Changes in disability, physical/mental health states and quality of life during an 8-Week multimodal physiotherapy programme in patients with chronic non-specific neck pain: A prospective cohort study

Aim The aim of this study was to analyse the effect of an 8-week multimodal physiotherapy programme (MPP), integrating physical land-based therapeutic exercise (TE), adapted swimming and health education, as a treatment for patients with chronic non-specific neck pain (CNSNP), on disability, general health/mental states and quality of life. Methods 175 CNSNP patients from a community-based centre were recruited to participate in this prospective study. Intervention: 60-minute session (30 minutes of land-based exercise dedicated to improving mobility, motor control, resistance and strengthening of the neck muscles, and 30 minutes of adapted swimming with aerobic exercise keeping a neutral neck position using a snorkel). Health education was provided using a decalogue on CNSNP and constant repetition of brief advice by the physiotherapist during the supervision of the exercises in each session. Study outcomes: primary: disability (Neck Disability Index); secondary: physical and mental health states and quality of life of patients (SF-12 and EuroQoL-5D respectively). Differences between baseline data and that at the 8-week follow-up were calculated for all outcome variables. Results Disability showed a significant improvement of 24.6% from a mean (SD) of 28.2 (13.08) at baseline to 16.88 (11.62) at the end of the 8-week intervention. All secondary outcome variables were observed to show significant, clinically relevant improvements with increase ranges between 13.0% and 16.3% from a mean of 0.70 (0.2) at baseline to 0.83 (0.2), for EuroQoL-5D, and from a mean of 40.6 (12.7) at baseline to 56.9 (9.5), for mental health state, at the end of the 8-week intervention. Conclusion After 8 weeks of a MPP that integrated land-based physical TE, health education and adapted swimming, clinically-relevant and statistically-significant improvements were observed for disability, physical and mental health states and quality of life in patients who suffer CNSNP. The clinical efficacy requires verification using a randomised controlled study design.

Focus on Form : J. J. Tikkanen, Giotto and Art Research in the 19th Century

My doctoral dissertation is on Johan Jakob Tikkanen (1857 1930), the first professor of art history in Finland, and his significance and methods in the context of late 19th and early 20th-century European art history. Tikkanen was one of the pioneering scholars in the field of medieval art research, and, along with Anton Springer, Heinrich Wölfflin, Aloïs Riegl, Adolfo Venturi, Franz Wickhoff, Julius von Schlosser, Aby Warburg, Emile Mâle and others, one of the scholars who defined art history as an independent academic discipline. Tikkanen s scholarly interests and his methods resemble those of many formalistically oriented German and Austrian art historians of his time. He became well known throughout Europe, mainly for his studies on illustrated medieval manuscripts. Tikkanen s dissertation, Der Malerische Styl Giotto s Versuch zu einer Characteristik Desselben, from 1884 was regarded in its day as the best form-analytical study on the painter. It has a central position in the present thesis, as it already included nearly all the methods that Tikkanen used and elaborated upon throughout his career. Giotto also gives a good perspective for comparing Tikkanen s ideas with a long art-historical tradition. Tikkanen was profoundly interested in artistic creativity. In his own words, he wanted to study das künstlerische Können , artistic ability, instead of das künstlerische Wollen or artistic will, which was an important theoretical issue in art history in the late 19th century. This starting point led him to the history of style and iconographical research. Along with the Danish art historian, Julius Lange, he was one of the first scholars who began to study the meaning of gestures and postures in art. In my dissertation I have emphasized the importance of Tikkanen s personal art education. I regard it as having influenced both his scholarly argumentation and his working methods. I have also written a short overview of the situation of art history in Finland and in Northern Countries before Tikkanen s time in order to give an idea of his scientific background. My thesis is a critical and historiographical study on J. J. Tikkanen s role in the development of art history and its methodology.

