Narrative Commentary Research Articles

Tryptophan and Membrane Mobility as Conditioners and Brokers of Gut–Brain Axis in Depression

The aim of this brief narrative commentary is to discuss some aspects involved in depression. It is increasingly evident that the phenomenon of mood disorders, despite its unequivocal genetic origin, slips into a multifactorial set of biochemical and molecular events that involve the whole organism. A vast literature has provided evidence that recognizes changes in serotonergic neurotransmission in the pathophysiology of depression. In addition, an increased arachidonic acid/omega-3 fatty acid ratio, which confers to mammalian cell membranes their fluidity, is associated with the depressive state. The combination of the excessive expression of kinurenine and the increased fluidity of the membrane has never been considered in the meaning of a simultaneous effect in the determinism of the depressive condition. Furthermore, various evidence supports the relationship between intestinal microbiota and depression and confirms alterations in the microbiota in depressive pathology.

The idealist and pragmatist view of qi in tai chi and qigong: A narrative commentary and review

Qi, often translated as “vital energy,” is a central concept in tai chi and qigong that has puzzled physicians, scientists, and people in the West. To date, qi is not falsifiable by the scientific method and thus cannot be subject to scientific inquiry, leading many to criticize it as “pseudoscientific.” Even as medical research reveals the health benefits of tai chi and qigong, many wonder how to treat this seemingly outdated concept when promoting these meditative practices. While some tai chi and qigong practitioners insist on the existence of qi, more skeptical thinkers suggest that a scientific understanding should replace this “superstitious” idea. Integrative health professionals must be equipped to discuss this concept intelligently by considering a couple of subtle, clarifying points often missing from the discussion. First, science’s inability to verify qi’s existence does not affirm its nonexistence. In fact, under the philosophical system of idealism, qi might not be said to be less real than things that are verifiable by science. Similarly, under the instrumental and pragmatic view of science, health professionals should be cautious not to declare what is metaphysically real or unreal but instead what is useful and not useful. Second, even though qi may be pseudoscientific, it remains useful and indispensable to the correct practice of tai chi and qigong. Tai chi and qigong practitioners routinely visualize and perceive the flow of qi to guide their movements, breathing, and mental activity. As such, qi and related metaphysical concepts serve as a useful mental model during practice, and belief in them may be viewed as an “expedient means” to achieve one’s health goals.

Risk communication during the COVID-19 pandemic: lessons for lifestyle interventions in cardiovascular prevention

Lifestyle is a cornerstone of cardiovascular prevention and the process of risk communication constitutes an important step to obtain favorable changes in daily habits. Nevertheless, there is no definite consensus on how health operators should provide information on cardiovascular risk, and several models have been proposed in different settings. The current COVID-19 pandemic - with related communication strategies to reduce the spread of the disease and morbidity - may offer an interesting opportunity to reconsider communication in cardiovascular prevention: even though cardiovascular conditions are not communicable diseases, both COVID-19 and cardiac illnesses force a huge segment of the population to major lifestyle changes. This narrative commentary describes similarities between these conditions, mainly focusing on modalities of risk communication, strategies to counteract fake news, actions to enhance the expertise of health operators, and finally on new skills that could derive as a lesson from COVID-19.

Music and sound in documentary film communication: an exploration of Une Affaire de Nègres and Chef!

This paper examines the function of music and sound as important elements of documentary film communication. It considers the soundtrack to have equal value as the visual track. This is even more appalling when sound is viewed as an aesthetic constituent of a film or as acoustic signs with equal communicative value as visual signs. Two films are used to show the role music and sound play in facilitating comprehension in a documentary film. Focusing particularly on testimonies, narrative commentary, filmic silence and music, the study shows how documentary films provide a unique medium to engage an audience in a story of facts and provides a unique vehicle for information transmission. The success of these two films among mainstream audiences indicates the power of a thoughtful and intentional soundtrack which accentuates the subject without dictating it and provides examples of a utilisation of music to build an emotional connection between the audience and the film’s subject matter.

