest Ecosystem
Authors: Ruesink Jennifer L , Hodges Karen E
Published: November 2023

The Kluane ecosystem project has generated detailed demographic portraits for many species that inhabit the boreal forest. The experimental manipulations have allowed us to test the impacts of food and predation on the population densities and demography of a number of herbivorous species, as well as to compare the strength of bottom-up versus top-down interactions among trophic levels (chapter 17). At Kluane we documented cycles occurring not only in species’ abundances, but also in survival, reproduction, and diet composition. A striking general result from the Kluane studies is the huge shift in bio­ mass in the forest throughout the 10-year cycle. Not only does overall herbivore biomass change more than threefold, but also the amount of the herbivore biomass represented by snowshoe hares varies from about 65% at the peak down to about 10% during the low phase (figure 19.l; CD-ROM frame 70). Predator biomass shows a similar overall shift, although no individual predator fluctuates as much in its proportional representation (figure 19.2). The dynamics of this multispecies food web may change substantially over the snowshoe hare cycle as a result of these biomass shifts.
Rén Ҵ and L𝔦 Ѭ in the Analects
Authors: Shun Kwong-Loi
Published: November 2023

There are at least two different views concerning the earlier meaning of the character “rén.” According to one view, the character originally referred to the quality that makes someone a distinctive member of an aristocratic clan.1 According to another view, it originally had the meaning of love, especially the kindness of rulers to their subjects.2 For the purpose of my discussion, it is not necessary to adjudicate between these competing views.
Shostakovich
Authors: Fay Laurel E
Published: November 2023

For this authoritative post-cold-war biography of Shostakovich's illustrious but turbulent career under Soviet rule, Laurel E. Fay has gone back to primary documents: Shostakovich's many letters, concert programs and reviews, newspaper articles, and diaries of his contemporaries. An indefatigable worker, he wrote his arresting music despite deprivations during the Nazi invasion and constant surveillance under Stalin's regime. Shostakovich's life is a fascinating example of the paradoxes of living as an artist under totalitarian rule. In August 1942, his Seventh Symphony, written as a protest against fascism, was performed in Nazi-besieged Leningrad by the city's surviving musicians, and was triumphantly broadcast to the German troops, who had been bombarded beforehand to silence them. Alone among his artistic peers, he survived successive Stalinist cultural purges and won the Stalin Prize five times, yet in 1948 he was dismissed from his conservatory teaching positions, and many of his works were banned from performance. He prudently censored himself, in one case putting aside a work based on Jewish folk poems. Under later regimes he balanced a career as a model Soviet, holding government positions and acting as an international ambassador with his unflagging artistic ambitions. In the years since his death in 1975, many have embraced a view of Shostakovich as a lifelong dissident who encoded anti-Communist messages in his music. This lucid and fascinating biography demonstrates that the reality was much more complex. Laurel Fay's book includes a detailed list of works, a glossary of names, and an extensive bibliography, making it an indispensable resource for future studies of Shostakovich.
Pioneer (1929-1932)
Authors: Fay Laurel E
Published: November 2023

Shostakovich’s professionalism and facility were to prove indispensable during a period of intensive, pioneering activity as composer for the dramatic theater, ballet, and film that began in late 1928. That summer, the directors of Leningrad’s Sovkino had fielded a bold new proposal: to hire a professional composer to furnish music designed expressly to complement and enhance a specific silent film. The benefits of such an enterprise were by no means self-evident; the mediocre conductors who routinely stitched together patchworks of musical clichés for their theater orchestras, together with legions of theater pianists, were almost guaranteed to fight the incursion into their domain. There were myriad practical problems to be dealt with as well. Nevertheless, Sovkino announced that directors Grigoriy Kozintsev and Leonid Trauberg were already scouting for a composer to provide the musical scenario for their upcoming film, The New Babylon,a story of the Paris Commune of 1871. By late December they had picked the composer they wanted to launch the experiment. For a fee of 2,000 rubles, Shostakovich contracted to deliver the piano score for The New Babylon on 1 February 1929, and full score and parts for a normal fourteen-piece theater orchestra on 1 March 1929.
Il mestiere di musico
Authors: Kendrick Robert L
Published: November 2023