Still in Search of the Good Life

At the 2014 G20 held in Brisbane, Australia took the position that climate change is not an economic issue. Most others thought it was - especially the Turkish Prime Minister who is hosting the 2015 G20. It is certainly an economic issue. But, it is not just an economic issue - either in the source or the solution.

The Restless Love of Thinking : The Concept Liebe in Hegel's Philosophy

The German philosopher G.W.F.Hegel (1770–1831) is best known for his idealistic system philosophy, his concept of spirit [Geist] and for his dictum that the existing and the rational overlap. This thesis offers a new perspective: it examines the working of the concept ‘love’ in Hegel’s philosophy by looking at the contexts and function he puts it to, from his earliest writings to the very last lectures he gave. The starting point of the inquiry is that he applied the concept Liebe to different contexts for different purposes, but each time to provide an answer to a specific philosophical problem. His formulation, reformulation and use of ‘love’ give possible solutions to problems the solving of which was crucial to the development of his thought as a whole. The study is divided into three parts, each analysing the different problems and solutions to which Hegel applied the concept of love. The first part, "Love, morality and ethical life", examines these interconnected themes in Hegel’s early work. The main questions he addressed during this period concerned how to unite Kant’s philosophy and the Greek ideal of the good life. In this context, the concept ‘love’ did three things. First, it served to formulate his grounding idea of the relation between unity and difference, or the manifold. Secondly, it was the key to his attempt to base an ideal folk religion on Christianity interpreted as a religion of love. Finally, it provided the means to criticise Kant’s moral philosophy. The question of the moral value of love helped Hegel to break away from Kant’s thought and develop his own theory about love and ethical life. The second part of the study, "Love and the political realm", considers the way 'Liebe' functions in connection with questions concerning the community and political life in Hegel’s work. In addition to questioning the universal applicability of the concept of recognition as a key to his theory of social relations, the chapters focus on gender politics and the way he conceptualised the gender category ‘woman’ through the concept ‘love’. Another line of inquiry is the way the figure of Antigone was used to conceptualise the differentiated spheres of action for men and women, and the part ‘love’ played in Hegel’s description of Antigone’s motives. Thirdly, Hegel’s analogy of the family and the state and the way ‘love’ functions in an attempt to promote understanding of the relation between citizens and the state are examined. The third and final part of the study, "Love as absolute spirit", focuses on ‘love’ within Hegel’s systemic thought and the way he continued to characterise Geist through the language of Liebe up until and including his very last works. It is shown how Liebe functions in his hierarchical organisation of the domains of art, religion and philosophy, and how both art and religion end up in similar structural positions with regard to philosophy. One recurrent theme in the third part is Hegel’s complex relation to Romantic thought. Another line of investigation is how he reconstructed Christianity as a religion of love in his mature work. In striking contrast to his early thought, in his last works Hegel introduced a new concept of love that incorporated negativity, and that could also function as the root of political action.

The Impact of Lifestyle and Cardiovascular Risk Factors in Midlife on the Health-Related Quality of Life among Old Men

