Seizure prediction and control in epilepsy

The first part of my thesis presents an overview of the different approaches used in the past two decades in the attempt to forecast epileptic seizure on the basis of intracranial and scalp EEG. Past research could reveal some value of linear and nonlinear algorithms to detect EEG features changing over different phases of the epileptic cycle. However, their exact value for seizure prediction, in terms of sensitivity and specificity, is still discussed and has to be evaluated. In particular, the monitored EEG features may fluctuate with the vigilance state and lead to false alarms. Recently, such a dependency on vigilance states has been reported for some seizure prediction methods, suggesting a reduced reliability. An additional factor limiting application and validation of most seizure-prediction techniques is their computational load. For the first time, the reliability of permutation entropy [PE] was verified in seizure prediction on scalp EEG data, contemporarily controlling for its dependency on different vigilance states. PE was recently introduced as an extremely fast and robust complexity measure for chaotic time series and thus suitable for online application even in portable systems. The capability of PE to distinguish between preictal and interictal state has been demonstrated using Receiver Operating Characteristics (ROC) analysis. Correlation analysis was used to assess dependency of PE on vigilance states. Scalp EEG-Data from two right temporal epileptic lobe (RTLE) patients and from one patient with right frontal lobe epilepsy were analysed. The last patient was included only in the correlation analysis, since no datasets including seizures have been available for him. The ROC analysis showed a good separability of interictal and preictal phases for both RTLE patients, suggesting that PE could be sensitive to EEG modifications, not visible on visual inspection, that might occur well in advance respect to the EEG and clinical onset of seizures. However, the simultaneous assessment of the changes in vigilance showed that: a) all seizures occurred in association with the transition of vigilance states; b) PE was sensitive in detecting different vigilance states, independently of seizure occurrences. Due to the limitations of the datasets, these results cannot rule out the capability of PE to detect preictal states. However, the good separability between pre- and interictal phases might depend exclusively on the coincidence of epileptic seizure onset with a transition from a state of low vigilance to a state of increased vigilance. The finding of a dependency of PE on vigilance state is an original finding, not reported in literature, and suggesting the possibility to classify vigilance states by means of PE in an authomatic and objectic way. The second part of my thesis provides the description of a novel behavioral task based on motor imagery skills, firstly introduced (Bruzzo et al. 2007), in order to study mental simulation of biological and non-biological movement in paranoid schizophrenics (PS). Immediately after the presentation of a real movement, participants had to imagine or re-enact the very same movement. By key release and key press respectively, participants had to indicate when they started and ended the mental simulation or the re-enactment, making it feasible to measure the duration of the simulated or re-enacted movements. The proportional error between duration of the re-enacted/simulated movement and the template movement were compared between different conditions, as well as between PS and healthy subjects. Results revealed a double dissociation between the mechanisms of mental simulation involved in biological and non-biologial movement simulation. While for PS were found large errors for simulation of biological movements, while being more acurate than healthy subjects during simulation of non-biological movements. Healthy subjects showed the opposite relationship, making errors during simulation of non-biological movements, but being most accurate during simulation of non-biological movements. However, the good timing precision during re-enactment of the movements in all conditions and in both groups of participants suggests that perception, memory and attention, as well as motor control processes were not affected. Based upon a long history of literature reporting the existence of psychotic episodes in epileptic patients, a longitudinal study, using a slightly modified behavioral paradigm, was carried out with two RTLE patients, one patient with idiopathic generalized epilepsy and one patient with extratemporal lobe epilepsy. Results provide strong evidence for a possibility to predict upcoming seizures in RTLE patients behaviorally. In the last part of the thesis it has been validated a behavioural strategy based on neurobiofeedback training, to voluntarily control seizures and to reduce there frequency. Three epileptic patients were included in this study. The biofeedback was based on monitoring of slow cortical potentials (SCPs) extracted online from scalp EEG. Patients were trained to produce positive shifts of SCPs. After a training phase patients were monitored for 6 months in order to validate the ability of the learned strategy to reduce seizure frequency. Two of the three refractory epileptic patients recruited for this study showed improvements in self-management and reduction of ictal episodes, even six months after the last training session.

