Meaning, Medicine, and the "Placebo Effect"

Meaning, Medicine, and the "Placebo Effect" Daniel Moerman Cambridge: Cambridge University Press, 2002. xiii. 172 pp.     

Hopi Indians, "cultural" selection,and albinism

The incidence of albinism in Hopi Indians has been estimated as approximately 1 in 200 individuals. It has been suggested that "cultural" selection as the result of a mating advantage of males with albinism has been important in the maintenance of this high incidence. To examine this hypothesis quantitatively, a model that includes male-mating advantage, mutation, and viability selection is analyzed. In order to play an important role in the maintenance of the high incidence of albinism, the necessary mating advantage of males with albinism appears unrealistically high. However, if the extent of viability selection against individuals with albinism is not as large as previously assumed, the necessary amount of mating advantage is not as high. Other related aspects are also discussed here, such as the type of albinism in Hopi Indians and its impact, the conditions for a polymorphism with male-mating advantage and viability selection, and the time necessary to change the incidence of albinism either by the relaxation or institution of male-mating advantage.     

"Brother" and "Uncle": An Analysis of Rules, Structural Contradictions, and Meaning in Vietnamese Kinship

This paper analyzes the meanings of Vietnamese kinship terms on the basis of the rules that regulate their referential and nonreferential uses. These rules are not completely consistent with one another. They constitute contradictory models of and for sociocultural reality at a certain level. The structural contradictions among these models render "fuzzy" even the definitions of the prototypical uses of Vietnamese kin terms. The coexistence of alternative models makes the use of a linguistic form both a goal-directed action and the representation of an order.     

"Sweeping up after the parade": professional, ethical, and patient care implications of "turfing"

"Turfing" denotes a patient transfer or triage from one physician to another when the care of that patient feels more troublesome than it is worth. A widespread phenomenon in medical training programs, turfing appears to allocate patient care to meet physicians' rather than patients' needs. Although turfing reportedly causes inter-physician discord and inter-specialty stereotyping, its deeper consequences are poorly understood. Turfing is an interpersonal conflict masquerading as a medical issue. After examining turfing alongside other patient-related slang, I analyze the distinction between "the turf," a person, and "to turf," a practice. Several explanatory models from medical practice are explored in order to illuminate turfing's implications for medical professionalism, ethics, and patient care. I suggest that a physician's medical specialty or practice type--that is, professional culture--may link to that physician's degree of altruism. If so, then what it means fundamentally to be a physician might vary across medical specialties. Such a link calls for a new notion of cultural competence, one that physicians may apply not to patients but to each other.     

蕲州地区的蕲艾、青蒿、黄花蒿与茵陈的考订

<正> 蕲州是我国中药材主要产地之一,是湖北省蕲春县的一个集镇,,是我国中医药大师李时珍的家乡。该地区生长的菊科蒿属植物Artemisia Linn。颇多,其中入药的有十余种,并在李时珍《本草纲目》中曾有记载。这里仅对该地区常见入药的蕲艾、青蒿、黄花蒿与茵陈结合《本草纲目》记载的材料作初步的考订。     

"Liking" and "wanting" of sweet and oily food stimuli as affected by high-fat diet-induced obesity, weight loss, leptin, and genetic predisposition

Cross-sectional studies in both humans and animals have demonstrated associations between obesity and altered reward functions at the behavioral and neural level, but it is unclear whether these alterations are cause or consequence of the obese state. Reward behaviors were quantified in male, outbred Sprague-Dawley (SD) and selected line obesity-prone (OP) and obesity-resistant (OR) rats after induction of obesity by high-fat diet feeding and after subsequent loss of excess body weight by chronic calorie restriction. As measured by the brief access lick and taste-reactivity paradigms, both obese SD and OP rats "liked" low concentrations of sucrose and corn oil less, but "liked" the highest concentrations more, compared with lean rats, and this effect was fully reversed by weight loss in SD rats. Acute food deprivation was unable to change decreased responsiveness to low concentrations but eliminated increased responsiveness to high concentrations in obese SD rats, and leptin administration in weight-reduced SD rats shifted concentration-response curves toward that seen in the obese state in the brief access lick test. "Wanting" and reinforcement learning as assessed in the incentive runway and progressive ratio lever-pressing paradigms was paradoxically decreased in both obese (compared with lean SD rats) and OP (compared with OR rats). Thus, reversible, obesity-associated, reduced "liking" and "wanting" of low-calorie foods in SD rats suggest a role for secondary effects of the obese state on reward functions, while similar differences between select lines of OP and OR rats before induction of obesity indicate a genetic component.     