Root caries: the intersection between periodontal disease and dental caries in the course of ageing.

Caries and periodontitis are the primary non-communicable oral diseases among elderly individuals. The burden of the disease increases with ageing, particularly as the elderly are tending to retain more teeth due to improvement of oral health measures and increased life expectancy. Root caries represents itself as an overlapping pathology, but not necessarily a summation of the two diseases. This narrative commentary discusses the cross-boundary nature of root caries, a periodontal-cariological condition, taking into account the multi-morbidities of ageing. The evidence includes epidemiological and pathophysiological features of root caries, and specific influencing factors of ageing, such as xerostomia, polypharmacy, functional and cognitive impairment and oral ecological alterations. Active or previous history of periodontal disease poses a risk for root caries, whereas the systemic co-morbidities of ageing may also increase the susceptibility to this pathology. It is plausible that root caries is the net outcome of coexisting risk for these conditions. There exists no standardised system for risk assessment and diagnosis that takes into account the interactive effect of caries, periodontitis and the constellation of age-specific influencing factors. As restorative treatment is challenging, cost-effective prevention and diagnosis methods are needed for vulnerable elderly populations. These may include improved clinical registration methods and establishment of individualised prevention and treatment protocols.

Musical interpretation of Hezekiah’s illness in Johann Kuhnau’s Biblical sonata

The article discusses Johann Kuhnau’s fourth keyboard sonata, Der todtkranke und wieder gesunde Hiskias (The Mortally Ill and Then Restored Hezekiah), from his last volume of six keyboard sonatas published in Leipzig in 1700, known popularly as “Biblical Sonatas.” Titled as Musicalische Vorstellung einiger biblischer Historien (Musical Representation of Several Biblical Stories), the set presents a remarkably thorough and detailed musical depiction of selected scenes from the Old Testament. This is also a rare collection of keyboard music to provide a detailed narrative commentary, consisting of verbal synopses of selected stories in German, which preface each sonata, and commentaries in Italian written into notation, which underline portrayed situations, events and affections. To examine the plot-based narrative underlying the storyline of this particular sonata, some authentic discourses have been taken into consideration for analytical purposes. These included the composer’s foreword to the collection of his “Biblical Sonatas,” synopsis of the story depicted in the fourth sonata, and a comprehensive theory of musical rhetoric and the doctrine of the affections found in various 17th and 18th century sources. In this article, the author specifies distinct musical-rhetorical figures that resemble (by analogy) or refer to certain extra-musical objects or phenomena and serve as vehicles for creating different moods and establishing the atmosphere. Depending on which narrative element – action or affections – is brought into focus in each of the six sonatas, the author distinguishes between two types of sonatas, namely ‘action sonatas’ and ‘affective sonatas.’ Affections and shifts in mood experienced by Hezekiah make an important narrative element in the storyline of the fourth sonata. Hence this particular sonata falls under the category of ‘affective sonatas.’ The analysis of this sonata revealed that the narrative is constructed therein in several layers. Firstly, there is a verbal layer: to depict the story in detail and with much consistency, the composer thought it necessary to accompany notation with the synopsis of the story and verbal commentaries. Moreover, quotations from the Protestant chorale Ach Herr mich armen Sünder (Ah Lord, poor sinner that I am) imply verbal connotations of their verses. Secondly, it contains a musical-affective layer: musical devices (such as musical-rhetorical figures, key, rhythm, metre, and the like) are employed there to convey the indicated affections, such as wailing (lamento) or, in other words, sorrow, confidence (confidenza) and joy (allegrezza). The author observes that many compositional choices made by Kuhnau adhere to the standard methods of expressing affects as they were defined in the Baroque treatises. Thirdly, there is an associative layer: certain fragments and elements resemble (by analogy) and refer to extra-musical objects and/or phenomena, such as Belshazzar’s face turning pale and his limbs trembling in terror, the sesquialtera ratio (3:2), which symbolizes the numerical proportion of steps on Ahaz’s sundial and the years of Hezekiah’s life. The alternating musical textures, normally associated with sadness (adagio) and merriment (allegro), can be also mentioned as a characteristic narrative feature in this sonata. Although Kuhnau claimed to have depicted Biblical stories according to his own imagination, the analysis revealed that his writing in this sonata does not veer away from the typical musical vocabulary of the Baroque era, which nowadays requires a more sensitive ear and keener insight into compositional conventions of the period.

