Journal articles on the topic 'Oral source citations'

Background. Citation analysis has emerged to play a significant role in recognition of the most useful areas of research. Endodontic microbiology has been a topic of interest for endodontists as well as periodontists and oral surgeons. This bibliometric analysis is aimed at identifying and reporting the characteristics of the top 50 cited articles on endodontic microbiology. Methods. The articles were identified through a search on Web of Science (WoS), property of Clarivate Analytics database published on endodontic microbiology. The citation information of the selected articles was recorded. The Journal of Endodontics, International Endodontic Journal, Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology, Dental Traumatology, and Australian Endodontic Journal were searched in the search title. Descriptive and bivariate analyses were performed using a statistical software package SPSS. Statistical analysis was performed using Shapiro-Wilk, Kruskal-Wallis, Post hoc, Mann-Kendall trend, and Spearman-rank tests. Results. The 50 most cited articles were published from 1965 to 2012 with citation count varying from 1065 to 103 times. The total citation counts of articles recorded were 11,525 (WoS), 12,602 (Elseviers’ Scopus), and 28,871 (Google Scholar). The most prolific years in terms of publications were 2001, 2002, and 2003, with five publications each, followed by 2005 with four. The year with most citations was 1998, with 1,330 citations, followed by 1965 and 2001, with 1,065 and 1,015 citations, respectively. A total of 136 authors contributed to the top 50 most cited articles with 27 corresponding institutions from 12 different countries. The most common methodological design was in vitro study, followed by clinic-laboratory study, literature review, systematic review and meta-analysis, and animal study. Conclusions. The present study provided a detailed list of the top 50 most cited and classic articles on microbiology in endodontics. This will help researchers, students, and clinicians in the field of endodontics as an impressive source of information.

AbstractA large volume of literature has become available to practitioners prescribing anticoagulants. The aim of this study was to analyze the bibliometric characteristics of the top 100 most cited articles related to anticoagulation over the past 25 years, with special consideration to impact of direct or “nonvitamin K antagonist” oral anticoagulants (NOACs) compared with vitamin K antagonists. A bibliometric analysis of the 100 most cited journal articles related to anticoagulants published between 1994 and 2019 was performed in April 2019. The top 100 articles by citation count were analyzed to extract bibliometric data related to journal title, impact factor, year of publication, place of publication, anticoagulant studied, indication for anticoagulation, study design, and conflicts of interest. The median (interquartile range) number of citations per article was 806 (621–1,085). The anticoagulant most frequently researched was warfarin (37%). NOAC publications (21%) grew at a relative rate of 3.4 times faster compared with all publications. The indication most commonly researched was venous thromboembolism (26%). Eighty articles constituted level I or II evidence, with randomized controlled trials the most common type of study (74). A financial conflict of interest was declared in 87% of articles with private, for-profit organizations the most common source of funding (26%). In summary, top research related to anticoagulation is highly impactful but may be at risk of sponsorship bias. High-level evidence for NOACs continues to expand across a range of indications with citation metrics likely to soon approach or surpass that of older drugs.

Forests are an immense reservoir of biological resources and provide the local population with subsistence needs, especially for edible fruits. This study contributes to a better knowledge of the use modes of non-cultivate edible plant species in the area of Kasa, traditional name for the department of Oussouye. Ethnobotanical surveys, based on an interview guide, oral discussions and direct observations were conducted among 178 people from the department of Oussouye, stronghold of the Diola ethnic group. A factorial correspondence analysis highlighted the relationship between species and categories of use. The frequency of citation, informant consensus factor and use value showed the socio-cultural importance of the species. The data collected identified 62 edible species divided into 31 families and 54 genera. The fruit species inventoried are used for different purposes. They are a food source with 62% of citations, energetic 19%, technological 14%, medicinal 13%, cultural 6% and agronomic 2% for the populations. Two species stand out for their high use value factor (UVt). These were Elaeis guineensis (12.24) and Borassus aethiopum (7.56). In addition to their use value, species such as Mangifera indica, Neocarya macrophylla, Parkia biglobosa, Anacardium occidentale, Ceiba pentandra, Parinari excelsa, stood out for their categories and organs used. These results inform us about the level of use of fruit species for different needs and open up avenues for research in sustainable management of this resource with the aim of reducing poverty.

Objective: To compare oral metronidazole and vancomycin for the treatment of mild-to-moderate Clostridioides difficile infection (mmCDI). Data Sources: A MEDLINE literature search (inception to November 2018) was performed using the search terms metronidazole, vancomycin, and Clostridium/Clostridioides difficile. Additional references were identified from a review of literature citations. Study Selection and Data Extraction: All English-language clinical studies (interventional and observational), meta-analyses, and cost-effectiveness analyses comparing the efficacy of metronidazole and vancomycin for mmCDI were evaluated. Data Synthesis: Nine clinical studies, 5 meta-analyses, and 1 cost-effectiveness analysis provided comparative data for metronidazole and vancomycin for the treatment of mmCDI. Improved treatment response with vancomycin as compared with metronidazole in adults with mmCDI reached statistical significance in a few studies; albeit, most studies and pooled analyses have results that numerically favor vancomycin. Furthermore, the cost per case treated appears to be lower with vancomycin compared with metronidazole based on data from hospitalized patients. Relevance to Patient Care and Clinical Practice: Recent updates to national guidelines now give preference to vancomycin over metronidazole for mmCDI; however, this has been a source of controversy. This review provides an appraisal of direct and indirect comparisons of oral metronidazole and vancomycin for mmCDI, including recent literature published after the release of current guidelines. Conclusions: The available outcome data suggesting that vancomycin is more effective than metronidazole, combined with the more favorable pharmacokinetics, safety, and tolerability profile of vancomycin, provide adequate clinical rationale for the preferential use of this agent for the treatment of mmCDI.

The reviewed book of Archimandrite Damascene (Orlovsky) ‘Through Suffering to Communion: New Martyrs of Russia, Ukraine, and Belarus’ describes 24 life paths of hierarchs and clergymen canonized by the Russian Orthodox Church and their spiritual endeavors amid anti-religious persecution of the 20th century. The book opens a door into the world of the heroes of spirit, who recreated reality in the most stifling time of mass anti-religious repression on the territory of the former Russian Empire. New martyrs come to life in the book to show an example of living Christian ideal (as imagined in Russia, Ukraine, Belarus) within this world. The group portrait of new martyrs shows features of national elite. Their spiritual endeavor, concludes the author's, is a phenomenon in the history of our currently divided people, which gives hope for creating a new unity through suffering. The source base that has provided biographical and hagiographic material for the book conclusively represents the realities of period in its macro and micro aspects. It consists of archival documents and oral history sources, most of which are being introduced into scientific use by the author. The review recognizes high scientific and archaeographic level of the book, as well as its informative value. The text includes 500 citations from archival documents and scholarship, as well as some documents, rare photographs, and scholarly commentary. It is of value for scientists who study the history of the Church and explore the role of individual and religious consciousness in the historical process.

Objective: To evaluate the data supporting the approval of selexipag and discuss its potential place in therapy for managing pulmonary arterial hypertension (PAH). Data Sources: A systematic review of the literature for all relevant articles was performed through January 16, 2017, using MEDLINE and SCOPUS. A manual search of references from reports of clinical trials, review articles, and recent conference abstracts was performed to identify additional relevant studies. Study Selection and Data Extraction: Eligible citations included in vitro or in vivo evaluations of selexipag, with no restrictions on patient population or indication. Data related to the patient populations and outcomes of interest were extracted from each citation. Data Synthesis: Single phase II and phase III trials have been published evaluating selexipag in patients with PAH. In 43 patients, the phase II trial showed that selexipag significantly reduced pulmonary vascular resistance by 30% versus placebo ( P = 0.0045) and improved 6-minute walk distance by 24 m ( P < 0.05). The larger phase III trial enrolled 1156 patients with PAH, showing that selexipag lowered the incidence of death or PAH-related complications by 40% versus placebo ( P < 0.001). Selexipag also improved 6-minute walk distance and lowered hospitalization risk. Common adverse events included headache, diarrhea, nausea, and jaw pain. Conclusions: The specific role of selexipag for managing PAH patients is unclear because of its modest efficacy, lack of mortality reduction, and cost similar to intravenous prostacyclins. Additional clinical trials exploring combination therapy as well as its role in other types of pulmonary hypertension are needed.

Background:Individuals with Sjögren’s syndrome (SS) experience significantly higher levels of sexual dysfunction and sexual distress than healthy controls (van Nimwegen et al., 2015). Identifying associated factors may help to identify a subgroup of patients with SS who may benefit from early intervention to maintain sexual wellbeing and avoid unnecessary sexual disruption.Objectives:To explore and map the salient symptoms and factors that influence alterations in sexual functioning and intimate relationships for people with SS.Methods:The protocol for this review was registered with the Open Science Framework prior to commencement of the searches. The peer-reviewed search strings were used to search the following databases from inception to June 2019: Cochrane Library, CINAHL [EBSCO], MEDLINE [ProQuest], PUBMED [MEDLINE], ScienceDirect, Scopus and Web of Science. Grey literature was searched for on academic databases, topic-specific repositories, and Google Scholar. Databases were searched using key terms corresponding to sexual functioning and intimate relationships. Studies were included if their participant sample was comprised of adults aged ≥18 years, with a diagnosis of primary or secondary SS. Studies were not excluded based on source type, methodology or design. To qualify for inclusion, studies needed to have been peer-reviewed and available in English. Retrieved articles were then screened against the inclusion/exclusion criteria by two reviewers. Hand-searching was conducted on the reference lists of included articles, as well as the three most prevalent publishing journals until saturation had been achieved.Results:The search strategy returned 3527 unique citations. After screening processes were completed, only 19 articles met the inclusion criteria. Studies were predominately conducted in European countries (79%), within the last decade (68%; 2010-2019), and were mainly quantitative (n = 17; 89.5%), case-controlled (88.3%), and cross-sectional (100%) in nature. In total there were 1281 patients, 47% (n = 605) were patients with primary SS and the remaining 53% (n = 676) were patients with secondary SS. Both patient groups were predominately comprised of females (n = 600; 99% and n = 673; 99.5%, respectively), with a combined mean age of 50.82 years (M ranges = 35 – 62.82 years). An amalgamation of results from 17 studies, found that women with SS who score higher on the ESSPRI scale (total score and the subdomains of pain, fatigue and dryness) were more likely to experience significantly greater levels of vaginal dryness, sexual dysfunction and sexual distress. Moreover, women with SS who present with clinical levels of anxiety or depression were also more likely to experience disruptions in their sexual functioning and appraise their sexual life more negatively. Furthermore, patients who report greater severity of oral or ocular dryness, or dyspareunia may experience vaginal dryness, which may have ramifications on sexual functioning. Women of all ages are at risk of experiencing sexual dysfunctions, however, younger women (≤50 years) may experience more burdensome disruptions than older women. Finally, women who do not use lubrication products during sexual activity may be impacted further.Figure 1.Factors significantly associated with sexual dysfunction and sexual distress for patients with SS.Conclusion:Younger women (≤50) with SS who present with more severe symptoms of fatigue, pain, and oral or ocular dryness, or with clinical levels of anxiety or depression, may be at increased risk of experiencing sexual dysfunction and sexual distress. Healthcare professionals should be aware of these potential risk factors and initiate conversations around sexuality as and when a potentially ‘at risk’ individual is identified.References:[1]van Nimwegen, J. F., Arends, S., van Zuiden, G. S., Vissink, A., Kroese, F. G. M., & Bootsma, H. (2015). The impact of primary Sjögren’s syndrome on female sexual function. Rheumatology, 54(7), 1286-1293.Disclosure of Interests:None declared

The article reveals specificity of internal converse practice in the media discourse. The converse is defined as a speech-and-cognitive category that characterizes a constructive principle of the media text manifested in insertion of other person's utterances into the monospeech of a journalist. It is stated that the major means of converse practice is citing direct speech of some other person, which enables precise marking of citation boundaries in media texts. The other person's utterance insertion is marked by the use of reporting verbs that nominate processes of saying or communication in oral or written forms of media discourse, indicating the source of citation with introductory constructions, as well as the names and nicknames of radio listeners who sent their questions. Direct speech may be introduced into the author's text without any special linguistic markers. The sources of quoting relevant for the media text are revealed, including radio listeners, journalists, writers, economists, public and political figures, heroes of modern books and popular movies, mass media. Four functions of the cited utterances are considered relevant for the modern media text: compositional, authoritarian, interpretive and constructive. The types of converse relations that arise between the author's and other person's cited speech are determined.

The aim of this study was to describe the current state of research on academic Japanese. In order to do this, 28 texts published between 2009 and 2013 in the Japanese journal Akademikku Japanîzu Jânaru were analyzed. Using as input studies of management (BERTERO; KEINERT, 1994; among others), themes, methods, theoretical bases, methodological foundations, and sources within the texts were examined. As a result, five thematic groups concerning the academic Japanese language have been observed: Japanese writing, teaching and learning of Japanese, oral comprehension and expression in Japanese, citations and other aspects of the Japanese text, and other themes. The subjects, methods, theoretical bases, methodological foundations, and sources found in the five groups are diverse. Such variety suggests that research on academic Japanese is still an emerging field.

Objective: To review the pharmacology, pharmacokinetics, efficacy, safety, dosage and administration, potential drug-drug interactions, and place in therapy of the intravenous (IV) formulation of carbamazepine (Carnexiv) for the treatment of seizures in adult patients. Data Sources: A comprehensive PubMed and EBSCOhost search (1945 to August 2017) was performed utilizing the keywords carbamazepine, Carnexiv, carbamazepine intravenous, IV carbamazepine, seizures, epilepsy, and seizure disorder. Additional data were obtained from literature review citations, manufacturer’s product labeling, and Lundbeck website as well as Clinicaltrials.gov and governmental sources. Study Selection and Data Extraction: All English-language trials evaluating IV carbamazepine were analyzed for this review. Data Synthesis: IV carbamazepine is FDA approved as temporary replacement therapy for treatment of adult seizures. Based on a phase I trial and pooled data from 2 open-label bioavailability studies comparing oral with IV dosing, there was no noted indication of loss of seizure control in patients switched to short-term replacement antiepileptic drug therapy with IV carbamazepine. The recommended dose of IV carbamazepine is 70% of the patient’s oral dose, given every 6 hours via 30-minute infusions. The adverse effect profile of IV carbamazepine is similar to that of the oral formulation, with the exception of added infusion-site reactions. Conclusion: IV carbamazepine is a reasonable option for adults with generalized tonic-clonic or focal seizures, previously stabilized on oral carbamazepine, who are unable to tolerate oral medications for up to 7 days. Unknown acquisition cost and lack of availability in the United States limit its use currently.

Objective: Direct oral anticoagulants (DOACs) are recommended for the prevention of stroke or systemic embolism in nonvalvular atrial fibrillation. Dabigatran, rivaroxaban, apixaban, and edoxaban represent possible alternatives to warfarin in the setting of cardioversion. A literature review was conducted to evaluate the safety and efficacy of DOAC use pericardioversion. Data Sources: A PubMed and MEDLINE search through August 2017 was conducted using the following search terms alone or in various combinations: dabigatran, rivaroxaban, apixaban, edoxaban, betrixaban, DOAC, NOAC, TSOAC, cardioversion. Study Selection and Data Extraction: All English-language, human studies comparing the safety and efficacy of DOACs with that of other anticoagulants in the setting of cardioversion were eligible for inclusion. References from published articles were reviewed for additional relevant citations for study inclusion. Four retrospective and 2 prospective trials comparing DOACs with warfarin were identified. Data Synthesis: The majority of studies included patients undergoing electric cardioversion. Based on current evidence, the DOACs perform similarly to warfarin in the prevention of stroke and systemic embolism, and bleeding rates are comparable. Conclusions: DOACs may be an attractive alternative to warfarin because of fast onset of action, potentially reducing delay to cardioversion. More robust studies are needed in patients with renal dysfunction and patients undergoing pharmacological cardioversion.

Objective: To review the pharmacology, pharmacokinetics, efficacy, and safety of the factor Xa (FXa) inhibitor betrixaban for extended-duration prophylaxis of acute medically ill patients with venous thromboembolism (VTE) risk factors. Data Sources: A MEDLINE/PubMed (January 1990 to October 2017) search was conducted using the following keywords: betrixaban, PRT054021, FXa inhibitor, novel oral anticoagulant, NOAC, direct oral anticoagulant, DOAC, and target specific oral anticoagulant, TSOAC. References of identified articles were searched by hand for additional relevant citations. Study Selection and Data Extraction: We included English-language articles evaluating betrixaban pharmacology, pharmacokinetics, efficacy, or safety in human subjects for VTE prophylaxis. Data Synthesis: Betrixaban is a FXa inhibitor that decreases prothrombinase activity and thrombin generation. Betrixaban efficacy and safety has been compared with that of enoxaparin for prophylaxis of VTE in acutely ill medical patients. In the APEX trial and substudies, extended-duration betrixaban was superior in efficacy to standard-duration enoxaparin in patients at high risk for VTE, including those with elevated D-dimer levels (≥2× upper limit of normal) and of older age (≥75 years). Betrixaban is noninferior to enoxaparin in rates of major bleeding, but the former is associated with more clinically relevant nonmajor bleeding events. Conclusion: Betrixaban is the first oral agent approved for extended-duration VTE prophylaxis in acutely ill hospitalized patients. Extended-duration thromboprophylaxis with betrixaban reduces the risk of VTE compared with standard-duration thromboprophylaxis with enoxaparin but is associated with increased risk of bleeding.

