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Individual actions, episodes and even experiences are, according to Rosa, increasingly compressed as a result of technological speed and the increasing social tempo of change. In a situation in which one needs to dwell in a field, which is exponentially expanding, speeding up of action becomes a natural and even rational temporal strategy. Indeed, due to the possibilities of smartphones and new ICTs such as wearable technologies , immediate response, reaction and continuous, flexible availability are now rapidly establishing themselves as social obligations and even penetrate work ethic.

Drawing on Niklas Luhmann, Rosa acknowledges another noteworthy and highly relevant facet: that the order of values is increasingly structured through temporal perspective, i. Yet, social acceleration is a highly differentiated and uneven phenomenon. Movement and inertia are dialectically intertwined in the process of modernization. Also, and importantly, there are processes and social instances that remain constant or even decelerate: natural limits of speed biological rhythms: i.

Finally, there is cultural and structural rigidity SA , p. Contemporary capitalist modernity can, in fact, be seen in terms of a relationship between the dynamic process of technological innovation ever intensifying and extensifying production and consumption as well as ever tighter proliferation of communication technologies into the individual lifeworld , the static principles of flexible accumulation and the rather deepening class antagonisms: these features of acceleration societies seem to remain more-or-less unchanged.

Countless modern inventions were simply intended to save physical effort and time see also Tomlinson, , p. However, despite this promise, modern society is also characterized by dramatic decrease of temporal resources, which is widely reported in empirical studies on time-use SA , p. How to explain such a paradox?

In other words, the fact that we can communicate, travel, produce, etc. Simply put, the possibility to cover a distance from A to B faster does not imply that one will travel less. The same goes for multiplication of options, possibilities and the volume of information readily accessible through Internet nowadays. Acceleration society is a society that is characterized by the simultaneous ability to cover processes faster in relation to time and the parallel qualitative rise of commodities, information, exchanges to be consumed, processed, and communicated.

This apparent paradox serves a strong explanatory purpose: that, on the one hand, time scarcity purports more speed and therefore drives the need for ever-faster time saving technological invention, on the other, the tension between rates of growth and rates of acceleration essentially explains why we tend to perceive the world as ever-faster SA , p. Moreover, differing temporal orders and patterns stand for the paradigmatic perspective, which allows one to rethink the mediation between structure and agency—as mentioned above.

Further conceptual move, then, lies in two epochal interpretations of modernity. In the second instance, diagnoses of time throughout modern era have stressed its rigidity and deep structural standstill. In the academic world, for instance, this might well be concerning early career researchers who are expected to produce increasing numbers of publications to even stand a chance in the higher education job market.

The rhythms of education or democratic polity simply cannot keep pace with the real-time tempo of algorithms-driven financial capitalism. Different temporalities define distinct generations, social worlds, fields, systems, and administrative apparatuses, which counteract and mutually exclude one another rather than coexist. It can be speculated that techno-savvy fast users and consumers of ever-changing hardware and software—those digitally literate—will be and already are in a structurally advantageous position in contrast to those lacking, or resisting the acquisition of, comparable skills.

According to the acceleration logic it seems that individuals are more or less passive victims of larger temporal structures and horizons. This is not to say that Rosa neglects the importance of temporal intentionality see Flaherty, , p. Furthermore, he notes that rather than another round of epistemological dispute a much more modest task is overdue: an empirical investigation of acceleration and temporal agency Flaherty, ; see also Wajcman, Ulferts et al.

The investigation of acceleration experience then becomes a methodological and theoretical issue. In this sense, acceleration can be understood figuratively and substantially. Customization and operationalization of specific language terms into analytical categories is not a deficiency of social inquiry, as social science can barely flourish without a degree of constructive imagination. Paradoxically, in most cases, and in the evidence Rosa uses, this is the prevalent type of acceleration experience: sedentary, mostly motionless phenomenological rather than directly physical time experience.

