Multiple Sensations Research Articles

A Multidimensional Profile of Dyspnea in Hospitalized Patients

Dyspnea is prevalent among hospitalized patients but little is known about the experience of dyspnea among inpatients. We sought to characterize the multiple sensations and associated emotions of dyspnea in patients admitted with dyspnea to a tertiary care hospital. We selected patients who reported breathing discomfort of at least 4/10 on admission (10= unbearable). Research staff recruited 156 patients within 24 hours of admission and evaluated daily patients' current and worst dyspnea with the Multidimensional Dyspnea Profile; patients participated in the study 2.6days on average. The Multidimensional Dyspnea Profile assesses overall breathing discomfort (A1), intensity of five sensory qualities of dyspnea, and 5 negative emotional responses to dyspnea. Patients were also asked to rate whether current levels of dyspnea were "acceptable." At the time of the first research interview, patients reported slight to moderate dyspnea (A1 median 4); however, most patients reported experiencing severe dyspnea in the 24 hours before the interview (A1 mean 7.8). A total of 54%of patients with dyspnea≥4 on day 1 found the symptom unacceptable. The worst dyspnea each day in the prior 24 hours usually occurred at rest. Dyspnea declined but persisted through hospitalization for most patients. "Air hunger" was the dominant sensation, especially when dyspnea was strong (>4). Anxiety and frustration were the dominant emotions associated with dyspnea. This first multidimensional portrait of dyspnea in a general inpatient population characterizes the sensations and emotions dyspneic patients endure. The finding that air hunger is the dominant sensation of severe dyspnea has implications for design of laboratory models of these sensations and may have implications for targets of palliation of symptoms.

Adaptable polyionic elastomers with multiple sensations and entropy-driven actuations for prosthetic skins and neuromuscular systems

Polyionic elastomers were designed to address issues encountered by soft electronic and ionic conductors, and be applied to human–machine interactions.

Zwitterionic Skins with a Wide Scope of Customizable Functionalities.

With growing interest in the fields of wearable devices, it is crucial yet rather challenging to develop skinlike soft conductive materials with customizable functionalities and human tissue-compatible mechanical properties. Previously reported electronic skins struggle to meet the demands for transparence, mechanical adaptability, and stable conductivity during deformation. The recent rise of ionic skins with inorganic salts or ionic liquids doping provides the intrinsic stretchability, however, dilemmas remain for their limited functionalities such as a monotonous appearance and a narrow scope of mechanical and sensory properties. Herein, we design a type of zwitterionic hydrogels from the perspective of molecular interactions, which successfully combines ultrastretchability (>10000% strain), high strength (∼300 kPa), self-healability (at room temperature within 12 h), 3D printability, distinct stimuli-responsibility, biocompatibility, and antibacterial activity. The wide spectrum of such excellent properties has been rarely reported before and along with the ability to fabricate bioinspired intelligent skins recreating multiple sensations and mechanical properties of human skin, covering a broad range of sensitivity, and displaying tunable visual effect. We believe this work will inspire the programming of stimuli-responsive skinlike materials and contribute to the smart devices for information transformation between natural and artificial interfaces.

Test–retest reliability of subjective supra-threshold scaling of multiple pressure-pain sensations among healthy individuals: a study using hydraulic pressure algometry

