Constraints in which the contextual factor is nonlinguistic, however, do not appear to be learnable by this method—for example, /f/ is an onset if the speech rate is fast, but /f/ is a coda if the speech rate is slow. The present study demonstrated that adult English speakers can learn (after a sleep period) constraints based on stress , but cannot learn analogous constraints based on tone . The results are consistent with the fact that, in English, stress is a relevant lexical phonological property , but tone is not . The results provide useful constraints on how consolidation effects in learning may interact with early learning experiences.Speech errors are sensitive to newly learned phonotactic constraints. For example, if speakers produce strings of syllables in which  One’s native language is learned in childhood. At the same time, it is acknowledged that the mature language processing and production systems continue to reflect linguistic experience throughout life. Learning new vocabulary is an uncontroversial example of continuing acquisition. Psycholinguistic findings have also shown that linguistic structures or rules are changeable. For example, syntactic priming Bock,  in adultphonotactic patterns. Each language has its own phonotactics—that is, a set of rules that constrain possible phoneme sequences. For example, in English, /ŋ/ (ng sound) can only be at the coda  position of a syllable, as in “sing.” But in Vietnamese, /ŋ/ can be an onset , as in /ŋɪj˧˧/ (meaning: “to doubt”). Phonotactic knowledge is acquired from linguistic experience during infancy and childhood, and it systematically influences both language perception and production , through the Fromkin, . For exah, ŋ, f, s, m, n, k, g) and a single vowel. An example sequence is “hes feng mek neg.” The participants simply had to say the syllables aloud in time with a metronome. The consonants in the sequences exhibited three types of constraint:language-restricted consonants.Language-wide constraint: /h/ must be an onset and /ŋ/ must be a coda. Slips involving these consonants were expected to follow English phonotactics; that is, /ŋ/, if it slipped, would always slip to coda position. Consonants subject to this constraint are referred to as experiment-restricted consonants.Experiment-wide constraint: /f/ must be an onset and /s/ must be a coda. This is not generally true for English, just for the experiment. The extent to which slips of /f/ and /s/ obeyed the constraint  was a measure of learning of the experiment-wide constraint. Consonants subject to this constraint are referred to as unrestricted consonants.Experimentally unrestricted consonants: /k, ɡ, m, n/ were not restricted, appearing as both onsets and codas. Errors involving consonants in this category were used as a baseline to compare to the slips involving consonants subject to experiment-wide constraints. Consonants subject to this constraint are referred to as In the original study of this sort, Dell et al.  presenteThe speech errors that occurred in the experiment were classified according to whether the slipping consonant moved “legally.” For consonants subject to language-wide and experiment-wide constraints, a legal slip obeys the constraint  and an illegal one (onset /h/ or onset /f/ moves to a coda position) does not. The proportions of slips from these conditions that are legal can be compared to a baseline by examining slips of unrestricted consonants, for example, slips of /k/. Within a sequence, the position of each unrestricted consonant—for example, /k/—is “restricted,” but just for that sequence. This is because each consonant appears just once in each sequence. So, if a /k/ was an onset in the current sequence, if it slipped to another onset position, it was “legally” following the constraint that /k/ is an onset within that sequence. If it slipped instead to a coda position, the slip was “illegal.” For a slip of /k/ in another sequence in which /k/ was a coda, a slip to a coda position would be legal, and a slip to an onset would be illegal. Thus, although the positions of unrestricted consonants and the corresponding implications for slip legality differ for different sequences, the overall proportion of legal slips for unrestricted consonants forms an unbiased baseline that can be compared to the legality proportion of slips of restricted consonants. Dell et al.  found, afirst-order. These are unconditioned constraints that certain consonants must occur in certain positions . Second-order constraints, on the other hand, depend on context. For example, /f/ must be an onset and /s/ must be a coda if /ɪ/ is the vowel in the syllable, but /f/ must be a coda and /s/ must be an onset if /æ/ is the vowel. That is, the positions of /f/ and /s/ depend on some property of the syllable, in this case, the vowel.When this speech error technique is used with other kinds of constraints, it has been found that not all constraints are learnable and not all learnable constraints are equally easy to learn. The constraints used by Dell et al.  have beef/ must be an onset and /s/ must be a coda if the speech rate is fast, but /f/ must be a coda and /s/ must be an onset if the rate is slow. Although the difference in rate was a salient feature of the speakers’ productions and had a very large effect on the number of slips, the slips failed to follow the rule. Warker et al. proposed that extralinguistic features such as speech rate are not present in the production component that represents the positions of speech sounds in syllables. That could be because such features were never present in that production component or because English speakers have learned that they do not constrain English phonotactics, and hence they are excluded as a result of experience. We shall expand on this notion of “extralinguistic” below.Warker, Dell, Whalen, and Gereg  discoverTo sum up, the studies of phonotactic learning using this speech-error method have shown three kinds of results: quick learning, learning after a sleep period, and failure to learn. Warker and Dell  developeThe Levelt et al. model distinguishes between phonological encoding, in which retrieved word-form information is assembled into syllables (syllabification), and later phonetic encoding processes. During phonological encoding, segments are assigned to syllable positions based on segmental and metrical information retrieved from the lexicon and on phonotactic knowledge. A version of the model for tone languages assumes that retrieved lexical tones, instead of stress-related metrical patterns, participate in this process  are present. Dell et al.  explaineWhy are the representations of the relevant conjunctions not immediately functional? After all, their inputs  are clearly part of English phonology. Dell et al.  proposedperceptual phonotactic learning, the vowel-contingent rules are easily learned in one session  even though, arguably, they