Women's lives and sex: Implications for AIDS prevention

Preliminary findings from the Women and AIDS program, a research grants program of the International Center for Research on Women in Washington, D.C. that supports 17 studies in developing countries worldwide, provide a glimpse into the complex interaction between women's social and economic status and risk of HIV infection. In many settings, the cultural norms that demand sexual fidelity and docile and acquiescent sexual behavior among women permit — and sometimes even encourage —early sexual experimentation, multiple partnerships, and aggressive and dominating sexual behavior among men. Drawing upon the findings from the program, the paper analyzes how such cultural norms, together with women's social and economic dependency, can limit a woman's ability to negotiate safer sex with her partner; restrict her access to information and knowledge about her body; force her to sometimes barter sex for survival; increase her vulnerability to physical violence in sexual interaction; and compromise her self-esteem. The findings highlight the limitations of the current HIV/AIDS prevention strategy for reducing women's risk of HIV, and underline the urgency for an approach to prevention that is grounded in the realities of women's lives and sexual experiences — an approach that recognizes the relationship between the dynamics of gender relations, sexual behavior, and HIV risk.     

Radiation exposure in supersonic transport by solar flares

Summary The following discourse presents the result of a theoretical analysis of the radiation exposure for solar proton beams and their secondaries in the altitude region of SST (supersonic transport) and pole regions. A statistical analysis of forms and intensities of measured solar flares has been made. The radiation dosage is calculated as a function of atmospheric depth for several characteristic flares. The dosage in rems from secondary neutrons exceeds the dosage in rems from protons in the altitude region of SST for flare events with low characteristic slopeparameterG, In general the radiation is — without some rare extreme events — beyond of dangerous limits and the rare extreme exposure values will be of some hundred mrem/h.     

Reproduction and the central project of evolutionary theory

In much of the discourse of evolutionary theory, reproduction is treated as an autonomous function of the individual organism — even in discussions of sexually reproducing organisms. In this paper, I examine some of the functions and consequences of such manifestly peculiar language. In particular, I suggest that it provides crucial support for the central project of evolutionary theory — namely that of locating causal efficacy in intrinsic properties of the individual organism. Furthermore, I argue that the language of individual reproduction is maintained by certain methodological conventions that both obscure many of the problems it generates and serve to actively impede attempts to redress those difficulties that can be identified. Finally, I suggest that inclusion of the complexities introduced by sexual reproduction — in both language and methodology — may radically undermine the individualist focus of evolutionary theory.I am indepted to the Rockefeller Foundation for a Humanities Fellowship that supported this research during the spring of 1986. I am also grateful to Richard Lewontin, Diane Paul, and Lisa Lloyd for many extremely helpful conversations.     

Do psychiatric diseases follow annual cyclic seasonality?

Seasonal affective disorder (SAD) famously follows annual cycles, with incidence elevation in the fall and spring. Should some version of cyclic annual pattern be expected from other psychiatric disorders? Would annual cycles be similar for distinct psychiatric conditions? This study probes these questions using 2 very large datasets describing the health histories of 150 million unique U.S. citizens and the entire Swedish population. We performed 2 types of analysis, using “uncorrected” and “corrected” observations. The former analysis focused on counts of daily patient visits associated with each disease. The latter analysis instead looked at the proportion of disease-specific visits within the total volume of visits for a time interval. In the uncorrected analysis, we found that psychiatric disorders’ annual patterns were remarkably similar across the studied diseases in both countries, with the magnitude of annual variation significantly higher in Sweden than in the United States for psychiatric, but not infectious diseases. In the corrected analysis, only 1 group of patients—11 to 20 years old—reproduced all regularities we observed for psychiatric disorders in the uncorrected analysis; the annual healthcare-seeking visit patterns associated with other age-groups changed drastically. Analogous analyses over infectious diseases were less divergent over these 2 types of computation. Comparing these 2 sets of results in the context of published psychiatric disorder seasonality studies, we tend to believe that our uncorrected results are more likely to capture the real trends, while the corrected results perhaps reflect mostly artifacts determined by dominantly fluctuating, health-seeking visits across a given year. However, the divergent results are ultimately inconclusive; thus, we present both sets of results unredacted, and, in the spirit of full disclosure, leave the verdict to the reader.

Should we expect psychiatric disorders to show a cyclic annual pattern? This study reveals that psychiatric diseases’ annual patterns were remarkably similar across the studied diseases in both the US and Sweden, with the magnitude of annual variation significantly higher in Sweden than in the US for psychiatric, but not infectious, diseases.     