OBJECTIVE: Part I of this review examines the relationship between antiepileptic drugs (AEDs) and pregnancy outcomes. Drug-induced folate deficiency and the role of AED metabolism are emphasized. Part II will discuss periconceptional folate supplementation for prevention of birth defects. Part III will discuss the mechanism of folate's protective effect, therapeutic recommendations, compliance, and cost. DATA SOURCES: A MEDLINE search was conducted for journal articles published through December 1997. Additional sources were obtained from Current Contents and citations from the references obtained. Search terms included phenytoin, carbamazepine, phenobarbital, primidone, valproic acid, oral contraceptives, clomiphene, drug-induced abnormalities, spina bifida, anencephaly, neural tube defect, folate, folic acid, and folic acid deficiency. STUDY SELECTION: Relevant animal and human studies examining the effects of AEDs, smoking, and oral contraceptives on folate status and pregnancy outcome are reviewed. DATA EXTRACTION: Studies and case reports were interpreted. Data extracted included dosing, serum and red blood cell folate concentrations, teratogenicity of anticonvulsant medications, metabolism of AEDs and folate, and genetic susceptibility to AED-induced teratogenicity. DATA SYNTHESIS: Low serum and red blood cell folate concentrations are associated with adverse pregnancy outcomes. Decreases in serum folate are seen with AEDs, oral contraceptives, and smoking. Since similar birth defects are observed with multiple AEDs, metabolism of aromatic AEDs to epoxide metabolites and genetic factors may play a role in teratogenesis. CONCLUSIONS: Adequate prepregnancy planning is essential for women who have epilepsy. Women receiving folate-lowering drugs may be at increased risk of adverse pregnancy outcomes. Therefore, epileptic women contemplating pregnancy should be treated with the minimum number of folate-lowering drugs possible and receive folic acid supplementation.

Background: Children’s oral health–related quality of life (COHQoL) measures are well known and widely used. However, rigorous systematic reviews of these measures and analyses of their quality are in absence. Objectives: To systematically review and quantitatively assess the quality of COHQoL measures through a scoping review. Data Sources: Systematic literature search of PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), EMBASE (Excerpta Medica database), HaPI (Health and Psychosocial Instruments), and DOSS (Dentistry and Oral Sciences Source). Study Eligibility: The measure’s focus was COHQoL; the child age ranged from 5 to 14 years; the publication was either a research article or a systematic review and related to caries; and it was written in English or had an English abstract. Two authors independently selected the studies. Disagreements were reconciled by group discussions with a third author. Appraisal: The International Society for Quality of Life Research minimum standards for patient-reported outcome measures were used for quality appraisal. Synthesis: Descriptive analysis. Results: We identified 18 measures. Their quality scores ranged from 9.5 to 15.0 on a scale of 16. The quality appeared to bear no relationship to the citation and use of these measures. However, elements of these measures might be more useful than others, depending on the age-specific use and primary quality concerns. Limitations: Some of the information on the minimum standards of the 18 measures cannot be found in the existing literature. Measures published without English abstract were not searched. Conclusions: The quality of these measures is suboptimal. Researchers and practitioners in this field should exercise caution when choosing and using these measures. Efforts at improving the quality of the COHQoL measures, such as refining existing ones or developing new measures, are warranted. Knowledge Transfer Statement: Researchers, clinician scientists, and clinicians can use the results of this study when deciding which oral health–related quality of life measure they wish to use in children.

iSybislaw is a Bibliographic Database for students, post-graduate students and researchersIn this paper the iSybislaw bibliographic database of World Slavic Linguistics publications is presented. The author demonstrates its vast potential as a research tool and citation source, concentrating on the possibilities of using all iSybislaw functions and options in university teaching and scientific research. The author points out that the database can be used not only by students and scientists of Slavic, Polish and Russian philology, but also, even if to a lesser extent, for philologies and linguistics of all languages. iSybislaw sprzymierzeńcem studentów, doktorantów oraz pracowników naukowychW pracy prezentowana jest bibliograficzna baza danych publikacji z zakresu światowego językoznawstwa slawistycznego. Autor pokazuje jej olbrzymi potencjał jako źródła informacji i cytowań, koncentrując się na możliwościach wykorzystania wszystkich funkcji iSybislawa w nauczaniu uniwersyteckim i pracy naukowej. Zostało podkreślone, że baza danych iSybislaw może być użyteczna nie tylko dla studentów i naukowców zajmujących się slawistyką, polonistyką i rusycystyką, ale także, nawet jeśli w mniejszym stopniu, dla filologów wszystkich języków oraz językoznawców.

Objective: To review the pharmacology, pharmacokinetics, efficacy, and safety of the fixed-dose combination of insulin degludec and the glucagon-like peptide-I receptor agonist (GLP-1 RA), liraglutide (IDegLira) in the treatment of type 2 diabetes mellitus (T2DM). Data Sources: A PubMed and MEDLINE search (1966 to July 2017) of the keywords insulin degludec, liraglutide, and type 2 diabetes mellitus was conducted. References were reviewed to identify additional citations. Study Selection and Data Extraction: Articles written in English were included if they evaluated the pharmacokinetics, pharmacology, clinical efficacy, or safety of IDegLira in humans. Data Synthesis: IDegLira displayed pharmacokinetic and pharmacodynamic properties similar to that of the individual components. IDegLira has shown significant hemoglobin A1C (A1C) reductions of 1.3% to 1.9% and fasting plasma glucose reductions of 45 to 65 mg/dL when used in patients with T2DM previously receiving oral antihyperglycemic agents (AHAs), GLP-1 RAs, or basal insulin. Weight loss also occurred when IDegLira was started in patients previously receiving oral AHAs or basal insulin. Adverse effects (AEs) tended to be mild and transient. The most common AEs were headache, nasopharyngitis, upper-respiratory infections, and gastrointestinal disorders. Hypoglycemia risk was lower with IDegLira than basal insulin alone but higher than liraglutide alone. Conclusions: IDegLira may provide additional glycemic control with fewer AEs for patients uncontrolled on a GLP-RA or basal insulin alone. Additional studies evaluating use in patients on oral AHAs with higher A1C values and in comparison to bolus insulin are needed.

Objective: The purpose of this article is to review the available clinical trial data for andexanet alfa and its role in clinical practice. Data Sources: A MEDLINE/PubMed search was conducted (January 2000 to January 2019) using the keyword andexanet alfa for clinical trials. References of identified articles were searched by hand for additional citations. Study Selection and Data Extraction: We included English-language articles related to the Food and Drug Administration (FDA) approval of andexanet alfa or provided novel information regarding this drug entity. Data Synthesis: The findings of the review show that andexanet alfa may be a safe and effective option for the reversal of apixaban and rivaroxaban. Relevance to Patient Care and Clinical Practice: With the approval of this reversal agent, patients and providers can feel safer when using apixaban and rivaroxaban, which in turn may increase the use of these anticoagulant agents. Conclusions: The new FDA approval of andexanet alfa will allow safer use of oral anticoagulants and will likely further the use of direct oral anticoagulants for anticoagulant needs. Reversing enoxaparin-/edoxaban-induced bleeding with this agent should be limited because there is no FDA approval owing to the fact that only phase II trial data available.

Abstract Objective.—To review the role of acquired and inherited prothrombotic risk factors that increase the risk of thrombosis in oral contraceptive users, during pregnancy, and in neonates, infants, and children; and to determine by the consensus opinion of recognized experts in the field which risk factors should be determined in which individuals at which time. Data Sources.—Review of the medical literature and current clinical practice by a panel of experts in the field of thrombophilia. Data Extraction and Synthesis.—The experts made an extensive review of the published literature and prepared a draft manuscript, which included preliminary recommendations. The draft manuscript was circulated to participants in the College of American Pathologists Conference XXXVI: Diagnostic Issues in Thrombophilia prior to the conference. The manuscript and recommendations were then presented at the conference for discussion. Recommendations were accepted if a consensus of the 26 experts attending the conference was reached. The results of the discussion were used to revise the manuscript into its final form. Conclusions.—This report reviews the options for testing for thrombophilic states in women using oral contraceptives, during pregnancy, and in neonates and children. General guidelines for testing in these clinical situations are provided, along with citation of the appropriate supporting literature.

Medicinal plants have been used for therapeutic and beauty applications in Sri Lanka with documented history of over 2,500 years. This inherited knowledge, which has been handed down from generation to generation, provides a largely unexplored source for the potential development of active ingredients for cosmetic formulations. Therefore, the present comprehensive survey was conducted to identify cosmetic potential medicinal plants species in Sri Lanka. Personal interviews were conducted via a semistructured questionnaire with randomly selected 30 traditional practitioners and 90 Ayurveda physicians in Sri Lanka. Data were collected on plants and specific plant parts used for the treatment of skin care, hair care, and oral care topically. The acquired data were verified using the Ayurveda authentic books and quantitatively analyzed using relative frequency of citation (RFC), use value (UV), relative importance (RI), and factor informant consensus (FIC). Results revealed about the usage of 133 different plant species belonging to 64 families in cosmetic treatments under the categories of skin care, hair care, and oral care. Majority of medicinal plants were used in skin care treatments (39%) followed by hair care (20%) and oral care (17%). Aloe vera (L.) Burm.f. reported the highest RFC value (0.83) and UV (3.66). The highest RI value was reported from Asparagus racemosus Willd. and Hibiscus rosa-sinensis L. (1.67). The dominant plant family was reported as family Fabaceae. The most utilized plant part was stated as leaves (34%) followed by bark (14%). The survey further revealed about treatments for 17 skin-related, 9 hair-related, and 2 oral-related beauty issues. All RFC values were comparatively high for identified different beauty issues. Many herbal preparations were prepared using water as the medium whilst most common mode of application was reported as paste (37%). In conclusion, acquired information could ultimately be utilized for the development of the herbal cosmetic industry through the isolation and characterization of bioactive compounds from the documented plants while preserving the traditional knowledge.

OBJECTIVE: To review the role of itraconazole as oral therapy for the major infections caused by Aspergillus spp.: allergic bronchopulmonary aspergillosis, aspergilloma, and invasive aspergillosis. DATA SOURCES: A MEDLINE search of articles published in the English language between 1986 and 1993 was used to identify relevant citations, including review articles. In addition, a search of the published abstracts of the past two Interscience Conferences on Antimicrobial Agents and Chemotherapy (ICAAC) was performed. STUDY SELECTION: Clinical trials that evaluated itraconazole therapy in either allergic bronchopulmonary aspergillosis, aspergilloma, or invasive aspergillosis were critically reviewed. Trials were evaluated based upon entry criteria for the diagnosis of each type of aspergillosis, risk factors for the development of aspergillosis (neutropenia, transplant recipient, hematologic malignancy), prior antifungal chemotherapy, and dose and duration of itraconazole therapy. DATA SYNTHESIS: Overall, the clinical trials of itraconazole therapy for aspergillosis are limited and of variable quality. In the treatment of allergic bronchopulmonary aspergillosis, itraconazole has been reported to prompt a reduction in corticosteroid dosage in selected patients. There have been no controlled trials of itraconazole as treatment for aspergilloma, but data from several open-label trials suggest that this agent may be of clinical benefit in aspergilloma, primarily as an alternative to surgery. The use of itraconazole for invasive aspergillosis has been evaluated in several trials, most often in patients who were intolerant to amphotericin B treatment. Response to oral itraconazole has generally been promising. CONCLUSIONS: Although itraconazole offers promise for oral therapy against infections caused by Aspergillus spp., it should not presently be regarded as primary therapy for any of these diseases. Amphotericin B, in doses ranging from 1 to 1.5 mg/kg to a total dose of 1.5–4.0 g, should remain the treatment of choice in both aspergilloma and invasive aspergillosis. Itraconazole use should be restricted to patients who experience severe toxicity with amphotericin B therapy. Corticosteroids continue to be first-line therapy for allergic bronchopulmonary aspergillosis, with the use of itraconazole reserved for those patients who would benefit from a reduction in corticosteroid dose.

Objective: To review evidence behind anticoagulants in cancer-associated venous thromboembolism (VTE) with a focus on low-molecular-weight heparins (LMWH) and the role of direct oral anticoagulants (DOACs). Data Sources: PubMed was searched using terms “venous thromboembolism,” “cancer,” and “anticoagulation.” This search was restricted to clinical trials, meta-analyses, and subgroup analyses. Additional references were identified from reviewing literature citations. Study Selection: English-language prospective and retrospective studies assessing the efficacy and safety of LMWH and DOACs in patients with cancer. Data Analysis: Several trials were analyzed that compared anticoagulation therapies for prevention of recurrent VTE in patients with cancer. Many studies comparing LMWH and vitamin K antagonists (VKAs) found nonsignificant differences between therapies. A single study demonstrated that LMWHs are superior to VKAs. This evidence supporting LMWH for long-term VTE treatment in patients with cancer is based on comparison to VKA, but results are limited by methodological issues, and the benefit of LMWH may be driven by poor control. Subanalyses of DOAC trials suggest these are equally or more effective as VKA in cancer, but this conclusion is underpowered. Conclusion: DOACs have the potential to bypass many challenges with traditional therapy. After analyzing the evidence available, we conclude that after careful consideration of risks and benefits, use of DOACs for VTE treatment are a reasonable option in patients with cancer.

Context: Female athletes aged 14 to 18 years are at particular risk for anterior cruciate ligament (ACL) injuries. Hormonal factors are thought to predispose them to this injury. Oral contraceptive pills (OCPs) might reduce ACL injury risk, although the literature appears controversial. Objective: To evaluate the association between OCP use and ACL injuries in women. The secondary objective was to determine the rates of ACL injuries in the pre- and postovulatory phases of the menstrual cycle in OCP and non-OCP (NOCP) users. Data Sources: Searches were performed across 4 reference databases (PubMed, CINAHL, Embase, Cochrane), abstracts from 6 specialty societies, ClinicalTrials.gov , and reference lists of relevant papers. Study Selection: We included studies investigating the association between OCP use and ACL injuries in females of any age or the distribution of ACL injuries across the menstrual cycle in OCP and NOCP users. Study Design: Systematic review. Level of Evidence: Level 3. Data Extraction: Data regarding study design, population characteristics, OCP details, outcome definitions, analytic methods, and results were extracted from the included studies. The methodological quality of each study was assessed using the Newcastle-Ottawa scale. Results: The search yielded 1305 citations, of which 7 retrospective observational studies met the inclusion criteria. Two large case-control studies with higher methodological quality suggested that OCP use may reduce the risk of sustaining an ACL injury. Five comparative studies examining injury distribution across the menstrual cycle in OCP and NOCP users had conflicting findings, were heterogeneous, and were limited by low methodological quality. Conclusion: The evidence suggests OCP use may reduce the risk of ACL injury; however, no conclusions can be drawn regarding differences in risk of ACL injuries between OCP and NOCP users across the menstrual cycle. Studies were limited by small sample sizes, heterogeneity, and methodological concerns.

Abstract The aim of this study was to determine the antibacterial activity in extracts obtained from various Nigerian chewing sticks. Aqueous extracts from seventeen chewing sticks and the fruit of C. ferruginea, one fruit used in oral hygiene in Nigeria, were screened for antibacterial activity against type cultures of Staphylococcus aureus, Bacillus subtilis, Escherichia coli, and Pseudomonas aeruginosa. Eleven of the test extracts showed activity against at least two of these referenced organisms. Minimum inhibitory concentrations (MIC) of these eleven extracts against clinical isolates from orofacial infection were determined. All the extracts demonstrated activity against Staphylococcal and Streptococcal isolates. Over half of the extracts were active against Enterobacteriaceae and obligate anaerobic isolates, including Prevotella melaninogenica, Porphyromonas gigivalis, Fusobacterium nucleatum, and Peptostreptococcus prevotii. Extracts of the Vitellaria paradoxa root, Bridellia ferruginea stem and twigs, Garcinia cola stem, Terminalia glaucescens root, Morinda lucida root, and Cnestis ferruginea fruit showed appreciable activity against all classes of bacterial isolates. The extracts of these plants may serve as sources for chemotherapeutic agents for the management of orofacial infections. Citation Ndukwe KC, Okeke IN, Lamikanra A, Adesina SK, Aboderin O. Antibacterial Activity of Aqueous Extracts of Selected Chewing Sticks. J Contemp Dent Pract 2005 August;(6)3:086-094.