Background: Supra-threshold scaling of multiple pressure-pain sensations involves delivery of varied stimulus intensities, either via stimulus-dependent or response-dependent manner, and recording of subjective pain ratings by participants. The focus of this study was to determine the intra- and inter-session reliability of pain intensity and pain unpleasantness ratings related to pressure-pain thresholds (PPTs) of just noticeable pain (JNP), weak pain (WP) and moderate pain (MP) among healthy individuals.Methods: Fourteen healthy participants (eight women, six men) participated in three sessions of testing at varied intervals over the course of 72 h. In session one, a multiple random staircase method using hydraulic pressure algometry was used to measure PPT of JNP, WP and MP on thumbnail bed. In session 2, ratings of pain intensity and pain unpleasantness were recorded when stimuli at levels corresponding to PPT of JNP, WP and MP were repeatedly applied before and after 20 min of no intervention.Results: Interclass correlation coefficient (ICC) values for pain ratings of JNP, WP and MP in intra-session reliability were 0.810, 0.826 and 0.881, respectively, whereas the values were 0.817, 0.792 and 0.910, respectively, for inter-session reliability. ICC values for pain unpleasantness were also highly consistent and repeatable. Temporal summation of pain intensity and pain unpleasantness were not related to the repeated application of pressure stimuli.Conclusions: The findings indicate that the pain intensity and pain unpleasantness ratings for stimuli at levels equal to the thresholds of JNP, WP and MP have good intra- and inter-session reliability.Significance: This study showed that both pain intensity and pain unpleasantness of JNP, WP and MP have good intra- and inter-session reliability and agreement. Furthermore, the temporal summation of pain or unpleasantness is not related to repeated application of pressure stimuli.Abbreviations: JNP: Just noticeable pain; WP: Weak pain; MP: Moderate pain; PPTs: pressure-pain thresholds; HPA: Hydraulic pressure algometry; MRSM: multiple random staircase method

The Thought of Music by Lawrence Kramer

Reviewed by: The Thought of Music by Lawrence Kramer Toby Young The Thought of Music. By Lawrence Kramer. California: University of California Press, 2016. [xviii, 224 p. ISBN 9780520288799 (hardcover). $70; ISBN 9780520288805 (paperback). $34.95.] Music examples, bibliography, index. “It’s disgraceful,” said Donald Trump of a piece of sculpture modelled on him, “[that] they take your tax dollars to make this filth” (Philip Kennicott, “Would Donald Trump Make Art Great Again?,” Washington Post, August 19, 2016 (https://www.washingtonpost.com/entertainment/would-donald-trump-make-art-great-again/2016/08/17/0c7300a2-60d1-11e6-af8e-54aa2e849447_story.html; accessed 5 January 2017). It is no secret that in today’s society there is a constant fear of the arts being undervalued and side-lined. This threat seems all the more ominous given the recent victory of Trump—a man who is known for deriding artists as being “lazy” or “losers”—as President-Elect (ibid.). It is in light of these circumstances that Lawrence Kramer’s recent book The Thought of Music (2016)—an epistemic study into the essence (and as such, the worth) of music—seems so utterly important. The Thought of Music forms the last part of Kramer’s epic trilogy on hermeneutics, which also includes Interpreting Music (Berkeley: University of California Press, 2010) and Expression and Truth (Berkeley: University of California Press, 2012). This series seeks to challenge models of music as inexpressible and to search for a new vocabulary to describe the multitude of ways in which music communicates. Kramer, a veritable elder statesman of (New) Musicology, approaches this monumental task with trademark flair and precision. He casts this book in seven chapters, the first three of which discuss issues of representation and language. The central fourth chapter explores the relationship between pleasure, entertainment, and value, and the final three chapters discuss extra-musical elements including context, authorship and performance. Unusually perhaps for New Musicology, there is a strong undertone here of an almost Adornian desire to seek objective meaning in the music, although such a desire is tempered by the main body of the book, which unpacks and extends the well-rehearsed argument of musical meaning as subjective, imparted by the broader sociocultural context of musicking rather than from the music itself (see for example Nicholas Cook, Beyond the Score: Music as Performance [New York: Ox ford University Press, 2013], 30–37). There is a lot to like in Kramer’s book. Particularly compelling is his discussion of the relationship between language, perception, and cultural expectation. Drawing on the work of Jacques Derrida, Kramer dedicates a substantial amount of space to a detailed discussion of the nature of music’s perceived ineffability, positing that the sociocultural context of the music “opens up” the ability of music to express linguistically (compare this with Kofi Agawu’s seminal work on the relationship or “play” between introversive and extroversive levels in Playing with Signs [Princeton: Princeton University Press, 1991], 12–25). Discussions like this form the basis of a powerful central chapter that examines the sensory force of music. In this chapter, Kramer masterfully balances discussions of beauty, desire (via Jacques Lacan), pleasure, and gratification, concluding that David Hume’s notion of “reason as the servant of passion” is still, to some extent, useful (pp. 74–5), and drives the formation of the multiple sensations of pleasure that music (and particularly musical narrative) offers (pp. 85–7). Work like this on musical sensation is still underrepresented in both musicology and philosophy, and it would be particularly interesting to see Kramer’s discussions extended into the realm of non-Western and popular music. [End Page 710] Central to many of Kramer’s arguments here are analyses—or perhaps “close readings”—of canonical works of Western art music, including pieces by Wolfgang Amadeus Mozart, Frédéric Chopin, and Franz Liszt. This typifies Kramer’s trademark approach of thinking “through” the music and certainly provides a rich palette to contextualise the more subjective elements of the discussion. One such example is the opening of Peter Ilich Tchaikovsky’s first Piano Concerto, which becomes the focus of an illuminating discussion on belonging. Kramer concentrates on two areas, the unsettled D♭ introduction...

