Behaviour of the dying patient.

One hundred and ten dying patients were studied during the 24 hours before death and 250 patients during the weeks before death: 60% were well orientated in time and space 24 hours before death and 26% at 15 minutes before death. A control group of patients with serious, but not fatal, illness were also studied. There was a contrast in attitude to death between the dying patients and the ill but not dying controls. The dying were resigned to their approaching death, experienced little or no fear, and did not wish to know about their illness, whereas the control patients wanted information about their condition and feared death, though few thought they would actually die. The relief of physical symptoms in the dying is important. There was often a brief improvement in condition, with reduced need for analgesic, shortly before death.     

Controlling death--compromising life: chronic disease, prognostication, and the new biotechnologies

Within the modern culture of control, patients and physicians seek to actively shape the uncertainty of prognostications concerning the course of disease and the anticipated effects of therapeutic and surgical interventions. This article discusses the results of a three-year ethnographic study of persons with cystic fibrosis (CF) who undergo double-lung transplant. It draws on interviews with a difficult-to-access patient group, adult CF sufferers, and investigates their dilemmas with regard to having or not having a double-lung transplant. It situates their decisions within a complex framework: the denial of death and disability in technological modernity, the consequent emphasis on cure and saving life at any cost, rather than the management of chronic illness, the extent to which health and illness constitute identity, and the problems of CF patients conceiving their life narrative when life will be short. This framework produces two key questions: Do patient beliefs in the progress narratives of medicine overshadow other considerations, and are biotechnologies such as organ transplant a calculated gamble on a better life or an uncertain reliance on biomedical expertise? I argue that risk interpretation is heavily influenced by the constant introduction of new therapeutics that intersect with social technologies of normalization to strongly influence patient decisions concerning the pursuit of high-risk surgeries such as organ transplant, surgeries that sometimes hasten a patient's decline and death.     

Information aggregation and communication in committees

In this paper, we attempt to explain the underlying strategic incentives confronting individuals when they must make a collective decision over a set of alternatives and each has information that is decision-relevant for others. A significant literature has emerged in formal political theory over the past several years that focuses on such problems, paying particular attention, first, to the extent to which voting can be expected to aggregate committee members'' information and, second, to the role of communication among committee members prior to voting. Inter alia, this literature reveals a surprisingly subtle interaction between the voting rules used to make decisions and the incentives for committee members to share information prior to voting.     

How should we talk about acute leukaemia to adult patients and their families?

Problems of communication with patients with acute leukaemia and their families were explored by interviewing the next of kin of 26 patients, six of whom were still alive. In all but two cases the diagnosis had been disclosed to the relatives before the patient, but almost one-third of the relatives were not entirely satisfied with the way in which the diagnosis was presented. Medical prognostications at these initial interviews were, on the whole, regarded as being realistic by the relatives. Nine patients learnt of their diagnosis at an early stage, but relatives were undecided whether patients should be told of the diagnosis in explicit terms. Patients often established complete dependence on the hospital and its staff and had difficulties in relating to their own general practitioners while at home during their illness. Social chats were preferred by the relatives rather than regular progress reports from the doctors.     

Consequences of the Trans-Atlantic Slave Trade on Medicinal Plant Selection: Plant Use for Cultural Bound Syndromes Affecting Children in Suriname and Western Africa

Folk perceptions of health and illness include cultural bound syndromes (CBS), ailments generally confined to certain cultural groups or geographic regions and often treated with medicinal plants. Our aim was to compare definitions and plant use for CBS regarding child health in the context of the largest migration in recent human history: the trans-Atlantic slave trade. We compared definitions of four CBS (walk early, evil eye, atita and fontanels) and associated plant use among three Afro-Surinamese populations and their African ancestor groups in Ghana, Bénin and Gabon. We expected plant use to be similar on species level, and assumed the majority to be weedy or domesticated species, as these occur on both continents and were probably recognized by enslaved Africans. Data were obtained by identifying plants mentioned during interviews with local women from the six different populations. To analyse differences and similarities in plant use we used Detrended Component Analysis (DCA) and a Wald Chi-square test. Definitions of the four cultural bound syndromes were roughly the same on both continents. In total, 324 plant species were used. There was little overlap between Suriname and Africa: 15 species were used on two continents, of which seven species were used for the same CBS. Correspondence on family level was much higher. Surinamese populations used significantly more weedy species than Africans, but equal percentages of domesticated plants. Our data indicate that Afro-Surinamers have searched for similar plants to treat their CBS as they remembered from Africa. In some cases, they have found the same species, but they had to reinvent the largest part of their herbal pharmacopeia to treat their CBS using known plant families or trying out new species. Ideas on health and illness appear to be more resilient than the use of plants to treat them.     