Retrieving, classifying and analysing narrative commentary in unstructured (glossy) annual reports published as PDF files

We provide a methodological contribution by developing, describing and evaluating a method for automatically retrieving and analysing text from digital PDF annual report files published by firms listed on the London Stock Exchange (LSE). The retrieval method retains information on document structure, enabling clear delineation between narrative and financial statement components of reports, and between individual sections within the narratives component. Retrieval accuracy exceeds 95% for manual validations using a random sample of 586 reports. Large-sample statistical validations using a comprehensive sample of reports published by non-financial LSE firms confirm that report length, narrative tone and (to a lesser degree) readability vary predictably with economic and regulatory factors. We demonstrate how the method is adaptable to non-English language documents and different regulatory regimes using a case study of Portuguese reports. We use the procedure to construct new research resources including corpora for commonly occurring annual report sections and a dataset of text properties for over 26,000 U.K. annual reports.

#freemind: Young Women Using Mindfulness Meditation to Cope with Life in a Juvenile Justice Institution.

The purpose of this study was to introduce mindfulness meditation, a recommended adjunctive treatment for trauma in juvenile justice-involved youth, to incarcerated young women and collect narrative commentary about their experiences to answer the following research questions: What is the experience of incarcerated young women who participate in Internet-based mindfulness meditation classes? How do incarcerated young women apply mindfulness meditation to life in a juvenile justice facility? Participants attended bi-weekly guided meditation sessions and wrote about their experiences after each session in a journal. Three coders used open-coding content analysis to identify topics and themes across 38 journal entries. The primary theme, found in 61% of entries, described the difficulties of living in a juvenile justice facility, providing context for the descriptions found in 58% of entries regarding the usefulness of mindfulness meditation to cope with those difficulties. This study highlights the challenges of living in a correctional institution as a young woman and the barriers such settings pose to the wellbeing and healthy development of their residents. It also points to mindfulness meditation as an operative method of supporting these highly traumatized young women until that time when alternatives to incarceration can be identified.

The Covert Inducer: Narrative Commentary of Marijuana in the 21st Century and its Connection to Psychological Disorders

Research into Cannabis induced psychosis and marijuana’s effect on pre-existing mental disorders has been underway for several decades. However, many of these findings have surfaced in the U.S. over the last 15 years. Most of the information includes endogenous cannabinoid receptors in the brain, facts recently discovered, and more scientific evidence is needed to fully understand their role in Cannabis induced psychosis. Because cannabinoid receptors are neuromodulators, neurotransmitters are involved and how these are affected has yet to be discovered. Based on current understanding of neurotransmitters, the central nervous system, and mental disorders, this narrative review explores possible mechanisms of Cannabis induced mental disorders from a toxicological, pharmacological, and psychological perspective. This review also discusses the myth that no long-term ailments or illnesses arise from Cannabis use. It also illustrates why it is important to consider the potential consequences of legalizing Cannabis due to costly impacts on society with respect to public health and safety. Additionally, the author shares an experience observing an individual suffering from a mental disorder whose increased marijuana use led to more frequent, and dangerous, manic episodes.