Mental Disorder or Creative Gift?

In cases where one sense-modality is stimulated by another, we speak of synesthesia, i.e., of a subjective experience of multiple distinct sensations as being quite literally conjoined. The term “synesthesia” is derived indirectly from the Greek words “syn,” meaning “together,” and “aisthesis,” meaning “sensation.” This article focuses on the question of whether synesthesia is in fact a mental disorder or a creative gift. Both the commonsense views that have emerged in recent times, and neurological research, demonstrate that our knowledge of this relatively uncommon phenomenon is slowly but constantly expanding. Proper experimental research conducted with the right sorts of synesthete, and philosophically and scientifically nuanced conceptual studies of synesthesia, can all be helpful when seeking answers to the question posed above, while also confirming general claims about the extent to which our perceptions are really subjective. Most synesthetes see themselves as gifted, and claim that this “conjoining of the senses” enriches the quality of their lives.

High resolution skin-like sensor capable of sensing and visualizing various sensations and three dimensional shape.

Human skin contains multiple receptors, and is able to sense various stimuli such as temperature, pressure, force, corrosion etc, and to feel pains and the shape of objects. The development of skin-like sensors capable of sensing these stimuli is of great importance for various applications such as robots, touch detection, temperature monitoring, strain gauges etc. Great efforts have been made to develop high performance skin-like sensors, but they are far from perfect and much inferior to human skin as most of them can only sense one stimulus with focus on pressure (strain) or temperature, and are unable to visualize sensations and shape of objects. Here we report a skin-like sensor which imitates real skin with multiple receptors, and a new concept of pain sensation. The sensor with very high resolution not only has multiple sensations for touch, pressure, temperature, but also is able to sense various pains and reproduce the three dimensional shape of an object in contact.

Sensory submodalities testing in neurolinguistic programming, part of mental training

Abstract Introduction: this study is part of a larger work, which involves increasing sporting performance by applying mental training techniques - special techniques of neurolinguistic programming. In this case we will discuss some aspects of the test application Jacobson S. (2011). Purpose of study and hypothesis: In neurolinguistic programming (NLP) we have studied the relationship between sensory submodalities, in accordance with the Jacobson test (2011). We wanted to check the degree of significance of the mean difference parameters studied and if the materiality result falls within the objective parameters. If ideomotor representations of athletes are completed with multiple sensations of all sensory submodalities such as visual, auditory, kinesthetic, olfactory and gustatory, the possibility of applying the techniques of NLP (neurolinguistic programming) will have more effective results. Methods and material: two records were made by using two tests, test1 and test2 on master students of the University “Babes-Bolyai” Cluj-Napoca, from FEFS from APS department (training and sports performance). The statistical indicators were calculated on elements of descriptive statistics and the data is presented using indicators of centrality, location and distribution. Statistical analysis of non-parametric Wilcoxon test was used for sample pairs (data uneven distribution/rank). Materiality tests used was α=0.05 (5%), α=0.01 (1%) or α=0.001. Results and deliberations: to detect the correlation between the two variables we used the Spearman rank correlation coefficient (ρ). Statistical analysis was performed using the correlation coefficients Colton’s rule. It was found that no statistically significant differences were observed (p>0.05) in the statistical analysis of sample pairs Jacobson test values (times T1-T2). This is a result of the short timeframe - just one month - for objectives reasons. However, many of them appear in a good and a very good correlation to both tests, between the values of the items studied. Conclusions and recommendations: we want to continue with this study because the time difference between T1 and T2 was very small and we want to extend this study to a minimum of three months. All sensory submodalities are particularly important in achievingideomotor representations underlying mental training.

