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After Cage and Tudor visited Japan in 1962, the term ‘Cage Shock’ circulated widely among the Japanese public. My interviews with Japanese composers suggest that the term ‘Cage Shock’ oversimplifies the reception of Cage's debut in Japan. Composer Yūji Takahashi stated that Cage would have met Japanese audiences well prepared for his visit by musical trends present in Japan as early as the late 1940s. Building on the statement that the Japanese avant-garde was thriving before Cage visited Japan in 1962, this article aims to deconstruct the term ‘Cage Shock’ by restoring the complexity of the reception of Cage in Japan and by analysing the reasons why critics adopted the term ‘Cage Shock’. I argue that ‘Cage Shock’ has functioned more as a media buzzword that sensationalizes the story of Cage's impact on Japan than as an objective description of Japanese reaction to Cage.

Critical illness resulting in a pediatric intensive care unit (PICU) admission is a profoundly stressful experience for a child and their family. Increasing evidence for emotional and behavioral sequelae post-PICU emphasizes a need to provide better support for families throughout this period of care and recovery. The aim of this qualitative investigation was to identify salient and modifiable aspects of a critical care experience that can be addressed to better support families of critically ill children. Individual semi-structured interviews were conducted with 26 caregivers of children who survived a PICU admission. Interviews were audio-recorded and transcribed verbatim; themes were identified via thematic analysis. Caregivers were enrolled using convenience sampling from seven tertiary care PICUs in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network. Themes from caregiver interviews were identified within two overarching categories containing three themes each. Advice for future PICU families: (1) Be intentional about caring for your own well-being, (2) speak up, ask questions, and challenge decisions you’re not comfortable with, and (3) continue to engage with your child. Characteristics of a satisfactory PICU experience: (1) A caregiver–provider relationship of mutual trust established through clear communication and respectful collaboration, (2) hospital environments that provide physical and social supports to maintain humanity in healthcare, and (3) preparing families for care transitions. Targeted, interdisciplinary approaches to partner with families during critical care may improve their PICU experience and contribute to improved long-term outcomes for PICU survivors.

Objectives This article described parents' experience and identifies outcomes important to parents following their child's critical illness. Methods Semistructured interviews with 22 female and 4 male parents representing 26 critically ill children with predominately neurologic and respiratory diagnoses. Most children were younger than 5 years at discharge with a median (interquartile range) of 2 (2.0–3.0) years from discharge to interview. Results Many children returned home with life-altering physical and cognitive disabilities requiring months to years of rehabilitation. Parents remembered feeling unprepared and facing an intense, chaotic time when the child first returned home. They described how they suddenly had to center their daily activities around the child's needs amidst competing needs of siblings and partners, and in some cases, the medicalization of the home. They recounted negotiating adjustments almost daily with insurance agencies, medical doctors and therapists, employers, the child, and other family members to keep the family functioning. In the long term, families developed a new norm, choosing to focus on what the child could still do rather than what they could not. Even if the child returned to baseline, parents remembered the adjustments made to keep the child alive and the family functioning. Conclusion Heightened awareness of family experiences after pediatric critical illness will allow health care providers to improve family preparedness for the transition from hospital to home.

Background: Patient-reported outcome (PRO) assessments are commonly used in clinical heart failure (HF) trials and have been shown to be valid, reliable, sensitive measures of patients’ symptoms, function and quality of life, as well as prognostic of clinical events. To be used in routine care, they also need to be interpretable to providers and patients. Patients’ perspectives on PRO collection and results communication have not been studied. Methods: We conducted a mixed methods study of 24 ambulatory adult HF patients (50% men) who completed PROs as part of care at a HF clinic. Study procedures included (1) qualitative telephone interviews and (2) quantitative surveys following interviews. We employed thematic analysis to analyze and code transcripts using an iterative coding process and descriptive statistics to analyze the survey. Qualitative findings were purposefully linked to quantitative results. Findings: Three themes in qualitative analyses were linked to the quantitative survey: 1. Utility of data: Most participants noted that PRO questionnaires were a useful tool to better understand their health if their providers discussed the results with them, and to provide additional information to help improve their treatment. Ninety-two % (22/24) of participants strongly agreed or agreed (SA/A) and 8% (2/24) were neutral that completing the questionnaires changed their care and improved their health. Ninety-six % (23/24) of participants SA/A and 4% (1/24) were neutral that completing the questionnaires would make evaluation of their well-being more accurate. 2. Length and frequency of data collection: Most participants felt that questionnaire length (13-29 questions completed in 3-8 minutes on average) and frequency of implementation (at every visit) were satisfactory. Sixty-three % (15/24) and 37% (9/24) of participants felt that maximum number of questions should be 5-15 and >15, respectively. Eighty-three % (20/24) and 17% (4/24) of participants felt that maximum time required for completion should be 5 or 10 and >10 minutes, respectively. 3. Communication with providers: Most participants noted that their providers discussed results of PRO questionnaires with them only once or not at all and participants who had this discussion with their providers felt that providers understood their responses. Sixty-two % (15/24), 21% (5/24) and 17% (4/24) of participants SA/A, were neutral and disagreed or strongly disagreed that their providers effectively discussed results of their PROs with them. Conclusions: Qualitative results provided depth and interpretability of quantitative survey results. These results indicate successful implementation and utility of PRO questionnaires in the HF clinic, while highlighting a need for more frequent discussion of PRO results between providers and patients. Further use of PROs may lead to improved cardiovascular health and prognosis in HF.