Testimony and Fictionality in Georgy Demidov’s Gulag Stories

Georgy Demidov’s Gulag stories were published belatedly, in the new millennium, and have acted as a timely reminder of the suffering and death of great numbers of innocent people in the camps. This article attempts to explain the literary qualities of Demidov’s Kolyma stories as well as the way in which, despite their fictionalized plots, they can be read as works of testimony. Comparing Demidov’s narrative techniques with those of his contemporaries, Aleksandr Solzhenitsyn and Varlam Shalamov, whom the sad history of the manuscripts had turned into his precursors, I focus on the significance of Demidov’s choice of extraordinary rather than typical characters and plots, his ample use of narrative commentary, and his gearing up narrative time to cognitive rather than experiential response of the audience. Judging by an implicitly autodescriptive touch in a story devoted to an artist who perished in the camps, the use of fictionalization in attesting to camp experience was not a calculated choice on Demidov’s part but a genuine product of the workings of his literary imagination.

Examining the Effects of Narrative Commentary on Evaluators' Summative Assessments of Resident Performance.

Anchor-based, end-of-shift ratings are commonly used to conduct performance assessments of resident physicians. These performance evaluations often include narrative assessments, such as solicited or "free-text" commentary. Although narrative commentary can help to create a more detailed and specific assessment of performance, there are limited data describing the effects of narrative commentary on the global assessment process. This single-group, observational study examined the effect of narrative comments on global performance assessments. A subgroup of the clinical competency committee, blinded to resident identity, assigned a single, consensus-based performance score (1-6) to each resident based solely on end-of-shift milestone scores. De-identified narrative comments from end-of-shift evaluations were then included and the process was repeated. We compared milestone-only scores to milestone plus narrative commentary scores using a nonparametric sign test. During the study period, 953 end-of-shift evaluations were submitted on 41 residents. Of these, 535 evaluations included free-text narrative comments. In 17 of the 41 observations, performance scores changed after the addition of narrative comments. In two cases, scores decreased with the addition of free-text commentary. In 15 cases, scores increased. The frequency of net positive change was significant (p = .0023). The addition of narrative commentary to anchor-based ratings significantly influenced the global performance assessment of Emergency Medicine residents by a committee of educators. Descriptive commentary collected at the end of shift may inform more meaningful appraisal of a resident's progress in a milestone-based paradigm. The authors recommend clinical training programs collect unstructured narrative impressions of residents' performance from supervising faculty.

The Emotional Cost of Caring for Others: One Pediatric Hospital's Journey to Reduce Compassion Fatigue.

This study examined the prevalence of compassion fatigue and life stress of pediatric nurses. Distressing patient situations over time may affect nurses' professional quality of life and result in compassion fatigue. If not addressed, compassion fatigue may have personal and organizational consequences. Using a descriptive, correlational design, a convenience sample of 268 nurses completed a web-based survey. High compassion satisfaction and moderate to low burnout and secondary traumatic stress were described by 49% of participants. Education was statistically associated with burnout and secondary traumatic stress. Life stress scores were significantly associated with age, experience, organizational tenure, and professional engagement. Narrative commentary yielded 5 themes: staffing, recognition, boundaries, expectations, and hopelessness. Organizational initiatives to prevent or mitigate compassion fatigue focused on awareness, balance, and connections. Nurses are negatively impacted by the emotional cost of caring. Future studies need to identify interventions to minimize compassion fatigue.

The potential and perils of prognosticating persistent post-traumatic problems from a postpositivist perspective

Background ContextPredicting recovery after traumatic neck pain has become an active area of research but is moving in several different directions with currently little consensus on the important outcomes to predict or relevant variables to predict them. PurposeThis editorial explores the current state of prognostic (risk)-based tools or algorithms for predicting the likelihood of chronic problems after acute axial trauma, with a focus on traumatic neck pain (ie, whiplash-associated disorder). Study Design/SettingThis paper has an editorial study design. MethodThis is a narrative commentary. ResultsPrognostic efforts have value in guiding clinical decision-making and optimizing resource allocation to those at highest risk while minimizing iatrogenic disability for those at lower risk, but there are also several important caveats that should be observed when applying and interpreting the results of such tools. These include the biases associated with predicting outcomes based on findings from a single administration of a tool, inappropriate assumptions of causality, assumptions of linear relationships, and inability to consider the unique individual traits and contexts of patients that likely interact with clinical variables to influence the actual degree of risk they impart. ConclusionsThe paper concludes with a brief overview of trends that are likely to dramatically change the field, including creation of large clinical databases and big data analytics.