Adjunctive strategies to enhance peripheral warming: Clinical techniques

This study investigates common successful strategies to increase peripheral temperature with biofeedback. Eighteen BCIA-certified therapists (average years of practice, 7.5) were interviewed by telephone for 30 to 45 minutes regarding successful peripheral warming strategies. The practitioners reported using multiple teaching strategies, either concurrently or sequentially. These responses were organized into an interrelated four-category model that consists of the following: (1) Attentional Category — shifting from active to passive attention; (2) General Arousal Category — shifting from hyper- to hypoarousal; (3) Proprioceptive/Kinesthetic Awareness Category — shifting from decreased to increased body awareness; (4) Self-Image/Self-Esteem Category — shifting from negative to positive self-image/self-esteem. These four categories and their corresponding techniques can be used to facilitate peripheral warming.We thank Jackie Myers for her helpful suggestions.     

Popper, falsifiability, and evolutionary biology

First, a brief history is provided of Popper's views on the status of evolutionary biology as a science. The views of some prominent biologists are then canvassed on the matter of falsifiability and its relation to evolutionary biology. Following that, I argue that Popper's programme of falsifiability does indeed exclude evolutionary biology from within the circumference of genuine science, that Popper's programme is fundamentally incoherent, and that the correction of this incoherence results in a greatly expanded and much more realistic concept of what is empirical, resulting in the inclusion of evolutionary biology. Finally, this expanded concept of empirical is applied to two particular problems in evolutionary biology — viz., the species problem and the debate over the theory of punctuated equilibria — and it is argued that both of them are still mainly metaphysical.     

The use of proteolytic enzymes for the mapping of structural rearrangements in the chromosomes of man

Chromosome preparations treated for short periods with the proteolytic enzyme trypsin show well defined banding patterns, comparable to those obtained by more elaborate techniques.—With such patterns it is possible to map in detail the position of chromosome rearrangements.—A rare balanced A1–E18 translocation in a phenotypically normal female and the unbalanced product in her abnormal child has been used to demonstrate this mapping method.     

Establishing irremediable psychiatric suffering in the context of medical assistance in dying in the Netherlands: a qualitative study

Background:Establishing irremediability of suffering is a central challenge in determining the appropriateness of medical assistance in dying (MAiD) for patients with a psychiatric disorder. We sought to evaluate how experienced psychiatrists define irremediable psychiatric suffering in the context of MAiD and what challenges they face while establishing irremediable psychiatric suffering.Methods:We conducted a qualitative study of psychiatrists in the Netherlands with experience assessing irremediable psychiatric suffering in the context of MAiD. We collected data from in-depth, semistructured interviews focused on the definition of irremediable psychiatric suffering and on the challenges in establishing irremediability. We analyzed themes using a modified grounded theory approach.Results:The study included 11 psychiatrists. Although irremediable psychiatric suffering is a prospective concept, most participants relied on retrospective dimensions to define it, such as a history of failed treatments, and expressed that uncertainty was inevitable in this process. When establishing irremediable psychiatric suffering, participants identified challenges related to diagnosis and treatment. The main diagnostic challenge identified was the frequent co-occurrence of more than 1 psychiatric diagnosis. Important challenges related to treatment included assessing the quality of past treatments, establishing when limits of treatment had been reached and managing “treatment fatigue.”Interpretation:Challenges regarding the definition, diagnosis and treatment of irremediable psychiatric suffering complicate the process of establishing it in the context of MAiD. Development of consensus clinical criteria for irremediable psychiatric suffering in this context and further research to understand “treatment fatigue” among patients with psychiatric disorders may help address these challenges. Registration: This study was preregistered under osf.io/2jrnd.