Restoring sensation to amputated limbs

Neuroprosthetics![Figure][1] Prosthetic hand holds cherry tomato CREDITS: (TOP TO BOTTOM) V. ALTOUNIAN/ SCIENCE ; RUSSELL LEE/RUSSELL LEE PHOTO A major challenge for amputees—even those who wear prosthetic limbs—is the loss of sensation from the missing limb. Tan et al. placed a simple electronic cuff around nerves in the upper arm of two amputees to activate the neural pathways responsible for hand sensations. The amputees could then perceive multiple natural sensations in their prosthetic hands and perform fine motor tasks such as picking up soft fruit and pulling the stalks out of cherries. Sci. Transl. Med. 6 , 257ra138 (2014). [1]: pending:yes

Tourism as a territorial strategy: The case of China and Taiwan

This paper examines the cultural and territorial politics of the rapid post-2008 growth in tourism from the People’s Republic of China (PRC) to Taiwan. Additionally, this paper presents an innovative theoretical argument that tourism should be viewed as a technology of state territorialization; that is, as a mode of social and spatial ordering that produces tourists and state territory as effects of power.Based on fieldwork conducted in Taiwan in 2012, it explores the engagement of PRC tourists with Taiwanese hosts, political representations of Taiwan and China, the territorializing effects of tourism, the production of multiple sensations of stateness, and the possibility that tourism is aggravating contradictions between the different territorialization programs of China and Taiwan.

Dizziness in an older community dwelling population: A multifactorial syndrome

The aim of this study was to determine the prevalence and related predictors of dizziness in a sample of community-dwelling people 65 years of age and older living in a metropolitan area in Germany. Prospective cohort study. Interdisciplinary Centre of Gerontology at the University of Erlangen- Nuremberg, Germany. 6000 people aged 65 years and older recruited and randomized from the registration office, 1801 were fully evaluated at baseline and were re-evaluated in a prospective follow-up two years later. A full data set was obtained for 620 participants, of which 297 (47.9%) were females. Mean age was 73.45 +/- 6.05. 200 participants (32.4%) were 65-69 years, 315 (51%) were 70-79 years, 92 (14.9%) 80-89 years and 11 (1.8%) 90 years and older. Demographic, medical, functional and psychological factors were measured by a standardised questionnaire in 2004. In a follow-up survey participants were reevaluated in a prospective design two years later (2006), including a dizziness questionnaire, containing frequency, duration, space of dizziness and releasing positions and activities. At the second measurement 181 persons (29.2%) reported dizziness in the last 6 months. Dizziness was age dependent, with a prevalence of 27% in participants aged 70 years and younger, up to 54% in the group of 90 years and older. 96 (68.2%) persons reported daily or weekly dizziness. 46 (27.9%) participants reported multiple sensations of dizziness. In 108 (59.7) persons dizziness was released by multiple positions or activities. The main predictors of dizziness were age, female gender, cardiovascular disease, osteoporosis, depression, sleep disorder, disturbance of memory, shortsightedness (defined by glasses), incontinence, 3 and more medical conditions, 4 and more medications, poor health status, falls and mobility problems. We found similar risk factors for dizziness and falls. Dizziness is a very common symptom in older community dwelling persons. Comorbidity, poor health status and mobility problems are strong medical predictors; age and female gender and decline in mobility are important predictors as well. Our study suggests, that dizziness in older age is often caused by multifactorial medical and functional conditions. Gait disorders and mobility problems also seem to play an important role in dizziness among older people. Therefore, interventions in dizziness should be developed in a multifactorial way. We suggest, that the interventions to be tested first, should be those that have been previously successful in older persons with gait disorders and falls.