Magnetohydrodynamic Effects On Mixed Convection Flows In Channels And Ducts

This work focuses on magnetohydrodynamic (MHD) mixed convection flow of electrically conducting fluids enclosed in simple 1D and 2D geometries in steady periodic regime. In particular, in Chapter one a short overview is given about the history of MHD, with reference to papers available in literature, and a listing of some of its most common technological applications, whereas Chapter two deals with the analytical formulation of the MHD problem, starting from the fluid dynamic and energy equations and adding the effects of an external imposed magnetic field using the Ohm's law and the definition of the Lorentz force. Moreover a description of the various kinds of boundary conditions is given, with particular emphasis given to their practical realization. Chapter three, four and five describe the solution procedure of mixed convective flows with MHD effects. In all cases a uniform parallel magnetic field is supposed to be present in the whole fluid domain transverse with respect to the velocity field. The steady-periodic regime will be analyzed, where the periodicity is induced by wall temperature boundary conditions, which vary in time with a sinusoidal law. Local balance equations of momentum, energy and charge will be solved analytically and numerically using as parameters either geometrical ratios or material properties. In particular, in Chapter three the solution method for the mixed convective flow in a 1D vertical parallel channel with MHD effects is illustrated. The influence of a transverse magnetic field will be studied in the steady periodic regime induced by an oscillating wall temperature. Analytical and numerical solutions will be provided in terms of velocity and temperature profiles, wall friction factors and average heat fluxes for several values of the governing parameters. In Chapter four the 2D problem of the mixed convective flow in a vertical round pipe with MHD effects is analyzed. Again, a transverse magnetic field influences the steady periodic regime induced by the oscillating wall temperature of the wall. A numerical solution is presented, obtained using a finite element approach, and as a result velocity and temperature profiles, wall friction factors and average heat fluxes are derived for several values of the Hartmann and Prandtl numbers. In Chapter five the 2D problem of the mixed convective flow in a vertical rectangular duct with MHD effects is discussed. As seen in the previous chapters, a transverse magnetic field influences the steady periodic regime induced by the oscillating wall temperature of the four walls. The numerical solution obtained using a finite element approach is presented, and a collection of results, including velocity and temperature profiles, wall friction factors and average heat fluxes, is provided for several values of, among other parameters, the duct aspect ratio. A comparison with analytical solutions is also provided, as a proof of the validity of the numerical method. Chapter six is the concluding chapter, where some reflections on the MHD effects on mixed convection flow will be made, in agreement with the experience and the results gathered in the analyses presented in the previous chapters. In the appendices special auxiliary functions and FORTRAN program listings are reported, to support the formulations used in the solution chapters.

No(i)rthern Ireland: Crime fiction and the northern-irish scene. Proposed translation into italian of two short stories from "belfast noir"

The present thesis aims at proving the importance of cultural and literary contexts in the practice of translation: I shall show that, in the case of Northern Irish crime fiction, knowledge of both Northern Irish history and culture as well as of the genre of crime fiction are essential prerequisites for the production of a “responsible” translation. I will therefore offer a brief overview of the history of crime and detective fiction and its main subgenres; some of the most important authors and works will be presented as well, in an analysis that goes from the early years of the genre to the second half of the 20th century. I will then move the focus to Northern Ireland, its culture and its history, and particular attention will be paid to fiction writing in Ireland and Northern Ireland, with a focus on the peculiar phenomenon of “Troubles Trash”. I will tackle the topic of Northern Irish literature and present the contemporary scene of Northern Irish crime fiction; the volume from which the texts for the translation have been taken will be presented, namely Belfast Noir. Subsequently the focus will move on the theoretical framework within which the translations were produced: I will present a literary review of the most significative developments in Translation Studies, with particular attention to the “cultural turn” that has characterised this subject since the 1960s. I will then highlight the phenomenon of “realia” in translation and analyse the approaches of different scholars to the translation of culture-bound references. The final part represents the culmination and practical application of all that was presented in the previous sections: I will discuss the translation of culture-bound references according to the strategies presented in Chapter 4, referring to the proposed translations of two stories. Such analysis aims to show that not only expert linguistic knowledge, but also cultural awareness and a wide literary background are needed in order to make conscious choices in translation.