Prevention of cardiovascular diseases is known to postpone death, but in an aging society it is important to ensure that those who live longer are neither disabled nor suffering an inferior quality of life. It is essential both from the point of view of the aging individual as well as that of society that any individual should enjoy a good physical, mental and social quality of life during these additional years. The studies presented in this thesis investigated the impact of modifiable risk factors, all of which affect cardiovascular health in the long term, on mortality and health-related quality of life (HRQoL). The data is based on the all male cohort of the Helsinki Businessmen Study. This cohort, originally of 3.490 men born between 1919 and 1934 has been followed since the 1960s. The socioeconomic status of the participants is similar, since all the men were working in leading positions. Extensive baseline examinations were conducted among 2.375 of the men in 1974 when their mean age was 48 and at this time the health, medication and cardiovascular risk factors of the participants were observed. In 2000, at the mean age of 73, the HRQoL of the survivors of the original cohort was examined using the RAND-36 mailed questionnaire (n=1.864). RAND-36, along with the equivalent SF-36, is the world s most widely used means of assessing generic health. The response rate was generally over 90%. Mortality was retrieved from national registers in 2000 and 2002. For the six substudies of this thesis, the impact of four different modifiable cardiovascular risk factors (weight gain, cholesterol, alcohol and smoking) on the HRQoL in old age was studied both independently and in combination. The follow-up time for these studies varies from 26 up to 39 years. Mortality is reported separately or included in the RAND-36 scores for HRQoL. Elevated levels of all the risk factors examined among the participants in midlife led to a diminished life expectancy. Among survivors, lower weight gain in midlife was associated with better HRQoL, both physically and mentally. Higher levels of serum cholesterol in middle age indicated both an earlier mortality and a decline in the physical component of HRQoL in a dose-response manner during the 39-year follow-up. Mortality was significantly higher in the highest baseline category of reported mean alcohol consumption (≥ 5 drinks/day), but fairly comparable in abstainers and moderate drinkers during the 29-year follow-up. When HRQoL in old age was accounted for mortality, the men with the highest alcohol consumption in midlife clearly had poorer physical and mental health in old age, but the HRQoL of abstainers and those who drank alcohol in moderation were comparatively similar. The amount of cigarette smoking in midlife was shown to have had a dose-response effect on both mortality and HRQoL in old age during the 26 year follow-up. The men smoking over 20 cigarettes daily in middle age lost about 10 years of their life-expectancy. Meanwhile, the physical functioning of surviving heavy smokers in old age was similar to men 10 years older in the general population. The impact of clustered cardiovascular risk factors was examined by comparing two subcohorts of men who were healthy in 1974, but with different baseline risk factor status. The men with low risk had a 50 % lower mortality during the 29-years follow-up. Their RAND-36 scores for the physical quality of life in old age were significantly better, and the 2002 questionnaire examining psychological well-being indicated also significantly better mental health among the low-risk group. The results indicate that different risk factor levels in midlife have a meaningful impact on life-expectancy and the quality of these extra years. Leading a healthy lifestyle improves both survival and the quality of life.

Reengaging, reenacting and reenvisaging discourses of disaster through public space performance: Austerity, art, and the art of protest

This paper offers a mediation on disaster, recovery, resilience, and restoration of balance, in both a material and a metaphorical sense, when ‘disaster’ befalls not the body politic of the nation but the body personal. In the past few decades, of course, artists, activists and scholars have deliberately tried to avoid describing personal, physical and phenomenological experiences of the disabled body in terms of difficulty and disaster. This has been part of a political move, from a medical model, in which disability, disease and illness are positioned as personal catastrophes, to a social model, in which disability is positioned as a social construct that comes from systems, institutions and infrastructure designed to exclude different bodies. It is a move that is responsible for a certain discomfort people with disabilities, and artists with disabilities, today feel towards performances that deploy disability as a metaphor for disaster, from Hijikata, to Theatre Hora. In the past five years, though, this particular discourse has begun rising again, particularly as people with disabilities fact their own anything but natural disasters as a result of the austerity measures now widespread across the US, UK, Europe and elsewhere. Measures that threaten people’s ability to live, and take part in social and institutional life, in any meaningful way. Measures that, as artist Katherine Araniello notes, also bring additional difficulty, danger, and potential for disaster as they ripple outwards across the tides of familial ties, threatening family, friends, and careers who become bound up in the struggle to do more with less. In this paper, I consider how people with disabilities use performance, particularly public space interventionalist performance, to reengage, renact and reenvisage the discourse of national, economic, environmental or other forms of disaster, the need for austerity, the need to avoid providing people with support for desires and interests as well as basic daily needs, particularly when fraud and corruption is so right, and other such ideas that have become an all too unpleasant reality for many people. Performances, for instance, like Liz Crow’s Bedding Out, where she invited people into her bed – for people with disabilities a symbolic space, which necessarily becomes more a public living room restaurant, office and so forth than a private space when poor mobility means they spend much time it in – to talk about their lives, their difficulties, and dealing with austerity. Or, for instance, like the Bolshy Divas, who mimic public and political policy, reports and advertising paranoia to undermine their discourses about austerity. I examine the effects, politics and ethics of such interventions, including examination of the comparative effect of highly bodied interventions (like Crow’s) and highly disembodied interventions (like the Bolshy Diva’s) in discourses of difficulty, disaster and austerity on a range of target spectator communities.

