AimsEvaluation of the efficacy and safety of slow-release oral morphine (SROM) compared with methadone for detoxification from methadone and SROM maintenance treatment.DesignRandomized, double-blind, double-dummy, comparative multi-centre study with parallel groups.SettingThree psychiatric hospitals in Austria specializing in in-patient detoxification.ParticipantsMale and female opioid dependents (age > 18 years) willing to undergo detoxification from maintenance therapy in order to reach abstinence.InterventionsAbstinence was reached from maintenance treatment by tapered dose reduction of either SROM or methadone over a period of 16 days.MeasurementsEfficacy analyses were based on the number of patients per treatment group completing the study, as well as on the control of signs and symptoms of withdrawal [measured using Short Opioid Withdrawal Scale (SOWS)] and suppression of opiate craving. In addition, self-reported somatic and psychic symptoms (measured using Symptom Checklist SCL-90-R) were monitored.FindingsOf the 208 patients enrolled into the study, 202 were eligible for analysis (SROM: n = 102, methadone: n = 100). Completion rates were 51% in the SROM group and 49% in the methadone group [difference between groups: 2%; 95% confidence interval (CI): −12% to 16%]. The rate of discontinuation in the study was high mainly because of patients voluntarily withdrawing from treatment. No statistically significant differences between treatment groups were found in terms of signs and symptoms of opiate withdrawal, craving for opiates or self-reported symptoms. SROM and methadone were both well tolerated.ConclusionsDetoxification from maintenance treatment with tapered dose reduction of SROM is non-inferior to methadone.
This introduction briefly surveys the current expansion of ekphrasis in terms of genres, visual objects, modes of writing, and cues for reader response. Drawing on suggestions from the subsequent individual essays that provide categories for organizing the great variety of ekphrases, such as pictured and picture-less, mimetic and transformed, notional and actual, abbreviated and described, printed and screen, canonical artwork and non-art image, narrative and poetic ekphrasis, the introduction further discusses ekphrastic theories with a specific focus on their relevance to its practices and cultural functions in the present media ecology. Despite its increasing frequency in recent years, theoretical conceptualizations have largely remained committed to traditional paradigms, such as competition ("paragone") and representation (Heffernan 1993: 1). What appears to be wanting is a revival of rhetorical and performative understandings of ekphrasis that can augment theoretical conceptualizations and bring them into line with the participatory and hybrid practices of ekphrasis today. Increasingly, what used to be a central aim of ekphrasisthe description of an artworkhas been replaced by modes of rewriting the artwork and in the process questioning accepted meanings, values, and beliefs, not just relating to the particular artwork in question but referencing the ways of seeing and the scopic regimes of the culture at large. Since these changes in writing and reading practices tend toward increasing the participation of the reader, a more meta-representational and rhetorical conceptualization of ekphrasis is desirable. From a functional perspective, I argue that the traditional purpose of ekphrasis to interrogate ways of seeing has acquired new urgency in today's media landscape.
This article deals with the phenomenology of reading narrative fictions, in particular with the production of mental imagery in the process of reading. Because readers differ in their capacities to visualize, this article proposes a distinction between default visualization and vivid images, a difference experienced by readers regardless of whether they are prone to more or less visual imagining. It argues that the default mode of visualization is unlike actual perception. It is indistinct, transient, and lacking in saturation and memorability, since it relies on cultural schemata and prototypes for efficient processing of the text. These indeterminacies do not, however, disturb readers or cause dissonance. Rather, they are advantageous, as they allow the constant accommodation of new incoming facts. In contrast to what is assumed by traditional reader response theories, gaps left in default visualization do not for the most part need filling in. At certain stages in the reading process, however, narrative texts do trigger a kind of vivid imagery that is akin to actual perception. Based on recent neuroscientific experiments, this article suggests that these highlighted and especially vivid images occur when fictional acts of seeing force readers to shift from action-oriented visualization to object visualization. Some pertinent examples of these close-up, focalized descriptions of perception are discussed, which encourage substituting the automatic default mode with a more conscious and focused object visualization.
The present contribution seeks to open up a new approach to intermediality by addressing its cognitive effects and functions. For this purpose it discusses current understandings of cognitive processing during reading, focusing especially on visualization in the reading experience and investigating what textual elements intensify the visual imagination. Intermedial reference is such a textual strategy for eliciting highlighted visualization. The article tests its claims in discussion of literary texts by Michel Houellebecq (The Map and the Territory, 2011) and Robert Coover (A Night at the Movies, 1987). It concludes that both the description of another medium in notional ekphrasis as well as the structural imitation of another medium can serve to unsettle conventional schemata of representation. As a trigger for cognitive participation, intermedial reference influences reception in important ways. On the level of the individual reading process it aids comprehension, memory and emotional response. These individual benefits can also have larger socio-cultural repercussion when they impact the formation of cultural memory. For the purpose of analyzing reception, cognitive models of 'visualization' for the study of narrative texts are a valuable complement to a more traditional hermeneutic understanding of the reader's 'imagination.'
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