In fact, two sedentary phenomenological time experiences can be identified. In his exemplary account Daniel Kahneman notes that the terminology of fast vs slow holds an important explanatory and analytical purchase for understanding of human mind and thinking. Kahneman argues that the complex structure of moral judgement and decision-making is composed of fast intuitive, quick, gut-like, emotional—System 1 and slow deliberate, concentrated, rational, contemplative—System 2 interacting modalities 9.

How many times a day or a week we literally i. In addition to the ECG on admission, cardiologic study included one TTE in all cases and one or more hour Holter recordings when the clinical records suggested a history of arrhythmia. In addition to the cardiologic study, TEE with injection of saline contrast material and the Valsalva maneuver to assess foramen ovale patency was done in patients with an inconclusive diagnosis after TTE, artificial valves, endocarditis and whenever an etiological diagnosis of cerebral infarction could not be established after performing the usual examinations in the following cases: a the patient was more than 60 years old; b TTE had shown atrial septal disease; or c paradoxical embolism peripheral venous thrombosis or pulmonary embolism during the month before or after cerebral ischemia was clinically suspected..

Classification of Cerebral Infarction. Ischemic cerebral infarction was classified according to the criteria of the Study Group for Cerebrovascular Disease of the Spanish Society of Nephrology 26 and included 3 groups of clinicopathological entities and 2 clinical neurological syndromes. The clinicopathological entities were: a atherothrombotic cerebral infarction; b cerebral infarction due to a cardioembolic mechanism; and c cerebral infarction of infrequent cause, including cerebral venous disease, hematological disease, coagulation disorders, vasculitis, infections, migraine with aura, aortic disease, trauma, and hypertensive encephalopathy.

Patients who did not fulfill the criteria of a clinicopathological entity were classified into 2 other groups according to the clinical neurological syndrome they presented: a lacunar cerebral infarction, and b unexplained cerebral infarction, in cases in which the inclusion criteria were not met for any of the 4 previous groups.. Diagnostic Criteria in the Subgroups of Cerebral Infarction.

To establish the diagnosis of cerebral infarction having a cardioembolic mechanism, we used the criteria recommended by the Study Group for Cerebrovascular Disease of the Spanish Society of Nephrology, 26 which are similar to those used in the classification of the National Institute of Neurological Disorders and Stroke NINDS. These include the heart diseases reported in the main published series involving cardioembolism 3,5,6 and those included in the major treatises on cardiology.

Cerebral infarction of unusual cause was diagnosed according to the data on cerebral venous diseases, hematological diseases, coagulation disorders, systemic vasculitis, central nervous system infections, migraine with aura, aortic involvement, trauma, and hypertensive encephalopathy.. The diagnosis of lacunar infarction was based on neuroimaging findings associated with the presence of a characteristic clinical syndrome pure motor hemiparesis, pure sensory syndrome, sensorimotor syndrome, ataxic hemiparesis, or clumsy hand-dysarthria..

Patients in Each Cerebral Infarction Subgroup.

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Among the patients with a first-ever cerebral infarction, Patients With Unexplained Cerebral Infarction. Among the patients with a first-ever cerebral infarction, the examination protocol used was unable to establish an etiological diagnosis in cases of non-lacunar infarction This subgroup, which was the subject of the present study, received antiplatelet treatment during 1 year of follow-up. When a new ischemic cerebral episode occurred, all diagnostic examinations performed in the initial protocol were repeated, and additionally TEE with saline contrast injection and the Valsalva maneuver was carried out..

Classification of Thoracic Aorta Atheromatous Plaques. To assess the importance of complex atheromatous plaques detected by TEE, we compared the prevalence of this finding in our patients with unexplained cerebral infarction who presented a second episode with a control group of patients with unexplained cerebral infarction who did not present a second episode during the first year of follow-up in the French Study of Aortic Plaques in Stroke.

In all cases TEE was carried out during the 2 weeks after the stroke, with special attention to the presence of plaques in the thoracic aorta. Follow-up was 2 to 4 years mean follow-up was 2. Comparisons between continuous variables were made with Student's t test. Comparisons between proportions used the Chi-square or Fisher exact test, depending on the size of the sample.