Non-polio enterovirus association with persistent diarrhea in children as revealed by a follow-up study of an Indian cohort during the first two years of life

Background: We recently reported significant association of non-polio enteroviruses (NPEVs) with acute diarrhea in children. Persistent diarrhea (PD) remains a major cause of morbidity and mortality in infants below two years of age in developing countries. Understanding age-dependent frequency and duration of NPEV infections is important to determine their association with persistent diarrhea and disease burden. Objectives: A cohort of 140 infants was followed for 6 months to 2 years of age to determine the frequency, duration, and association with PD of NPEV infections in comparison with rotavirus and other agents. Study design: Stool samples were collected every 14 days, and diarrheal episodes and their duration were recorded. Enteroviruses were characterized by RT-PCR and VP1 gene sequence analysis, rotavirus by electropherotyping, and other agents by PCR. Results: Of 4545 samples, negative for oral polio vaccine strains, 3907 (85.96%) and 638 (14.04%) were NPEV-negative and NPEV-positive, respectively, representing 403 (8.87%) infection episodes. About 68% of NPEV infections occurred during the first year with every child having at least one episode lasting between four days and four months. Approximately 38% and 22% of total diarrheal episodes were positive for NPEV and RV, respectively. While about 18% of NPEV infection episodes were associated with diarrhea, 6% being persistent, 13% of total diarrheal episodes were persistent involving infections by monotype NPEV strains or sequential infections by multiple strains and other agents. Conclusions: This is the first report revealing NPEVs as the single most frequently and persistently detected viral pathogen in every PD episode. (C) 2014 Elsevier B.V. All rights reserved.

Divining for meaning and searching for a female literary identity in Alice Munros Lives of girls and women and Margaret Laurences The diviners

Esta dissertação tem por objetivo investigar como Alice Munro e Margaret Laurence se apropriam de gêneros canônicos, especificamente do Bildungsroman e do Künstlerroman, para subvertê-los e representar versões diferentes do sujeito feminino através de romances de cunho autobiográfico escritos por mulheres. A investigação é focada em dois romances: Lives of Girls and Women (1971), escrito por Alice Munro, e The Diviners (1974), escrito por Margaret Laurence. No romance de Alice Munro, as estratégias de apagamento das fronteiras entre gêneros, a ideia de que perspectivas de realidade mudam de acordo com a experiência e a memória de cada indivíduo, como também a ênfase no desenvolvimento da protagonista enquanto pessoa e escritora, são assuntos amplamente discutidos. No romance de Margaret Laurence, a ênfase no aspecto subjetivo da memória, a desconstrução de estereótipos de gênero e a renegociação da representação do sujeito feminino para o alcance de uma identidade feminina autônoma na vida e na arte são os principais assuntos investigados. Em vista disso, esta dissertação visa mostrar como a representação da identidade feminina é redefinida por duas escritoras canadenses que se apropriaram de discursos dominantes para subvertê-los e, então, reescreverem suas histórias

Corporeal prisons: dynamics of body and mise-en-scène in three films by Paul Schrader