Health impacts from cyanobacteria harmful algae blooms: Implications for the North American Great Lakes

Harmful cyanobacterial blooms (cHABs) have significant socioeconomic and ecological costs, which impact drinking water, fisheries, agriculture, tourism, real estate, water quality, food web resilience and habitats, and contribute to anoxia and fish kills. Many of these costs are well described, but in fact are largely unmeasured. Worldwide cHABs can produce toxins (cyanotoxins), which cause acute or chronic health effects in mammals (including humans) and other organisms. There are few attempts to characterize the full health-related effects other than acute incidences, which may go unrecorded. At present these are difficult to access and evaluate and may be ascribed to other causes. Such information is fundamental to measure the full costs of cHABs and inform the need for often-costly management and remediation. This paper synthesizes information on cHABs occurrence, toxicology and health effects, and relates this to past and current conditions in the Great Lakes, a major global resource which supplies 84% of the surface water in North America. This geographic region has seen a significant resurgence of cHABs since the 1980s. In particular we focus on Lake Erie, where increased reporting of cHABs has occurred from the early 1990's. We evaluate available information and case reports of cHAB-related illness and death and show that cHABs occur throughout the basin, with reports of animal illness and death, especially dogs and livestock. Lake Erie has consistently experienced cHABs and cyanotoxins in the last decade with probable cases of human illness, while the other Great Lakes show intermittent cHABs and toxins, but no confirmed reports on illness or toxicity. The dominant toxigenic cyanobacterium is the genus Microcystis known to produce microcystins. The presence of other cyanotoxins (anatoxin-a, paralytic shellfish toxins) implicates other toxigenic cyanobacteria such as Anabaena (Dolichospermum) and Lyngbya.     

Sorcerers,saints and charlatans: Black folk healers in urban America

Case histories of black Americans who believe their illness has been caused by sorcery have been reported with increasing frequency in the clinical literature. Such individuals often believe that their problems are not amenable to orthodox medical regimens and they may leave treatment to seek out a folk healer. Healers believed to be able to cure sorcery are viewed ambivalently as they are thought able to magically cause illness as well as cure it. There is little information available on such individuals or their modes of treatment, making it difficult to assess their abilities. This article reviews what is known about such individuals, including an attempt to learn more about those who have advertised in a large city newspaper. It is concluded that some of these individuals provide a useful service to their clients but that many others use their reputations as manipulators of occult powers to extract money from the poor and gullible.     

Combination and competition between path integration and landmark navigation in the estimation of heading direction

Successful navigation requires the ability to compute one’s location and heading from incoming multisensory information. Previous work has shown that this multisensory input comes in two forms: body-based idiothetic cues, from one’s own rotations and translations, and visual allothetic cues, from the environment (usually visual landmarks). However, exactly how these two streams of information are integrated is unclear, with some models suggesting the body-based idiothetic and visual allothetic cues are combined, while others suggest they compete. In this paper we investigated the integration of body-based idiothetic and visual allothetic cues in the computation of heading using virtual reality. In our experiment, participants performed a series of body turns of up to 360 degrees in the dark with only a brief flash (300ms) of visual feedback en route. Because the environment was virtual, we had full control over the visual feedback and were able to vary the offset between this feedback and the true heading angle. By measuring the effect of the feedback offset on the angle participants turned, we were able to determine the extent to which they incorporated visual feedback as a function of the offset error. By further modeling this behavior we were able to quantify the computations people used. While there were considerable individual differences in performance on our task, with some participants mostly ignoring the visual feedback and others relying on it almost entirely, our modeling results suggest that almost all participants used the same strategy in which idiothetic and allothetic cues are combined when the mismatch between them is small, but compete when the mismatch is large. These findings suggest that participants update their estimate of heading using a hybrid strategy that mixes the combination and competition of cues.     