Sight, sensibility, simulation: Tomás Eloy Martínez’s El vuelo de la reina

This article traces the inscription of Deleuzian concepts on the texture and style of El vuelo de la reina. ‹Becomings’ and ‹lines of flight’ condition a text notable not for its intellectual ideas but for its portrayal of multiple sensations and intensities: here Martinez is the writer of vitality rather than the writer of textuality as he was in his earlier novel, Santa Evita (1995). One of the protagonists, the newspaper editor, Camargo, representing danger, flux and volatility, is associated with both larva and lava, twin images that recur in the text. Camargo, the obsessive voyeur, experiences his self as divided and his failure to exert total control over his lover, Reina, gives rise to his paranoid suspicion of her. His penetrative gaze is augmented by mechanical means (telescope, camera, binoculars and magnifying glass); but, instead of holding Reina prisoner, he himself becomes a prisoner to his own obsession. He is finally reduced to dependence on his wife, Brenda, whom he had previously discarded. Martinez’s bodily language suggests the ‹becoming-sensation’ of language. Martinez constructs a universe of parallel lines, marked by ‹hot spots’ of contagion. Reina’s own metamorphoses include that of ‹becoming animal’. Her trajectory exemplifies Deleuze’s ‹lines of flight’, her final flight brutally terminated by Camargo as his virulent masculinity snuffs out her vibrant, molecular existence. This is a Deleuzian text with Peronist undertones: Camargo and Reina can be seen as blurred portraits of Peron and Eva. Peronism continues to spread its infectious power throughout Argentina, most spectacularly represented by Eva’s multiple becomings. But, in addition, the text’s internal mirroring recalls Borges. El vuelo de la reina is marked not by a single debt to one overarching influence but rather by the ebb and flow of multiple currents: Deleuzian, Peronist and Borgesian.

Sensory Neuroscience: From Skin to Object in the Somatosensory Cortex

Humans can perceive the shape of objects by touch alone, by extracting geometric features such as edges. Recently recorded responses of single neurons in the secondary somatosensory cortex of monkeys suggest how the brain integrates tactile shape information across different regions of skin and builds up a representation of tactile objects.

Sensory Mediated Dissociation Affects RPE and Ride Time to Fatigue in Trained Cyclists

Cognitive dissociation from exercise strain, mediated through a variety of sensory signals such as listening to music, has been reported in the literature when the exercise load is light to moderate and the subject sample is fit but not well trained. PURPOSE: This project investigated dissociation from exercise strain in trained cyclists during high intensity work and its influence on high intensity cycling to fatigue. METHODS: Ten cyclists (Mean ± SE: Age = 33.1 ± 3.2 years, VO2max 4.96 ± 0.2 L/min, 40km time 59.7 ±1.4 min) completed four 15-min cycle trials (80% VO2max.) under music (M), video (V), normal (N) and deprived (D) conditions (Latin-square ordering). RPE (Borg's 6–20) and HR were recorded at 5-min intervals. Cyclists then completed high intensity cycle rides to fatigue under the same four conditions. RPE and HR were recorded throughout and time to fatigue, average speed, and distance completed was recorded at the end of each trial. Repeated-measures ANOVA'S assessed the significance of any changes observed. RESULTS: In general, exercise RPE was lower in the music condition and higher in the deprived condition than other conditions and the differences among the four conditions increased over the 15-min exercise duration (conditions x time P = 0.01). HR was not different among conditions but did increase by 10% (15 bpm) over the 15 min. (P <0.01). Cycling times to fatigue and distances completed were −10.5%, +12.6%, and +21.6% for D, V, and M conditions respectively when compared to N (73.4 ± 6.3 min; 46.5 ± 4.4 km) (P = 0.01); however, average speed was not different among conditions (37.7 ± 0.6 kph). CONCLUSIONS: The characteristics of the exercise environment impacted the perceptual responses to high intensity exercise in trained cyclists which is in contrast to previous observations for similar work intensities using untrained subjects. Ride times to fatigue were longer under V and M conditions supporting a temporal extension of the observations made over the shorter 15-min exercise bout. These data suggest that psychometric components contribute substantially to factors that limit prolonged exercise. The data also support information-processing models that hypothesize competition among multiple sensations from both endogenous and exogenous sources for attentional focus.