OBJECTIVE: To review the pharmacology, pharmacokinetics, efficacy, and safety of Exubera, a novel, dry-powder formulation of insulin for inhalation, and describe patient satisfaction and quality-of-life data. DATA SOURCES: A MEDLINE search (1966–November 2004) was conducted using the key words inhaled insulin and Exubera for clinical trials limited to human research published in English. BIOSIS Previews and the American Diabetes Association Scientific Abstracts were used for published abstract information. STUDY SELECTION AND DATA EXTRACTION: All available human studies of Exubera were selected for review. References of identified articles were used for additional citations. DATA SYNTHESIS: Exubera is a rapid-acting insulin administered by oral inhalation before meals with long-acting insulin administered subcutaneously once or twice daily for type 1 or 2 diabetes mellitus. Exubera provides similar efficacy and improved patient satisfaction compared with standard subcutaneous insulin therapy (ie, NPH twice daily with regular insulin before meals). Efficacy has also been demonstrated for Exubera when used as adjunctive therapy with oral medications for type 2 diabetes. The onset of Exubera is more rapid and its duration of action is similar to that of regular insulin. To date, Exubera administered before meals with a once-daily long-acting subcutaneous insulin (usually Ultralente) has been compared with standard subcutaneous NPH/regular insulin regimens. Comparison of premeal Exubera plus a basal long-acting insulin analog (eg, glargine) with a regimen of premeal subcutaneous rapid-acting insulin analog (eg, lispro or aspart) plus a basal long-acting insulin analog (eg, glargine) is needed to fully evaluate Exubera. Pulmonary safety appears to be maintained for up to 4 years, although there are no data, as of this writing, on the use of this agent in patients with pulmonary conditions. CONCLUSIONS: Exubera is an effective inhaled insulin for preprandial use in type 1 or 2 diabetes. Improved patient satisfaction over injected insulin increases its potential for use earlier in the treatment of type 2 diabetes.

OBJECTIVE: To provide product information; review and analyze the clinical literature studying combination therapy, budesonide, and formoterol in asthmatics; and to define the role for this therapy in asthma treatment. DATA SOURCES: A MEDLINE search (1990–September 2001) was conducted to identify the primary literature. Bibliographies were reviewed for further relevant citations. STUDY SELECTION/DATA EXTRACTION: All randomized, blinded, controlled studies at least 3 months in duration exploring the efficacy of the combination of budesonide and formoterol (in 1 or separate formulations) compared with other treatments were selected to be included in the review of clinical studies. DATA SYNTHESIS: The combination of budesonide and formoterol was more effective than increasing the dose of budesonide in patients with moderate or severe persistent asthma and in patients with mild asthma not previously controlled with inhaled corticosteroids. Milder corticosteroid-naïve asthmatics did not derive benefit compared with inhaled corticosteroids alone. CONCLUSIONS: Combination therapy in 1 device is a preferred treatment option in patients with moderate to severe persistent asthma and in those with milder asthma not controlled with inhaled corticosteroids. Advantages of this product include rapid onset of action, long duration of action, and a wide dosing range to assist with titration. Further research is required to evaluate this therapy in asthmatic children <5 years old and in patients with oral corticosteroid—dependent asthma. Investigations into the effect of this combination product on other disease outcomes, such as quality of life and productivity, will further define the role for this drug therapy.

AbstractThe present paper proposes to establish (§ 1) the data that can be drawn securely from a controversial testimonium on an oration of Cato (Cato, orat. 99 Sblend.) contained in a late antique panegyric (Pan. Lat. 8 (5).13.3), and to illustrate (§ 2) some of its textual and exegetical problems. Further, in the light of a hitherto overlooked comparison with a gloss of Festus, proposals are made: (§ 3) for a new constitutio and interpretation of the text of the panegyric; and (§ 4) for the identification of a textual citation (which will emerge also as a new fragment) from the orations of Cato the Censor, and the identification with Cato of the anonymous antiqui to whom Festus attributes the use (until now not attested elsewhere) of the rare substantive oliueta in feminine singular with the sense of ‘gathering of olives’. Finally (§ 5) some considerations are offered on the possible sources used by Festus (hypothesising as intermediary the De obscuris Catonis of Verrius, which could in turn have drawn its note on the oliueta from the very passage of Cato attested by the panegyric) and by the panegyrist (for whom a direct knowledge of the speech of Cato is proposed).

The appeal of history to us all is in the last analysis poetic. But the poetry of history does not consist of imagination roaming at-large, but of imagination pursuing the fact and fastening upon it. That which compels the historian to “scorn delights and live laborious days” is the ardour of his own curiosity to know what really happened long ago in that land of mystery which we call the past.This paper is about qualitative research methods, and thus more about hard labor than about poetry and imagination. But to those scholars to whom the above citation gives meaning there is a clear connection between hard labour, imagination and poetry. As scholars, we are looking for facts, and looking for facts can be hard work. As scholars, we also know that facts must be ascribed with meaning in order to become sources, a process of interpretation which demands both imagination and poetry.I will present some of the challenges we face when doing anthropological historical research in Africa, and I will argue that the tools of qualitative methods will have to be sharpened and modified with this particular goal in mind. The main aim will be to discuss how we can acquire information in an African setting by analyzing the role of the interview as a communicative event. Other important topics to be treated are African oral tradition, the culture and tradition (the metacommunicative competence) of the respondents, and their use of metaphors to convey meaning.

Abstract Aim The aim of this report is to describe the relationship of some salivary parameters to dental erosion resulting from excessive citric acid consumption and present a description of a prosthetic approach used to restore the damaged dentition of a patient with severe erosion. Background The high consumption of dietary sources of acids can lead to erosion or the excessive wear of dental hard tissues. Erosion may be modified by salivary parameters such as flow rate, pH, and buffering capacity. Porcelain-fused-to-metal (PFM) restorations and composite resin veneers can be used successfully to restore impaired esthetics and eliminate tooth hypersensitivity in such cases. Results A 37-year-old woman with a history of excessive lemon consumption presented with a complaint of tooth hypersensitivity and the poor appearance of her dentition due to erosion. Stimulated and unstimulated salivary samples of the patient were evaluated for flow rate, pH, and buffering capacity before and after treatment. The pre-treatment values were found to be higher than post-treatment values. Stimulated samples showed an increase of salivary flow rate, pH, and buffering capacity. The measured parameters put forth the defensive potential of saliva against the acidic diet, and the salivary flow rate and buffering capacity decreased after reducing acidic consumption. The excessively eroded teeth were restored using PFM restorations whereas the superficially eroded teeth were restored with composite resins. Summary The introduction of acidic foods, beverages, or other agents can exceed the natural buffering capacity of saliva. The result is a lowering of the pH of the oral environment which can lead to erosion of enamel and dentin. Loss of tooth structure due to erosion can compromise the esthetics of the dentition and lead to hypersensitivity of the teeth. Teeth damaged by erosion can be successfully restored by composite resin or porcelain restorations and esthetics and function of dentition can be improved. Clinical Significance This report is a profound example of how the over consumption of acidic agents affect not only dental tissues but also the chemical balance of the oral environment as well as the oral habitat. Citation Bavbek AB, Dogan OM, Yilmaz T, Dogan A. The Role of Saliva in Dental Erosion and a Prosthetic Approach to Treatment: A Case Report. J Contemp Dent Pract 2009 May; (10)3:074-080.

Context: Supplementing iron-deficient nonanemic (IDNA) athletes with iron to improve performance is a trend in endurance sports. Objectives: To investigate the benefits of iron on performance, identify a ferritin level cutoff in IDNA athletes, and determine which iron supplementation regimens are most effective. Data Sources: A search of the PubMed, CINAHL, Embase, ERIC, and Cochrane databases was performed in 2014 including all articles. Citations of pertinent review articles were also searched. In 2017, the search was repeated. Study Selection: Inclusion criteria comprised studies of level 1 to 3 evidence, written in the English language, that researched iron supplementation in nonanemic athletes and reported performance outcomes. Study Design: Systematic review. Level of Evidence: Level 3. Data Extraction: The search terms used included athletic performance, resistance training, athletes, physical endurance, iron, iron deficiency, supplement, non-anemic, low ferritin, ferritin, ferritin blood level, athletes, and sports. Results: A total of 1884 studies were identified through the initial database search, and 13 were identified through searching references of relevant review articles. A subsequent database search identified 46 studies. Following exclusions, 12 studies with a total of 283 participants were included. Supplementing IDNA athletes with iron improved performance in 6 studies (146 participants) and did not improve performance in the other 6 studies (137 participants). In the 6 studies that showed improved performance with iron supplementation, all used a ferritin level cutoff of ≤20 μg/L for treatment. Additionally, all studies that showed improved performance used oral iron as a supplement. Conclusion: The evidence is equivocal as to whether iron supplementation in IDNA athletes improves athletic performance. Supplementing athletes with ferritin levels <20 μg/L may be more beneficial than supplementing athletes with higher baseline ferritin levels.

ObjectiveTo examine the overall treatment effect and the proportion attributable to contextual effect (PCE) in randomised controlled trials (RCTs) of diverse treatments for osteoarthritis (OA).MethodsWe searched Medline, Embase, Central, Science Citation Index, AMED and CINAHL through October 2014, supplemented with manual search of reference lists, published meta-analyses and systematic reviews. Included were RCTs in OA comparing placebo with representative complementary, pharmacological, non-pharmacological and surgical treatments. The primary outcome was pain. Secondary outcomes were function and stiffness. The effect size (ES) of overall treatment effect and the PCE were pooled using random-effects model. Subgroup analyses and meta-regression were conducted to examine determinants of the PCE.ResultsIn total, 215 trials (41 392 participants) were included. The overall treatment effect for pain ranged from the smallest with lavage (ES=0.46, 95% CI 0.24 to 0.68) to the largest with topical non-steroidal anti-inflammatory drugs (ES=1.37, 95% CI 1.19 to 1.55). On average, 75% (PCE=0.75, 95% CI 0.72 to 0.79) of pain reduction was attributable to contextual effect. It varied by treatment from 47% (PCE=0.47, 95% CI 0.32 to 0.70) for intra-articular corticosteroid to 91% (PCE=0.91, 95% CI 0.60 to 1.37) for joint lavage. Similar results were observed for function and stiffness. Treatment delivered by needle/injection and other means than oral medication, longer duration of treatment, large sample size (≥100 per arm) and public funding source were associated with increased PCE for pain reduction.ConclusionsThe majority (75%) of the overall treatment effect in OA RCTs is attributable to contextual effects rather than the specific effect of treatments. Reporting overall treatment effect and PCE, in addition to traditional ES, permits a more balanced, clinically meaningful interpretation of RCT results. This would help dispel the frequent discordance between conclusions from RCT evidence and clinical experience—the ‘efficacy paradox’.

Tbolis in Lemsnolon, Tboli, South Cotabato are one of the ethnic groups in the Philippines serving as repository of novel knowledge on ethnomedicine. On July 2014, a research was conducted among Tboli tribe in Lemsnolon to document the local knowledge on ethnomedicinal plants before environmental and cultural changes deplete the resources. Selected important ethnomedicinal plants were quantified through Relative Frequency Citation and Use Value. Selected important medicinal plants were screened for phytochemical constituents, and their antibacterial property was determined through paper disc diffusion method. A total of 28 medicinal plants belonging to 21 families were recorded, most are used for symptoms, signs and abnormal clinical and laboratory findings (13spp.) and certain infectious and parasitic diseases (5spp.). The most abundant medicinal plant families were Asteraceae (5spp.) and Euphorbiaceae (3spp.), the most dominant life forms of the species includes herbs (17spp.) followed by shrubs (4spp.), the most frequent used part were leaves (42%) followed by stems (11%), the most common preparation method was decoction (47%), the most common route of administration is through oral (66%). Artemisia vulgaris, Bryophyllum pinnatum, Elephantopus sp., Emilia sonchifolia, Ficus pseudopalma, Hyptis capitata, and Leucaena glauca have the highest RFC (0.29), E. sonchifolia has the highest Use Value (0.71).Selected important ethnomedicinal plants, Artemisia vulgaris, Costus malorticanus, Elephantopus sp., Emilia sonchifolia and H. capitata, were found to be rich in alkaloids while free fatty acids, flavonoids, tannins and anthraquinones were present in most of these selected plants. However, ethanolic extracts of the selected important medicinal plants showed inactive zone of inhibition against S. aureus and E. coli. Results showed that plants used for healing among Tboli community in Lemsnolon are found to be possible sources of potential drugs and are subject for further phytochemical and pharmacological investigations.

BackgroundSelf-monitoring (self-testing and self-management) could be a valid option for oral anticoagulation therapy monitoring in the NHS, but current evidence on its clinical effectiveness or cost-effectiveness is limited.ObjectivesWe investigated the clinical effectiveness and cost-effectiveness of point-of-care coagulometers for the self-monitoring of coagulation status in people receiving long-term vitamin K antagonist therapy, compared with standard clinic monitoring.Data sourcesWe searched major electronic databases (e.g. MEDLINE, MEDLINE In Process & Other Non-Indexed Citations, EMBASE, Bioscience Information Service, Science Citation Index and Cochrane Central Register of Controlled Trials) from 2007 to May 2013. Reports published before 2007 were identified from the existing Cochrane review (major databases searched from inception to 2007). The economic model parameters were derived from the clinical effectiveness review, other relevant reviews, routine sources of cost data and clinical experts’ advice.Review methodsWe assessed randomised controlled trials (RCTs) evaluating self-monitoring in people with atrial fibrillation or heart valve disease requiring long-term anticoagulation therapy. CoaguChek®XS and S models (Roche Diagnostics, Basel, Switzerland), INRatio2®PT/INR monitor (Alere Inc., San Diego, CA USA), and ProTime Microcoagulation system®(International Technidyne Corporation, Nexus Dx, Edison, NJ, USA) coagulometers were compared with standard monitoring. Where possible, we combined data from included trials using standard inverse variance methods. Risk of bias assessment was performed using the Cochrane risk of bias tool. A de novo economic model was developed to assess the cost-effectiveness over a 10-year period.ResultsWe identified 26 RCTs (published in 45 papers) with a total of 8763 participants. CoaguChek was used in 85% of the trials. Primary analyses were based on data from 21 out of 26 trials. Only four trials were at low risk of bias. Major clinical events: self-monitoring was significantly better than standard monitoring in preventing thromboembolic events [relative risk (RR) 0.58, 95% confidence interval (CI) 0.40 to 0.84;p = 0.004]. In people with artificial heart valves (AHVs), self-monitoring almost halved the risk of thromboembolic events (RR 0.56, 95% CI 0.38 to 0.82;p = 0.003) and all-cause mortality (RR 0.54, 95% CI 0.32 to 0.92;p = 0.02). There was greater reduction in thromboembolic events and all-cause mortality through self-management but not through self-testing. Intermediate outcomes: self-testing, but not self-management, showed a modest but significantly higher percentage of time in therapeutic range, compared with standard care (weighted mean difference 4.44, 95% CI 1.71 to 7.18;p = 0.02). Patient-reported outcomes: improvements in patients’ quality of life related to self-monitoring were observed in six out of nine trials. High preference rates were reported for self-monitoring (77% to 98% in four trials). Net health and social care costs over 10 years were £7295 (self-monitoring with INRatio2); £7324 (standard care monitoring); £7333 (self-monitoring with CoaguChek XS) and £8609 (self-monitoring with ProTime). The estimated quality-adjusted life-year (QALY) gain associated with self-monitoring was 0.03. Self-monitoring with INRatio2 or CoaguChek XS was found to have ≈ 80% chance of being cost-effective, compared with standard monitoring at a willingness-to-pay threshold of £20,000 per QALY gained.ConclusionsCompared with standard monitoring, self-monitoring appears to be safe and effective, especially for people with AHVs. Self-monitoring, and in particular self-management, of anticoagulation status appeared cost-effective when pooled estimates of clinical effectiveness were applied. However, if self-monitoring does not result in significant reductions in thromboembolic events, it is unlikely to be cost-effective, based on a comparison of annual monitoring costs alone. Trials investigating the longer-term outcomes of self-management are needed, as well as direct comparisons of the various point-of-care coagulometers.Study registrationThis study is registered as PROSPERO CRD42013004944.FundingThe National Institute for Health Research Health Technology Assessment programme.