Medical assistance in dying (MAiD), also known as physician-assisted death, has been legalized in an increasing number of jurisdictions around the world.¹ In 2023, Canada will join a small group of countries that allow MAiD for people with mental illness, more commonly referred to as persons with a psychiatric disorder. ² In the Netherlands, MAiD for irremediable psychiatric suffering has been approved by jurisprudence since the 1990s and it has been regulated by law since 2002. The last decade has seen a marked increase in MAiD for irremediable psychiatric suffering; in 2020, MAiD was performed 88 times for psychiatric suffering (1.3% of all MAiD cases), compared with just 2 instances in 2010.³ The number of requests by patients with a psychiatric disorder is much higher, but 90% of requests do not end in MAiD. Sometimes, they are retracted by patients, but most are denied by psychiatrists.⁴The main legal requirements for MAiD in the Netherlands are that the patient must be able to make a competent request, that the patient’s suffering must be unbearable and irremediable, and that the patient and physician agree that there are no other reasonable treatment options. The process for MAiD requires an assessment by an independent physician and, in the case of psychiatric suffering, a third assessment by an independent psychiatrist, preferably one with specific expertise regarding the patient’s disorder.⁵ The Canadian legal requirements under the amended Bill C-7, which will come into effect in 2023, will be largely similar to the Dutch requirements.⁶ However, Canadian legislation, which does not yet permit MAiD for mental illness, has 1 important difference: patients with decision-making capacity can qualify for MAiD if they refuse treatments that they do not find acceptable. It is as yet unknown whether this approach to refusal of treatment will also be applied to MAiD where mental illness is the sole underlying condition.Although there are concerns about decision-making capacity, the central dilemma of MAiD for patients with a psychiatric disorder appears to revolve around applying the concept of irremediability to psychiatric disorders. The 2018 guideline by the Dutch Psychiatry Association defines irremediable psychiatric suffering in the context of MAiD as follows: “irremediability means that there is no longer any prospect of alleviating, mitigating, enduring or removing suffering. There is no longer a reasonable treatment perspective.”⁷ Elsewhere, the guideline states that reasonable treatment perspective means that “there is a prospect of improvement with adequate treatment, within a foreseeable period, and with a reasonable ratio between the expected results and the burden of the treatment for the patient.”⁷A recent scoping review identified a multitude of conceptual articles addressing irremediability in the context of psychiatric MAiD but few empirical studies.¹ This suggests that the assessment of irremediable psychiatric suffering is particularly difficult relative to suffering arising from other types of conditions.Surveys estimate that 46% of psychiatrists in the Netherlands have received an explicit MAiD request at least once in their career, and 4% actually assisted in the death of a patient with a psychiatric disorder.⁸ The experiences of psychiatrists who have handled MAiD requests can be seen as an important source of knowledge about the challenges of establishing irremediable psychiatric suffering in practice. The aim of this study was to learn how experienced psychiatrists define psychiatric suffering as irremediable in the context of a MAiD request and what challenges they face while establishing irremediable psychiatric suffering.     

The ultrastructure of the duct system in the rat extraorbital lacrimal gland

Summary The duct system of the rat exorbital lacrimal gland consists of intercalated ducts, interlobular ducts and excretory ducts. The morphological changes from one type of duct to the next are gradual. At the light microscopical level this consists of a change from a bilaminar epithelium in the intercalated ducts to an epithelium, consisting of approximately three layers — which may be pseudostratified — in the excretory ducts. The basal layer of the intercalated ducts consists of myoepithelial cells, whereas the inner epithelial cells may have both a secretory and an electrolyte transporting function. The interlobular duct epithelium contains many cells with deep infoldings of the basolateral plasma membranes and associated mitochondria, suggesting a similar function to the striated duct epithelium in salivary glands. Numerous basal cells in this epithelium have tentatively been interpreted as unusual myoepithelial cells. Nerve terminals have been observed in the ductal epithelium.This work was supported by the National Health and Medical Research Council of Australia. — We wish to thank Mrs. Eva Vasak for her expert technical assistance.     

The use of khat

Chewing of khat leaves has been noted to be widespread in Yemen. Immigrants to Israel brought that practice along and have kept it alive ever since their initial settlement over thirty years ago. The small epidemiological study reported here made an inquiry into the extent of khat use in two agricultural villages. It also explored the association of that practice with social and psychiatric variables. Of interest was the finding that — contrary to most addictions — the prevalence rate of psychopathology was not higher among users than among abstainers.     

A short history of western European rotifer research

The course of rotifer research in western Europe including Denmark and the British Isles is traced from its commencement at the end of the seventeenth century to the middle of the twentieth. The development of each discipline involved — taxonomy, anatomy, physiology, phylogenetic relationships, histology, embryology and ecology — is examined in an historical context.     

No aging in India: The uses of gerontology

This paper develops a critique of international gerontology through an ethnography and analysis of gerontological practice in India. The central theme of Indian gerontology — that of an imminent demographic and social explosion of an aging population who will tax the country's slender resources — misrepresents available data and fails to signify the experience of most Indian old people. Narrative and deconstructive techniques are deployed to examine the language of crisis and the complex sources of this misrepresentation. Three sources are explored: local disjunctions of class and gender in India, neocolonial biases in the structure of knowledge on aging central to international discourse, and subaltern strategies within India for subverting Western and elite Indian imperatives of what it means to be old.A variety of textual, ethnographic, and historical materials are examined: Indian and American literature pertaining to the 1982 World Assembly on Aging, a series of sociological texts each entitled Aging in India, and four contemporary Indian institutions designed to meet the needs of old people: a social service agency, a geriatric clinic, a retirement community, and an old age home.     