This thesis focuses on the complex relationship between representations of the human body and the formal processes of mise-en-scène in three consecutive films by the writer-director Paul Schrader: American Gigolo (1980), Cat People (1982) and Mishima: A Life in Four Chapters (1985). While Schrader’s work has typically been critiqued under the broad category of masculinity in crisis (and often as a subset of the films of his more famous long-time collaborator, Martin Scorsese), I focus on a fiveyear early period of his filmography when he sought to explore his key themes of bodily crisis, fragmentation and alienation through an unusually intense focus upon the expressive potential of film form, specifically via the combined elements of colour, lighting, camerawork and production design. By approaching these three films as corporeal character studies of troubled figures whose emotional and psychosexual neurosis is experienced in and through the body, I will locate Schrader’s filmmaking process and style within the thematic and aesthetic contexts of both his own early film criticism and the European and Japanese art cinemas that he claims as his primary influence. In doing so, I will establish Schrader’s position as a director whose literary and theological background differentiated him from his peers of the postclassical Hollywood generation, and who thus continually sought to develop his own visual literacy through his relationship with the camera and his collaborations with more overtly style-oriented film artists. But instead of merely focusing on mise-en-scène to gain a formalist appreciation of these films, I mobilise stylistic analysis as a new critical approach towards the problematic discourses of identity and embodiment that have haunted Schrader’s career from the beginning. In particular, I argue that paying closer attention to Schrader’s formal choices sheds new light on how these films – which he approached as exercises in style – repeatedly deal with the volatile and unavoidably body-oriented categories of race, gender and sexuality. In the process, I argue that a formalist attentiveness to mise-en-scène can also provide valuable cultural insights into Schrader’s oeuvre.

Quality of Life and Neurocognitive Functioning in Children with Sickle Cell Disease: Investigating the Feasibility of a Computerized Cognitive Training Program

Children with sickle cell disease (SCD) have a high risk of neurocognitive impairment. No known research, however, has examined the impact of neurocognitive functioning on quality of life in this pediatric population. In addition, limited research has examined neurocognitive interventions for these children. In light of these gaps, two studies were undertaken to (a) examine the relationship between cognitive functioning and quality of life in a sample of children with SCD and (b) investigate the feasibility and preliminary efficacy of a computerized working memory training program in this population. Forty-five youth (ages 8-16) with SCD and a caregiver were recruited for the first study. Participants completed measures of cognitive ability, quality of life, and psychosocial functioning. Results indicated that cognitive ability significantly predicted child- and parent-reported quality of life among youth with SCD. In turn, a randomized-controlled trial of a computerized working memory program was undertaken. Eighteen youth with SCD and a caregiver enrolled in this study, and were randomized to a waitlist control or the working memory training condition. Data pertaining to cognitive functioning, psychosocial functioning, and disease characteristics were obtained from participants. The results of this study indicated a high degree of acceptance for this intervention but poor feasibility in practice. Factors related to feasibility were identified. Implications and future directions are discussed.

PIANO AS A PARTNER IN TWENTIETH­ CENTURY ART SONG REPERTOIRE: A RECORDING PROJECT

The piano's role in art song repertoire has evolved from a modest one during its formative years to the versatility, complexity and creativity found in the twentieth-century. The art song repertoire of the twentieth century is vast and has secured the reputation for being the most diverse, innovative, illustrative, atmospheric and colorful in all of art song literature. Within this time period, there are compositions that reach back to the romantic works of nineteenth century, others which combine old and new traditions, and finally those which adopt new means and new ends. In choosing the material for this project, I have focused on compositions with uniquely challenging and unusual piano accompaniments in order to achieve a balance between well- known and rarely performed works, as well as those pieces that combine various languages and styles. Selections range from Claude Debussy, Richard Strauss, Sergey Rachmaninoff, Ralph Vaughan Williams, Roger Quilter, Francis Poulenc, Fernando Obradors, and Joaquin Rodrigo to composers such as Samuel Barber, Marc Blitzstein, Dominick Argento, William Bolcom, and John Duke, including arrangements of traditional spirituals by Harry T. Burleigh and Florence B. Price, all of which helped to establish the American Art Song. My objective is to trace the development of the twentieth-century art song from the late Romantic Period through nationalistitrends to works which show the influences of jazz and folk elements. The two CD's for this dissertation recording project are available on compact discs which can be found in the Digital Repository at the University of Maryland (DRUM). The performers were Daniel Armstrong, baritone, Giles Herman, baritone, Thomas Glenn, tenor, Valerie Yinzant, soprano, Aaron Odom, tenor, Jennifer Royal, soprano, Kenneth Harmon, tenor, Karen Sorenson, soprano and Maxim Ivanov, baritone.