OBJECTIVE: To review the pharmacology, biopharmaceutics/pharmacokinetics, clinical efficacy, adverse effects, and therapeutic considerations regarding the use of tacrine in patients with Alzheimer's disease. DATA SOURCES: Data from the scientific and professional literature were analyzed, interpreted, and summarized. Citations were obtained by performing a MEDLINE search using the following indexing terms: tacrine, tetrahydroaminoacridine, and Alzheimer's drug therapy. Data also were obtained from a summary of the New Drug Application (Summary Basis of Approval of Cognex) and from the approved product labeling. STUDY SELECTION: Studies in Alzheimer's disease have been plagued by methodologic inconsistencies and deficiencies. Only efficacy studies subsequent to the Food and Drug Administration's (FDA) issuance of recommendations for studies in Alzheimer's disease (1991) were used. Therefore, only double-blind, placebo-controlled, parallel design studies of at least three-month's duration using the Alzheimer's Disease Assessment Scale-Cognitive Subscale and the Clinical Interview-Based Impression of Change as efficacy parameters were included. DATA EXTRACTION: Trials were assessed according to the criteria listed above. Results were evaluated on the basis of both completed patients and last observation carried forward models. DATA SYNTHESIS: Tacrine is a cholinesterase inhibitor that increases the availability of acetylcholine in muscarinic neurons. It has a mean bioavailability after oral administration of about 17 percent and an elimination half-life of approximately three hours. Although drug interactions are poorly studied, tacrine is metabolized by isoenzyme P-450IA2 and may interact with other drugs metabolized by this isoenzyme. Tacrine has been shown to have efficacy in mildly to moderately impaired Alzheimer's patients on both psychometric testing and a clinician's structured interview. Although efficacious, its effects are not dramatic, and it does not affect the ultimate course of the disease. Adverse effects are frequent, and significantly elevated hepatic transaminase concentrations may occur in approximately 25 percent of patients. CONCLUSIONS: Tacrine is the first drug approved by the FDA for treatment of Alzheimer's disease. Although it may improve psychometric test scores in mild to moderately impaired patients, it is not a panacea and does not affect the course of the disease. Patients must be monitored closely for elevated transaminase, cholinergic adverse effects, and interactions with drugs metabolized through P-450IA2.

OBJECTIVE: To characterize the usefulness of mesalamine and nicotine in the treatment of active ulcerative colitis and inactive Crohn's disease. DATA SOURCES: Citations were selected from the MEDLINE database. Only those involving human subjects, inflammatory bowel disease, and available in English were selected. STUDY SELECTION: Selection criteria consisted of clinical trials and review articles assessing the effects of mesalamine and nicotine in active ulcerative colitis or inactive Crohn's disease and the utility of reducing steroid dependence or relapse rate. Less than 20% of the articles identified met the selection criteria. DATA SYNTHESIS: In patients with inactive Crohn's disease, mesalamine 2 g/d significantly reduced the risk of relapse in high-relapse-risk patients compared with placebo, reducing the relapse rate from 71% to 55%, but was ineffective in preventing recurrence of inactive Crohn's disease following surgical resection. Mesalamine 4 g/d was effective in decreasing weaning failure due to steroid dependence by 67%, although the relapse rate was not significant compared with placebo at the end of 12 months. Following surgical resection, mesalamine was unable to significantly reduce the incidence of recurrence compared with placebo at the end of 1 year. In patients with active ulcerative colitis, oral mesalamine 2 and 4 g/d was superior to placebo in inducing remission compared with placebo. Among patients with prior steroid or sulfasalazine treatment, rectal mesalamine 4 g hs achieved a remission rate of 78% in more than 12 weeks of therapy. Other studies have not found a dose—response relationship with lower dosages of mesalamine. Whereas nicotine 15–25 mg/d administered as a transdermal patch produced greater symptomatic improvement in active ulcerative colitis compared with placebo, nicotine 15 mg/16 h produced results no different from those with placebo in maintaining remission in inactive ulcerative colitis. Nicotine appears to have an adverse effect on the course of Crohn's disease and is not recommended. CONCLUSIONS: Mesalamine has demonstrated clinical effectiveness as a therapeutic agent in the treatment of active ulcerative colitis and inactive Crohn's disease. Although its relationship to inflammatory bowel disease has been known for many years, the usefulness of nicotine for the treatment of active ulcerative colitis requires further exploration before it can be recommended as a therapeutic agent.

Background. Ethnobotanical knowledge on four herbaceous species, Acmella uliginosa (Sw.) Cass., Momordica charantia L., Phyllanthus amarus Schumach. & Thonn., and Scoparia dulcis L., in Benin was investigated. Methods. Herbal medicine traders in six different markets were interviewed using a semi-structured questionnaire. The linear regression test was performed to check for the influence of respondent’s age on ethnobotanical uses they hold. Relative frequency citation, fidelity level, use value, and Rahman similarity index were calculated to assess the diversity of medico-magic knowledge. The Informant Consensus Factor is not applicable in this study since we are dealing neither with the diversity of medicinal plants used by a community of people nor with a great number of plant species used for medicinal purposes, nor the diversity of plant species used in the treatment of a specific or group of ailments. Results. The respondent's age did not influence the ethnobotanical uses they hold on the species. All thirty-six informants surveyed traded Phyllanthus amarus Schumach. & Thonn., Momordica charantia L., and Scoparia dulcis L., and the majority traded Acmella uliginosa (Sw.) Cass. The respondent's age does not influence the diversity of ethnobotanical uses they hold on the study species. Purchase in traders’ own markets was the predominant source of Phyllanthus amarus Schumach. & Thonn., Momordica charantia L., and Scoparia dulcis L. while Acmella uliginosa (Sw.) Cass. was mostly purchased in other more distant markets. A noticeable proportion of traders also collect Phyllanthus amarus Schumach. & Thonn. and Momordica charantia L. from wild populations. Phyllanthus amarus Schumach. & Thonn. was the species most demanded by customers followed by Momordica charantia L. Traders confirmed the scarcity of all species in recent years and climate change and destruction of natural habitats for logging were the most cited causes. The entire plant of Phyllanthus amarus Schumach. & Thonn. was used mainly to treat malaria, diabetes, and constipation, and decoction with oral administration was the most frequent preparation for malaria treatment. To treat diabetes, informants mixed Phyllanthus amarus Schumach. & Thonn. with Momordica charantia L. used as a decoction with oral administration. Momordica charantia L. was also used to treat measles and chicken pox. Acmella uliginosa (Sw.) Cass. and Scoparia dulcis L. were mostly used for their spiritual use for luck, predominantly by chewing fresh leaves or flowers, and by bathing with the ground plant mixed with soap, respectively. Overall, Momordica charantia L. had the greatest use value followed by Phyllanthus amarus Schumach. & Thonn. The majority of traders do not plant the species. Conclusions. The harvesting and trade of the species threaten their natural populations and urgent tools, including in situ and ex situ conservation, are needed to ensure their long-term sustainable exploitation.

The continuous poor results of science and mathematics in Athi-River Sub-County of Machakos County-Kenya has yielded to the study of determinants of pre-primary school teachers’ use of instructional resources in teaching science and mathematics activities. The effects of use of the instructional resources in learning achievement which has led to poor performance in science and mathematics activities in the current study locale. The major purpose of the study was to establish the extent of teachers’ use of instructional resources in teaching pre-primary science and mathematics activities in Athi-River Sub County of Machakos County, Kenya. The study also found out the effects of teachers’ training level in the use of instructional resources in teaching science and mathematics, Teacher- gender and use of instructional resources, Teacher’s attitude and use of instructional resources in teaching science and mathematics activities and teacher- motivation on the use of instructional resources in teaching science and mathematics in pre-primary schools. This study employed Bruner’s learning theory (1966), which matched well with the determinants of pre-primary teachers’ use of instructional resource. The study targeted 40 pre-primary head teachers, 600 pre-primary teachers and 1800 pre-primary children in Athi-River Sub-County, Machakos County. Athi-River Sub-County was sub-divided to 5 bases and stratified sampling technique was used to select 6 pre-schools from each base translating to a total of 30 pre-schools. Random sampling was used to select 6 pupils from each of the sampled schools for focused study giving a sample size of 1800 pupils. Purposive sampling was also used to select 2 teachers for science and mathematics activities from each of the sampled schools. All head teachers from all the 30 sampled schools were selected leading to a sample of 30 head teachers. A sample size of 270 respondents including 60 teachers, 30 head teachers and 180 pupils) was used in the study. Questionnaires and oral-interviews were used to collect data. Validity of the instruments was determined through examining of the items using content validity. A. Pilot test of the research instruments was done in two schools in the neighboring sub county. Quantitative data was generated from the close-ended items from the questionnaires. Descriptive statistics was used to analyze data such as frequency; standard deviation and mean data analysis was analyzed according. The data was presented in tables. Qualitative data produced from the questionnaire, interview schedules, focused group discussion, as well as data obtained through the observation checklists was analyzed with regards to relevant themes and discussed in line with the research objectives. The findings of the study were as follows: teachers with higher training qualifications were more likely to use instructional resources in teaching science and mathematical activities than their counterparts with less or no training. Male teachers were found to use instructional resources more often in teaching science and mathematics than their female counterparts. Teachers with positive attitude towards science and mathematics were also found to use more instructional resources than teachers with negative attitude. The study recommends that the ministry of education should facilitate pre-primary school teachers to advance their studies through in-service training and that the government of Kenya should motivate pre-primary teachers by paying them reasonable salary. All stakeholders should ensure that instructional resources are made available for better pupil achievement in science and mathematics. This is an open-access article published and distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License of United States unless otherwise stated. Access, citation and distribution of this article is allowed with full recognition of the authors and the source.

Abstract Background To describe the impact of research, beyond the limits of the academic environment, Altmetric, a new social and traditional media metric was proposed. The aims of this study were to analyze the online activity related to orthodontic research via Altmetric and to assess if a correlation exists among citations, Mendeley reader count, and the AAS (Altmetric Attention Score). Method The Dimensions App was searched for articles published in the orthodontic journals listed in the Journal Citation Reports (JCR) throughout the years 2014 to 2018. The articles with a positive AAS were collected and screened for data related to publication and authorship. The articles with an AAS higher than 5 were screened for research topic and study design. Citation counts were harvested from Web of Science (WOS) and Scopus. Results The best performing journals were Progress in Orthodontics and the European Journal of Orthodontics with a mean AAS per published item of 1.455 and 1.351, respectively and the most prevalent sources were Tweets and Facebook mentions. The most prevalent topic was Oral Health-Related Quality of Life (OHRQOL) and the study design was systematic reviews. The correlation between the AAS and the citations in both WOS and Scopus was poor (r = 0.1463 and r = 0.1508, p < .05). The correlation between citations count and Mendeley reader (r = 0.6879 and r = 0.697, p < .05) was moderate. Conclusions Few journals displayed a high level of web activity. Journals and editors should enhance online dissemination of the scientific outputs. The authors should report the impact of the findings to the general public in a convenient way to facilitate online dissemination but to avoid an opportunistic use of the research outputs. Despite the lack of correlation, a combination of the citation count and the AAS can give a more comprehensive assessment of research impact.

Abstract Introduction Atrial fibrillation (AF) is the most common cardiac arrhythmia and can lead to significant comorbidities and mortality. Persistence with oral anticoagulation (OAC) is crucial to prevent stroke but rates of discontinuation are high. This systematic review explored underlying reasons for OAC discontinuation. Methods A systematic review was undertaken to identify studies that reported factors influencing discontinuation of OAC in AF, in 11 databases, grey literature and backwards citations from eligible studies published between 2000 and 2019. Two reviewers independently screened titles, abstracts and papers against inclusion criteria and extracted data. Study quality was appraised using Gough’s weight of evidence framework. Data were synthesised narratively. Results Of 6,619 sources identified, 10 full studies and 2 abstracts met the inclusion criteria. Overall, these provided moderate appropriateness to answer the review question. Four reported clinical registry data, six were retrospective reviews of patients’ medical records and two studies reported interviews and surveys. Nine studies evaluated outcomes relating to dabigatran and/or warfarin and three included rivaroxaban (n = 3), apixaban (n = 3) and edoxaban (n = 1). Bleeding complications and gastrointestinal events were the most common factors associated with discontinuation, followed by frailty and risk of falling. Patients’ perspectives were seldom specifically assessed. Influence of family carers in decisions regarding OAC discontinuation was not examined. Conclusion The available evidence is derived from heterogeneous studies with few relevant data for the newer direct oral anticoagulants. Reasons underpinning decision-making to discontinue OAC from the perspective of patients, family carers and clinicians is poorly understood.

Abstract Objective To assess the effects of different oral antithrombotic drugs that prevent saphenous vein graft failure in patients undergoing coronary artery bypass graft surgery. Design Systematic review and network meta-analysis. Data sources Medline, Embase, Web of Science, CINAHL, and the Cochrane Library from inception to 25 January 2019. Eligibility criteria for selecting studies Randomised controlled trials of participants (aged ≥18) who received oral antithrombotic drugs (antiplatelets or anticoagulants) to prevent saphenous vein graft failure after coronary artery bypass graft surgery. Main outcome measures The primary efficacy endpoint was saphenous vein graft failure and the primary safety endpoint was major bleeding. Secondary endpoints were myocardial infarction and death. Results This review identified 3266 citations, and 21 articles that related to 20 randomised controlled trials were included in the network meta-analysis. These 20 trials comprised 4803 participants and investigated nine different interventions (eight active and one placebo). Moderate certainty evidence supports the use of dual antiplatelet therapy with either aspirin plus ticagrelor (odds ratio 0.50, 95% confidence interval 0.31 to 0.79, number needed to treat 10) or aspirin plus clopidogrel (0.60, 0.42 to 0.86, 19) to reduce saphenous vein graft failure when compared with aspirin monotherapy. The study found no strong evidence of differences in major bleeding, myocardial infarction, and death among different antithrombotic therapies. The possibility of intransitivity could not be ruled out; however, between-trial heterogeneity and incoherence were low in all included analyses. Sensitivity analysis using per graft data did not change the effect estimates. Conclusions The results of this network meta-analysis suggest an important absolute benefit of adding ticagrelor or clopidogrel to aspirin to prevent saphenous vein graft failure after coronary artery bypass graft surgery. Dual antiplatelet therapy after surgery should be tailored to the patient by balancing the safety and efficacy profile of the drug intervention against important patient outcomes. Study registration PROSPERO registration number CRD42017065678.

Abstract Background The local wild edible plants (WEPs) are still used traditionally in the rural communities in Yemen, but this traditional knowledge is still undocumented and has been never reported before. Therefore, this study is the first ethnobotanical survey on WEPs conducted in Yemen. Methods The study is based on two field surveys made in two periods 1988–1992 and 2014–2016 to document the wild plants used as edible by local indigenous peoples in 23 districts belonged to five governorates, in southern Yemen. Information data were collected by oral face-to-face interviews from 250 informants. Citations numbers were calculated for each species. Results A total of 58 plant species belonged to 37 genera and 21 families are reported as wild edible plants consumed in southern Yemen. Apocynaceae was the dominant plant family with 18 species followed by Asteraceae (6) and Malvaceae (5). The most widely used edible parts are stem, leaf and fruit with more than 17 species for each. Herbs were reported as the most important sources (31 species), followed by shrubs (16) and trees (9). Most of reported wild edibles (48 species parts) are consumed in raw form; only 12 of them are cooked. Seven wild edible plants were collected in dry season, 16 species throughout the year and 38 in rainy season. In this study, 58 wild plants were reported for the first time as food in Yemen. Comparing the southern Yemeni findings to those from other world countries, 12 of them are new WEPs eaten only in southern Yemen, while 46 species are shared in the use in different world countries practically in East Africa and Arab countries. Conclusions The results data reflect the strong relationship between the local peoples and the local WEPs as potential sources insure food security. The traditional use of these WEPs is attributed to food shortage, nutritional values and local cultural tradition. The study is of great importance in preserving the traditional and knowledge heritage from being lost due to the risks of time, war and immigration.

Abstract Background Candidiasis, an opportunistic cosmopolitan disease is nowadays like bacterial infections which is a real public health problem. In view of the emergence of Candida strains resistant to existing antifungal agents, alternative solutions should be considered. This is the purpose of this ethnobotanical survey, which aims to identify the medicinal plant species traditionally used to treat candidiasis in traditional markets of southern Benin. Methods The study was performed from October 2015 to January 2018 in the traditional markets of Southern-Benin. Data were collected by two complementary methods: triplet purchase of medicinal recipes (ATRM) from herbalists markets and semi-structured interview (ISS) from traditional healers. Results A total of 109 species of medicinal plants belonging to 44 families have been listed and identified. The most frequently cited species were Pteleopsis suberosa Engl. & Diels, Lantana camara L., Cyanthillium cinereum (L.) H. Rob, Ocimum gratissimum L. and Lippia multiflora Moldenke with respectively 43.84, 39.73 and 34.25% citation frequencies for the last three species respectively. Leguminosae (20.18%), Euphorbiaceae (5.50%) and Apocynaceae (5.50%) were the most represented botanical families. Leafy stems were more used than other plant organs. The decoction and the oral route were the most appropriate methods of preparation and administration reported by traditional healers. Conclusion Benin’s plant cover is made up of a wide variety of medicinal plant species used in the traditionnal treatment of candidiasis and which may constitute new sources of medicines to be developed.