have the same segment sequence. From the perspective of our theoretical framework, the crucial difference between tone and stress is that stress, but not tone, would be expected to be an input to the syllabification process. We developed these predictions first for the tone experiment.The experiments in this article investigated second-order constraint learning with two kinds of suprasegmental contexts: tone (Exp. 1) and stress (Exp. 2). English’s use of intonation patterns includes two functions that, when applied to single-syllable utterances, create analogues to the lexical tones used, for example, in Mandarin Chinese. In an utterance such as “yes?,” the rising pitch pattern is quite similar to the Mandarin second tone, and in an utterance such as “yes!,” the falling pattern corresponds to the Mandarin fourth tone. We will use the distinctive rising (?) and falling (!) pitch patterns as “tones” in our study, and refer to them as such, while recognizing that English intonation patterns are not technically lexical tones.The framework for phonotactic learning in production that we summarized above predicts that a tone-contingent second-order constraint—in which, for example, /f/ is an onset and /b/ is a coda if the tone is rising, but /b/ is an onset and /f/ is a coda if the tone is falling—should not be learnable by adult English speakers. That is, English “tone” should be like speech rate. The framework assumes that the input to the syllabification process is restricted by the features that distinguish lexical items, and English pragmatic tone is not such a feature. We recognize that at some point during linguistic development, tone must have had the potential to be such a feature. Lexical tone is a feature of many languages, and moreover, different tones can be associated with different phonotactic patterns  was marked by a single orthographic symbol for each syllable. Aside from changing the contingency from the vowel to the tone, the only other significant design change was that we attempted to increase experimental power. The most powerful of the vowel contingency studies tested a total of 12 participants each doing 96 trials per day  from the University of Illinois at Urbana-Champaign provided the data. These 18 participants were part of a larger group of 23, all of whom underwent pretesting as described below, which was carried out to ensure that all analyzed participants accurately and consistently produced the tone patterns in the artificial materials. The 18 successful participants were paid $20 for participating in one session per day for two separate days. The participants were randomly assigned to one of six constraints, described below. The use of these six constraints ensured that each consonant had an equal chance of participating in the experimental constraint, and that the resulting constraints would balance consonants across rising and falling tones and onset–coda combinations.f/ must be an onset and /b/ must be a coda if the tone is falling, but /f/ must be a coda and /b/ must be an onset if the tone is rising. In pilot work, we showed that English speakers naturally use a rising tone to say, for example, “bef?,” and a falling tone to say “bef!.” As in the standard design used for testing second-order phonotactic learning, all syllables of a sequence had the same tone, and “?” and “!” trials alternated. For example, two adjacent sequences in the feb!–bef? condition might be:hem! feb! dek! neng! (2) mef? beng? hen? dek?Each sequence in the tone experiment consisted of four CVC syllables using the following eight consonants, /h, ŋ, f, b, k, d, m, n/, and the short e vowel, spelled with “e” and pronounced as /ɛ/. The eight consonants each appeared once in each sequence (four times as onsets and four times as codas). The actual syllables in each sequence and their order were randomly determined, except for the influence of language-wide and experiment-wide constraints: The /h/ must appear as an onset and the /ŋ/ as a coda, as dictated by English phonotactics. In addition, two other consonants followed a tone-based second-order experiment-wide constraint, and this constraint varied among participants. In the sequence, each syllable was presented as a single word—separated by a space from its neighbor syllables—and its desired tone was marked with either “?” or “!” after the syllable. Participants were randomly assigned one of six constraints: feb!–bef?, bef!–feb?, dek!–ked?, ked!–dek?, men!–nem?, nem!–men? This notation stands for what tone-based constraints participants received. For example, feb!–bef? means the constraint, /Each participant performed 96 trials on each of two days. On a single trial, a sequence was visually presented on a computer screen. Participants recited the sequence following a computer-generated metronome, associating a tone with each syllable. For each sequence, participants first read it aloud once at a rate of 1.1 syllable per second, and then repeated the sequence three times without pause at a faster rate of 2.8 syllable per second. All recitations were digitally recorded. There were both practice and experimental sessions on the first day, but only an experimental session on the second day.In the practice session, participants were shown two practice trials, one with rising tones and one with falling tones. The experimenter instructed the participants how to pronounce the syllables, and they practiced these several times until they had accurately produced the patterns and their timing with the metronome. If participants could not reproduce the tones or the metronome timing after 5 min of such training, the experimenter would remove them from the study . The logic for excluding participants who had difficulty is that, if they could not pronounce the tones correctly, anything that they would have learned would not have been a true tone-based rule.During the experimental session, the experimenter sat next to the participants and listened to their pronunciation of the experimental trials. The experimenter would correct participants if they produced a tone incorrectly. If the participants, despite having passed the practice session, still exhibited difficulty after 20 trials, the experimenter marked this participant as eliminated, and their data were not examined. After the 20-trial period, the experimenter would leave the room, to let the participants finish the rest of the experiment unsupervised.Aside from the opportunity to eliminate participants because of failure to complete the practice and because of a judged lack of tone accuracy during the first 20 trials of the experiment, the experimenters reserved the right to eliminate participants as a result of an initial scrutiny of their recorded productions after the experiment was over. In all cases, though, participants were eliminated before any consideration of their consonant slips, which constituted the key data.Consonant slips