"Post-residency disease" and the medical self: identity, work, and health care among doctors who become patients

Doctors who become patients due to serious illnesses face many challenges related to issues of identity, work, and professionalism. In-depth interviews with such doctors reveal the complex ways in which illness threatens identity in these professionals. In comparison with "medical student's disease," these doctors now exhibit "post-residency disease"-minimizing physical symptoms that are in fact present, leading to decreases in care sought. Doctors often feel they are somehow invulnerable to disease and have to remain strong, not burdening others. Many describe themselves as "workaholics," which can prove to be a double-edged sword, posing problems as well as providing benefits. This professional commitment could interfere with preventive health behaviors and with "practicing what they preach." Some view their illness with their "medical self" - as if they were a physician observing another patient rather than themselves. These doctors often support their approach by choosing a colleague as a doctor who will not challenge them, thereby establishing a "denial system" as opposed to a support system. These doctor-patients confront difficult issues of how much their physicianhood is an identity or an activity, illustrating the intricate relationships and tensions between work, identity, professionalism, and health in contemporary medicine.     

Instruments and demonstrations in the astrological curriculum: evidence from the University of Vienna, 1500–1530

Historians have used university statutes and acts to reconstruct the official astrology curriculum for students in both the arts and medical faculties, including the books studied, their order, and their relation to other texts. Statutes and acts, however, cannot offer insight into what actually happened during lectures and in the classroom: in other words, how and why astrology was taught and learned in the medieval university. This paper assumes that the astrology curriculum is better understood as the set of practices that constituted it and gave it meaning for both masters and students. It begins to reconstruct what occurred in the classroom by drawing on published and unpublished lecture notes. These offer insight into how masters presented the material as they did, and why. The paper argues three points: first, the teaching of astrology centered on demonstrations involving astrological instruments: specifically, various kinds of paper astrolabes. Second, the astrological instruction focused on conveying the pragmatics of astrology rather than esoteric, theoretical issues. Finally, astrology as it was taught in the arts curriculum was explicitly intended to provide a foundation for students who would advance to study medicine at the university.     

How portraits turned their eyes upon us: Visual preferences and demographic change in cultural evolution

It has often been suggested that innate features of the human mind could make some cultural forms more successful than others. This paper presents a case study consistent with this “cognitive attraction” hypothesis. Numerous studies show that direct eye-gaze catches the attention of adults and newborns. Adults find it more attractive. We explore one possible cultural consequence of this cognitive appeal. Among XVIth century European portraits, direct-gaze paintings are more likely to be featured in today's art books. In Renaissance Europe, the proportion of paintings that stare at the viewer grows gradually, strongly, and remains prevalent for centuries. A demographic analysis of this shift shows that it was due to the arrival of new generations of painters. Those artists show a preference for direct-gaze portraits as soon as they start painting, suggesting that they acquired the new style in the years of their apprenticeship. The preferences of those painters and of contemporary art critics seem consistent with the innate attentional bias that favours direct-gaze faces. The structure of the “Renaissance gaze shift” bears evidence for the importance of demographic turn-over in cultural change.     