Ethnobotany is the scientific study of the relationships that exist between people and plants. Ethnobotanists aim to document, describe and explain complex relationships between cultures and plants, focusing primarily on how plants are used, managed and perceived across human societies. This includes use for food, clothing, currency, ritual, medicine, dye, construction, cosmetics. Ethnobotanical studies are often significant in revealing locally important plant species especially for the discovery of crude drugs The documentation of traditional knowledge, especially on the medicinal uses of plants. has provided many important drugs of modern day. Out of the total flowering plants reported from the world, more than 50, 000 are used for medicinal purposes ( Govaerts, 2001 ). Extensive and intensive field trips were conducted to the study area during a course of two years from 2013 to 2015 representing several sites through Jebel Aulia district, Khartoum state. The study revealed a total of 117 species belonging to 100 genera and 45 families were recorded at Jebel Aulia locality. The family Poaceae was found to be the richest (13 species) followed by Ceasalpiniaceae, Euphorbiaceae, Mimosaceae (7 species) and Asteraceae (6 species). Herbs have dominated the vegetation of the study area (62. 40%) followed with trees (15. 40%), shrubs (8. 5%). Genus Euphorbia was considered as the most speciose (4 species) pursued with Senna and Ipomea which were represented by 3 species each. Tribulus longipetalus and Cyperus alopecuroides along with their Ethnomedicinal uses were documented for the first time. Fruits were the most commonly used plant part to prepare medicine followed with leaves and seeds. The main preparation methods of herbal remedies were infusion (25%) followed with decoction (14. 3%), edible (10. 7%) and pills (10. 7%). Oral administration was the most common route of herbal remedies within traditional medicine. Urinary tracts, kidney and abdominal complaints were the most frequent ailments traditionally healed. The source of medicinal plants was wild, (41. 66%), were cultivated (33. 34%) and (25%) were commercially bought from the market. Senna alexandrina was the most cited and important plant in the study area followed with Ziziphus spina-christi, Acacia nilotica, Solenostemma argel and Cymbopogon proximus. High informants consensus factor was indicated for Medicinal, furniture and food uses. Ziziphus spina Christi, Acacia senegal, Allium sativum and Cinnamomum verum have highest use-value ranging from (0. 062 to 0. 05). Cytotoxicity was evaluated using plants with a high relative frequency of citation. The results revealed that LC50 of water and ethanolic extracts of Acacia nilotica were more than 1000 µg/ml which considered not toxic and consequently safe at this dose. Whereas, water and ethanolic extracts of Senna alexandrina were less than LC 50 =256. 206 - 409. 6079 µg/ml. which is considered moderately toxic. Therefore, Senna extracts should be carefully used.

Abstract Background Traditional medicine is a major component in the primary healthcare system in the southeast of Iran, which has a rich floral diversity. However, there is no comprehensive report on the use of medicinal herbs in this specific region. This traditional usage of medicinal plants by local communities could serve as a source for pharmacological and phytochemical studies. The main objective of this study was to identify ethnopharmacological knowledge on medicinal plant species and their local healing applications by the folk communities of Kerman province in the southeast of Iran. Methods In this cross-sectional study, data were collected from 217 herbal healers using semi-structured questionnaires, open interviews, and field surveys. Factors including use reports (UR) for each species, frequency of citation (FC), and informant consensus factor (ICF) were used to analyze the data. Plant species were identified by botanists through standard taxonomic methods. Results A total of 402 medicinal plants were used in healing practices by the local communities of Kerman province. These species belong to 273 genera of 73 families, among which 367 species are dicotyledons, 27 are monocotyledons, 7 species are cryptogam, and one species is gymnosperm. An important implication from the current study is the identification of the traditional medicinal use of 292 plant species in this region for the first time. Asteraceae, Apiaceae, Lamiaceae, and Fabaceae were the dominant medicinally utilized plant families, respectively. Leaf, flower, fruit, and seed were the most common plant parts used. Generally, crude drugs were used in the form of decoction, followed by poultice and infusion forms. Moreover, oral route is considered as the most common administration route followed by topical route. Endocrine (diabetes), dermatological, gastrointestinal, and respiratory problems were ranked as the most frequent ailment categories for which medicinal plants in this region were applied, respectively. Our findings suggested dominant use of Asteraceae and Apiaceae plants for the treatment of gastrointestinal disorders, Lamiaceae plants for respiratory and gastrointestinal ailments, and Apocynaceae plants for dermatological problems. Conclusion Our findings suggested that Asteraceae and Apiaceae plants were used for the treatment of gastrointestinal disorders, Lamiaceae plants for respiratory and gastrointestinal ailments, and Apocynaceae and Euphorbiaceae plants for dermatological problems. Among the medicinal plants with high UR and new ethnobotanical uses, Rhazya stricta was used for wound healing, Calotropis procera, Clematis ispahanica and Euphorbia spp. for eczema, Cionura erecta for the treatment of cough, Launaea acanthodes for the treatment of gastrointestinal parasites, Berberis integrrima as an antidiabetic medicinal herb, Dracocephalum polychaetum and Rydingia persica for various types of chronic diseases, Citrus limon and Citrus aurantium for the treatment of ocular diseases and making the traditional kohl, Calendula officinalis for the treatment of pterygium and Prosopis farcta for preventing nasal bleeding. The identified medicinal plants can be further evaluated for their pharmacological activity and underlying mechanisms of action.

ObjectiveThe purpose of the study was to confirm the hypothesis of possible intestinal viruses circulation in wastewater in Dnipropetrovsk Oblast, Ukraine.IntroductionThe main reservoir of intestinal viruses in the environment is human feces and contaminated wastewater. Sewage contamination preconditions further contamination of surface water serving as a source of water supply [2,7,8]. High resistance to physical and biological exposures ensures long-term survival of the viruses in water with various type and level of contaminants, especially in sewage. Detection of enteroviruses of a specific serotype in sewage indicates a significant number of people releasing the virus with feces [1,2]. There are two peaks of enteroviruses concentration in sewage: in January-April, and in June-September [8]. Sewage testing for enteroviruses is one of effective methods for their detection and risk assessment [3]. European region, including Ukraine, is recognized as free from of wild polioviruses, and a systematic study of sewage samples is important for identifying the possibilities of their "silent" circulation [6].MethodsWastewater samples from large sewerage collectors, sewage wells of infectious departments, city hospitals and district sewerage networks of Dnipropetrovsk Oblast were tested in 2007-2017 (39-64 samples monthly in the points are determined by the national regulations [7]). Gauze tampons (Moore's method) were used to collect wastewater [8]. In addition, samples were collected from wastewater flow into 1-liter sterile bottle with a sampler. Concentration was carried out using Enterosgel (hydroxyl methyl silicic acid) with high adsorption capacity [7]. The supernatant after all the concentration steps was used for culture on cell cultures RD, HEP-2, L20B [4,7,8].In the presence of cytopathic action in RD cells, culture liquid was inoculated into L20B cells to detect clear cytopathic activity. Culture liquids were investigated to identify enteroviruses in neutralization reaction. In HEP-2, cytopathic effects were observed in the form of clusters of different sizes cells, "grape clusters", which indicated the presence of adenoviruses. Adenoviruses were confirmed by immunochromatographic tests for adenovirus antigens "Cito Test Adeno" Pharmasko, Ukraine).ResultsDuring 10 years, 150 viruses were isolated, 2 of them were a mixture of polioviruses. The frequency of detection of enteroviruses (including polioviruses) and adenoviruses was 2.5% (Tab 1).The isolated strains of enteroviruses, including polioviruses, were sent for confirmation the Public Health Center of the Ministry of Health of Ukraine and Regional WHO polio reference laboratories (Moscow and Helsinki). All polio strains were attributed to the vaccine strain Sabin. Also, the result Coxsackie viruses B typing was confirmed.ConclusionsThe data testify to presence of Picornaviridae (polioviruses, Coxsackie B, non-polio enteroviruses (NPEVs), and Adenoviridae in the wastewater in Dnipropetrovsk Oblast, Ukraine. The typical composition of viruses was not constant. Types 1, 2 polioviruses (Sabin) were occasionally isolated from wastewater. Type 2 polioviruses (Sabin) were isolated only in 2015. In 2009, 2012-2014, 2017, polioviruses did not stand out. Polioviruses isolation is associated with mass immunization of children against polioviruses carried out to maintain polio-free status of the country. In average, 150,000 children are vaccinated annually. Oral poliomyelitis vaccine (OPV) produced in Russia, France, Belgium was used in 2007-2017 (attenuated Sabin strains, 1,2,3 types). From April 2016, Ukraine refused to use trivalent OPV and switched to bivalent vaccine (Sabin strains, types 1 and 2).Sewage testing for polioviruses and their differentiation at WHO National and Regional Centers for Polio Diagnosis ensures a system for monitoring of possible "silent" circulation [6]. Sewage testing using cell cultures is one of the most affordable, effective and reliable methods for controlling the presence of viruses in the environment [4,7,8]. RD and L20B cell lines are useful for poliovirus isolation from sewage [4].In addition to polioviruses, 1,2,3 types Coxsackie viruses B were isolated from wastewater samples. However, starting from 2013, Coxsackie viruses were isolated only in sporadic cases (Cox.vir.B5). In 2007-2011, NPEVs were isolated in some cases. Because polio is on the verge of eradication, more attention should be paid to study of NPEVs [5]. For 10 years, adenoviruses were isolated, which are well preserved in wastewater [1]. The maximum number of adenoviruses was isolated in 2014.References1. Quantification and stability of human adenoviruses and polyomavirus JCPyV in wastewater matrices. Bofill-Mas, S., N. Albinana-Gimenez, P. Clemente-Casares, A. Hundesa, J. Rodriguez-Manzano, A. Allard, M. Calvo, and R. Girones. 2006. Appl. Environ. Microbiol. 72:7894-7896.2. Poliovirus detection in wastewater and stools following an immunization campaign in Havana, Cuba/P.Más Lago, Howard E Gary, Jr Luis Sarmientos Pérez, V.Cáceres, J. B. Olivera, R.P.Puentesk, M.Bello Corredor, P.Jímenez, M. A Pallansch, R.G. Cruz/International Journal of Epidemiology, Issue 5, 1 October 2003, p.772–777.3. Role of environmental poliovirus surveillance in global polio eradication and beyond. Hovi T., L.M. Shulman, H. van der Avoort, J. Deshpande, M. Roivainen and E.M. de Gourville.2010. Epidemiol. Infect.140:1-13.4. Detection of Polioviruses in Sewage Using Cell Culture and Molecular Methods/ Anieska Figas, M.Wieczorek, B.Litwinska and W.GU/ Polish Journal of Microbiology 2016, Vol. 65, No 4, 479–483.5. Identification and molecular characterization of non-polio enteroviruses from children with acute flaccid paralysis in West Africa, 2013–2014/Maria D. Fernandez-Garcia, Ousmane Kebe, AichatouD., Kader Ndiaye/Scientific Reportsvolume 7, Article number: 3808 (2017) | Download Citation.6. World Health Organization (WHO). 2007.World Health Organization Regional Office for Europe. Wild poliovirus isolated in Switzerland’s sewer system, insignificant risk of outbreak. Monthly AFP surveillance bulletin.7. Sanitary-virological control of water bodies / Methodological recommendations approved by the order of the Ministry of Health of Ukraine, 30.05.2007, 284: 8.8. Comparative characteristics of the isolation of enterovirus from water of various types in Ukraine / Doan S., Zadorozhna V., Bondarenko V., Zubkova N., Burat T., 2002,38-41.