The Nightmare of Actual Identity": Franco-Algerian Literature after Liberation"

In this thesis I examine the issues of postcolonial Algerian identity expressed in literature, and the difficulty of defining an Algerian identity independent of French influence. I analyze and contextualize three novels (Le Polygone etoile by Kateb Yacine,L'Amour, la fantasia by Assia Djebar, and Le Village de l'allemand ou le journal des freres Schiller) representative of their respective periods. I explore the evolution of expressions of identity through post-liberation Algeria. The years immediately following decolonization are marked by the effort to return to aprecolonial blank slate, an effort that Yacine cautions against. The 1980s and 1990s are most concerned with re-inserting Algeria into the Western historical discourse, and the most recent literature moves beyond decolonization to discuss the current Islamistchallenge and immigration. Among the pertinent issues are language, oral vs. written traditions, the often blatant absence of Algerians and women from the accounts in the French colonial archives, and, of course, the Self/Other binary. I have found that theserepresentative authors and texts use asynchronic time, fragmented narrative, re-written history, and expressions of violence in an attempt to cope with the colonial period and decolonization. I show that these authors provide a commentary on those who have triedto erase their French side, but with little success. Ultimately, though in different ways, each author writes that Algerians much accept their French past and move beyond it,rather than fighting their collective history.

Problem of Tragedy and Tragic Consciousness in Russia at the turn of the 19th Century