that occurred during the rapidly produced recitations were the data of interest. There were two coders, and each identified slips from high-quality audio recordings of the sessions. One coder examined the output of nine participants, and the other did the other nine participants. The coders identified all errors, without attending to the condition that the participant was in. In addition, a subset of the recordings, containing 1,152 syllables, were coded by both coders, in order to determine coding reliability. In this reliability check, both coders agreed that there were no errors in 1,752 out of the 2,304 consonants, and agreed on the nature and presence of 508 errors. The overall agreement between the two coders was 98.1%. This reliability is comparable to those in previous speech error studies  and unrestricted consonants occurred approximately equally on rising-tone  and falling-tone  syllables. The speech errors involving consonants restricted by experiment-wide constraints were classified as legal if they followed their respective constraints , and illegal if they did not. The slips involving unrestricted consonants constituted the baseline. A slip of an unrestricted consonant was classified as legal or not as in previous studies, that is, by examining whether the slipping consonant preserved or changed its syllable position. For example, if the original position of the consonant was as an onset, and it slipped to another onset position, the slip would be legal, and if it slipped to a coda position it would be illegal.The data analysis procedures followed standards that had been used for other second-order phonotactic-learning studies that involved two testing sessions . See Table There were no significant differences between the restricted and unrestricted legality proportions on either Day 1 (5% difference in the wrong direction) or Day 2 (0.5% difference in the wrong direction), as well as no significant interaction . At the same time, though, the status of a syllable as stressed or not is not a useful cue for whether a particular consonant may be restricted to the onset or coda position (as /h/ and /ŋ/ are). In this respect, stress is like a syllable’s vowel. It is an important aspect of English word form, but it provides little information about how consonants may be restricted to onset or coda position. Thus, within our framework, we expected the stress constraint to be learnable in the same way that a vowel-contingent constraint is; the learning effect should appear on the second testing day, because of the need for a consolidation period to restore the functionality of representations that can code for the conjunction of stress values and consonants .Here we tested constraints such as this one: /f/ must be an onset and /ʃ/ must be a coda in stressed syllables, but /ʃ/ must be an onset and /f/ must be a coda in unstressed syllables. These constraints have the same form as the second-order vowel-contingent constraints that were learnable after the first day, as well as the same form as the tone constraints that were not learnable. From the perspective of the framework that we summarized earlier, we would expect the stress constraint to be learnable, because stress distinguishes English words and, hence, would be an input to phonological encoding. Stress interacts with syllable structure in English in a number of ways  English avoids stress clash—that is, adjacent stressed syllables within a phonological domain are avoided; (2) English tends toward stress-timing—that is, stressed syllables are produced at approximately regular intervals. Thus, our stressed and unstressed syllables alternated within a sequence, and stressed but not unstressed syllables aligned with metronome signals.The stress experiment kept its methods as close as possible to those of the tone experiment, while ensuring that the stress manipulation effectively manipulated stress as experienced in English. The stress constraints to be learned were directly analogous to the tone ones: For instance, /A total of 18 native monolingual English speaking students  from the same population as before provided the data. These 18 participants were part of a larger group of 48, all of whom were pretested as in the tone experiment. The 18 successful participants were paid $20 for participating in one session per day for two separate days. The participants were randomly assigned to one of six constraints, which counterbalanced the materials and conditions: FISH–shif, SHIF–fish, DIK–kid, KID–dik, MIN–nim, and NIM–min (as we describe below).The sequences were randomly generated as before, subject to language-wide and experiment-wide constraints. Each sequence contained eight consonants /h, ŋ, f, ʃ, k, d, m, n/, each of which appeared only once per sequence, and orthographic “i” (/ɪ/) was the vowel used in all syllables. Notice that there are two changes from the phonemes used in the tone experiment. First, the /b/ used in the tone experiment was replaced with /ʃ/ (spelled “sh”). This change made the consonants more distinct from one another, to aid coding of the often difficult-to-hear consonants in unstressed syllables. Second, the short “i” vowel was chosen instead of the short “e” vowel used in the tone study, because it can occur in both stressed and unstressed syllables of English. We acknowledge that the phonetics of stressed and unstressed utterances of “i” vowels in the study would not be exactly the same, but we assume that their differences would be those determined by stress rather than by different lexical representations.f/ must be an onset and /ʃ/ must be a coda if a syllable is stressed; /f/ must be a coda and /ʃ/ must be an onset if a syllable is unstressed. The other five constraints were defined analogously. An example of two consecutive trials in the FISH–shif condition would be (1) HIMdin FINGshik; (2) nifMISH kidHIN . Language-restricted, experiment-restricted, and unrestricted consonants were defined as in the tone study, the only difference being that the constraints were stress-based instead of tone-based.The first two, and the last two, syllables of each sequence were each concatenated as a single two-syllable “word” (spelled without a space between the syllables). Half of the sequences were made up of two trochaic (stress on the first syllable) words, and half had two iambic (stress on the second syllable) words. These two sequence types alternated. The use of both trochaic and iambic trials ensured that the stress constraints present in the materials concerned the stress value of the syllable and not its word position. The sets of sequences prepared for each participant exhibited one of the six possible constraints mentioned above. The FISH–shif constraint was shorthand for the rule that /As before, each participant received 96 trials on each day. The sequences were presented visually, one at a time, to the participants on the computer