On the morning of Thursday, 4 May 2006, the United States House Permanent Select Committee on Intelligence held an open hearing entitled “Terrorist Use of the Internet.” The Intelligence committee meeting was scheduled to take place in Room 1302 of the Longworth Office Building, a Depression-era structure with a neoclassical façade. Because of a dysfunctional elevator, some of the congressional representatives were late to the meeting. During the testimony about the newest political applications for cutting-edge digital technology, the microphones periodically malfunctioned, and witnesses complained of “technical problems” several times. By the end of the day it seemed that what was to be remembered about the hearing was the shocking revelation that terrorists were using videogames to recruit young jihadists. The Associated Press wrote a short, restrained article about the hearing that only mentioned “computer games and recruitment videos” in passing. Eager to have their version of the news item picked up, Reuters made videogames the focus of their coverage with a headline that announced, “Islamists Using US Videogames in Youth Appeal.” Like a game of telephone, as the Reuters videogame story was quickly re-run by several Internet news services, each iteration of the title seemed less true to the exact language of the original. One Internet news service changed the headline to “Islamic militants recruit using U.S. video games.” Fox News re-titled the story again to emphasise that this alert about technological manipulation was coming from recognised specialists in the anti-terrorism surveillance field: “Experts: Islamic Militants Customizing Violent Video Games.” As the story circulated, the body of the article remained largely unchanged, in which the Reuters reporter described the digital materials from Islamic extremists that were shown at the congressional hearing. During the segment that apparently most captured the attention of the wire service reporters, eerie music played as an English-speaking narrator condemned the “infidel” and declared that he had “put a jihad” on them, as aerial shots moved over 3D computer-generated images of flaming oil facilities and mosques covered with geometric designs. Suddenly, this menacing voice-over was interrupted by an explosion, as a virtual rocket was launched into a simulated military helicopter. The Reuters reporter shared this dystopian vision from cyberspace with Western audiences by quoting directly from the chilling commentary and describing a dissonant montage of images and remixed sound. “I was just a boy when the infidels came to my village in Blackhawk helicopters,” a narrator’s voice said as the screen flashed between images of street-level gunfights, explosions and helicopter assaults. Then came a recording of President George W. Bush’s September 16, 2001, statement: “This crusade, this war on terrorism, is going to take a while.” It was edited to repeat the word “crusade,” which Muslims often define as an attack on Islam by Christianity. According to the news reports, the key piece of evidence before Congress seemed to be a film by “SonicJihad” of recorded videogame play, which – according to the experts – was widely distributed online. Much of the clip takes place from the point of view of a first-person shooter, seen as if through the eyes of an armed insurgent, but the viewer also periodically sees third-person action in which the player appears as a running figure wearing a red-and-white checked keffiyeh, who dashes toward the screen with a rocket launcher balanced on his shoulder. Significantly, another of the player’s hand-held weapons is a detonator that triggers remote blasts. As jaunty music plays, helicopters, tanks, and armoured vehicles burst into smoke and flame. Finally, at the triumphant ending of the video, a green and white flag bearing a crescent is hoisted aloft into the sky to signify victory by Islamic forces. To explain the existence of this digital alternative history in which jihadists could be conquerors, the Reuters story described the deviousness of the country’s terrorist opponents, who were now apparently modifying popular videogames through their wizardry and inserting anti-American, pro-insurgency content into U.S.-made consumer technology. One of the latest video games modified by militants is the popular “Battlefield 2” from leading video game publisher, Electronic Arts Inc of Redwood City, California. Jeff Brown, a spokesman for Electronic Arts, said enthusiasts often write software modifications, known as “mods,” to video games. “Millions of people create mods on games around the world,” he said. “We have absolutely no control over them. It’s like drawing a mustache on a picture.” Although the Electronic Arts executive dismissed the activities of modders as a “mustache on a picture” that could only be considered little more than childish vandalism of their off-the-shelf corporate product, others saw a more serious form of criminality at work. Testifying experts and the legislators listening on the committee used the video to call for greater Internet surveillance efforts and electronic counter-measures. Within twenty-four hours of the sensationalistic news breaking, however, a group of Battlefield 2 fans was crowing about the idiocy of reporters. The game play footage wasn’t from a high-tech modification of the software by Islamic extremists; it had been posted on a Planet Battlefield forum the previous December of 2005 by a game fan who had cut together regular game play with a Bush remix and a parody snippet of the soundtrack from the 2004 hit comedy film Team America. The voice describing the Black Hawk helicopters was the voice of Trey Parker of South Park cartoon fame, and – much to Parker’s amusement – even the mention of “goats screaming” did not clue spectators in to the fact of a comic source. Ironically, the moment in the movie from which the sound clip is excerpted is one about intelligence gathering. As an agent of Team America, a fictional elite U.S. commando squad, the hero of the film’s all-puppet cast, Gary Johnston, is impersonating a jihadist radical inside a hostile Egyptian tavern that is modelled on the cantina scene from Star Wars. Additional laughs come from the fact that agent Johnston is accepted by the menacing terrorist cell as “Hakmed,” despite the fact that he utters a series of improbable clichés made up of incoherent stereotypes about life in the Middle East while dressed up in a disguise made up of shoe polish and a turban from a bathroom towel. The man behind the “SonicJihad” pseudonym turned out to be a twenty-five-year-old hospital administrator named Samir, and what reporters and representatives saw was nothing more exotic than game play from an add-on expansion pack of Battlefield 2, which – like other versions of the game – allows first-person shooter play from the position of the opponent as a standard feature. While SonicJihad initially joined his fellow gamers in ridiculing the mainstream media, he also expressed astonishment and outrage about a larger politics of reception. In one interview he argued that the media illiteracy of Reuters potentially enabled a whole series of category errors, in which harmless gamers could be demonised as terrorists. It wasn’t intended for the purpose what it was portrayed to be by the media. So no I don’t regret making a funny video . . . why should I? The only thing I regret is thinking that news from Reuters was objective and always right. The least they could do is some online research before publishing this. If they label me al-Qaeda just for making this silly video, that makes you think, what is this al-Qaeda? And is everything al-Qaeda? Although Sonic Jihad dismissed his own work as “silly” or “funny,” he expected considerably more from a credible news agency like Reuters: “objective” reporting, “online research,” and fact-checking before “publishing.” Within the week, almost all of the salient details in the Reuters story were revealed to be incorrect. SonicJihad’s film was not made by terrorists or for terrorists: it was not created by “Islamic militants” for “Muslim youths.” The videogame it depicted had not been modified by a “tech-savvy militant” with advanced programming skills. Of course, what is most extraordinary about this story isn’t just that Reuters merely got its facts wrong; it is that a self-identified “parody” video was shown to the august House Intelligence Committee by a team of well-paid “experts” from the Science Applications International Corporation (SAIC), a major contractor with the federal government, as key evidence of terrorist recruitment techniques and abuse of digital networks. Moreover, this story of media illiteracy unfolded in the context of a fundamental Constitutional debate about domestic surveillance via communications technology and the further regulation of digital content by lawmakers. Furthermore, the transcripts of the actual hearing showed that much more than simple gullibility or technological ignorance was in play. Based on their exchanges in the public record, elected representatives and government experts appear to be keenly aware that the digital discourses of an emerging information culture might be challenging their authority and that of the longstanding institutions of knowledge and power with which they are affiliated. These hearings can be seen as representative of a larger historical moment in which emphatic declarations about prohibiting specific practices in digital culture have come to occupy a prominent place at the podium, news desk, or official Web portal. This environment of cultural reaction can be used to explain why policy makers’ reaction to terrorists’ use of networked communication and digital media actually tells us more about our own American ideologies about technology and rhetoric in a contemporary information environment. When the experts come forward at the Sonic Jihad hearing to “walk us through the media and some of the products,” they present digital artefacts of an information economy that mirrors many of the features of our own consumption of objects of electronic discourse, which seem dangerously easy to copy and distribute and thus also create confusion about their intended meanings, audiences, and purposes. From this one hearing we can see how the reception of many new digital genres plays out in the public sphere of legislative discourse. Web pages, videogames, and Weblogs are mentioned specifically in the transcript. The main architecture of the witnesses’ presentation to the committee is organised according to the rhetorical conventions of a PowerPoint presentation. Moreover, the arguments made by expert witnesses about the relationship of orality to literacy or of public to private communications in new media are highly relevant to how we might understand other important digital genres, such as electronic mail or text messaging. The hearing also invites consideration of privacy, intellectual property, and digital “rights,” because moral values about freedom and ownership are alluded to by many of the elected representatives present, albeit often through the looking glass of user behaviours imagined as radically Other. For example, terrorists are described as “modders” and “hackers” who subvert those who properly create, own, legitimate, and regulate intellectual property. To explain embarrassing leaks of infinitely replicable digital files, witness Ron Roughead says, “We’re not even sure that they don’t even hack into the kinds of spaces that hold photographs in order to get pictures that our forces have taken.” Another witness, Undersecretary of Defense for Policy and International Affairs, Peter Rodman claims that “any video game that comes out, as soon as the code is released, they will modify it and change the game for their needs.” Thus, the implication of these witnesses’ testimony is that the release of code into the public domain can contribute to political subversion, much as covert intrusion into computer networks by stealthy hackers can. However, the witnesses from the Pentagon and from the government contractor SAIC often present a contradictory image of the supposed terrorists in the hearing transcripts. Sometimes the enemy is depicted as an organisation of technological masterminds, capable of manipulating the computer code of unwitting Americans and snatching their rightful intellectual property away; sometimes those from the opposing forces are depicted as pre-modern and even sub-literate political innocents. In contrast, the congressional representatives seem to focus on similarities when comparing the work of “terrorists” to the everyday digital practices of their constituents and even of themselves. According to the transcripts of this open hearing, legislators on both sides of the aisle express anxiety about domestic patterns of Internet reception. Even the legislators’ own Web pages are potentially disruptive electronic artefacts, particularly when the demands of digital labour interfere with their duties as lawmakers. Although the subject of the hearing is ostensibly terrorist Websites, Representative Anna Eshoo (D-California) bemoans the difficulty of maintaining her own official congressional site. As she observes, “So we are – as members, I think we’re very sensitive about what’s on our Website, and if I retained what I had on my Website three years ago, I’d be out of business. So we know that they have to be renewed. They go up, they go down, they’re rebuilt, they’re – you know, the message is targeted to the future.” In their questions, lawmakers identify Weblogs (blogs) as a particular area of concern as a destabilising alternative to authoritative print sources of information from established institutions. Representative Alcee Hastings (D-Florida) compares the polluting power of insurgent bloggers to that of influential online muckrakers from the American political Right. Hastings complains of “garbage on our regular mainstream news that comes from blog sites.” Representative Heather Wilson (R-New Mexico) attempts to project a media-savvy persona by bringing up the “phenomenon of blogging” in conjunction with her questions about jihadist Websites in which she notes how Internet traffic can be magnified by cooperative ventures among groups of ideologically like-minded content-providers: “These Websites, and particularly the most active ones, are they cross-linked? And do they have kind of hot links to your other favorite sites on them?” At one point Representative Wilson asks witness Rodman if he knows “of your 100 hottest sites where the Webmasters are educated? What nationality they are? Where they’re getting their money from?” In her questions, Wilson implicitly acknowledges that Web work reflects influences from pedagogical communities, economic networks of the exchange of capital, and even potentially the specific ideologies of nation-states. It is perhaps indicative of the government contractors’ anachronistic worldview that the witness is unable to answer Wilson’s question. He explains that his agency focuses on the physical location of the server or ISP rather than the social backgrounds of the individuals who might be manufacturing objectionable digital texts. The premise behind the contractors’ working method – surveilling the technical apparatus not the social network – may be related to other beliefs expressed by government witnesses, such as the supposition that jihadist Websites are collectively produced and spontaneously emerge from the indigenous, traditional, tribal culture, instead of assuming that Iraqi insurgents have analogous beliefs, practices, and technological awareness to those in first-world countries. The residual subtexts in the witnesses’ conjectures about competing cultures of orality and literacy may tell us something about a reactionary rhetoric around videogames and digital culture more generally. According to the experts before Congress, the Middle Eastern audience for these videogames and Websites is limited by its membership in a pre-literate society that is only capable of abortive cultural production without access to knowledge that is archived in printed codices. Sometimes the witnesses before Congress seem to be unintentionally channelling the ideas of the late literacy theorist Walter Ong about the “secondary orality” associated with talky electronic media such as television, radio, audio recording, or telephone communication. Later followers of Ong extend this concept of secondary orality to hypertext, hypermedia, e-mail, and blogs, because they similarly share features of both speech and written discourse. Although Ong’s disciples celebrate this vibrant reconnection to a mythic, communal past of what Kathleen Welch calls “electric rhetoric,” the defence industry consultants express their profound state of alarm at the potentially dangerous and subversive character of this hybrid form of communication. The concept of an “oral tradition” is first introduced by the expert witnesses in the context of modern marketing and product distribution: “The Internet is used for a variety of things – command and control,” one witness states. “One of the things that’s missed frequently is how and – how effective the adversary is at using the Internet to distribute product. They’re using that distribution network as a modern form of oral tradition, if you will.” Thus, although the Internet can be deployed for hierarchical “command and control” activities, it also functions as a highly efficient peer-to-peer distributed network for disseminating the commodity of information. Throughout the hearings, the witnesses imply that unregulated lateral communication among social actors who are not authorised to speak for nation-states or to produce legitimated expert discourses is potentially destabilising to political order. Witness Eric Michael describes the “oral tradition” and the conventions of communal life in the Middle East to emphasise the primacy of speech in the collective discursive practices of this alien population: “I’d like to point your attention to the media types and the fact that the oral tradition is listed as most important. The other media listed support that. And the significance of the oral tradition is more than just – it’s the medium by which, once it comes off the Internet, it is transferred.” The experts go on to claim that this “oral tradition” can contaminate other media because it functions as “rumor,” the traditional bane of the stately discourse of military leaders since the classical era. The oral tradition now also has an aspect of rumor. A[n] event takes place. There is an explosion in a city. Rumor is that the United States Air Force dropped a bomb and is doing indiscriminate killing. This ends up being discussed on the street. It ends up showing up in a Friday sermon in a mosque or in another religious institution. It then gets recycled into written materials. Media picks up the story and broadcasts it, at which point it’s now a fact. In this particular case that we were telling you about, it showed up on a network television, and their propaganda continues to go back to this false initial report on network television and continue to reiterate that it’s a fact, even though the United States government has proven that it was not a fact, even though the network has since recanted the broadcast. In this example, many-to-many discussion on the “street” is formalised into a one-to many “sermon” and then further stylised using technology in a one-to-many broadcast on “network television” in which “propaganda” that is “false” can no longer be disputed. This “oral tradition” is like digital media, because elements of discourse can be infinitely copied or “recycled,” and it is designed to “reiterate” content. In this hearing, the word “rhetoric” is associated with destructive counter-cultural forces by the witnesses who reiterate cultural truisms dating back to Plato and the Gorgias. For example, witness Eric Michael initially presents “rhetoric” as the use of culturally specific and hence untranslatable figures of speech, but he quickly moves to an outright castigation of the entire communicative mode. “Rhetoric,” he tells us, is designed to “distort the truth,” because it is a “selective” assembly or a “distortion.” Rhetoric is also at odds with reason, because it appeals to “emotion” and a romanticised Weltanschauung oriented around discourses of “struggle.” The film by SonicJihad is chosen as the final clip by the witnesses before Congress, because it allegedly combines many different types of emotional appeal, and thus it conveniently ties together all of the themes that the witnesses present to the legislators about unreliable oral or rhetorical sources in the Middle East: And there you see how all these products are linked together. And you can see where the games are set to psychologically condition you to go kill coalition forces. You can see how they use humor. You can see how the entire campaign is carefully crafted to first evoke an emotion and then to evoke a response and to direct that response in the direction that they want. Jihadist digital products, especially videogames, are effective means of manipulation, the witnesses argue, because they employ multiple channels of persuasion and carefully sequenced and integrated subliminal messages. To understand the larger cultural conversation of the hearing, it is important to keep in mind that the related argument that “games” can “psychologically condition” players to be predisposed to violence is one that was important in other congressional hearings of the period, as well one that played a role in bills and resolutions that were passed by the full body of the legislative branch. In the witness’s testimony an appeal to anti-game sympathies at home is combined with a critique of a closed anti-democratic system abroad in which the circuits of rhetorical production and their composite metonymic chains are described as those that command specific, unvarying, robotic responses. This sharp criticism of the artful use of a presentation style that is “crafted” is ironic, given that the witnesses’ “compilation” of jihadist digital material is staged in the form of a carefully structured PowerPoint presentation, one that is paced to a well-rehearsed rhythm of “slide, please” or “next slide” in the transcript. The transcript also reveals that the members of the House Intelligence Committee were not the original audience for the witnesses’ PowerPoint presentation. Rather, when it was first created by SAIC, this “expert” presentation was designed for training purposes for the troops on the ground, who would be facing the challenges of deployment in hostile terrain. According to the witnesses, having the slide show showcased before Congress was something of an afterthought. Nonetheless, Congressman Tiahrt (R-KN) is so impressed with the rhetorical mastery of the consultants that he tries to appropriate it. As Tiarht puts it, “I’d like to get a copy of that slide sometime.” From the hearing we also learn that the terrorists’ Websites are threatening precisely because they manifest a polymorphously perverse geometry of expansion. For example, one SAIC witness before the House Committee compares the replication and elaboration of digital material online to a “spiderweb.” Like Representative Eshoo’s site, he also notes that the terrorists’ sites go “up” and “down,” but the consultant is left to speculate about whether or not there is any “central coordination” to serve as an organising principle and to explain the persistence and consistency of messages despite the apparent lack of a single authorial ethos to offer a stable, humanised, point of reference. In the hearing, the oft-cited solution to the problem created by the hybridity and iterability of digital rhetoric appears to be “public diplomacy.” Both consultants and lawmakers seem to agree that the damaging messages of the insurgents must be countered with U.S. sanctioned information, and thus the phrase “public diplomacy” appears in the hearing seven times. However, witness Roughhead complains that the protean “oral tradition” and what Henry Jenkins has called the “transmedia” character of digital culture, which often crosses several platforms of traditional print, projection, or broadcast media, stymies their best rhetorical efforts: “I think the point that we’ve tried to make in the briefing is that wherever there’s Internet availability at all, they can then download these – these programs and put them onto compact discs, DVDs, or post them into posters, and provide them to a greater range of people in the oral tradition that they’ve grown up in. And so they only need a few Internet sites in order to distribute and disseminate the message.” Of course, to maintain their share of the government market, the Science Applications International Corporation also employs practices of publicity and promotion through the Internet and digital media. They use HTML Web pages for these purposes, as well as PowerPoint presentations and online video. The rhetoric of the Website of SAIC emphasises their motto “From Science to Solutions.” After a short Flash film about how SAIC scientists and engineers solve “complex technical problems,” the visitor is taken to the home page of the firm that re-emphasises their central message about expertise. The maps, uniforms, and specialised tools and equipment that are depicted in these opening Web pages reinforce an ethos of professional specialisation that is able to respond to multiple threats posed by the “global war on terror.” By 26 June 2006, the incident finally was being described as a “Pentagon Snafu” by ABC News. From the opening of reporter Jake Tapper’s investigative Webcast, established government institutions were put on the spot: “So, how much does the Pentagon know about videogames? Well, when it came to a recent appearance before Congress, apparently not enough.” Indeed, the very language about “experts” that was highlighted in the earlier coverage is repeated by Tapper in mockery, with the significant exception of “independent expert” Ian Bogost of the Georgia Institute of Technology. If the Pentagon and SAIC deride the legitimacy of rhetoric as a cultural practice, Bogost occupies himself with its defence. In his recent book Persuasive Games: The Expressive Power of Videogames, Bogost draws upon the authority of the “2,500 year history of rhetoric” to argue that videogames represent a significant development in that cultural narrative. Given that Bogost and his Watercooler Games Weblog co-editor Gonzalo Frasca were actively involved in the detective work that exposed the depth of professional incompetence involved in the government’s line-up of witnesses, it is appropriate that Bogost is given the final words in the ABC exposé. As Bogost says, “We should be deeply bothered by this. We should really be questioning the kind of advice that Congress is getting.” Bogost may be right that Congress received terrible counsel on that day, but a close reading of the transcript reveals that elected officials were much more than passive listeners: in fact they were lively participants in a cultural conversation about regulating digital media. After looking at the actual language of these exchanges, it seems that the persuasiveness of the misinformation from the Pentagon and SAIC had as much to do with lawmakers’ preconceived anxieties about practices of computer-mediated communication close to home as it did with the contradictory stereotypes that were presented to them about Internet practices abroad. In other words, lawmakers found themselves looking into a fun house mirror that distorted what should have been familiar artefacts of American popular culture because it was precisely what they wanted to see. References ABC News. “Terrorist Videogame?” Nightline Online. 21 June 2006. 22 June 2006 http://abcnews.go.com/Video/playerIndex?id=2105341>. Bogost, Ian. Persuasive Games: Videogames and Procedural Rhetoric. Cambridge, MA: MIT Press, 2007. Game Politics. “Was Congress Misled by ‘Terrorist’ Game Video? We Talk to Gamer Who Created the Footage.” 11 May 2006. http://gamepolitics.livejournal.com/285129.html#cutid1>. Jenkins, Henry. Convergence Culture: Where Old and New Media Collide. New York: New York UP, 2006. julieb. “David Morgan Is a Horrible Writer and Should Be Fired.” Online posting. 5 May 2006. Dvorak Uncensored Cage Match Forums. http://cagematch.dvorak.org/index.php/topic,130.0.html>. Mahmood. “Terrorists Don’t Recruit with Battlefield 2.” GGL Global Gaming. 16 May 2006 http://www.ggl.com/news.php?NewsId=3090>. Morgan, David. “Islamists Using U.S. Video Games in Youth Appeal.” Reuters online news service. 4 May 2006 http://today.reuters.com/news/ArticleNews.aspx?type=topNews &storyID=2006-05-04T215543Z_01_N04305973_RTRUKOC_0_US-SECURITY- VIDEOGAMES.xml&pageNumber=0&imageid=&cap=&sz=13&WTModLoc= NewsArt-C1-ArticlePage2>. Ong, Walter J. Orality and Literacy: The Technologizing of the Word. London/New York: Methuen, 1982. Parker, Trey. Online posting. 7 May 2006. 9 May 2006 http://www.treyparker.com>. Plato. “Gorgias.” Plato: Collected Dialogues. Princeton: Princeton UP, 1961. Shrader, Katherine. “Pentagon Surfing Thousands of Jihad Sites.” Associated Press 4 May 2006. SonicJihad. “SonicJihad: A Day in the Life of a Resistance Fighter.” Online posting. 26 Dec. 2005. Planet Battlefield Forums. 9 May 2006 http://www.forumplanet.com/planetbattlefield/topic.asp?fid=13670&tid=1806909&p=1>. Tapper, Jake, and Audery Taylor. “Terrorist Video Game or Pentagon Snafu?” ABC News Nightline 21 June 2006. 30 June 2006 http://abcnews.go.com/Nightline/Technology/story?id=2105128&page=1>. U.S. Congressional Record. Panel I of the Hearing of the House Select Intelligence Committee, Subject: “Terrorist Use of the Internet for Communications.” Federal News Service. 4 May 2006. Welch, Kathleen E. Electric Rhetoric: Classical Rhetoric, Oralism, and the New Literacy. Cambridge, MA: MIT Press, 1999. Citation reference for this article MLA Style Losh, Elizabeth. "Artificial Intelligence: Media Illiteracy and the SonicJihad Debacle in Congress." M/C Journal 10.5 (2007). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0710/08-losh.php>. APA Style Losh, E. (Oct. 2007) "Artificial Intelligence: Media Illiteracy and the SonicJihad Debacle in Congress," M/C Journal, 10(5). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0710/08-losh.php>.

