Background: Recent research highlights the glymphatic system’s role in clearing waste from the central nervous system. Its dysfunction is linked to neurodegenerative diseases like Alzheimer’s and Parkinson’s, but its impact on multiple sclerosis (MS) remains unclear. This retrospective study examines glymphatic function in MS and its link to clinical disability using MRI. Methods: The study included 18 patients diagnosed with MS, comprising 3 with primary progressive MS and 15 with secondary progressive MS, along with 7 healthy control participants. All subjects underwent neurological evaluations and MRI assessments, which included high-resolution T1, T2, and diffusion-weighted imaging. Statistical comparisons between the groups were conducted using a two-sample t-test. Results: MS patients exhibited a reduced diffusion along the perivascular space index (DTI-ALPS) compared to healthy controls. Patients with primary progressive MS demonstrated lower DTI-ALPS values than those with secondary progressive MS. Lower DTI-ALPS was associated with a higher Expanded Disability Status Scale (EDSS) score, indicating a correlation between glymphatic system dysfunction and greater clinical disability in MS. Conclusions: The study suggests that glymphatic system dysfunction is present in MS and is inversely associated with the severity of disability. This impairment may contribute to the disease’s pathological mechanisms.

Multiple sclerosis (MS) is characterized by focal inflammatory activity in the central nervous system and a diffuse, compartmentalized inflammation that is the primary driver of neuroaxonal damage and worsening disability. It is now recognized that higher-efficacy disease-modifying therapies (HE-DMT) are often required to treat the complex neuropathological changes that occur during the disease course and improve long-term outcomes. The optimal use of HE-DMTs in practice was addressed by a Canadian panel of 12 MS experts who used the Delphi method to develop 27 consensus recommendations. The HE-DMTs that were considered were the monoclonal antibodies (natalizumab, ocrelizumab, ofatumumab) and the immune reconstitution agents (alemtuzumab, cladribine). The issues addressed included defining aggressive/severe disease, patient selection of the most appropriate candidates for HE-DMTs, baseline investigations and efficacy monitoring, defining suboptimal treatment response, use of serum neurofilament-light chain in evaluating treatment response, safety monitoring, aging and immunosenescence and when to consider de-escalating or discontinuing treatment. The goals of the consensus recommendations were to provide guidelines to clinicians on their use of HE-DMTs in practice and to improve long-term outcomes in persons with MS.

People with multiple sclerosis (pwMS) commonly describe cognitive decline later in the day, but few studies have evaluated this perception’s validity. In a consecutive sample of 791 pwMS, this study evaluated whether time-of-testing predicted Minimal Assessment of Cognitive Function in MS raw scores, accounting for age, sex, educational years, disease duration, disability and disease-modifying therapy use. The mean age was 43.76 years (SD = 11.30), 76.74% were female and most had mild disability. Later time-of-testing independently predicted reduced Judgment of Line Orientation scores (p < 0.01), but not other cognitive variables. In pwMS, there is a diurnal decline in visuospatial cognitive test performance.

1. 1. Introduction to the Special Issue in Honor of Kyoko Selden: Japan in Translation - Alisa Freedman

2. 2. Introduction to the Taiheiki: The Chronicle of Great Peace - Joan Piggott

3. 3. Selections from the Taiheiki: The Chronicle of Great Peace - translated by Kyoko Selden and Joan Piggott

4. 4. Introduction to the Hinin Taiheiki: The Paupers' Chronicle of Peace - Kyoko Selden

5. 5. Hinin Taiheiki: The Paupers' Chronicle of Peace - translated by Kyoko Selden with Joshua Young

6. 6. Renga by Sasaki Dōyo: Selected from the Tsukubashū (Tsukuba Anthology) -translated and annotated by Kyoko Selden, edited by Lili Selden

7. 7. The Takarazuka Concise Madame Butterfly- translated by Kyoko Selden and Lili Selden

Introduction

Born in Tottori Prefecture (where her last name is pronounced Osaki rather than Ozaki), Osaki Midori (1896-1971) was the fourth of seven children in a middle-class, intellectual family. Her mother was the daughter of the head priest of a Buddhist temple; her father was a teacher, who died while Osaki was a teenager. Osaki graduated from the Tottori Girls' School (Tottori Jogakko), and, at age eighteen, became an elementary school teacher. Aspiring to a literary career, she wrote poetry, essays, and fiction and sold a novel for schoolgirls (shōjo shōsetsu) to Shōjo sekai (Girls' World) magazine in 1917.