As John Cage wrote in his bookA Year from Monday, the “current use for art [is] giving instances of society suitable for social imitation—suitable because they show ways . . . people can do things without being told or telling others what to do.” Cage's ideal anarchic music emphasizes not only renouncing compositional control, but also the process of self-discovery happening to everyone, a process that leads participants to discover their creative abilities. This paper argues that Cage's penchant for self-discovery came from his understanding of George Herbert Mead's theories of the process of individuation (the “me” and the “I”). Cage discovered Mead through readingZen and American Thought(1962) by his friend Van Meter Ames, a professor of philosophy at the University of Cincinnati, who saw the compatibility between Zen and Mead's concept of self in the capacity of the “I,” a phase of self whose unpredictable steps contribute to human innovation. Cage found the possibility of overthrowing the thought of the world through triggering a self-discovery of the “I” in everyone. He realized this idea in his happenings, such as0’00”, by requiring performers to respond to the simple descriptions without specifying sound or duration.

The authors outline the major role played by Ohtsuki Kenji in the formation of the Japanese Psychoanalytic Society. Unlike the other pioneers of psychoanalysis in Japan, Ohtsuki never went abroad or met Freud. He was a literature graduate who taught himself the fundamentals of psychoanalysis. He organised the translation of Freud's complete works, formed a psychoanalytic training institute and started a journal that carried English-language editorials. These became the major means whereby foreign analysts came to know and understand the Japanese psychoanalytic scene. A number of rival groups amalgamated to form the Japanese Psychoanalytical Association in the mid-fifties, excluding Ohtsuki's group despite its pre-war prominence. The authors reconsider Ohtsuki's role in the light of his many articles, his autobiography, new information uncovered in interviews conducted with current analysts and with Ohtsuki's widow and son. They describe his championing of lay analysis, and his criticisms of medicalisation of the discipline and of the view from abroad that questioned the suitability of Japanese culture for psychoanalytic therapy, as well as his efforts to modify some of the basic tenets of psychoanalysis to accord with his own views in his later work.

This paper presents an account of four Japanese men, three of whom had an audience with Freud and who, with differing experiences and ambitions, returned to Japan to practice and develop psychoanalysis. Only two received any formal training, and two were strongly influenced by Buddhist thought. Freud gave no clear sign as to whom to appoint as leader, leaving the situation unsettled. This may have contributed to the continuing split and rivalry between groups, a split which was not resolved until the formation of the Japanese Psychoanalytic Society for trained analysts and the Association for interested laymen in the 1950s. From the beginning the development of psychoanalysis in Japan was informed by a paradox: the need to get Freud's approval and hence appear orthodox, while assimilating some of the concepts to the dictates of the culture.

(83%) were male. Prior NMIBC diagnosis was Ta, T1, and Tis-only in 106 (44%), 91 (37%), and 46 (19%) patients, respectively. 196 (81%) were high grade and 126 (52%) had carcinoma-in-situ (CIS). 155 (64%) patients had a history of any prior intravesical therapy, with 121 (50%) receiving BCG only. Initial FISH results were positive in 103 (42%), uninformative in 64 (26%), and negative in 76 (31%). Recurrence and progression occurred in 97 and 24 patients, with median follow up for survivors of 25 and 17.5 months, respectively. Differences in RFS were statistically significant by FISH result, with three-year recurrence rates of 34%, 43%, and 64% for patients with negative, uninformative, and positive FISH (p 0.001, log rank test). On multivariate analysis, positive FISH result was a significant predictor of recurrence (HR 2.4, 95% CI 1.4, 4.0). Differences in PFS were also significant, with three-year progression rates of 7%, 8%, and 22% for patients with negative, uninformative, and positive results (p 0.024, log rank test). In univariate analysis, positive FISH was also a predictor for progression (HR 3.9, 95% CI 1.3, 11.6). CONCLUSIONS: Urinary FISH is a useful adjunct in the surveillance regimen for NMIBC patients with atypical cytology but negative cystoscopy. For these patients, positive FISH reflects an increased risk of recurrence and may warrant more frequent, long-term cystoscopic follow-up.