The distinctiveness of ionic and nonionic bitter stimuli

The diverse chemical structures of stimuli that are bitter to humans suggest a need for multiple bitter receptors. Reactions of golden hamsters (Mesocricetus auratus) to 1 mM quinine hydrochloride, 3 mM denatonium benzoate, 180 mM magnesium sulfate, 30–100 mM caffeine, and 1–1.5 mM sucrose octaacetate (SOA) were studied to address whether there are multiple sensations elicited by bitter stimuli. Methods included behavioral generalization of LiCl-induced conditioned taste aversions (CTAs), intake preference tests, and electrophysiological recordings from the chorda tympani (CT) nerve. The five compounds, all bitter to humans, were all innately aversive to hamsters. CTA for the ionic quinine·HCl, denatonium benzoate, and MgSO4 mutually cross-generalized and these ionic compounds were effective CT stimuli. Yet, the hamsters were much less sensitive to denatonium than humans, requiring a 100,000 times higher concentration for detection. CTA for nonionic caffeine and SOA did not cross-generalize to quinine or the other two ionic stimuli and these nonionic compounds were not effective CT stimuli. SOA and caffeine may elicit aversive reflexes or systemic reactions rather than taste sensations in the animals. Thus, the three ionic and two nonionic compounds form separate aversive stimulus classes in hamsters, neither of which appears to be a close homologue of the human bitter taste.

Noxious cold evokes multiple sensations with distinct time courses

A noxious cold stimulus can evoke multiple sensations each occurring with a different time course. We have performed psychophysical studies to identify the time course of five sensations evoked by a noxious cold stimulus applied to the hand. Subjects continuously rated either pain, ache, cold, heat or prickle sensations throughout repeated presentations of a noxious cold stimulus (3°C) from a neutral (32°C) baseline. Separate runs were used to assess each of the five types of sensation. Cold was reported throughout the period of cooling. The time course of pain and ache sensations were similar. However, prickle and heat sensations had time courses that could be distinguished from each other, and from ache and pain. Identification of these temporal profiles could provide clues to their underlying mechanisms. The temporal dissociation of these sensations will also enable neuroimaging studies of the cortical mechanisms associated with these sensations. Thus our results constitute a first step toward identifying the distinct modes of neural activity associated with different types of pain sensation.

Viajantes-naturalistas no Brasil oitocentista: experiência, relato e imagem

As concepções sobre o modo de fazer ciência que privilegiam o trabalho de campo ou o de gabinete coexistem no século XIX. Os naturalistas que vieram ao Brasil haviam feito a opção de "ver com os próprios olhos". Nas grandes expedições científicas, os viajantes buscam dar conta das sensações e impressões experimentadas durante sua estada no Brasil não só utilizando o desenho e a pintura, mas também fazendo ricas descrições textuais. Para grande parte dos naturalistas do século XIX, a multiplicidade de sensações que envolvem o naturalista em sua viagem poderia e deveria ser descrita pela ciência. Assim, o cientista que se faz viajante escolheu não apenas ver com os próprios olhos, mas ouvir e sentir com o próprio corpo os fenômenos lá onde acontecem. Porém, o viajante romântico, se por um lado produzia ciência in loco, por outro, acabou se especializando no registro preciso de sensações e fenômenos, em consonância com os métodos científicos estabelecidos na época.

Human thalamic nucleus mediating taste and multiple other sensations related to ingestive behavior.

Until now, taste was the only primary sensory modality for which the human central nervous system pathways were unknown. We report sensations evoked by stimulation at microampere current levels in the region of the human thalamic nucleus (ventralis caudalis parvocellularis internis) corresponding to the monkey taste relay nucleus. Stimulation in this region during awake neurosurgical procedures evoked special visceral/somatic (taste/pungent smell), general visceral (fullness of a hollow viscus), as well as painful and nonpainful general somatic sensations. General somatic or visceral sensation was evoked by stimulation at 80% of sites where special visceral/somatic sensation was evoked. These results suggest that primate taste relay mediates multiple sensations in addition to taste.