Sakiyama Tami (1954-), real name Taira Kuniko, was born on Iriomote Island, the largest of the Yaeyama island group in Okinawa Prefecture, where she lived until age fourteen when her family moved to Koza (present-day Okinawa City). Sakiyama graduated from the Department of Law, Economics, and Literature at the University of the Ryukyus. She began publishing in Okinawan periodicals in 1979 and in mainland Japanese literary magazines, a conventional means of launching a literary career, starting in 1988.

This issue of The Asia-Pacific Journal: Japan Focus is the first of three special online issues that can be read in conjunction with a 2015 special issue of the Review of Japanese Culture and Society (Volume XXVII). Together the issues offer examples of Kyoko Selden's literary translations and writings that span Japanese history, literature, and multiple genres. The two journals were venues through which Kyoko shared much of her work. These poems, stories, novellas, essays, plays, memoirs, and biographies—drawn from her more than twenty books and fifty short pieces—exemplify her belief in the humanizing power of literature and art, concern for the human toll of historical events, and gentle humor. They reveal new dimensions of established authors while ensuring that marginalized voices are heard. The selections highlight Kyoko's emphasis on women writers and her interlocking themes: war and peace, classical literature and art, Ainu traditions, Okinawan literature, atomic cataclysm, music, education, and childhood, among others. We have prioritized texts that have not been published and those that were first circulated in private venues; included are a few of her many contributions to the Asia Pacific Journal and Japan Focus. We have completed translations that Kyoko did not have a chance to finish before her passing in January 2013.

Introduction

Author Nagai Kafū (1879-1959; given name Nagai Sōkichi) is best known for his fictionalized personal travel accounts American Stories (Amerika monogatari, 1908) and French Stories (Furansu monogatari, 1915), short stories and novellas about Tokyo courtesans and low-ranking geisha, and an extensive illustrated diary, Dyspepsia House Diary (Danchōtei nichijō, 1917-59). Kafū was fascinated with Edo-period (1603-1868) culture, especially that of the chōnin, or urban commoners. He prided himself on his resemblance to Edo literati, such as poet Ōta Nanpo (also known as Shokusanjin, discussed in the selection below), who used kyōka (playful, often satirical, poetry) as an elegant form of veiled social commentary. Kafū challenged authority throughout his career, as evidenced in his professed dislike of Meiji-period (1868-1912) leaders, his opposition to the war and Japanese militarism in the 1930s and 1940s, and conflicts with censors and publishers.

The failed 2020 revolution in Belarus and Russia’s full-scale invasion of Ukraine in 2022 served as catalysts for the creation of the Insulted. Belarus Worldwide Readings Project based on a play by Andrei Kureichik. The project provided the material for hundreds of performances in over 30 countries, while dozens of texts by members of Kyiv’s Theatre of Playwrights formed the core of the Worldwide Ukrainian Play Readings, a similar project that generated over 660 performances, refuting Russian president Vladimir Putin’s claim that Ukrainian culture does not exist.

In response to “Origin of ‘Conscientious Objection’ in Health Care: How Care Denials Became Enshrined into Law Because of Abortion,” in which Christian Fiala, Joyce Arthur, and Amelia Martzke trace the origins of “conscientious objection” (CO) policy, this commentary looks at the implications of their arguments for large religious health systems where CO disingenuously constrains care. Within such health institutions, the constraints on standard obstetric care reflect the conscience of bishops who write religious policy, not the beliefs of providers who must implement them, or the patients subject to them.

As relations between the United States and China have grown tenser, how has the Chinese Communist Party's (CCP) portrayal of the United States changed? And what might portrayals of the United States tell us about domestic messaging in China? This study systematically investigates CCP messaging about the United States in the contemporary era. To do this, we hand code, categorize and analyse 1,761 editorials about the United States published between 2003 and 2022 in People's Daily, the Party's flagship newspaper. In addition to showing a sustained rise in critical portrayals since 2018, we identify and elaborate three distinct critical narratives about the United States: it is a dangerous hegemon abroad, it has poor values at home, and it is increasingly weak and in decline. These narratives appear both independently and in combination and are often framed to contrast with portrayals of China. We argue that these narratives are not just negative propaganda to discredit the United States but can also be a strategy to promote a positive vision of the CCP's virtues and governance at home. This study contributes empirically and theoretically to research on propaganda and legitimation in China.

Objectives: Loneliness is a modifiable risk factor for depression and dementia in older age. Validated interventions are needed to mitigate the impact of loneliness in older adults. Some evidence suggests that mindfulness meditation may reduce stress, improve mood and cognitive function, and may also impact loneliness per se. Many meditation apps offer an accessible way to meditate at home. However, robust research is needed to assess the benefits of meditation using this technology for older adults. Muse is a meditation app that analyzes brain signals during meditation and provides users with real-time neurofeedback on their level offocus.