screen, with word boundaries marked with spaces and stressed syllables capitalized. Participants recited the sequence following the tone of the metronome, associating a tone with a stressed syllable. For each sequence, participants first read it aloud once at a rate of 1.0 word per second, and then repeated the sequence three times without pause at a faster rate of 1.9 words per second. All recitations were digitally recorded. Practice sessions were conducted as before in the tone experiment, and participants were replaced using the same procedure. More participants were replaced in the stress than in the tone study, likely because accurately producing stress timing using unknown words does not come easy to many participants. Because such timing is a central feature of English stress, we felt it necessary to require it of the participants’ speech.The errors that occurred in Experiment 2 were transcribed and coded as before. In the reliability check, two coders coded the same set of 1,152 spoken syllables . Both coders agreed that there were no errors on 1,882 out of the 2,304 consonants, and agreed on the nature and presence of 383 errors. The overall agreement between the coders was 98.3%. If a word was given the wrong stress pattern, no segmental errors were counted from either syllable of the word. These stress errors occurred on 2.7% of the trochaic words and 3.1% of the iambic words. Thus, these participants were producing the stress patterns as directed. Please note that these elimination percentages are somewhat higher for the stress experiment than for the tone experiment, consistent with our claim that the stress procedure, which necessitates alternations of stressed and unstressed syllables, was more difficult.There were 1,225 errors  involving experiment-restricted consonants (restricted errors). These were classified as legal if the slips still conformed to the experimental constraint assigned to that participant. For example, when a participant said “FISHmik HINGnid” when he or she was supposed to say “FIMshik HINGnid” in the FISH–shif condition , the slip of the experiment-restricted /ʃ/ was considered legal, since /ʃ/ was supposed to be a coda in stressed syllables. But if the participant said “FIKmish HINGnid,” then the slip was illegal, since /ʃ/ should not be a coda in unstressed syllables. We used the 2,447 errors involving unrestricted consonants (or unrestricted errors) as the baseline. As before, we note that the unrestricted consonant involved in each error was “restricted” within the sequence, because each consonant occurred exactly once in every sequence. Thus, we can label the potential positions that it could slip to within this sequence as “legal” or “illegal,” just as if the consonant had been restricted, and in so doing classify the slip as legal or illegal. For example, if /m/ were unrestricted in the trial “FISHmik HINGnid” in the FISH–shif condition, we can note that /m/, in this sequence, was restricted the same way that /ʃ/ was restricted for the entire experiment . Then the proportion of unrestricted errors that were legal in this sense is an unbiased baseline to compare to the legality of restricted slips.We expected no difference between the restricted and unrestricted legality proportions on Day 1, since previous studies on second-order learning have shown that any such learning only shows up after sleep. But we expected restricted legality to be significantly higher than unrestricted legality on Day 2. As before, we tested the three planned contrasts with nonparametric methods: between restricted and unrestricted legality on Day 1, restricted and unrestricted legality on Day 2, and the interaction between day and restrictedness.p = .17), but a robust 12.3% effect on Day 2 (Wilcoxon p < .05). In addition, the interaction between days and restrictedness was significant (Wilcoxon p < .05). The results were exactly as predicted. They supported the hypothesis that English speakers can learn stress-based constraints, but not until Day 2. The magnitude of the difference on Day 2 is close to the mean expected effect for other second-order effects  than on stressed  syllables. This was expected, from findings that attended or otherwise emphasized syllables are relatively immune to production errors . In the stress experiment, there were both stressed and unstressed syllables in a trial, and hence the legal slip of a particular consonant could be to either onset or coda positions. Because of these facts, legal slips in the stress experiment often had to violate the syllable position effect , whereas the ones in the tone experiment did not. Thus, the syllable position effect worked against the stress-based rule. In the tone experiment, the syllable-position effect worked along with the tone-based rule.The results were as predicted. Experiment 2 showed that English speakers can learn stress-based phonotactic constraints, but not until the second day. Previous phonotactic learning studies involving production have also found this phenomenon of delayed learning of a constraint in which some linguistic factor  constrained whether a consonant can be an onset or a coda  are, in some way, unable to operate immediately. That is, they are backgrounded. The framework does not specify a mechanism for such backgrounding.fully produce all of the syllable-tone combinations that they experienced. Their failure to learn was not a sensory or motor problem. The participants’ only failure, as it were, was that their slips did not obey rules such as that /f/ is an onset when the tone is rising, but a coda when the tone is falling. Thus, our findings speak to a role of linguistic experience as defining the abstract form of what is learnable, not the particular sensory–motor features and feature combinations.Furthermore, our findings may relate to two phenomena: one well known, one less so. The well-known fact is the ubiquity of foreign accents. Older speakers usually have great difficulty learning to produce phonological contrasts that are not present in their native language; for instance, producing and recognizing lexical tone is quite difficult for adult English speakers  and age of acquisition/critical periods (the unlearnability of tone by English-speaking adults). At present, no learning theory simultaneously addresses both of these important questions (see Smalle, Page, Duyck, Edwards, & Szmalec, In conclusion, through the two experiments in this article, we investigated the limits of context-dependent phonotactic constraint learning, and the results showed that English speakers could learn stress-based but not tone-based phonotactics in our experiments. This suggests that learning of English shapes the adult production system in such a way that stress and tone features are differentially available to phonological encoding, thus subsequently enabling the learning of new stress-based but not tone-based constraints.