FOLK ELEMENTS IN TWENTIETH-CENTURY HUNGARIAN MUSIC

At the beginning of the twentieth century, composers Béla Bartók and Zoltán Kodály collected thousands of folksongs from the rural regions of Hungary. In an effort to preserve a part of their culture that they feared would be lost, they not only transcribed and catalogued these folksongs, but also incorporated the folk traditions they encountered into their own compositional style. This dissertation deals with violin music written by Bartók, Kodály and their Hungarian contemporaries that have in common the use of rhythms, modes, melodies, figurations and playing techniques sourced in folk traditions. The use of the Hungarian folk idiom in classical music was not exclusive to the twentieth century. From the late eighteenth century until the first decades of the twentieth century, composers utilized aspects of a popular eighteenth-century form of Hungarian folk music called verbunkos. What makes the use of folk music unique in the twentieth century is that, thanks to the work of Bartók and Kodály, composers found inspiration in the more authentic “peasant music.” Unlike the popular, urban verbunkos music, peasant music was the product of the more secluded village-music tradition, largely untouched by the influences of city life. In addition to stimulating a new focus on peasant music, Bartók and Kodály fully assimilated the folk idiom into their compositional toolkits, creating a new style of folk-inspired art music that influenced a generation of Hungarian composers. The new style included characteristic elements of both peasant music and the verbunkos tradition, such as ancient modes and scales, accompanimental and melodic rhythmic patterns, ornamentation, and phrase structures sourced in folk song. To demonstrate the implementation of the folk idiom by twentieth-century Hungarian composers, three recital programs were given at the University of Maryland that included works by Béla Bartók, Sándor Veress, Leo Weiner, Zoltán Kodály, Ernő Dohnányi, Zoltán Székely and György Kurtág. The works can be divided into two main categories: settings or transcriptions of folk material (e.g. Bartók’s Hungarian Folksongs) and compositions using classical forms that include the Hungarian folk idiom (e.g. Bartók’s Contrasts). Recital collaborators include Li-Tan Hsu, Evelyn Elsing, Elizabeth Brown, Shelby Sender and Samantha Angelo.

A case study of pre-midlife crisis: an extraordinary transformational episode in an ordinary life

This case study explored a single in-depth narrative of an episode of crisis. The participant, an English Jewish man in his late thirties (Guy), was selected using a ‘random purposeful’ design from a sample who had previously participated in a study on the experience of crisis in pre-midlife adulthood. From a subgroup of participants chosen for giving full accounts of both inner and outer dimensions of crisis, the individual was selected randomly. Data collection comprised two interviews followed by an email discussion. The crisis occurred in Guy’s late thirties, just before the midlife transition, and so can be considered a ‘pre-midlife’ crisis. It subsumed the period surrounding leaving a high-profile banking career and a dysfunctional marriage, and the ensuing attempts to rebuild life after this difficult and emotional period. Qualitative analysis found four trajectories of personal transformation over the course of the episode: Firstly there was a shift away from the use of a conventional persona to a more spontaneous and ‘authentic’ expression of self; secondly there was a move away from materialistic values toward relational values; thirdly a developing capacity to reflect on himself and his actions; fourthly an emerging feminine component of his personality. The case study portrays an extraordinary event in the life of an ordinary man approaching middle age. It illustrates the transformative nature of crisis in ordinary lives, the dramatic nature of narrative surrounding crisis, and also illustrates existing theory about the nature of adult crises.