Use of online resources in the taxonomy and ecology of harmful phytoplankton

The internet is becoming increasingly important for the dissemination of biological information. Large target audiences are reached rapidly, large amounts of information can be assembled and distributed, sites can include search facilities, and information might be handled online or as printable output. Many websites are now producing libraries of phytoplankton images including toxic dinoflagellates. But while some provide valuable resources others lack focus and do not address any specific problems, for example the morphological variability in many major groups such as Dinophysis and Alexandrium. Yet it is this morphological variation which often hinders taxonomic and ecologic research of harmful dinoflagellates. Taxonomic information as well as information about sample origin and preservation methods is also often lacking. This makes comparisons between taxonomic websites difficult. Therefore, while documenting the presence of certain taxa, some sites cannot be used as a taxonomic training or research tool. Yet, if online resources were to reflect these complexities they could become valuable tools in the dissemination of data as well as actual research and training tools. One reason for the lack of consistency between sites could be that these sites, as a teaching and research tool, are a relatively recent development and no criteria have therefore been established as to the contents and structure of such sites, as are commonplace for conventional publications. This comment will discuss different approaches to, and tools for, the production of online taxonomic resources (depending on the site's objectives, e.g. research or teaching) using the Harmful Plankton Project ( http://www.liv.ac.uk/hab ) designed at the University of Liverpool as one example of a user‐friendly and adaptable tool.     

The hidden variables of leadership

The dynamics of a collective move can be untangled into three components: initiation, following and cancellation. Varying the response function parameters attached to one individual can switch the collective phenomenology from an absence of well identified leader (“distributed leadership”) to the emergence of a “despotic regime”, i.e. this individual leading more often the collective moves. I show that not all parameters have the same impact but rather that only a large increase of the initiation rate can empower an obvious leader, up to the “despotic” regime. Being more readily followed, or cancelling less often can enhance the leader's prominence only up to a limited level. To overtake this limit would then further require to affect also the parameters attached to the others (e.g. to lower their eagerness to initiate group motion as well as their probability to be followed when they do).     

Anecdotal,Historical and Critical Commentaries on Genetics: Darwin and Darwinism: The (Alleged) Social Implications of The Origin of Species

Most scientific theories, even revolutionary ones, change the practice of a particular science but have few consequences for culture or society at large. But Darwinism, it has often been said, is different in this respect. Since the publication of The Origin of Species, many have claimed that Darwinism has a number of profound social implications. Here, I briefly consider three of these: the economic, the political, and the religious. I suggest that, for the most part, these supposed implications have been misconstrued or exaggerated. Indeed, it is reasonably clear that the chain of implication sometimes primarily ran in the opposite direction—from, for instance, economics and political theory to Darwinism.THE appearance of The Origin of Species launched one of the greatest, and most justly celebrated, revolutions in the history of science. But in the 150 years since the appearance of Darwin''s book, many scholars, scientists, and pundits have claimed that Darwinism did more than revolutionize biology. Darwinism, they claim, also had a number of social and cultural consequences: economic and political, medical, eugenic, educational, and religious. Some of these consequences are to be applauded and others regretted, but all, it is said, can be traced to important strands of thought in The Origin of Species. One of the ironies of modern history would thus seem to be that the close scientific study of pigeons, mockingbirds, and barnacles could have such consequences.But while the case for the scientific importance of Darwinism is incontestable, the case for its presumed social and cultural consequences is far more complex and, in places, dubious. Here I consider three of these supposed consequences: the economic, the political, and the religious. Because the economic and religious cases have been widely discussed, I focus on the political one. I should note that I am not an expert on economics, political theory, or religion, but a biologist. Perhaps fortunately, then, little that I have to say is new but reflects the efforts of many social scientists and historians. Because their ideas seem little known among biologists, they may be worth recounting here.     

Scientific Independence and Credibility in Sociopolitical Processes

Abstract: Absence of scientific independence can be associated with a lack of impartiality and therefore with a lack of credibility. Yet scientific credibility is essential for effective participation in sociopolitical processes—processes that necessarily involve politics and often result in decisions about land management, conservation, and public policy. All scientists are aware of these processes, many wish to participate, and some wish to advocate for their personal policy preferences. However, scientists who lack impartiality often create the perception of bias, and they can suffer a concomitant loss of credibility. Some policy-makers also have personal preferences for certain policies, and the term normative policies can be used here even though all policies can be viewed as normative in the sense that they involve multiple inputs. Hence, the idea that scientists must provide unbiased information for unbiased application by policy-makers is sometimes wrong. For scientists to be effective participants in sociopolitical processes that lead to conservation policies or related actions, they should inform the public about issues while avoiding direct involvement in policy development and the political considerations this necessarily entails. Scientists should only participate in the decision-making process with impartial information and in their proper role as objective scientists.     