Historically the impact of the printing press on Western culture is a truism. Print gave rise to the mass reproduction and circulation of information with wide reaching consequences in all fields: political, social, and economic. An aspect that this paper wishes to focus on is that this moment also saw the birth (and necessity) of copyright legislation, to administer and protect this new found ability to package and disseminate text. The term copyright itself, used freely in debates surrounding contemporary topics such as iTunes, DVD piracy, and file-sharing, is not only semantically anachronistic but, as will be shown, is an anachronistic problem. The history that it carries, through almost three hundred years, underscores the difficulties at the heart of copyright in the contemporary scene. Indeed the reliance on copyright in these debates creates an argument based on circular definitions relating to only the statutory conception of cultural rights. No avenue is really left to imagine a space outside its jurisdiction. This paper asserts that notions of the “culture industry” (as opposed to some other conception of culture) are also inherently connected to the some three hundred years of copyright legislation. Our conceptions of the author and of intellectual pursuits as property can also be traced within this relatively small period. As clarified by Lord Chief Baron Pollock in the English courts in 1854, “copyright is altogether an artificial right” that does not apply at common law and relies wholly on statute (Jeffreys v Boosey). Foucault (124-42) highlights, in his attack on Romantic notions of the author-genius-God, that the author-function is expressed primarily as a legal term, through the legal concepts of censorship and copyright. Copyright, then, pays little attention to non-economic interests of the author and is used primarily to further economic interests. The corporate nature of the culture industry at present amounts to the successful application of copyright legislation in the past. This paper suggests that we look at our conception of literary and artistic work as separate from copyright’s own definitions of intellectual property and the commercialisation of culture. From Hogarth to File-Sharing The case of ‘DVD Jon’ is instructive. In 1999, Jon Lech Johansen, a Norwegian programmer, drew the ire of Hollywood by breaking the encryption code for DVDs (in a program called DeCSS). More recently, he has devised a program to circumvent the anti-piracy system for Apple’s iTunes music download service. With this program, called PyMusique, users still have to pay for the songs, but once these are paid for, users can use the songs on all operating systems and with no limits on copying, transfers or burning. Johansen, who publishes his wares on his blog entitled So Sue Me, was in fact sued in 1999 by the Motion Picture Association of America (MPAA) for copyright infringement. He argued that he created DeCSS as part of developing a DVD player for his Linux operating system, and that copying DVD movies was an ancillary function of the program for which he could not be held responsible. He was acquitted by an Oslo district court in early 2003 and again by an appeals court later that year. During this time many people on the internet found novel ways to publish the DeCSS code so as to avoid prosecution, including many different code encryptions incorporated into jpeg images (including the trademarked DVD logo, owned by DVD LLC) and mpeg movies, as an online MUD game scenario, and even produced in the form of a haiku (“42 Ways to Distribute DeCSS”). The ability to publish the code in a format not readily prosecutable owes less to encryption and clandestine messages than it does to anachronistic laws regarding the wholly legal right to original formats. Prior to 1709, copyright or licensing related to the book publishing industry where the work as formatted, pressed and disseminated was more important to protect than the text itself or the concept of the author as the writer of the text. Even today different copyrights may be held over the different formatting of the same text. The ability for hackers to attack the copyright legislation through its inherent anachronism is more than smart lawyering or a neat joke. These attacks, based on file sharing and the morphing fluid forms of information (rather than contained text, printed, broadcast, or expressed through form in general), amount to a real breach in copyright’s capability to administer and protect information. That the corporations are so excited and scared of these new technologies of dissemination should come as no surprise. It should also not be seen, as some commentators wish to, as a completely new approach to the dissemination of culture. If copyright was originally intended to protect the rights of the publisher, the passing of the Act of Anne in 1709 introduced two new concepts – an author being the owner of copyright, and the principle of a fixed term of protection for published works. In 1734, William Hogarth, wanting to ensure profits would flow from his widely disseminated prints (which attracted many pirate copies), fought to have these protections extended to visual works. What is notable about all this is that in 1734 the concept of copyright both in literary and artistic works applied only to published or reproduced works. It would be over one hundred years later, in the Romantic period, that a broader protection to all artworks would be available (for example, paintings, sculpture, etc). Born primarily out of guild systems, the socio-political aspect of protection, although with a passing nod to the author, was primarily a commercial concern. These days the statute has muddied its primary purpose; commercial interest is conflated and confused with the moral rights of the author (which, it might be added, although first asserted in the International Berne Convention of 1886 were only ratified in Australia in December 2000). For instance, in a case such as Sony Entertainment (Australia) Ltd v Smith (2005), both parties in fact want the protection of copyright. On one day the DJ in question (Pee Wee Ferris) might be advertising himself through his DJ name as an appropriative, sampling artist-author, while at the same time, we might assume, wishing to protect his own rights as a recording artist. Alternatively, the authors of the various DeCSS code works want both the free flow of information which then results in a possible free flow of media content. Naturally, this does not sit well with the current lords of copyright: the corporations. The new open-source author works contrary to all copyright. Freed Slaves The model of the open source author is not without precedent. Historically, prior to copyright and the culture industry, this approach to authorship was the norm. The Roman poet Martial, known for his wit and gifts of poetry, wrote I commend to you, Quintianus, my little books – if I can call them mine when your poet recites them: if they complain of their harsh servitude, you should come forward as their champion and give your guarantees; and when he calls himself their master you should say they are mine and have been granted their freedom. If you shout this out three or four times, you will make their kidnapper (plagiario) feel ashamed of himself. Here of course the cultural producer is a landed aristocrat (a situation common to early Western poets such as Chaucer, Spencer and More). The poem, or work, exists in the economy of the gift. The author-function here is also not the same as in modern times but was based on the advantages of reputation and celebrity within the Roman court. Similarly other texts such as stories, songs and music were circulated, prior to print, in a primarily oral economy. Later, with the rise of the professional guild system in late medieval times, the patronage system did indeed pay artists, sometimes royal sums. However, this bursary was not so much for the work than for upkeep as members of the household holding a particular skill. The commercial aspect of the author as owner only became fully realised with the rise of the middle classes in the eighteenth and nineteenth century and led to the global adoption of the copyright regime as the culture industry’s sanction. Added to this, the author is now overwhelmingly a corporation, not an individual, which has expanded the utilisation of these statutes for commercial advantage to, perhaps, an unforeseen degree. To understand the file-sharing period, which we are now entering at full speed, we cannot be confused by notions found in the copyright acts; definitions based on copyright cannot adequately express a culture without commercial concerns. Perhaps the discussion needs to return to concepts that predate copyright, before the author-function (as suggested by Foucault) and before the notion of intellectual property. That we have returned to a gift economy for cultural products is easily understood in the context of file-sharing. But what of the author? Here the figure of the hacker suggests a movement towards such an archaic model where the author’s remuneration comes in the form of celebrity, or a reputation as an exciting innovator. Another model, which is perhaps more likely, is an understanding that certain material disseminated will be sold and administered under copyright for profit and that the excess will be quickly and efficiently disseminated with no profit and with no overall duration of protection. Such an amalgamated approach is exemplified by Radiohead’s Kid A album, which, although available for free downloads, was still profitable because the (anachronistic) printed version, with its cover and artwork, still sold by the millions. Perhaps cultural works, the slaves of the author-corporation, should be granted their freedom: freedom from servitude to a commercial master, freedom to be re-told rather than re-sold, with due attribution to the author the only payment. This is a Utopian idea perhaps, but no less a fantasy than the idea that the laws of copyright, born of the printing press, can evolve to match the economy today that they purport to control. When thinking about ownership and authorship today, it must be recalled that copyright itself has a history of useful fictions. References Michel Foucault; “What Is an Author?” Twentieth-Century Literary Theory. Eds. Vassilis Lambropoulos and David Neal Miller. Albany: State UP of New York, 1987. 124-42. “42 Ways to Distribute DeCSS.” 5 Jun. 2005 http://decss.zoy.org/>. Jeffreys v Boosey, 1854. Johansen, Jon Lech. So Sue Me. 5 Jun. 2005 http://www.nanocrew.net/blog/>. Citation reference for this article MLA Style Phillips, Dougal, and Oliver Watts. "Copyright, Print and Authorship in the Culture Industry." M/C Journal 8.2 (2005). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0506/06-phillipswatts.php>. APA Style Phillips, D., and O. Watts. (Jun. 2005) "Copyright, Print and Authorship in the Culture Industry," M/C Journal, 8(2). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0506/06-phillipswatts.php>.

Sphincter I hope my good old asshole holds out 60 years it's been mostly OK Tho in Bolivia a fissure operation survived the altiplano hospital -- a little blood, no polyps, occasionally a small hemorrhoid active, eager, receptive to phallus coke bottle, candle, carrot banana & fingers -- Now AIDS makes it shy, but still eager to serve -- out with the dumps, in with the condom'd orgasmic friend -- still rubbery muscular, unashamed wide open for joy But another 20 years who knows, old folks got troubles everywhere -- necks, prostates, stomachs, joints -- Hope the old hole stays young till death, relax -- March 15, 1986, 1:00 PM, Allen Ginsberg Lucky to the end, Allen Ginsberg (1926-97) achieved his first and final wish. Despite the constipation mentioned occasionally in his later poems, the anus of the grand gay father of the Beats remained relatively healthy until his death while other vital organs failed. Ginsberg, who had also described the erectile misfunction of his penis in mid-to-late career poems, died from a heart attack brought on by liver cancer. While the poet fleshed out references to the male anus in at least fifty of his poems, his "Sphincter" comprises the chronological climax in the development of both his anal and erotic verse. The poem was written just months after the beginning of the global media demonisation of Hollywood star Rock Hudson who was found in late 1985 to be both gay and to have died from AIDS complications. Ginsberg's timely "Sphincter" reflects on the poet's survival as an anally-active gay man through both the pre-AIDS and AIDS eras. While criticism of the (homo)eroticism in Ginsberg's verse ranges from utter denial to near hagiography, overall the significance of his musings on male ani has been avoided. The rather anal-retentive Thomas Merrill claims that, "even sophisticated readers of Ginsberg's poetry are apt to be put off, perhaps bored by, his obsession not only with four-letter words, but with the clinical, strikingly nonerotic descriptions of his homosexuality" (24). For the far less uptight John Tytell, on the other hand, "Ginsberg has always reveled in the divinity of his own sexuality, his homosexuality, adorning his own physical propensities and urging the life of the body on his readers" (245). However, "Sphincter" which is an intensely erotic (albeit anti-Romantic) poem, contains none of the expletives (apart from "asshole") nor divine associations used repeatedly by the poet elsewhere to represent the (homo)eroticised male body, and his anus in particular. Six decades of anal health and recovery aside, Ginsberg packs a suggestive lot into his "Sphincter" with the list of objects wielded during the pre-AIDS period as the means to his erotic end. The term "phallus" -- while suggesting the penis and allo-erotic activity -- may also mean dildoes with certain tactile qualities and anus-fitting shapes and sizes ideal for auto-erotic delight. Indeed, the "coke bottle, candle, carrot/banana & fingers" -- with their smooth to slightly rough texture, stiff to pliable constituency, hard to semi-hard density, and rounded pointedness -- offer more reliable potential for sustained anal stimulation than the occasionally tumescent penis. These objects may answer the decades-old queries in "Iron Horse" (1966): "What can I shove up my ass?" and "Oh if only somebody'd come in &/shove som'in up that ass a mine" (432). The bottle and candle are appropriated from a passage in Ginsberg's signature poem, "Howl" (1955), about the "best [male] minds" (126) of the poet's generation, "who copulated ecstatic and insatiate with a bottle of beer a sweetheart a/package of cigarettes a candle . . . and ended fainting on the wall with/a vision of ultimate cunt and come..." (128). In his "Sphincter", Ginsberg reminisces about the pleasurable insertion into his anus of such props to heterosexual romance. The coke (rather than beer) bottle signifies the contemporary product probably most commodified along with youthful images of (compulsory) heterosexuality in global mass media advertising. Through sodomy with that iconic item of American capitalist cultural imperialism, the poet's jingle valorises his rectum as one of the most fitting and wonderfully subversive "things" that "go better with coke!" As items usually for oral insertion rather than anal penetration, the carrot and banana (and bottle) here play on a subtle metaphor of "receptive"-anus-as-"active"-mouth. Allusions to the (frequently 'cock-hungry') oral-anal configuration of the anus denatus are more explicit in other Ginsberg poems. In "Journal Night Thoughts" (1961) the poet awaits as "a cock throbs I lie still my/mouth in my ass" (271). Ginsberg asks his sexual partner in "Please Master" (1968) to "make me wriggle my rear to eat up the prick trunk", and describes his anus as his "hairmouth" (494). In "Sweet Boy, Gimme Yr Ass" (1974) he desires a young man's "soft mouth asshole" (613). While containing "phallus" and "fingers", there is no tongue nor other oral referent in the rather clean "Sphincter". By contrast, "Iron Horse" (1966) includes the growly request: "Sweet Prince --/open yr ass to my mouth" (433-4). Ginsberg's Pre-AIDS poems frequently celebrate the joining of the uncondomed penis, anus and body fluids in sensational detail. In "This Form of Life Needs Sex" (1961) "joy" comes to mean the very act of joining male anus with penis: "You can joy man to man but the Sperm/comes back in a trickle at dawn/in a toilet on the 45th floor" (285). "Please Master" (1968) includes the demand, "fuck me more violent ... & throb thru five seconds to spurt out your semen heat over & over" (495). In "Love Comes" (1981) the period of the sex act and whether condoms are used is not stated: "I relaxed my inside/loosed the ring in my hide ... He continued to beat/his meat in my meat" (11). The memorial "'What You Up To?'" (1982) recaptures his most scatological unsafe copulation: "That white boy ... one night in 1946/he fucked me naked in the ass/till I smelled brown excrement/staining his cock" (29). While "Sphincter" marks the chronological peak in the development of Ginsberg's erotic poetry, the unbroken line, "unashamed wide open for joy", comprises the structural and thematic climax within the poem itself. This current of anal-erotic joy traces back to "Howl" (1955) with its passage about those men, "who let themselves be fucked in the ass by saintly motorcyclists/and screamed with joy" (128). Ginsberg has said that he wrote "joy" here instead of the expected "pain" as a reaction to the "James Dickey film Deliverance where [receptive anal sex] is supposed to be the worst thing in the world" (Young 103). In the inter-male rape scene in the 1972 film version of Dickey's 1970 novel, actions indicate that one man uses his penis to penetrate the anus of another who is held at gunpoint and ordered to squeal like a pig throughout the assault. Prior to this the raped man is taunted with female names. The consensual 'safe' gay anal joy exhibited by Ginsberg's "Sphincter" counters such homo-, gyno- and porcine-phobic violence. While the anal-erotic jouissance in poems that preceded "Sphincter" was overshadowed at times by non-reproductive aims and scatological themes, "Sphincter" delivers the explicit message that consensual protected anus-around-penis eroticism (particularly for actively "receptive" men) creates penultimate emotional and physical pleasure. The "phallus/coke bottle, candle, carrot/banana & fingers" leave any specified penis out of the pre-AIDS picture. By contrast, "Now" as Ginsberg states "[in the mid-Eighties age of] AIDS", at a time when auto-eroticism, digital/dildo stimulation and other penetrations without penis mean the safest anal sex, the poet himself celebrates contact with the safe sex penis -- "the condom'd/orgasmic friend" -- for which he is "unashamed wide open for joy". The preceding phrase, "out with the dumps", refers to the expulsing of two combined types of "dumps". Firstly, the mental depression about the end of skin-to-skin anus-penis sex and secondly, defecated matter which brings not only physical relief but an anus open to penetration. Unlike "Sphincter", later poems do not specify whether sexual encounters are 'safe' or 'unsafe'. In "The Guest" (1992) the question of whether condoms are used is open but the consensual status of the encounter is stressed: "I ask permission, he says 'yes,'/I pull his hips up, hold his breast,/spurt my loves deep in his bum" (78). Other poems such as "Violent Collaborations" (written with Peter Hale, 1992) humorously relish sadomasochistic and coprophilic pleasure: "Fuck me & fist me/in your army enlist me/Poop on me when you're at ease" (92). Again there is no specification that condoms are used nor that there is 'unsafe' contact. With its "shy" but "eager" anus and "condom'd/orgasmic friend", "Sphincter" marks not so much an end to 'unsafe' sex as an end to the specification of 'safe' sex in Ginsberg's poetry. No Ginsberg poem specifically addresses his penis (and/or testicles) in the way that "Sphincter" is devoted to his anus. In his poetry he does not epitomise himself as any libidinous body part other than his anal hole. In "Please Master" (1968) the poet conflates his anus with his selfhood when exclaiming: "touch your cock head to my wrinkled self-hole/... please please master fuck me again" (494-5), and "Please call me ... a wet asshole" (495). In Ginsberg's "Sphincter" moreover, his anus synecdochically represents not only his whole person but a type of gay Everyman. His sphincter is "active" and "receptive", "old" and "young", "shy" and "unashamed", and "rubbery" and "muscular". These antithetical qualities also characterise the male body idealised in gay culture (in reaction to media images of decaying 'plague victims') during the AIDS-era. This body is sexually 'versatile' (as both 'bottom' and 'top'), boyish-looking but sexually mature, introspective but assertively 'out', and physically toned but flexible. The "rubbery muscular" qualities of Ginsberg's anus are focal, because -- apart from the "blood" and "hemorrhoid" which evoke colours and shapes -- "Sphincter" contains no other physical representations of his anal orifice nor any of the myriad hyperbolic metaphorisations found in his earlier visceral verses. Anal-roseate associations appear in "A Methedrine Vision in Hollywood" (1965) and "Hiway Poesy" (1966). In the first there is wind of the floral: "one-eyed sparkle, giant glint, any tiny fart/or rose-whiff before roses were/Thought Impossible" (381). In the second, the anus-as-flower manifests through ambiguous layers. The word "rose" may be read as noun, adjective or verb: "Oh that I were young again and the skin in my anus folds/rose" (386). "Kaddish" (1959) draws on topographical metaphors: "a mortal avalanche, whole mountains of homosexuality, Matter-/horns of Cock, Grand Canyons of Asshole" (214). Manifestations of the anus as a cosmic portal or eye appear in several poems, but not in "Sphincter". Ginsberg draws on Yogic beliefs to cast the anus as the source of the enlightening kundalini in "Iron Horse" (1966): "Muladhara sphincter up thru/mind aura/Sahasrarapadma promise/another universe" (435). In the only reference to the anus in the copious footnotes to his Collected Poems, the editors explain 'Muladhara Sphincter' simplisticly as "anal chakra (one of seven bodily centers of spirit energy in Orient [sic] yoga practice)", while 'Sahasrarapadma' is described in detail as "Seventh chakra, 'thousand-petal lotus' at skulltop" (781). Ginsberg, however, seems to have placed his stress on these first and last chakras more equally or in reverse. In "Scatalogical Observations" (1997) he declares, "The Ass knows more than the mind knows" (85-6). In "Journal Night Thoughts" (1961) the poet's anus comprises a universal 'third eye' through which he comes to 'know' and 'see'. This anus/eye in the formulation of "the eye in the center of the moving/mandala -- the/eye in the hand/the eye in the asshole" (267) is later eroticised as "I prostrate my sphincter with my eyes in/the pillow" (271). As we have seen, Ginsberg's erotic poetry frequently features imagery of the sexual orifice that is beyond any man's individual scope and culturally most proscribed from public view. While many passages in his verse evoke the male anus as a subject worthy of versification and visualisation, Ginsberg's "Sphincter" comprises an ode which literally and literarily presents the poet's anus to the audience as a poetic vision in itself. The succinctly anti-analphobic and anti-homophobic "Sphincter" finely balances critical aspects of the ars poetica. Devoid of signature tropes such as the anus/mouth, anus/I and anus/eye, "Sphincter" with its relative lack of euphemism and clever mix of metonymy and metaphor nonetheless merges antithetical themes to relay a profound spiritual message. The poet's ode to his ageing anus matter-of-factly and humorously revels in memories of auto- and allo-erotic 'phallo-morphous' perversity and celebrates the anal-erotic joy in being 'fucked safely' as a personal and political act. As this millennium closes, we could do worse in our 'anal-retentive' culture than following one of the century's wisest poetic ends: "till death, relax". References Deliverance. Dir. John Boorman. U.S.A.: Warner Bros., 1972. Dickey, James. Deliverance. Boston, MA: Houghton Mifflin, 1970. Ginsberg, Allen. Collected Poems 1947-1980. New York: Viking Penguin, 1985. ---. Cosmopolitan Greetings: Poems 1986-1992. London: Penguin, 1994. ---. Death and Fame: Poems 1993-1997. London: Penguin, 1999. ---. White Shroud: Poems 1980-1985. New York: Harper and Row, 1986. Merrill, Thomas F. Allen Ginsberg. Boston, MA: Twayne, 1988. Tytell, John. Naked Angels: The Lives and Literature of the Beat Generation. New York: McGraw-Hill, 1976. Young, Allen. "Allen Young Interviews Allen Ginsberg." 1973. Gay Sunshine Interviews. Ed. Winston Leyland. San Francisco: Gay Sunshine Press, 1978: 96-128. Citation reference for this article MLA style: Simon-Astley Scholfield. "A Poetic End: Allen Ginsberg's 'Sphincter'." M/C: A Journal of Media and Culture 2.8 (1999). [your date of access] <http://www.uq.edu.au/mc/9912/sphincter.php>. Chicago style: Simon-Astley Scholfield, "A Poetic End: Allen Ginsberg's 'Sphincter'," M/C: A Journal of Media and Culture 2, no. 8 (199x), <http://www.uq.edu.au/mc/9912/sphincter.php> ([your date of access]). APA style: Simon-Astley Scholfield. (1999) A poetic end: Allen Ginsberg's "Sphincter". M/C: A Journal of Media and Culture 2(8). <http://www.uq.edu.au/mc/9912/sphincter.php> ([your date of access]).