Ted Moser’s interesting views on the changing role of marketing raise a fundamental question of timeless interest: What is marketing? Ted offers three central observations. First, we need to move beyond the division between “digital” and “analogue” to think about marketing as a whole, of which some parts are digital, and others are not. Second, Ted argues that marketing is taking territory from sales, which implies that marketing does not restrict itself to general communication, market-offering presentations, and lead generation. It often completes the buying cycle and, thereby, generates sales. Third, marketing is undergoing a necessary transition. While I recognize and agree with these arguments based on my own work, we need to ask whether it is, or was, meaningful to divide marketing into different parts and assign them different labels. In other words, we need to think about what marketing is.There is a distinction between a functional view of marketing and a capability-based view of marketing, which is also known as the distinction between “Marketing as a function (big M) in relation to marketing as a process … (little m)” . It is also hard to allow the continued use of different terms by academia and practitioners, which serves to increase the gap between them.While I personally prefer “marketing” as the overarching term  and subsequent digitalization  have profound impacts on marketing, customer relationships, markets, and buyers  does not stop by moving the boundary between sales and marketing. As Ted points out, digital has a ripple effect on marketing—and marketing has to align with the rest of the organization, including new business models. There is also a “loop ripple effect,” as marketing offers the organization new inputs, such as information on the need to differentiate and individualize offerings. The increase in the availability and use of data more closely connects marketing to other organizational functions. For instance, delivery and service units have direct access to customer data and add customer data to the system, and real-time information about customer-usage patterns provides the basis for better planning of production and service schedules. As marketing becomes more data driven and more accountable for results, it also becomes closer, better aligned, and more integrated with other parts of organizations. Digitization offers improved ways of achieving new heights in market orientation, which refers to the “organization-wide generation of market intelligence, dissemination of intelligence across departments, and organization-wide responsiveness to it” (Jaworski and Kohli Research has for a long-time analyzed opportunities and challenges around the collaboration of marketing with finance, production, R&D, logistics, and others (e.g., Ellinger Ted proposes a set of transitions that marketing must undergo and enable in the wider context. I support the idea that marketing has to change in order to understand and develop new tools, methods, and technologies in order to build new capabilities for driving corporate performance. Marketing also has to reinvent and reposition itself in organizations and academia alike. Thus, beyond the capability challenge, there are challenges related to the mindset and our fundamental understanding. Not only do we need to find a way to deal with “digital”—we also need to find out what we mean by “marketing.”


Finally, the assessment of therapeutic sensations may help to gain a deeper understanding of such concepts, finding a common language between scientists, patients and practitioners, and bridging the wide gap between materialistic and vitalistic views.Physical sensations of tingling, warmth, dull pain, and heaviness are a common phenomenon in mind-body interventions, such as acupuncture, hypnotherapy, osteopathy, qigong, meditation, and progressive muscle relaxation. Even though there are striking parallels between sensations produced by many different interventions, no attempt has yet been made to understand them from a unifying perspective that combines information from different therapies and practices. Therefore, this narrative systematic review introduces the concept of therapeutic sensations and summarizes studies of their sensory quality, bodily topography, and the meaning that patients attach to them. Furthermore, it highlights the essential role of therapeutic sensations in the development of vital energy concepts, such as  It's usually during the treatment... but not right off. It takes a few minutes...”“I always felt the heat coming out of the therapist's hands, in every session I felt.”Patient after sham acupuncture treatment .“I alway“It's quite a bizarre sensation that I've never had before.”Nursing student after therapeutic touch treatment .“It's qu“You can feel the wind going round in your body ... it was like she was chasing wind round my body.”Patient after acupuncture treatment .“You can”I feel a sense of peace, calm, and warmth all over my body when I walk into the room. It's a tingling feeling that flows like a stream over me.”Patient after therapeutic touch treatment .”I feel “I had the impression that I could direct a subtle tingling, a flow of energy, through my entire body.”Practitioner after Taijiquan session .“I had tPractitioner of Vipassana meditation .Complex bodily sensations like the ones described above are a common phenomenon in mind-body interventions, such as acupuncture, hypnotherapy, osteopathic medicine, qigong, meditation, and progressive muscle relaxation. Well-known examples include the feeling of heaviness and warmth in autogenic training , the neetherapeutic sensations for them  for such body experiences at the border between psyche and soma and described them very vividly: “The sensation of warmth and cold, including the sensation aroused by the mind , belong to the vital sense. The shudder that seizes man himself at the thought of the sublime, and the terror with which the nurse's tales drive children to bed late at night, belong to the latter; they penetrate the body to the extent that there is life in it.”  combining the advantages of these two complementary review approaches . ThematiThe first phenomenological domain of therapeutic sensations includes somatosensory qualities, that is, verbal descriptions by the person experiencing them. These are either collected as free responses or by having the person choose from a list of predefined descriptors. Six examples obtained with the former method are shown in the beginning of this article. Naturally, they exhibit a high level of variability, and similar reports are often mixtures of sensory, evaluative, and affective descriptions . StudieAll questionnaires on somatosensory qualities of therapeutic sensations have in common