Current methods for assessing the severity of aortic stenosis depend primarily on measures of maximum systolic pressure drop at the aortic valve orifice and related calculations such as valve area. It is becoming increasingly obvious, however, that the impact of the obstruction on the left ventricle is equally important in assessing its severity and could potentially be influenced by geometric factors of the valve, causing variable degrees of downstream pressure recovery. The goal of this study was to develop a method for measuring fluid mechanical energy losses in aortic stenosis that could then be directly related to the hemodynamic load placed on the left ventricle. A control volume form of conservation of energy was theoretically analyzed and modified for application to aortic valve stenosis measurements.In vitro physiological pulsatile flow experiments were conducted with different types of aortic stenosis models, including a venturi meter, a nozzle, and 21-mm Medtronic-Hall tilting disc and St. Jude bileaflet mechanical valves. The energy loss created by each model was measured for a wide range of experimental conditions, simulating physiological variation. In all cases, there was more energy lost for the nozzle (mean=0.27 J) than for any other model for a given stroke volume. The two prosthetic valves generated approximately the same energy losses (mean=0.18 J), which were not statistically different, whereas the venturi meter had the lowest energy loss for all conditions (mean=0.037 J). Energy loss correlated poorly with orifice pressure drop (r 2=0.34) but correlated well with recovered pressure drop (r 2=0.94). However, when the valves were considered separately, orifice and recovered pressure drop were both strongly correlated with energy loss (r 2=0.99, 0.96). The results show that recovered pressure drop, not orfice pressure drop, is directly related to the energy loss that determines pump work and therefore is a more accurate measure of the hemodynamic significance of aortic stenosis.

The effect of aortic outflow on the quantification of mitral regurgitation by the flow convergence method was investigated by both in vitro experiments and computational simulations. Digital analysis of the color Doppler M-mode images was compared with results obtained with laser Doppler anemometry, an engineering gold standard, and three-dimensional computational simulations. Regurgitant orifices of 3.2 and 6.4 mm in diameter were used with instantaneous aortic flow rates from 0 to 500 ml/sec, corresponding to net cardiac outputs of 0 to 5 L/min. In the absence of aortic outflow, a clear plateau was observed in plots of the calculated flow rate as a function of the distance from the orifice, indicating that there was a zone in which the hemispheric assumption was valid. As the aortic outflow was increased, the length of this plateau region decreased and then disappeared at high aortic flow rates. Farther from the orifice, beyond the plateau zone, the flow rate was overestimated and this overestimation increased with increasing aortic flow rate. Results showed excellent agreement between in vitro experiments and computational stimulations. This study demonstrated that aortic outflow has a dramatic effect on the flow convergence region and therefore must be considered in flow rate calculations.

Cyclic nucleotide phosphodiesterase-8 (PDE8) is a family of cAMP-specific enzymes and plays important roles in many biological processes, including T-cell activation, testosterone production, adrenocortical hyperplasia, and thyroid function. However, no PDE8 selective inhibitors are available for trial treatment of human diseases. Here we report kinetic properties of the highly active PDE8A1 catalytic domain prepared from refolding and its crystal structures in the unliganded and 3-isobutyl-1-methylxanthine (IBMX) bound forms at 1.9 and 2.1 A resolutions, respectively. The PDE8A1 catalytic domain has a K(M) of 1.8 microM, V(max) of 6.1 micromol/min/mg, a k(cat) of 4.0 s(-1) for cAMP, and a K(M) of 1.6 mM, V(max) of 2.5 micromol/min/mg, a k(cat) of 1.6 s(-1) for cGMP, thus indicating that the substrate specificity of PDE8 is dominated by K(M). The structure of the PDE8A1 catalytic domain has similar topology as those of other PDE families but contains two extra helices around Asn685-Thr710. Since this fragment is distant from the active site of the enzyme, its impact on the catalysis is unclear. The PDE8A1 catalytic domain is insensitive to the IBMX inhibition (IC(50) = 700 microM). The unfavorable interaction of IBMX in the PDE8A1-IBMX structure suggests an important role of Tyr748 in the inhibitor binding. Indeed, the mutation of Tyr748 to phenylalanine increases the PDE8A1 sensitivity to several nonselective or family selective PDE inhibitors. Thus, the structural and mutagenesis studies provide not only insight into the enzymatic properties but also guidelines for design of PDE8 selective inhibitors.

The Texas Children's Hospital Residents' Primary Care Group Clinic provides primary care to urban low-income children. The objective of this cross-sectional study was to investigate the impact of transportation problems on a family's ability to keep an appointment. One hundred eighty-three caregivers of children with an appointment were interviewed. Caregivers who kept their appointment were compared with those who did not with respect to demographic and transportation-related characteristics. Logistic regression modeling predicted caregivers with the following characteristics were more likely not to keep an appointment: not using a car to the last kept appointment, not keeping an appointment in the past due to transportation problems, having more than two people in the household, and not keeping an appointment in the past due to reasons other than transportation problems. Future research should focus on developing interventions to help low-income urban families overcome non-financial access barriers, including transportation problems.