Leaders benefit followers in the collective movement of a social sawfly

The challenges of maintaining cohesion while making collective decisions in social or aggregating insects can result in the emergence of a leader or leaders. Larval aggregations of the steel-blue sawfly Perga affinis forage nocturnally, and some larvae lead the aggregation on foraging trips more often than expected by chance. We investigated the relationship between these leader and follower roles by comparing the weight and growth of individual larvae with different roles. Our observations reveal no significant difference between the growth of leaders and followers, suggesting that the role of leadership may not provide direct foraging benefits. However, by experimentally manipulating the social structure of larval aggregations, we found that individuals within aggregations that comprise a mixture of leaders and followers enjoy higher growth rates than those in aggregations comprising a single behavioural type. These data demonstrate, for the first time, individual benefits to maintaining a balance of leader and follower roles within larval aggregations, and highlight the importance of considering the perspectives of both leaders and followers when investigating the evolutionary significance of this behavioural variation within animal groups.     

Children and the nuclear threat: a child psychiatrist's personal reflections

From the very first stages of life, parents have provided their children with love and protection against harm from within or without, especially from life-threatening situations. Children's perception of death as a unique phenomena develops around age ten and later on, when they begin to grasp the meaning of mortality. This often occurs when they themselves suffer from terminal illness. Children have been the object of destruction, as witnessed by The Holocaust and Hiroshima. The threat of nuclear war poses a new problem for parents, since threatening others is no longer a viable solution to the conflict. In addition, adults manifest a massive denial that the destruction of mankind can take place at any time. This denial, like a family secret, prevents children from asking questions and expressing to their parents their fears about their own and mankind's destruction. Examples are given of how children do express their concerns and fears about the nuclear threat when they are allowed to express themselves. Unless this denial is replaced by open communication about the seriousness of the situation, children and adolescents will view the adults' denial as numbness and folly and as responsible for the world's destruction. A meaningful dialogue between parents and children about the threat is given as the solution to the family conflict.     

Problem Solving in the Presence of Others: How Rank and Relationship Quality Impact Resource Acquisition in Chimpanzees (Pan troglodytes)

In the wild, chimpanzees (Pan troglodytes) are often faced with clumped food resources that they may know how to access but abstain from doing so due to social pressures. To better understand how social settings influence resource acquisition, we tested fifteen semi-wild chimpanzees from two social groups alone and in the presence of others. We investigated how resource acquisition was affected by relative social dominance, whether collaborative problem solving or (active or passive) sharing occurred amongst any of the dyads, and whether these outcomes were related to relationship quality as determined from six months of observational data. Results indicated that chimpanzees obtained fewer rewards when tested in the presence of others compared to when they were tested alone, and this loss tended to be greater when paired with a higher ranked individual. Individuals demonstrated behavioral inhibition; chimpanzees who showed proficient skill when alone often abstained from solving the task when in the presence of others. Finally, individuals with close social relationships spent more time together in the problem solving space, but collaboration and sharing were infrequent and sessions in which collaboration or sharing did occur contained more instances of aggression. Group living provides benefits and imposes costs, and these findings highlight that one cost of group living may be diminishing productive individual behaviors.     

The Renaissance or the cuckoo clock

‘…in Italy, for thirty years under the Borgias, they had warfare, terror, murder and bloodshed, but they produced Michelangelo, Leonardo da Vinci and the Renaissance. In Switzerland, they had brotherly love, they had five hundred years of democracy and peace—and what did that produce? The cuckoo clock’.Orson Welles as Harry Lime: The Third Man

Orson Welles might have been a little unfair on the Swiss, after all cuckoo clocks were developed in the Schwartzwald, but, more importantly, Swiss democracy gives remarkably stable government with considerable decision-making at the local level. The alternative is the battling city-states of Renaissance Italy: culturally rich but chaotic at a higher level of organization. As our understanding of the cell cycle improves, it appears that the cell is organized more along the lines of Switzerland than Renaissance Italy, and one major challenge is to determine how local decisions are made and coordinated to produce the robust cell cycle mechanisms that we observe in the cell as a whole.