Down from Troy: A Doctor Comes of Age (review)

128 BOOK REVIEWS the multifactorial etiologies of disease or fiction, and the inability of any one schema to encompass all that might occur. In summary, Vital Signs fulfills some of the urgent needs of literature and medicine as a discipline through its rigorous historical and intellectual scholarship, its perceptive close readings of several texts in the canon of literature and medicine, and its challenging assertions of the intimacy between clinical medicine and realism. Had the author more experience with medicine, he might have avoided some of the unfortunate overstatements that cloud his arguments. As I was reading the text, the paper closest to hand for a bookmark was a copy of an electrocardiogram of a woman whose atrial fibrillation, an abnormal heart rhythm, had recently been converted to normal sinus rhythm, a healthier state for her heart. The sight of the tracing evoked multiple sensations: an initial flush of victory in having brought about the conversion to normal sinus rhythm, an instantaneous reliving of all aspects of what had been a complicated and draining hospitalization, and then the recollection of alarm experienced earlier on noting an abnormally prolonged interval in the tracing, something most likely caused by the medical treatment. That is, the medical text not only contained disembodied pathological information about the corporeal fact of the patient, but also biographical material about her internist. If Rothfield could realize the depth of medical practice, the extent to which the physician inhabits nonironic corners of the universe, and the intimacy that doctor and patient can achieve, perhaps he could make even more lasting contributions to this field. —Rita Charon Columbia University Richard Selzer, Down from Troy: A Doctor Comes of Age. New York: William Morrow, 1992. 288 pp. Clothbound, $20.00. As a prelude to my reactions to Down from Troy, I would like first to describe my perceptions of Richard Selzer's writing in general. To begin, I suspect that response to Selzer's work tends to separate his readers into two camps. Many find his writing overworked and flowery. For them, his use of language is too rich; it is too "literary." These readers like their prose focused, tight, and do not wish to struggle with meta- Book Reviews 129 phorical flights of fancy. They see the purpose of writing to be direct communication in as clear a fashion as possible, and they do not esteem anything that interferes with this directness. This type of writing occupies an essential place in many dimensions of our personal and professional lives. Many aspects of medical discourse must be simple, direct, and objective so that factual information can be communicated easily from one practitioner to another. As a scientist, I usually place high value on prose that is simple, descriptive, and direct. Despite the necessity for concise, nonmetaphorical prose in human affairs, however, the human condition would be very poor indeed if all our written work were so constructed. Humanity is such a complex state of being that the concise prose of science is often inadequate to capture humanistic essence. Recognizing this, the second camp of Selzer's readers delights in the literary and metaphorical complexity of his writing style, believing that he has done much to illuminate and clarify the fundamental complexity of our shared humanity. Like many others, I have always been awed by Selzer's breadth of cultural understanding and his often brilliant use of language. He is a writer able to create words, images, and metaphors that capture the essence of what it means to be human. At his best, Selzer can finely balance the essence of both writing styles. Some of his stories, such as "The Consultation" or "Brute," demonstrate lean and precise prose that quickly conveys powerful messages about both doctors and medicine. Much of his other work, however, is more complex and requires greater engagement from the reader. This requirement for engagement is illustrated by his essay "Abortion." Although Selzer himself holds a "pro-choice" position in the abortion controversy , I believe that this essay is one of the best antiabortion statements ever put to paper. It is a complex and convoluted essay, with many seeming stops, starts, and diversions. Nevertheless, in it Selzer does...

Distinguishable Types of Dyspnea in Patients with Shortness of Breath

Dyspnea frequently accompanies a variety of cardiopulmonary abnormalities. Although dyspnea is often considered a single sensation, alternatively it may encompass multiple sensations that are not well explained by a single physiologic mechanism. To investigate whether breathlessness experienced by patients represents more than one sensation, we studied 53 patients with one of the following seven conditions: pulmonary vascular disease, neuromuscular and chest wall disease, congestive heart failure, pregnancy, interstitial lung disease, asthma, and chronic obstructive pulmonary disease. Patients were asked to choose descriptions of their sensation(s) of breathlessness from a dyspnea questionnaire listing 19 descriptors. Cluster analysis was used to identify natural groupings among the chosen descriptors. We found that patients could distinguish different sensations of breathlessness. In addition, we found an association between certain groups of descriptors and specific conditions producing dyspnea. These findings concur with those in an earlier study in normal volunteers in whom dyspnea was induced by various stimuli. We conclude that different types of dyspnea exist in patients with a variety of cardiopulmonary abnormalities. Furthermore, different mechanisms may mediate these various sensations.