Methods: We conducted a pilot, randomized controlled trial to establish the acceptability and feasibility of a remote, mindfulness intervention using Muse in older adults, and to obtain preliminary data on its impact on mood and cognition. Twenty-six adults reporting feeling lonely were enrolled and randomized to an 8-week Muse- based meditation (MM) or a brain- training active control (BT) program. The MM group completed meditation sessions with real- time neurofeedback and guided meditation sessions using Muse. The BT group completed cognitively challenging games on the commercially available Peak app and listened to podcasts. The groups were matched on the amount of interactions with study staff and total program duration. Outcome measures included standardized self-report scales of loneliness, stress, depression, well-being, quality of life, sleep disturbance, resilience, and mindfulness. Staff blinded to program assignment administered cognitive tasks of episodic memory, working memory, and sustained attention, as well as a breath counting task. Assessments were taken at Pre, Mid, and Post intervention, and after a 2-month and 4-month (4M) follow-upperiod.

Results: Participants found both programs engaging and the remote assessments were feasible. The MM group showed a greater improvement in depressive symptoms, and psychological andphysical QOL, compared to the BT group, at Post and at 4M.

Conclusions: A Muse-based mindfulness program is an acceptable and accessible intervention for older adults. A large-scale randomized trial is warranted to evaluate the efficacy of this intervention in this group.

Objectives: Patients with dementia (PWD) benefit from interdisciplinary care. Depression is a well-known risk factor for the progression of neurocognitive impairment and dementia; other psychiatric disorders (i.e. anxiety, post-traumatic stress disorder, bipolar disorder, psychotic disorders) also may confer an increased risk for dementia. PWD may also present with behaviours and psychological symptoms that overlap with psychiatric disorders. Our aim is threefold: (1) Review the current literature on managing psychiatric comorbidities in PWD. (2) Present an illustrative case series of PWD with psychiatric comorbidities. (3) Introduce a model of care on our Behavioural Neurology Unit (BNU) for treating PWD with psychiatric comorbidities.

Methods: Our BNU is a 20-bed quaternary inpatient unit for difficult-to-treat behaviours related to dementia. Psychiatric consultation is readily available to clinicians and often times for PWD with psychiatric comorbidities. We review best practices in managing these patients. We present a case series of PWD with psychiatric comorbidities predating their diagnosis of dementia who have significant behavioural and psychological symptoms and have failed other settings.

Results: Current guidelines for PWD do not discuss the management of psychiatric and neurologic comorbidities in detail. Among 26 cases, we highlight the judicious use of anticonvulsants, lithium, clozapine, and nabilone in PWD. We also demonstrate the importance of interdisciplinary care with primary care, neurology, psychiatry, and allied health support.

Conclusions: Dementia care is challenging and requires individualized attention and interdisciplinary collaboration. These challenges are augmented when dealing with psychiatric comorbidities. We advocate for increased attention and creative solutions to address these complex cases.

Motivated ignorance is an incentivized absence of knowledge that arises in circumstances of unequal power relations, a self-protective non-knowing which frees individuals from having to reflect on the privileges they have in virtue of membership in a dominant social group. In philosophical discussions, the term “motivated ignorance” gets used interchangeably with “willful ignorance.” In the first half of this paper, using Charles Mills’ (2007) white ignorance as the defining case, I argue that this is a mistake. A significant swath of cases of motivated ignorance are non-willful, or deep, following Rik Peels (2010). But in all cases, benefits accrued to some in virtue of their social position are gained and maintained at the expense of harms to others. In the second half of this paper, I argue that these harms are what ground attributions of culpability in cases of motivated ignorance and drive the normative requirement that the subject know better, so long as the facts in question are ordinarily and easily knowable (in a sense to be specified). Willfulness is not a necessary condition for culpability, even if it is a sufficient one.

The synchronization hierarchy of finite permutation groups consists of classes of groups lying between $2$-transitive groups and primitive groups. This includes the class of spreading groups, which are defined in terms of sets and multisets of permuted points, and which are known to be primitive of almost simple, affine or diagonal type. In this paper, we prove that in fact no spreading group of diagonal type exists. As part of our proof, we show that all non-abelian finite simple groups, other than six sporadic groups, have a transitive action in which a proper normal subgroup of a point stabilizer is supplemented by all corresponding two-point stabilizers.