The circumstances of a musician’s life differed, often dramatically, from the prestige of his institution, while a professional training, from choirboy to maestro, seemed anything but systematic. The arrangements, connections, and support that musicians attempted to establish rendered them dependent on employers, patrons, and printers in the city. And the grammatical gender of these sentences underscores the initial impression that most public performers, outside the women’s religious houses and the occasional theatrical event, were indeed male. But the evidence of dedications and the practice of domestic music suggest that the distribution of music between the sexes was more complex than appears.
From Triumph to Plague, 1610–1630
Authors: Kendrick Robert L
Published: November 2023

By the time of Carlo’s canonization, city music was well in place, part innovative, part retrospective and, despite Lomazzo’s best efforts, part provincial. During the next decade, the musical life of the female houses continued to grow, and the boom economy provided financing until about 1620. The concordat reached by Federigo and the governor Hinojosa, proclaimed in 1618, underscored the temporary sense of harmony and tranquility. Fresh from the dual civic triumphs of the Ambrosiana and the new patron, the city’s cultural life showed the interpenetration of sacred and secular.
Hormonally Active Agents
Authors: Wigle Donald T
Published: November 2023

In multicellular organisms, cell signaling through the nervous, immune, and endocrine systems is essential for coordinating metabolic functions among all cells. Signals range from nutrient and metabolite levels in extracellular fluids to specialized systems including chemical messengers, storage and transportation mechanisms, and receptors. Specialized endocrine cells produce chemical messengers (hormones) that interact with receptors in local and distant target cells. There are intimate links between the endocrine and nervous systems such as the hypothalamic–pituitary gland complex in which specialized neurons produce hormones.

Depending on the hormone, target cells may be confined to a specific organ or may be more widespread. By binding to receptors and influencing intracellular signaling systems, hormones control many processes at the molecular level during gestation and postnatal life. Major endocrine glands include the pituitary gland, thyroid gland, parathyroid glands, pancreatic islets, adrenal glands, testes, and ovaries. When activated by a hormone, receptors on or in target cells trigger a cascade of intracellular reactions. An agonist is a hormone or chemical that binds to a receptor and induces specific biochemical effects; antagonists compete for binding to a receptor but do not induce the biochemical effects associated with the receptor.
Schumann’s Compositions Prior to 1834
Authors: Jensen Eric Frederick
Published: November 2023

According To His Own Recollections, Schumann Began compose when he was seven or eight (not long after beginning to study the piano). None of these earliest works, which he described as dances, is known to have survived. A setting for voices and orchestra of Psalm 150 followed at the age of twelve. On an elaborate, handmade title page in childish handwriting, Breitkopf & Hartel is listed as its publisher.
Endenich
Authors: Jensen Eric Frederick
Published: November 2023

The prison became a veritable tomb, but one in which all peace was denied us. One by one all human consolations were taken away; our sufferings became ever greater. I resigned myself to the will of God, but in sorrow.
Enemies of the Enlightenment
Authors: McMahon Darrin M
Published: November 2023

Critics have long treated the most important intellectual movement of modern hstory—the Enlightenment—as if it took shape in the absence of opposition. In this ground-breaking new study, Darrin McMahon demonstrates that, on the contrary, contemporary resistance to the Enlightenment was a major cultural force, shaping and defining the Enlightenment from the moment of its inception, while giving rise to an entirely new ideological phenomenon—what we have come to think of as the “Right”. Born in France, but spread throughout Europe and the New World in the eighteenth and early nineteenth centuries, the Counter-Enlightenment was neither a rarified current in the history of ideas nor an atavistic relic of the past, but an extensive, international, and thoroughly modern affair. Drawing on a range od primary sources, McMahon shows that well before the French Revolution, enemies of the Enlightenment were warning that the secular thrust of modern philosophy would give way to horrors of an unprecedented kind, Greeting 1789, in turn, as the realization of their worst fears, they fought the Revolution from its onset, profoundly affecting its subsequent course, The radicalization—and violence—of the Revolution was as much the product of militant resistance as any inherent logic. In the wake of Revolutionary upheaval, enemies of the Enligtenment assumed positions of immense cultural authority, consolidating their political vision of the Right in the first third of the nineteenth century, and spreading their construction of the Enlightenment throughout the world. In doing so they developed a critique of modernity that remains with us to the present day.