Sarcolemmal and mitochondrial effects of a KATP opener, P-1075, in "polarized" and "depolarized" Langendorff-perfused rat hearts

We investigated consequences of cardiac arrest on sarcolemmal and mitochondrial effects of ATP-sensitive potassium channel (KATP) opener, P-1075, in Langendorff-perfused rat hearts. Depolarised cardiac arrest (24.7 mM KCl) did not affect glibenclamide-sensitive twofold activation of rubidium efflux by P-1075 (5 microM) from rubidium-loaded hearts, but eliminated uncoupling produced by P-1075 in beating hearts: 40% depletion of phosphocreatine and ATP, 50% increase in oxygen consumption, and reduction of cytochrome c oxidase. Depolarized cardiac arrest by calcium channel blocker, verapamil (5 microM), also prevented uncoupling. Lack of P-1075 mitochondrial effects in depolarized hearts was not due to changes in phosphorylation potential, because 2,4-dintrophenol (10 microM) reversed the [PCr]/[Cr] increase and Pi decrease, characteristic of KCl-arrest, but did not restore uncoupling. In agreement with this conclusion, pyruvate (5 mM) increased [PCr]/[Cr] and decreased Pi, but did not prevent uncoupling in beating hearts. A decrease in mean [Ca2+] in KCl-arrested hearts could not account for lack of P-1075 mitochondrial effects, because calcium channel opener, S-(-)-Bay K8644 (50 nM), and beta-agonist, isoproterenol (0.5 microM), did not facilitate uncoupling. In contrast, in adenosine (1 mM)-arrested hearts (polarized arrest), P-1075 caused 40% phosphocreatine and ATP depletion. In isolated rat liver mitochondria, P-1075 (20 microM) decreased mitochondrial membrane potential (DeltaPsi) by approximately 14 mV (demonstrated by redistribution of DeltaPsi-sensitive dye, rhodamine 800) in a glibenclamide-sensitive manner. We concluded that cell membrane depolarization does not prevent activation of sarcolemmal KATP by P-1075, but it plays a role in mitochondrial uncoupling effects of P-1075.     

Arginine, scurvy and Cartier's "tree of life"

Hunting for wild animals is stimulated by the many different human uses of faunal resources, and these animals constitute important subsistence items in local communities in the Caatinga region. In order to gain access to these resources, hunters have developed a series of techniques and strategies that are described in the present work. The principal hunting techniques encountered were: waiting, especially directed towards hunting diurnal birds; calling ("arremedo"), a technique in which the hunters imitate the animal's call to attract it to close range; hunting with dogs, a technique mostly used for capturing mammals; tracking, a technique used by only a few hunters who can recognize and follow animal tracks; and "facheado", in which the hunters go out at night with lanterns to catch birds in their nests. Additionally, many animal species are captured using mechanical traps. The types of traps used by the interviewees were: dead-fall traps ("quixó"), iron-jaw snap traps ("arataca"), wooden cages with bait ("arapuca"), iron-cage traps ("gaiola'), "visgo", multi-compartment bird cages ("alçapão"), buried ground traps with pivoted tops ("fojo"), and nooses and cages for carnivorous. The choice of which technique to use depends on the habits of the species being hunted, indicating that the hunters possess a wide knowledge of the biology of these animals. From a conservation perspective, active hunting techniques (waiting, imitation, hunting with dogs, and "facheado") have the greatest impact on the local fauna. The use of firearm and dogs brought greater efficiency to hunting activities. Additional studies concerning these hunting activities will be useful to contribute to proposals for management plans regulating hunting in the region – with the objective of attaining sustainable use of faunal resources of great importance to the local human communities.     