This project intertwines philosophical and historico-literary themes, taking as its starting point the concept of tragic consciousness inherent in the epoch of classicism. The research work makes use of ontological categories in order to describe the underlying principles of the image of the world which was created in philosophical and scientific theories of the 17th century as well as in contemporary drama. Using these categories brought Mr. Vilk to the conclusion that the classical picture of the world implied a certain dualism; not the Manichaean division between light and darkness but the discrimination between nature and absolute being, i.e. God. Mr. Vilk begins with an examination of the philosophical essence of French classical theatre of the XVII and XVIII centuries. The history of French classical tragedy can be divided into three periods: from the mid 17th to early 19th centuries when it triumphed all over France and exerted a powerful influence over almost all European countries; followed by the period of its rejection by the Romantics, who declared classicism to be "artificial and rational"; and finally our own century which has taken a more moderate line. Nevertheless, French classical tragedy has never fully recovered its status. Instead, it is ancient tragedy and the works of Shakespeare that are regarded to be the most adequate embodiment of the tragic. Consequently they still provoke a great number of new interpretations ranging from specialised literary criticism to more philosophical rumination. An important feature of classical tragedy is a system of rules and unities which reveals a hidden ontological structure of the world. The ontological picture of the dramatic world can be described in categories worked out by medieval philosophy - being, essence and existence. The first category is to be understood as a tendency toward permanency and stability (within eternity) connected with this or that fragment of dramatic reality. The second implies a certain set of permanent elements that make up the reality. And the third - existence - should be understood as "an act of being", as a realisation of permanently renewed processes of life. All of these categories can be found in every artistic reality but the accents put on one or another and their interrelations create different ontological perspectives. Mr. Vilk plots the movement of thought, expressed in both philosophical and scientific discourses, away from Aristotle's essential forms, and towards a prioritising of existence, and shows how new forms of literature and drama structured the world according to these evolving requirements. At the same time the world created in classical tragedy fully preserves another ontological paradigm - being - as a fundamental permanence. As far as the tragic hero's motivations are concerned this paradigm is revealed in the dedication of his whole self to some cause, and his oath of fidelity, attitudes which shape his behaviour. It may be the idea of the State, or personal honour, or something borrowed from the emotional sphere, passionate love. Mr. Vilk views the conflicting ambivalence of existence and being, duty as responsibility and duty as fidelity, as underlying the main conflict of classical tragedy of the 17th century. Having plotted the movement of the being/existence duality through its manifestations in 17th century tragedy, Mr. Vilk moves to the 18th century, when tragedy took a philosophical turn. A dualistic view of the world became supplanted by the Enlightenment idea of a natural law, rooted in nature. The main point of tragedy now was to reveal that such conflicts as might take place had an anti-rational nature, that they arose as the result of a kind of superstition caused by social reasons. These themes Mr. Vilk now pursues through Russian dramatists of the 18th and early 19th centuries. He begins with Sumarakov, whose philosophical thought has a religious bias. According to Sumarakov, the dualism of the divineness and naturalness of man is on the one hand an eternal paradox, and on the other, a moral challenge for humans to try to unite the two opposites. His early tragedies are not concerned with social evils or the triumph of natural feelings and human reason, but rather the tragic disharmony in the nature of man and the world. Mr Vilk turns next to the work of Kniazhnin. He is particularly keen to rescue his reputation from the judgements of critics who accuse him of being imitative, and in order to do so, analyses in detail the tragedy "Dido", in which Kniazhnin makes an attempt to revive the image of great heroes and city-founders. Aeneas represents the idea of the "being" of Troy, his destiny is the re-establishment of the city (the future Rome). The moral aspect behind this idea is faithfulness, he devotes himself to Gods. Dido is also the creator of a city, endowed with "natural powers" and abilities, but her creation is lacking internal stability grounded in "being". The unity of the two motives is only achieved through Dido's sacrifice of herself and her city to Aeneus. Mr Vilk's next subject is Kheraskov, whose peculiarity lies in the influence of free-mason mysticism on his work. This section deals with one of the most important philosophical assumptions contained in contemporary free-mason literature of the time - the idea of the trinitarian hierarchy inherent in man and the world: body - soul - spirit, and nature - law - grace. Finally, Mr. Vilk assess the work of Ozerov, the last major Russian tragedian. The tragedies which earned him fame, "Oedipus in Athens", "Fingal" and "Dmitri Donskoi", present a compromise between the Enlightenment's emphasis on harmony and ontological tragic conflict. But it is in "Polixene" that a real meeting of the Russian tradition with the age-old history of the genre takes place. The male and female characters of "Polixene" distinctly express the elements of "being" and "existence". Each of the participants of the conflict possesses some dominant characteristic personifying a certain indispensable part of the moral world, a certain "virtue". But their independent efforts are unable to overcome the ontological gap separating them. The end of the tragedy - Polixene's sacrificial self-immolation - paradoxically combines the glorification of each party involved in the conflict, and their condemnation. The final part of Mr. Vilk's research deals with the influence of "Polixene" upon subsequent dramatic art. In this respect Katenin's "Andromacha", inspired by "Polixene", is important to mention. In "Andromacha" a decisive divergence from the principles of the philosophical tragedy of Russian classicism and the ontology of classicism occurs: a new character appears as an independent personality, directed by his private interest. It was Katenin who was to become the intermediary between Pushkin and classical tragedy.