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Demographic Characteristics of Unexplained Cerebral Infarction. The most frequent cardiovascular risk factor was hypertension Over 1 year of treatment with antiplatelet agents, 20 of patients 8. All cases of recurrent ischemia occurred during the first 4 months of follow-up and none of the patients had undergone TEE study previously in the first diagnostic assessment. Among the 17 patients who had a second infarction, the new episode was the cause of death in one patient and there was some degree of residual disability in four cases..

Transesophageal Echocardiography. Transesophageal echocardiography with administration of saline contrast material and use of the Valsalva maneuver was carried out in all patients who experienced a second cerebral ischemic episode.

This examination established the probable cause of the ischemic event in 16 of the 20 cases In 10 of the 15 patients Lastly, in one patient with recurrent cerebral infarction, substantial concentric left ventricular hypertrophy, mild ejection fraction depression and sinus rhythm, TEE showed spontaneous echo contrast in a dilated left atrium with thrombosis of the auricular appendage.. Comparability With the Control Group. Both studies used the same classification to assign aortic plaque complexity. Similar to our study where TEE was not systematically performed in all patients , in the French Study the classification unexplained cerebral infarction was given to patients in which an etiological diagnosis could not be established regardless of whether they presented aortic plaques, and antiplatelet agents were also administered during the follow-up of these patients.

In addition, the 2 subgroups of patients with unexplained cerebral infarction presented a similar incidence of recurrent infarction during antiplatelet follow-up in the French study, episodes of transient ischemia were not included in the analysis. In our study 17 cases of a second infarction were recorded 6. Hence, these 2 populations of consecutive cerebral infarction patients were acceptably comparable, as was the incidence of recurrent infarction during antiplatelet therapy follow-up in the 2 subgroups of unexplained infarction derived from each of the general populations.. Role of Complex Atheromatous Plaques.

In our patients with unexplained cerebral infarction who presented a second episode, the prevalence of complex aortic plaques 14 of 17 patients; Comparison between our patients with uncertain cause and reinfarction and patients in the French Study with uncertain cause who did not present recurrence over the entire follow-up period also showed a significant difference in the prevalence of complex plaques Even though there are no randomized studies defining the most appropriate treatment in this situation, antiplatelet drugs are generally prescribed in clinical practice..

Transesophageal echocardiography has broadened the diagnostic potential in the assessment of ischemic stroke. Nevertheless, because of the relative complexity of this technique, the slight risk involved and its limited availability, the indications for TEE have not been well established in cerebral ischemia 22 and its use is restricted in the large elderly population, where this disease is mainly centered. With the application of our protocol of diagnostic examinations, TEE was performed in only 4. The etiological diagnosis could not be established in patients Over the last decades increasing evidence has pointed to the importance of aortic arch atherosclerotic disease as a source of cerebral embolism.

The presence of a mobile atherothrombotic component aortic debris can increase the risk of stroke up to 17 times 14 and also increase the risk of death. As the control group we used patients with unexplained cerebral infarction who did not experience recurrence, included in the French Study of Aortic Plaques in Stroke. In addition, there was a similar incidence of second cerebral infarction in the subgroups of uncertain etiology derived from each of the total populations.

Such a comparison between different population groups has certain limitations and the results should be interpreted with caution. Nonetheless, in the absence of other etiological findings that could explain the ischemic events occurring in these patients, the much higher prevalence of complex aortic plaques in our patients with a recurrent event, as compared to those of the French Study without recurrence, suggests that this disease plays a true causal role and is associated with a high risk of new ischemic events, despite administration of antiplatelet agents..

In a considerable percentage of patients with cerebral infarction, assessment by routine non-invasive examinations does not result in an etiological diagnosis. Although at mid-term most of these patients do not present new ischemic cerebral events while under antiplatelet treatment, a small subgroup 8. Our study suggests a central causal role for complex atheromatous plaques of the aorta in patients with unexplained cerebral infarction who present a recurrent event during the first year of treatment with antiplatelet drugs, and indicates the usefulness of TEE for establishing the diagnosis in this situation.

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