that they report one or more of the following variables: intensity ratings of individual descriptors measured with some form of analogue scale e.g., , 56), fr, fr56]),To compare the somatosensory qualities of therapeutic sensations across interventions, the author conducted a systematic literature search (see Supplementary Methods), which yielded the following 18 studies. Abundant literature exists for manual acupuncture , 58–65, Therapeutic sensations from different interventions showed a broad similarity see  as evideThe multitude of descriptors encountered in therapeutic sensations makes neurophysiological characterization of the phenomenon a challenging task. The five most common descriptors alone cover somatosensory experiences of temperature (“warm”), innocuous sensations (“heaviness”), pain (“dull pain”), and paresthesia . The fact that many descriptors cannot be unambiguously assigned to a single somatosensory submodality further complicates the situation.Valuable insights come from studies of acupuncture-related therapeutic sensations, where several groups have analyzed descriptor profiles and thereby added to our understanding of different sensation components. Using principal component analysis, Vincent and colleagues reported that one of the seven components detected by this approach comprised the descriptors “pulling,” “numb,” “heavy,” “dull,” and “aching” and likely corresponded to the acupuncture-related therapeutic sensations widely known as deqi (see below for detailed discussion) . Other cpainful and nonpainful variety. However, since warm and tingling are very different sensations from a neurophysiological point of view, it may be more appropriate to distinguish three main categories: (1) painful, as described by “dull pain,” “soreness,” “sharp pain,” “aching,” and so on, (2) paresthetic, as described by words such as “tingling,” “numbness,” or “throbbing,” and (3) thermal, as described by “warm,” “hot,” “cold,” and so on  and where they have been studied since the early 1950s . AbstracFurthermore, the methodology of many of the Chinese PSC studies (as judged from the available information) leaves much to be desired. What can be said with some certainty from these sources, however, is that subject reports indicate that PSC appear in the form of linear-type therapeutic sensations that propagate with a velocity of 20 cm/s or less and have a width of 1 to 10 cm. Propagation can be stopped by applying pressure or cold . PSC canFurthermore, there is a latent form of PSC elicited by electrical stimulation of acupuncture points that follows the same patterns as prominent PSC but only emerges when the skin is additionally stimulated by slight tapping with a hammer , 80. FinDespite the methodological shortcomings of early PSC studies, some of their findings have been confirmed by recent studies. These include their linear patterns , their pThe following section examines the meaning dimension of therapeutic sensations, that is, the significance and perceived importance that patients and practitioners attach to them. A systematic literature search (see Supplementary Methods) identified seven studies reporting the results of qualitative unstructured, semistructured, or structured interviews of patients and healthy subjects on their experiences with therapeutic sensations. The studied interventions included acupuncture , 59, 85,The list of meanings that patients commonly attached to therapeutic sensations is surprisingly long . Some paMany of the topics identified in the systematic literature review have also been covered in a quantitative study that the author conducted in 108 patients receiving body-oriented psychotherapy combined with acupuncture for various conditions  . PatientThe results indicate that less than ten percent of the patients saw their therapeutic sensations as normal sensations with no particular meaning attached to them or stated that they did not know what the sensations meant. In stark contrast, the majority of patients in this study associated therapeutic sensations with emotional processes and saw them as an essential part of the therapy and as a sign of the upcoming healing. As in the preceding section, interpretations as vital energy were a common theme, as almost 50 percent of the patients stated that the sensations they experienced were an expression of their vital energy. One-quarter of them even saw therapeutic sensations as a sign that the therapist was guiding her vital energy into them. Interestingly, this did not correspond to the narrative of the treatment.In the previous section, we have seen that taking therapeutic sensations as a sign for vital energy processes is one of the most common meanings that patients attach to them. Similar observations have been made by many other scholars before. For instance, Wilhelm Reich states that “subjective vegetative sensations are at the basis of every kind of mysticism, be it Yoga, or the Fascist ‘surging of the blood,' or the reaction of a spiritist medium, or the ecstasies of a dervish” . On a modeqi  and qizhi . Both expressions date back to the earliest classics, namely, the Huang Di Nei Jing  location in sequence and hold the breath [there]” ” .). The idea of directing vital energy through the body has an obvious parallel in attention-related sensations. In the former, patients or practitioners use their mind to move vital energy to different places inside their bodies [Let us now look at the parallels between therapeutic sensations and the vital energy concepts reviewed above . The ider bodies –104. In r bodies , 40–42. r bodies , who quiTingling is the most common descriptor for both therapeutic and attention-related sensations and seems to evoke energy-related associations in many people. One reason may be that tingling is commonly elicited by an alternating electrical current of high frequency or by static electricity. Since the latter has been described as early as 600 BCE, we can assume that the connection between this energetic phenomenon and the sensation it evokes has accompanied humans since classical antiquity, which gives a hint, why we equate the two so easily.wen 温, meaning “warm” or “moderate temperature,” and the earliest glyph for mai, meaning “vessel” [Continuing with the somatosensory qualities of therapeutic sensations, the second most common descriptor, warmth, is a general sign of energy and, in the form of body warmth, a core feature of all life. Huang and colleagues even hypothesize that warm sensations experienced during moxibustion may have played a central role in the development of the East-Asian channel concept. This is suggested by the similarity of the glyphs for “vessel” .Another group of frequent descriptors of therapeutic sensations are “fullness,” “distention,” and “pressure.” The accumulation or build-up of an unnamed something implicated by these words is paralleled by East-Asian medicine and other traditional systems attributing to vital energy the ability to fill previously empty spaces. Fullness, distention, and pressure are thus plausible ways of perceiving and describing such accumulation of energy.quite a bizarre sensation that I've never had before” [The focus on individual descriptors should not disguise the fact that patients frequently need five or even ten descriptors to describe their therapeutic sensations adequately. Thus, we are dealing with complex sensations that are hard to describe and often reflect the entire bandwidth of possible somatic sensations . Further before” . Their cpneuma, prana, and qi are not static, but in constant motion or flow. Similarly, “flowing” or “streaming” are common ways, how people describe therapeutic sensations in qualitative studies. Furthermore, other common descriptions, such as “spreading” or “radiating,” seem to depict movement inside the body, just like the constant flow attributed to vital energies, moreover, just like warmth movement is a core feature of life.Another parallel between therapeutic sensations and vital energy concepts is nonstationarity, that is, tendency to move. This is paralleled by “flowing” or “streaming” being common descriptions of therapeutic sensations in qualitative studies. As discussed above, propagated sensations along channels [Further exciting parallels that we are just beginning to understand exist between the topography of therapeutic sensations and some aspects of the subtle body. A central observation is that linear-type therapeutic sensations bear many similarities with the concept of channels . Severalchannels , 80, 81.channels . It is tchannels , 108). Tchannels   and be transmitted directly to another one (client) for instance, by laying on of hands. However, the experience of vital energy is still limited to the body as evidenced by two quotes from the beginning of the article. Here, one client reports that the healer “was chasing wind round my body” , while as hands” . Furthers hands” . Thus, tTherapeutic sensations are ubiquitous in mind-body interventions and exercises. The similarity of their topography and somatosensory qualities suggests that they are a universal phenomenon that can be studied across the boundaries of the individual interventions. Furthermore, their close connection with vital energy concepts makes them an ideal starting point to study such concepts scientifically.Can we confirm the hypothesis that the somatosensory qualities of therapeutic sensations are similar across interventions and exercises? How can we construct a suitable questionnaire for such a task and for the study of therapeutic sensations in general?Are there other important sensory aspects of therapeutic sensations that we might have missed due to the lack of descriptor-based questionnaires for (innocuous) tactile, haptic, proprioceptive, and visceral sensations?Are there differences  between therapeutic sensations elicited by invasive and noninvasive interventions? Is there a special role for painful sensations?Do linear-type and areal-type sensations differ in their somatosensory qualities?What are the temporal dynamics of therapeutic sensations? At what speed do linear-type therapeutic sensations propagate? Can the propagation be blocked  as suggested by the PSC literature?Is there a latent form of therapeutic sensations as suggested by the PSC literature?Is it possible to construct a map of the subtle body  based on sensation drawings? Would practitioners from different systems agree on such a map?What is the affective dimension of therapeutic sensations? Are the sensations emotionally coloured?To what extent do sensory qualities, topography, and contextual factors influence the meaning that people attach to therapeutic sensations?What are possible mechanisms by which therapeutic sensations exert their clinical effect?The following list contains some of the most urgent unresolved research questions, the answers to which have the potential to significantly improve our understanding of therapeutic sensations. Of course, it is not exhaustive.To conclude, therapeutic sensations are a fascinating object of study at the boundary between medicine, neuroscience, anthropology, and ethnology. Unlike previous attempts that have tried to measure a physicalized version of vital energy, therapeutic sensations offer a means to study this phenomenon by focusing on the human being and may thus help to find a common language between scientists, patients, and practitioners.


In 2016, the Alcohol Hangover Research Group defined the alcohol hangover as “the combination of mental and physical symptoms experienced the day after a single episode of heavy drinking, starting when blood alcohol concentration (BAC) approaches zero”. In the light of new findings and evidence, we carefully reviewed the different components of that definition. Several studies demonstrated that alcohol hangovers are not limited to heavy drinking occasions. Instead, data from both student and non-student samples revealed that at a group level, alcohol hangover may occur at much lower BAC levels than previously thought. Regression analysis further revealed that for individual drinkers, the occurrence of hangovers is more likely when subjects consume more alcohol than they usually do. However, hangovers may also occur at a drinker’s usual BAC, and in some cases even at lower BAC (e.g. in case of illness). We also carefully reviewed and modified other parts of the definition. Finally, hangovers are not necessarily limited to the ‘next day’. They can start at any time of day or night, whenever BAC approaches zero after a single dinking occasion. This may also be on the same day as the drinking occasion . To better reflect the new insights and sharpen the description of the concept, we hereby propose to update the definition of the alcohol hangover as follows: “The alcohol hangover refers to the combination of negative mental and physical symptoms which can be experienced after a single episode of alcohol consumption, starting when blood alcohol concentration (BAC) approaches zero”, and recommend to use this new definition in future hangover research. In 2016, the Alcohol Hangover Research Group defined the alcohol hangover as “the combination of mental and physical symptoms experienced the day after a single episode of heavy drinking, starting when blood alcohol concentration (BAC) approaches zero” [The most important discussion pertains to the amount of alcohol consumption that is required to elicit a hangover. Given this discussion, there is controversy about the word ‘heavy’ in the definition