Multiple spinal extradural meningeal cysts presenting as acute paraplegia. Case report and review of the literature

Multiple spinal extradural meningeal cysts are rare. To the authors' knowledge, there have been only four reported cases in the world literature. The authors report a case of multiple spinal extradural meningeal cysts in a 31-year-old woman presenting with acute paraplegia. Magnetic resonance imaging of the thoracolumbar spine revealed multiple extradural cystic lesions extending from T-7 to T-8 and from T-12 to L-3. Intraoperative findings demonstrated a white, fibrous, and tense cyst filled with cerebrospinal fluid-like colorless fluid. Excision of the posterior wall of the symptomatic cyst was followed by immediate neurological improvement. The examination of the pathological specimen showed a thick duralike layer of collagen and an inner membrane of arachnoid that is often not found in these lesions. The final diagnosis was based on combined imaging, intraoperative, and histopathological findings. The authors review the literature and discuss the etiological, diagnostic, and therapeutic aspects of this lesion.

Words, words, words: Philology and Beyond: Festschrift for Andreas Fischer on the Occasion of his 65th Birthday

This Festschrift comprises a series of papers written in honour of the philologist Andreas Fischer, on the occasion of his sixty-fifth birthday. As in Andreas Fischer s own research, the main focus of the volume is on words: words in modern varieties, such as emergent conjunctions in Australian, American and British English; words in their cultural and historical context, such as English keywords in Old Norse literature; and words in a diachronic perspective, such as Romance suffixation in the history of English. Many contributions are anchored in the philological tradition that has informed much of Andreas Fischer s own scholarship, such as the study of verbal duelling in the late thirteenth-century romance Kyng Alisaunder. Others examine the construction ofdiscourses, such as those surrounding the Black Death. The volume, with its innovative studies,offers fascinating insights into words, discourses,and their contexts, both past and present.

Rhyming the National Spirit: Taras Shevchenko and Ilia Chavchavadze

The paper is a comparative inquiry into the roles of Ilia Chavchavadze (1837-1907) and Taras Shevchenko (1818-1861) as national poets and anti-colonial (anti-Tsarist) intellectuals within the context of their respective national traditions (Georgia and Ukraine). During the period of their activity (19th and the beginning of 20th century) both Ukraine and Georgia were under Tsarist imperial rule, albeit the two poets lived in different periods of Russian empire history. Through their major works, each called on their communities to ‘awaken’ and ‘revolt’ against oppression, rejected social apathy caused by Tsarist subjugation and raised awareness about the historical past of their nations. The non-acceptance of present and belief in an independent future was one of the dominant themes in the poetry and prose of both. Their contemporary importance is illustrated in political discourse both after Orange Revolution in Ukraine (2004), and Rose Revolution in Georgia (2003) where both poets are referred “as founding fathers of national ideology”, the history textbooks alluding to them as “symbols of anti-colonial resistance”. To this day, however, there has been surprisingly little academic writing in the West endeavoring to compare the works and activities of the two poets and their impact on national mobilization in Tsarist Ukraine and Georgia, even though their countries are often mentioned in a same breath by commentators on contemporary culture and politics. The paper attempts to fill this gap and tries to understand the relationship between literature and social mobilization in 19th century Russian Empire. By reflecting on Taras Shevchenko’s and Ilia Chavchavadze’s poetry, prose and social activism, I will try to explain how in different periods of Russian imperial history, the two poets helped to develop a modern form of political belonging among their compatriots and stimulated an anti-colonial mobilization with different political outcomes. To theorize on the role of poets and novelists in anti-colonial national movement, I will reflect on the writings of Benedict Anderson (1991), John Hutchinson (1994; 1999), Rory Finnin (2005; 2011) and problematize Miroslav Hroch’s (1996) three phase model of the development of national movements. Overall, the paper would aim to show the importance of, what John Hutchinson called, ‘cultural nationalists’ in understanding contemporary nationalist discourse in Georgian and Ukrainian societies.

The evidence from systematic reviews and meta-analyses published in orthodontic literature. Where do we stand?