The Neanderthal "chignon": variation, integration, and homology

The occipital bun ("chignon") is cited widely as a Neanderthal derived trait. It encompasses the posterior projection/convexity of the occipital squama and is associated with lambdoid flattening on the parietal. A 'hemibun' in some Upper Paleolithic Europeans is thought by some authors to indicate interbreeding between Neanderthals and early modern Europeans. However, 'bunning' is difficult to measure, and the term has been applied to a range of morphological patterns. Furthermore, its usefulness in phylogenetic reconstruction and its homologous status across modern and fossil humans have been disputed. We present a geometric morphometric study that quantitatively evaluates the chignon, assesses its usefulness in separating Neanderthals from modern humans, and its degree of similarity to Upper Paleolithic 'hemibuns.' We measured the three-dimensional coordinates of closely spaced points along the midsagittal plane from bregma to inion and of anatomical landmarks in a large series of recent human crania and several Middle and Late Pleistocene European and African fossils. These coordinate data were processed using the techniques of geometric morphometrics and analyzed with relative warps, canonical variates, and singular warps. Our results show no separation between Neanderthals and modern humans, including early modern Europeans, when the shape of the occipital plane midsagittal-profile is considered alone. On the other hand, Neanderthals are well separated from both recent and fossil modern humans when information about the occipital's relative position and relative size are also included. Furthermore, the occurrence of a highly convex and posteriorly projecting midline occipital profile (interpreted as the occipital bun) is highly correlated (>0.8) with a flat parietal midsagittal profile and with antero-superiorly positioned temporal bones across both our recent and our fossil human samples. We conclude that the shape of the occipital profile alone should not be considered an independent trait, as it is very tightly integrated with braincase shape. Our analysis does not support differences in integration of the posterior midsagittal profile and the cranial base in Pleistocene and recent humans.     

Decision making in the NICU--strategies,statistics, and "satisficing"

As science progresses, new issues in bioethics grab the headlines, but in neonatal medicine communication and decision making for sick and premature infants is as important today as it was thirty years ago. Decisions have to be made and made well, despite suboptimal time, data, or knowledge. To this end, the authors propose good communication and a cooperative model as key to interpreting the best interest standard in a way that respects parental rights and responsibility and allows best interest to be decided from an amalgam of medical facts and human values.     

Toxoplasma gondii, "new" genotypes and virulence

Toxoplasma gondii has been described as a parasite with a low genetic diversity and a clonal population structure. The three main clonal lineages designated as type I, II or III largely predominate in Europe and North America. But strains not related to these main lineages circulate, notably, in other continents. They possess a shuffled combination of alleles that typify the three clonal types and unique polymorphisms detected by multilocus analysis. The population structure of Toxoplasma in these continents is also characterized by a higher genetic diversity associated with a lower linkage desequilibrium suggesting a role for genetic exchange. Due to their genomic diversity, it is difficult to draw global conclusions about their virulence. However, most of them are virulent in mice at isolation. Several reports also suggest a higher pathogenicity in humans and an association with ocular toxoplasmosis or severe cases of acquired toxoplasmosis in immunocompetent patients.     

Physiological effects of alveolar, tracheal, and "standard" pressure supports.

Pressure support (PS) is characterized by a pressure plateau, which is usually generated at the ventilator level (PS(vent)). We have built a PS device in which the pressure plateau can be obtained at the upper airway level (PS(aw)) or at the alveolar level (PS(A)). The effect of these different PS modes was evaluated in seven healthy men during air breathing and 5% CO(2) breathing. Minute ventilation during air breathing was higher with PS(A) than with PS(aw) and lower with PS(vent) (16 +/- 3, 14 +/- 3, and 11 +/- 2 l/min, respectively). By contrast, there were no significant differences in minute ventilation during 5% CO(2) breathing (25 +/- 5, 27 +/- 7, and 23 +/- 5 l/min, respectively). The esophageal pressure-time product per minute was lower with PS(A) than with PS(aw) and PS(vent) during air breathing (29 +/- 26, 44 +/- 44, and 48 +/- 30 cmH(2)O. s, respectively) and 5% CO(2) breathing (97 +/- 40, 145 +/- 62, and 220 +/- 41 cmH(2)O. s, respectively). In conclusion, during PS, moving the inspiratory pressure plateau from the ventilator to the alveolar level reduces pressure output, particularly at high ventilation levels.