of alcohol hangover. First, the word ‘heavy’ is unspecific, as it does not define what exact amount of alcohol should actually be consumed to elicit a hangover. Second, it suggests that hangovers occur only when large amounts of alcohol are consumed. However, the Alcohol Hangover Research Group recently reached a consensus to abandon the criterion that a BAC of 0.11% or higher is needed to provoke a hangover . This coN = 176) who consumed a mean (SD) of 3.0 (1.8) alcoholic drinks (10 g ethanol each) reported considerable next-morning hangover severity, i.e., a mean (SD) overall hangover severity score of 4.6 (2.4) on a 0–10 scale. Despite this, their peak estimated BAC was 0.03%. In another student sample, Kruisselbrink et al. [N = 5540) and The Netherlands (N = 6002) further confirmed that alcohol hangovers are reported across all BAC levels [For example, Verster et al.  found thk et al.  found siWhen developing a definition, it is vital to accurately describe the concept . Furthermore, a proper definition of a phenomenon should not contain potential risk factors for its occurrence. There are many risk factors for hangover including, but not limited to, the amount of consumed alcohol , peak BAC, congener content of drinks, smoking, activities during drinking (e.g. dancing or sitting in a bar), or the emotional state during drinking. While these risk factors are of course important to investigate and mention in relation to alcohol hangover, they should not be included in a definition of the concept itself, as the observation/diagnosis of a condition should be separate from the risk/likelihood that it will occur. It is however important to still refer to ‘alcohol consumption’ in the definition of alcohol hangover as this behavior is mandatory to elicit the condition (rather than a mere risk factor). Evaluating hangover experiences from individual drinkers has shown that developing a useful, short, and accurate description of the relevant amount of alcohol intake to elicit a hangover is not straightforward. First of all, the presence and severity of alcohol hangovers may vary from day to day , even whThe definition refers to a ‘combination of mental and physical symptoms’. Hangover symptoms are generally perceived to be negative, but the original wording does not specify whether these symptoms are expected to be negative or positive. Therefore, we suggest to modify this as a ‘combination of negative mental and physical symptoms’. In line with previous discussions , hangoveThe previous definition states that hangover is ‘experienced the day after…’, which was included to clearly differentiate the intoxication phase from the hangover phase. In the vast majority of cases, the hangover starts when waking up after an afternoon, evening, or night of drinking, followed by a period of sleep. Yet, this definition would not properly match cases where an individual drinks past midnight, in the morning, or during the day . For exaThe definition refers to ‘a single episode…’. This was included to differentiate hangovers in social drinkers from withdrawal symptoms experienced by individuals with alcohol use disorders , who tend to not only engage in alcohol binges but also maintain a rather steady baseline level of alcohol consumption with continuous drinking for several days, or even longer. This leads to extensive homeostatic adaptations in the regulation of many vital parameters as well as neuroadaptive processes , which fThe definition states that hangover is ‘starting when blood alcohol concentration (BAC) approaches zero’. This is crucial in order to clearly distinguish between alcohol intoxication and alcohol hangover on the basis of timing. We did therefore not alter this part of the definition.We hereby propose to update the definition of alcohol hangover as follows: “The alcohol hangover refers to the combination of negative mental and physical symptoms which can be experienced after a single episode of alcohol consumption, starting when blood alcohol concentration (BAC) approaches zero”.


In modern times, scant attention has been given to understanding this condition. We review the historical and geographic evidence and consider possible infective explanations for Hannibal's condition, including elephant-associated zoonoses. Ultimately, we suggest that a keratitis from waterborne organisms, such as Pseudomonas spp. or Acanthamoeba spp., might provide the best answer to this ancient enigma.In the spring of 217  The Roman historian Polybius’ account in Greek of Hannibal’s affliction is brief, stating, “Hannibal himself on the sole remaining elephant got across with much difficulty and suffering, being in great pain from a severe attack of ophthalmia (Greek ’οφθαλμια), which finally led to the loss of one eye as he had no time to stop and apply any treatment to it, the circumstances rendering that impossible” , zoonotic infections must be considered (Mycobacterium tuberculosis and M. bovis are known to infect elephants, and human-to-elephant transmission has been described (Among possible alternatives, tuberculosis and brucellosis are both recognized to have potential for ocular involvement, including choroiditis and uveitis. Both Staphylococcus spp. and Streptococcus pneumoniae (Pseudomonas aeruginosa or Acanthamoeba keratitis would be consistent with the setting and clinical description of Hannibal’s illness.Perhaps the diagnosis most consistent with Polybius’ account is a form of keratitis. Keratitis might be caused by a range of pathogens, with or without preceding trauma, and is manifested typically with unilateral pain and visual disturbance (Acanthamoeba keratitis in industrialized world settings today is most commonly associated with contact lens use, globally, it has been reported in the setting of either minor trauma or environmental exposure to contaminated water and so remains plausible as a cause of Hannibal’s condition given the environmental settings in which it originated (Acanthamoeba keratitis has also been reported from a variety of settings, although this appears to predominate in summer months and might in part be related to modern patterns of contact lens use (,Of the 2 forms of keratinitis, pseudomonal keratitis is more common and acute and perhaps the more likely. However, although P. aeruginosa or Acanthamoeba, as the cause of Hannibal’s ophthalmia. This diagnosis provides a more adequate account of his visual loss than traditional explanations have offered and, we hope, sheds a small additional light on the life of one of the greatest military leaders in world history.In conclusion, although no definitive diagnosis can ever be established, we would argue that the historical record most strongly suggests keratitis caused by a waterborne pathogen, particularly