AIM To analyse meta-analyses included in systematic reviews (SRs) published in leading orthodontic journals and the Cochrane Database of Systematic Reviews (CDSR) focusing on orthodontic literature and to assess the quality of the existing evidence. MATERIALS AND METHODS Electronic searching was undertaken to identify SRs published in five major orthodontic journals and the CDSR between January 2000 and June 2014. Quality assessment of the overall body of evidence from meta-analyses was conducted using the Grading of Recommendations Assessment, Development and Evaluation working group (GRADE) tool. RESULTS One hundred and fifty-seven SRs were identified; meta-analysis was present in 43 of these (27.4 per cent). The highest proportion of SRs that included a meta-analysis was found in Orthodontics and Craniofacial Research (6/13; 46.1 per cent), followed by the CDSR (12/33; 36.4 per cent) and the American Journal of Orthodontics and Dentofacial Orthopaedics (15/44; 34.1 per cent). Class II treatment was the most commonly addressed topic within SRs in orthodontics (n = 18/157; 11.5 per cent). The number of trials combined to produce a summary estimate was small for most meta-analyses with a median of 4 (range: 2-52). Only 21 per cent (n = 9) of included meta-analyses were considered to have a high/moderate quality of evidence according to GRADE, while the majority were of low or very low quality (n = 34; 79.0 per cent). CONCLUSIONS Overall, approximately one quarter of orthodontic SRs included quantitative synthesis, with a median of four trials per meta-analysis. The overall quality of evidence from the selected orthodontic SRs was predominantly low to very low indicating the relative lack of high quality of evidence from SRs to inform clinical practice guidelines.

Strategy and Circumstance: the Response of American Firms to Japanese Competition in Semiconductors, 1980-1995

The transistor was an American invention, and American firms led the world in semiconductor production and innovation for the first three decades of that industry's existence. In the 1980s, however, Japanese producers began to challenge American dominance. Shrill cries arose from the literature of public policy, warning that the American semiconductor industry would soon share the fate of the lamented American consumer electronics business. Few dissented from the implications: the only hope for salvation would be to adopt Japanese-style public policies and imitate the kinds of capabilities Japanese firms possessed. But the predicted extinction never occurred. Instead, American firms surged back during the 1990s, and it now seems the Japanese who are embattled. This striking American turnaround has gone largely unremarked upon in the public policy literature. And even scholarship in strategic management, which thrives on stories of success instead of stories of failure, has been comparatively silent. Drawing on a more thorough economic history of the worldwide semiconductor industry (Langlois and Steinmueller 1999), this essay attempts to collect some of the lessons for strategy research of the American resurgence. We argue that, although some of the American response did consist in changing or augmenting capabilities, most of the renewed American success is in fact the result not of imitating superior Japanese capabilities but rather of taking good advantage of a set of capabilities developed in the heyday of American dominance. Serendipity played at least as important a role as did strategy.

Anadromous Rainbow Smelt and Tomcod in Connecticut: Assessment of populations, conservation status, and need for restoration plan