Landscapes as Narrative Commentary in Cormac McCarthy’s Blood Meridian or the Evening Redness in the West

This study argues that in Blood Meridian (1985) McCarthy creates landscape scenes that function as narrative commentary on the Glanton gang’s Indian-fighting, on America’s pursuit of Manifest Destiny, and on humanity’s innate aptitude for violence. The article surveys the biographical evidence for McCarthy’s interest in the visual arts, then inventories the language of art in Blood Meridian and explores the novel’s allusions to specific artworks. It culminates in readings of several scenes in which the narrator interprets the landscape before him in moments of sober contemplation. Each of these scenes bears a title reminiscent of painted landscapes, such as “Under the Animas peaks” or “Night scene with moon, blossoms, judge.” Each comprises a static composition that slows the violent action and also functions as a prose poem, rich in allusiveness. Evoking in the reader the perceptual and interpretive modes of a pensive viewer of a painted landscape, these scenes invite us to apply techniques drawn from art criticism to comprehend them as the narrator’s sober meditations on the Glanton gang’s violent enterprise.

The Medical Humanities Effect: a Pilot Study of Pre-Health Professions Students at the University of Rochester.

Qualitative and quantitative research on the impact of medical and health humanities teaching in baccalaureate education is sparse. This paper reviews recent studies of the impact of medical and health humanities coursework in pre-health professions education and describes a pilot study of baccalaureate students who completed semester-long medical humanities courses in the Division of Medical Humanities & Bioethics at the University of Rochester. The study format was an email survey. All participants were current or former baccalaureate students who had taken one or more courses in literature and narrative in medicine, bioethics, history of medicine, and/or visual arts and healthcare during the past four years. The survey gathered numerical data in several areas: demographic information, career plans, self-reported influence of coursework on educational and career plans, and self-reported influence of coursework on intellectual skills and abilities. It also gathered narrative commentary that elaborated on students' responses to the numerically-based questions. Notable findings from preliminary analysis of the data include higher scores of self-reported impact of the coursework on specific habits of mind and on preparedness for intended career rather than on gaining admission to future educational programs. Discussion of the results focuses on several potential future directions this type of study might take, including multi-center, longitudinal, and sequential approaches.

Desocupado Lector: Cervantes, Poetry, and the Idle Reader

The following script is a celebration of the poetry of Miguel de Cervantes (1547-1616), as found in his narrative and dramatic works. The narrative commentary is by Edward Friedman, the poetry by Don Miguel. The original performance was a one-man show that featured a bilingual professional actor. The second performance was by nine graduate students in the Department of Spanish and Portuguese at Vanderbilt University. The version here is that of the first performance