Playing in childhood we are presented with foundational puzzles. Many of these arise directly from our negotiations with the laws of physics; others arise from the deliberate activities of our elders, teachers and siblings. As we sit on our grandmother’s knee we are presented with a range of playful and deceptive games. Something as simple as a loop of wool can initiate this play: now it is a straight thread; now it is a loop. Something as simple as the opening hand is the potential source of a problem that may stay with us for a lifetime: now it is a hand with open palm; now it is a fist that hides. Something as simple as a dropped toy ball can initiate the motive to engage with the world as a problem: now it is here, at hand; now it is gone, down there and rolling away. While each of these events is real, the space and time of such play can be described as an illusion. The figure of this illusion is itself a loop within which a special kind of logic pertains. This logic is illustrated in D. W. Winnicott’s concept of illusory experience and in John Dewey’s concept of perplexity as the source of human thinking. As illusions, loops are puzzling; as real objects and events, loops pre-figure and offer to mediate the development of our understanding of our being in the world. Donald Woods Winnicott (1896-1971) a British child psychoanalyst, spent much of his time exploring the relationships that children form with objects. His work offers accounts of an extraordinary array of everyday engagements that children have with simple things such as their own toes and bits of string. A key aspect of Winnicott’s theories of the formative years is the sustaining of a loop, or in Winnicott’s terms, "an intermediate state" between the child and reality. I am here staking a claim for an intermediate state between a baby’s inability and his growing ability to recognize and accept reality. I am therefore studying the substance of illusion, that which is allowed to the infant, and which in adult life is inherent in art and religion, and yet becomes the hallmark of madness when an adult puts too powerful a claim on the credulity of others, forcing them to acknowledge a sharing of illusion that is not their own. We can share a respect for illusory experience, and if we wish we may collect together and form a group on the basis of the similarity of our illusory experiences. This is a natural root of grouping among human beings. (Winnicott 3) Social groups establish preferred forms to account for dynamic systems in everyday life. The hand, for example, might be generally agreed to be an open hand, at rest, which means that fingers are curved towards the palm and the palm is down. The number of variations in the way in which a hand might be found, and described, is so large as to be able to symbolise an entire language. From the outside, to a non-signer, it is an illusion that hand-signing is language, just as it is an illusion that spoken and written languages are languages to those who do not share the particular language illusion. Within the range of possible hand gestures, a loop or tension-of-illusion is established: those in the loop can comprehend the signing as language; those outside the loop can only pretend that the illusion works. Recalling that the word "illusion" takes its origin in the Latin for play ("ludere") it comes as no surprise that initiation games frequently use spurious loop activities to trap the outsider in ways that will embarrass the new-comer. The sense of mockery in the word "illusion" is made evident as the new-comer has no way of determining the validity of the pretend inside information. Suggestions that they drink some foul concoction can only be answered by drinking the concoction: there is no way from the outside of the illusion group to resolve the challenge. To enter the inside of the loop, the new-comer has to cross some kind of line in a way that leaves a mark: the affect of embarrassment is often enough. Our ability to suspend disbelief and sustain the illusion as loop is a fundamental requirement of our social being and of our cognitive development. "Once upon a time" is a call to step inside the loop of fiction where things may emerge that cannot otherwise emerge. While this loop may be seen as nothing more than an inner fantasy world, it is impossible to sustain this concept unless we deny the common reality of such a world. The world of the loop is not some kind of denial of an outer reality, nor is it an assertion of an inner freedom that can remain separate to an external reality. We may claim to make words mean whatever we wish them to mean in an inner and private dimension, but in making such a claim we must use a common meaning of "meaning" and we must use the syntax and grammar of a language. Much as we might wish for such an interiority, Winnicott requires us to recognise the further need for an "intermediate area of experience". This intermediate area is the public space of shared illusion: It is an area that is not challenged, because no claim is made on its behalf except that it shall exist as a resting-place for the individual engaged in the perpetual human task of keeping inner and outer reality separate yet interrelated. (Winnicott 2) In this intermediate area, it is possible to sustain illusions only in relation to a presumed other reality. That is, the logics of illusion are logics that apply, if differently, in the outer and inner realms of experience. The reality of a loop may seem soft. Loops are readily formed without substantial alteration of the loop forming material. Loops are also frightening in their potential operation as capturing devices. The forces they can activate are deadly. As dynamic objects, loops offer their own interpretation of Winnicott’s concept of illusion. At some point the game or play of illusions terminates in a disclosure of closure that instructs the play. The closed hand that hides the marble opens to reveal the marble. One moment in the play of logics is elected or given a priority. The relative stability of this pattern is made obvious in certain forms of illusion that take illusions as their "fixed" shape. Knitting, for example, consists of loops interlocked with loops. As anyone who has pulled knitting apart knows, interlocking is fundamentally an illusion in its making and a disillusion in its pulling apart. Knitting can then be seen, in this sense to be "fake". Fakes "Fake" does not mean "false" except that we have come to see the dressing up of things as being insubstantial and therefore not warranting attention. Worse, we see "fake" as being morally repugnant in that a fake thing takes the place of a real thing. But "fake" also means "a coil of rope". In this case, the fake is substantial while ever it exists. Thus, a fake is a kind of benevolent illusion. The shape that the coil of rope makes is no less real, in time, than the ship-deck on which it is formed. When it is uncoiled, the rope takes on its "true" or active shape. Should the uncoiled rope form a loop, this loop is potentially malevolent. It may take the leg of a sailor. In childhood, this game is played out using simple loops and slip knots that hold but let go when pulled. The dynamic forms are sometimes the illusion; sometimes it is the static form that is the illusion. That is, the pragmatic interpretation allows for the display of the fake as a cognitive toy. Any state of the dynamic form may take priority at any one time for the purposes of the use of the system. When we sit down, our height differences are reduced: this fake is a crucial part of our social world. Loops Winnicott lets us see the life-long significance of the looping and faking that we daily use to sustain our dynamic worlds . In our loop worlds we establish a space "between thumb and the teddy bear, between the oral erotism and the true object-relationship" (Winnicott 2). Within the loop, the status of objects and systems is open to transformation, just as, over time, in the material world, objects and systems are transformed. The valency of any object or system, viewed from within the loop, is fundamentally indeterminate and hence open. It is within this loop-logic that we can understand the ironic singing of songs whose content is radically alternative to the situation of the singing: children can be heard singing songs filled with sexual connotations without there being any awareness of the inappropriate content; many people can hear and sing along with Bette Midler’s rendition of "God is watching us" without the irony striking home that God is doing this from a distance of total indifference. The tongue in Bette’s cheek could not get any bigger, but from within the loop, the song can have any value the singer selects. While we may sustain fantasy worlds as intermediate worlds, Winnicott makes obvious that "the mother’s main task (next to providing opportunity for illusion) is disillusionment" (Winnicott 12). At some point the disjunction between illusion and reality becomes perplexing. The ball that the child drops does evade the child’s grasp. It is not simply a matter of sustaining the mood. Either the ball can be recovered or else it cannot. Perplexity and the Dialectic of Loss John Dewey (1859-1952) is a major figure in American pragmatist schools of philosophy and in educational philosophy, especially problem-based theories of learning. His work bridges the nineteenth and twentieth centuries and covers all the major social and cultural issues of his day. As a thorough thinker, Dewey offers to provide explanations for most aspects of what is practically required of us in our living socially responsible lives. Even our "negative" affects, such as perplexity, are presented by Dewey as indicators of our practical connection with reality. For Dewey, perplexity is a key feature of the state of mind that initiates the growth of the individual through engagement with the problematics of the world in which they live. Dewey points out that "thinking begins as soon as the baby who has lost the ball that he is playing with begins to foresee the possibility of something not yet existing—its recovery" (How We Think 89). Losing the ball creates a difficulty, seeing that the ball might be recovered, the child is then able to move to resolve the difficulty, through action, in the real world. In this simple form we can determine the process of thesis (loss), anti-thesis (promise of recovery or remedy), synthesis (resolution of the problem with an enhanced understanding of the process). The theological allusions should not be discounted in this model. Nor should we forget Winnicott’s caution here "that the task of reality-acceptance is never completed". The ball game is still a game that retains the general forgiveness of the loop in that the real loss is mitigated by the surrounding and support "illusion" that the parent will recover the ball for the child. It may be socially frowned on, but adults still drop things just to instigate the "illusion" that others will recover their loss (for an extended account of Dewey’s notion of perplexity, see Russell). Still, the loss of the ball is a problem that holds very real interest for the baby and therefore the problem is perplexing. According to Dewey: "Interest marks the annihilation of the distance between the person and the materials and results of his action; it is the sign of their organic union" (Middle Works 160). Being "entirely taken up with" (p. 160) the loss of the ball, the baby experiences the situation in what McLuhan describes as "depth". In the depth approach attention is able to shift from content to attention itself: "Consciousness itself is an inclusive process not at all dependent on content. Consciousness does not postulate consciousness in particular" (McLuhan 247). Conclusion The capacity of consciousness to take an interest, in Dewey’s terms, is the same capacity that consciousness displays in the sustaining of the loop of illusion. For Dewey, "interest marks the annihilation of the distance between the person and the materials and results of his action". This annihilation, in Winnicott’s gentler terms, is more of respite in the long journey. For Winnicott "no human being is free from the strain of relating inner and outer reality". The intermediary illusions remain illusions even if they are instructive. For Dewey, the focus on perplexity allows that the strain is integrated in an affect-complex that both sustains the illusion ("I can get the ball back") in the manner of a hypothesis ("I had the ball, I lost the ball—losing the ball was a process, regaining the ball could also be a process—I can have the ball again"). Granted, Dewey, as a pragmatist, starts with a real world process. Nonetheless, his approach points to the deeper connections between consciousness itself and the operations of the psychological development of the individual. From the perspective of perplexity, the puzzles of childhood are also the puzzles of the adult. As adults we continue to play with loops of all kinds. We maintain intermediary spaces and we conspire in the social illusions of language References Dewey, John. How We Think: A Restatement of the Relation of Reflective Thinking to the Educative Process. Boston: D.C. Heath, 1933. Dewey, John. The Middle Works, 1899-1924. Ed. Jo Ann Boydston. Vol. 7. Carbondale and Edwardsville: South Illinios U P, 1979. McLuhan, Marshall. Understanding Media: The Extensions of Man. New York: Signet, 1964. Russell, Keith. "The Problem of the Problem and Perplexity." Themes and Variations in PBL. Proc. of the 5th International Biennial PBL Conference, 7-10 Jul. 1999, U of Quebec. U of Newcastle: PROBLARC, 1999. 180-95. Winnicott, D. W. Playing and Reality. London: Tavistock, 1971. Citation reference for this article MLA Style Russell, Keith. "Loops and Fakes and Illusions" M/C: A Journal of Media and Culture 5.4 (2002). [your date of access] < http://www.media-culture.org.au/mc/0208/fakes.php>. Chicago Style Russell, Keith, "Loops and Fakes and Illusions" M/C: A Journal of Media and Culture 5, no. 4 (2002), < http://www.media-culture.org.au/mc/0208/fakes.php> ([your date of access]). APA Style Russell, Keith. (2002) Loops and Fakes and Illusions. M/C: A Journal of Media and Culture 5(4). < http://www.media-culture.org.au/mc/0208/fakes.php> ([your date of access]).