(beginning of rainbow smelt executive summary) Evidence indicates that anadromous rainbow smelt (Osmerus mordax) populations in Connecticut and elsewhere in the northeast United States have severely declined. Several sampling programs have documented declines in Connecticut’s smelt populations over the last three decades (Marcy 1976a, Marcy 1976b, Millstone Environmental Laboratory 2005). Similar declines have also been documented in the Hudson River (ASA Analysis & Communication 2005) and in Massachusetts (personal communication, Brad Chase, MA Division of Marine Fisheries 2004). Recreational and commercial fisheries in the region for this species have virtually ceased (Blake and Smith 1984). The Connecticut Fish Advisory Committee of the Endangered Species Program has recommended that rainbow smelt be listed as threatened in Connecticut, and the National Marine Fisheries Service (2004) has recently listed rainbow smelt as a Federal Species of Concern. The purpose of this project is to develop an environmental history of rainbow smelt in Connecticut and surrounding regions, and document the current status of populations in Connecticut waters. An environmental history that assesses trends in abundance, environmental threats and historical efforts to ameliorate the threats will contribute to regional efforts to conserve these fish. Comprehensive review of the regional literature and trends associated with rainbow smelt has not been undertaken since Kendall (1926). Assessment of current abundance, distribution, areas of critical habitat, and whether the species is presently reproducing in state waters is critical for clarifying conservation status, designing a monitoring program and developing a recovery or enhancement plan, if this appears to be necessary. (beginning of tomcod executive summary) Atlantic tomcod (Microgadus tomcod) are believed to have declined significantly in Connecticut and other estuaries of the Northeast and Middle Atlantic states. Several monitoring programs indicate that the species is scarce and/or declining in the region’s estuaries (Gottschall and Pacileo 2004, Molnar 2004, Millstone Environmental Laboratory 2005, ASA Analysis and Communication 2005). Once-active recreational (NMFS MRFSS 2005, http://www.st.nmfs.gov) and commercial fisheries for this species in Connecticut are now dormant. For the past 10 years, the Connecticut Fish Advisory Committee of the Endangered Species Program has recommended that studies be undertaken to quantify the status of tomcod populations and to determine if conservation actions should be initiated. The purpose of this project is to develop an environmental history of Atlantic tomcod in Connecticut and surrounding regions, and document the current status of populations in Connecticut waters. An environmental history that assesses trends in abundance, environmental threats and historical efforts to ameliorate the threats will contribute to regional efforts to conserve these fish. Assessment of current abundance, distribution, areas of critical habitat, and whether the species is presently reproducing in state waters is critical for determining conservation status, designing a monitoring program and developing a recovery or enhancement plan, if this appears to be necessary.

Women in Eighteenth Century London: Female Coming of Age in Frances Burney’s Evelina, Cecilia, and The Witlings

The late eighteenth-century author Frances Burney is best known for popularizing the “comedy of manners,” a literary style later adopted by Jane Austen. Burney’s novels, journals, and plays offer an intriguing commentary on contemporary social customs and etiquette. In particular, she voices the concerns and desires of women, leading scholars to focus on the feminist overtones of her writing. Although she carefully examined female roles in the household and family structure, Burney also provided an insider’s perspective into London high life. As an acclaimed author and member of the royal court, Burney offers a rare insight into the lives of the urban elite. For these reasons, I have chosen to examine three of her works within the context of their London setting. In Evelina, Cecilia, and The Witlings, Burney examines women’s struggle for independence against the backdrop of the city. These works offer a new interpretation of the female Bildungsroman, or coming of age story. Burney shows how London life influences her heroines’ expectations, ambitions and desires. Evelina’s coming of age centers around the quest for family and social acceptance, while the two Cecilias of Cecilia and The Witlings confront the financial pressures that accompany their inheritance. Ultimately, the three protagonists learn important lessons that are specific to city life. Although Burney concludes each story with the heroine’s marriage, her focus is not on romance, as has been suggested, but on the cultural landscape of the city. Coming of age in her stories is inextricably connected to the diverse challenges and opportunities presented to urban women.

The opioid antagonist naltrexone and its pharmacological role in treating alcohol dependence: A literature review

Naltrexone, an opioid antagonist, was the second drug approved for treatment of alcohol dependence in the U.S. Its approval followed two landmark studies published in the U.S. in 1992. [1, 2] These studies showed that a combined treatment of naltrexone and behavioral therapy reduced alcohol consumption in alcoholics. Opioid antagonists decrease craving for alcohol and help to reduce drinking by blocking opioid peptide receptors in the body that are active in a dopamine chemical reward system. ^ Despite their usefulness, opioid antagonists have been underutilized. Health providers not educated in the use of opioid antagonists hold the view that opioid antagonist therapy is ineffective. However, it is apparent from the relevant literature that this therapy, when properly understood and targeted, has the potential to make a positive contribution in treating alcohol dependent patients. ^ This thesis will review the scientific literature and the present body of knowledge regarding opioid antagonists (naltrexone) and their pharmacological role in treating alcohol dependence.^