Did It Matter That the Cancer Drugs Fund Was Not NICE? A Retrospective Review

BackgroundThe Cancer Drugs Fund (CDF) will have spent more than £1 billion between October 2010 and the introduction of reforms to its structure and operations in July 2016. There has been much more debate about the existence of the fund than about how it spent its substantial budget. It is important to undertake a retrospective examination of “where the money went” in light of the substantial reforms that will be introduced in 2016. ObjectivesWe review the means by which the CDF made recent funding decisions for cancer drugs to provide an assessment of the merits of the CDF “model” as a basis for allocation decisions. We assess the extent to which proposed reforms could overcome defects in the original CDF model of prioritization, and lessons for other countries. MethodsWe provide a narrative commentary on CDF’s methods and processes since 2014. We evaluate methods against best practice in cost-effectiveness analysis, and processes against the “accountability for reasonableness” framework. We comment on reforms to the fund. ResultsThere are no grounds for concluding that the opportunity costs imposed on cancer patients were well evidenced, or the product of legitimate deliberative processes. We note that some of these issues will be addressed in the next incarnation of the fund, but the rationale for the fund’s existence remains unconvincing. ConclusionsIt is important and timely to debate how cancer drugs appraisal ought to be conducted to confront the consequences of CDF’s model of appraisal. We conclude that it did matter that the CDF was not NICE.

Rhetoric and the archive

ABSTRACTBlending personal narrative, pedagogical guidance, and analytic commentary, this essay performatively explores the individual and social dimensions of contemporary rhetorical inquiry, claiming the experiential interdependence of its manifold forms. Situating archive as a conceptual bridge that links different types of practice, the essay first proffers an approach to reading the archive of rhetorical scholarship in order to ascertain its evolving dynamics. Next, it explicates the creation of an archive for an individual project, demonstrating that a letter of condolence written by a Union soldier in 1863 represents text or context, and is recognizable as fragment or icon, depending not on its physical or formal features but on the analytic purposes and processes of the scholar. The essay constitutes pluralism and specialization as a productive paradox for individual scholars as well as the disciplinary community, and it emphasizes the interactions of analytic approach and affective associations.

Acupuncture for Pediatric Conditions: A Narrative Review

Abstract Background: The use of acupuncture for common pediatric conditions continues to grow. Three previous overviews have summarized the research literature. Objective: The aim of this article is to provide an updated narrative review of the literature on the use of acupuncture within the pediatric population. Methods: A systematic search was performed to identify clinical trials and reviews published through July 2015. Trials were excluded if they were not: (1) acupuncture-specific; (2) limited to pediatric patients; (3) published in English. The literature was assessed and synthesized into a narrative review and commentary. Results: Seventy-one publications were identified (59 clinical trials and 12 reviews) that represented 20 conditions. Since the prior overviews, 36 new publications (33 clinical trials) were identified and represented nine countries; the top three were China, Norway, and the United States. The top five areas of research at that timepoint were autism spectrum disorder, cerebral pal...

Legal Instruments and Practice of Arbitration in the EU - Survey Responses (EU-Wide)

This document includes the results of the Survey undertaken as part of the study Instruments and Practice of Arbitration in the EU.The Study was prepared for the JURI Committee of the European Parliament, and was published by the Parliament in February 2015. It investigates the law and practice of arbitration across the European Union and Switzerland, at both a national level and at the level of the European Union. It includes an in-depth examination of the practice and the laws relating to arbitration in each Member State of the European Union and Switzerland, as well as an examination of the involvement of Member States and the European Union in arbitration. It addresses not only commercial arbitration, but also investment arbitration and consumer arbitration.The Study was undertaken and drafted from November 2013 to September 2014, and includes information developed through academic research, the largest empirical study ever undertaken of arbitration practitioners (receiving nearly 900 respondents, from every State in the and Switzerland), in-person visits to roughly 20 of the leading arbitral institutions in Europe, questionnaires from additional institutions, and a day-long conference on consumer arbitration involving participants from across the European Union and the United States.The Study 312 pages long, with 302 further pages of Annex material (including a 116 page narrative commentary on the arbitration laws of every State in the plus Switzerland). Among other specific findings, it broadly concludes that while substantial harmony exists across the European Union at both the level of law and practice, arbitration in the European Union is predominantly regional, rather than transnational. It also concludes that investment arbitration is often a beneficial feature of investment agreements, although the terms of such agreements must be carefully designed.The paper Legal Instruments and Practice of Arbitration in the EU to which these Survey Responses (EU-Wide) applies is available at the following URL: http://ssrn.com/abstract=2637305