ABSTRACT
Perhaps because of the elegance of the central limit theorem, it is often assumed that distributions in nature will approach singly-peaked, unimodal shapes reminiscent of the Gaussian normal distribution. However, many systems behave differently, with variables following apparently bimodal or multimodal distributions. Here, we argue that multimodality may emerge naturally as a result of repulsive or inhibitory coupling dynamics, and we show rigorously how it emerges for a broad class of coupling functions in variants of the paradigmatic Kuramoto model.
ABSTRACT
PURPOSE: Bone pain is a common side effect of pegfilgrastim and can interfere with quality of life and treatment adherence. This study investigated the impact of antihistamine prophylaxis on pegfilgrastim-induced bone pain. METHODS: This is a two-stage enrichment trial design. Patients receiving an initial dose of pegfilgrastim after chemotherapy were enrolled into the observation (OBS) stage. Those who developed significant back or leg bone pain (SP) were enrolled into the treatment (TRT) stage and randomized to daily loratadine 10 mg or placebo for 7 days. SP was defined by Brief Pain Inventory as back or leg pain score ≥5 and a 2-point increase after pegfilgrastim. The primary end point of TRT was reduction of worst back or leg bone pain with loratadine, defined as a 2-point decrease after treatment compared to OBS. RESULTS: Two hundred thirteen patients were included in the final analysis. Incidence of SP was 30.5 %. The SP subset had a worse overall Functional Assessment of Cancer Therapy-Bone Pain score (33.9 vs. 51.7, p < 0.001) and a higher mean white blood cell count (15.4 vs. 8.4 K/cm(3), p = 0.013) following pegfilgrastim than those without SP. Forty-six patients were randomized in the TRT. Benefit was 77.3 % with loratadine and 62.5 % with placebo (p = 0.35). Baseline NSAID use was documented in four patients (18.2 %) in loratadine arm and two patients (8.3 %) in placebo arm, with baseline non-NSAID use documented in five (22.7 %) and six (25 %) patients, respectively. Eight additional patients used NSAIDS by day 8 compared to day 1 (six in the loratadine and two in the placebo arm). A total of six additional patients used non-NSAIDS by day 8 compared to day 1 (four in the loratadine and two in the placebo arm). CONCLUSIONS: Administration of prophylactic loratadine does not decrease the incidence of severe bone pain or improve quality of life in a high-risk patient population. ClinicalTrials.gov identifier: NCT01311336.
Subject(s)
Bone Diseases/prevention & control , Granulocyte Colony-Stimulating Factor/adverse effects , Histamine H1 Antagonists, Non-Sedating/therapeutic use , Loratadine/therapeutic use , Pain Management/methods , Adult , Aged , Aged, 80 and over , Bone Diseases/chemically induced , Female , Filgrastim , Humans , Male , Middle Aged , Polyethylene Glycols , Quality of Life , Recombinant Proteins/adverse effects , Young AdultABSTRACT
This paper presents the analysis of a profoundly deaf 12-year-old girl. The main referring symptom was a pattern of intense libidinal looking at and aggressive looking away from others, which functioned as a preoedipal splitting to keep apart opposite "all good," life-enhancing and "all bad," deathlike self and object representations. The preoedipal splitting seemed to have its etiology in traumatic experiences in the symbiotic and rapprochement phases. The analysis followed the sequence of separation-individuation, as blocks to development were progressively removed.
Subject(s)
Borderline Personality Disorder/therapy , Deafness/complications , Defense Mechanisms , Psychoanalytic Therapy , Psychosexual Development , Borderline Personality Disorder/complications , Borderline Personality Disorder/psychology , Child , Deafness/psychology , Female , Follow-Up Studies , Humans , Individuation , Mother-Child RelationsABSTRACT
The spontaneously reported narrative fictions collected from 5- to 11-year-old children were examined for the presence of overt psychosexual elements. Two developmental hypotheses were advanced: (1) that the children's expressions would become more inhibited and therefore more indirect with age (Wolfenstein) and (2) that their expressions would not be more inhibited with age but simply more complex and wide ranging (Legman). The data are interpreted as supporting the latter proposition. The older children in the present sample give a wide-ranging display of psychosexual material stated just as directly as is the case with the narrower array for the younger children. Freud's dictum that the higher a joke rises in polite society the more indirect must be its form of expression is thus not supported in the present elementary school. The cultural relativity of the hypothesis is suggested. A folktale analysis of these materials shows that they are most appropriately described as typical of the "trickster" figure in folkloric genre. The Fucker appears to be a subcategory of this genre as well as an enduring folk figure.