Zezuru turn of the screw

Zezuru adults and children take into account concepts of evil in directing their lives, especially in managing incidents of trauma and sickness. Using the story The Turn of the Screw by Henry James to reflect on these notions, evil is traced in the expressions heard and treatment sessions witnessed during two years research with 60 traditional healers in Mashonaland, Zimbabwe.Evil, particularly as evidenced in witchcraft and possession by aggrieved spirits, is part of a discourse on human suffering — illness, misfortune, death — within a specific community. Healers' treatment of children and their conceptions of childhood form the base for a discussion of evil.     

Exploded worlds — Text as a metaphor for ethnography (and vice versa)

Conclusion There is a class of scholars who seek to write about and perpetuate the culture of all those who do not write about and perpetuate their own culture. Do these scholars write about and perpetuate their own culture?Paul Ricouer and others have put forward the text metaphor for social science production — for what we produce and the way we work with it. It is one of many metaphors that we anthropologists have available to enable us to grasp better our challenging and so often inchoate enterprise. I have expressed misgivings about this metaphor because it takes us back into a world, the academic one, where we do not really belong — with its concerns for distance, invariance, truth value — and away from a world — the variable and voluble world of discourse — where anthropology should be at work if not at home. It is also a metaphor that can beguile us into ignoring the pervasiveness of self-reference and self-replication in our (the intellectual's) creation of worlds and surely in our anthropological creation of other people's worlds. As the pronouns are the fundamental entities of the world of discourse, we have focused on what we can learn from them about the dynamics of self-reference and reference and particularly about the parlous shift from talking to persons — as with the first two persons of discourse — to talking about persons — which is to say the third or absent person of discourse. The pronouns also teach us about turn-taking. Here also one has misgivings about the text metaphor for it takes us into altogether too sui generis a world of the scholar alone with his writings and his imagined or self-created audience for those writings. It is the world of the I perpetually talking and the other perpetually listening. Anthropology in contrast works on the other side of turn-taking where we emphasize the other as an I talking and we ourselves as a you listening. In a world where the powerful military-industrial centers of things do most of the talking, it is altogether appropriate that the peripheries should have their turn through the work of anthropology. That those voices should be heard is a fundamental anthropological task.We should not pretend in the conclusion, however, that the channel for hearing those voices is absolutely clear and unimpeded by self-reference — from the insertion, as it were, of the anthropologist's own voice. We do not escape the need to negotiate these various voices. And for that reason I have placed as an epigraph to the conclusion a rephrasing for the anthropologist of Epimenides' paradox. It is a rephrasing that evokes the paradox involved in giving voice to the voices of others. but to recognize the problem at the very center of our enterprise does not justify the abandonment of that enterprise nor the admirable and unique efforts at turn-taking that characterize the calling of anthropologists.James W. Fernandez is Professor of Anthropology at Princeton University, Princeton, NJ.     

An immunological time scale for primate evolution consistent with fossil evidence

Summary An immunological time scale of primate, evolution is derived, which is based on the comparison of determinant structure — colinear to the corresponding structural genes —of homologous plasma proteins. The ages calculated for the last common ancestors (LCA) of man and pongids, cercopithecoids, platyrrhinians, (cebus) and prosimians are 13.9, 28.3, 54.9, and 63.3 million years respectively, with the LCA of all eutherians assumedto be 70 million years old. The result and the concept employed are discussed.

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Zusammenfassung Es wird eine immunologische Zeitskala der Primatenevolution abgeleitet, die auf einem Vergleich der Determinantenstrukturen — die colinear mit den entsprechenden DNS-Basensequenzen sind — von homologen Plasmaeiweißen, beruht. Die Alter der letzten gemeinsamen Vorfahren (LGV) von Mensch und Pongiden Ceropithecoiden, Platyrrhiniern (Cebus) und Prosimiern wurden mit 13,9, 28,3 54,9 und 63,3 Millionen Jahren ermittelt. Die Zahlen beruhen auf der Annahme, daß der LGV aller Eutheria 70 Millionen Jahre alt ist. Dieses Ergebnis und unser theoretisches Konzept werden näher erörtert.

     

Fine structure of the giant aflagellate spermatozoon in pseudostomum quadrioculatum (leuckart) (platyhelminthes,prolecithophora)

The giant aflagellate spermatozoa of P. quadrioculatum are composed of two different parts: a thicker head piece and a more slender tail piece. In the head there exist a large elongated nucleus and an elongated mitochondrial derivative situated in a groove-like cavity of the nucleus. In mature spermatozoa the nuclear material is arranged in many small membrane bounded areas. Both structures, nucleus and mitochondrial derivative, are spirally coiled. The outer part of the membrane in the mitochondrial derivative forms many loop-like foldings. Both organelles continue to the tail in form of two small, helically coiled ribbons; the nucleus is anchored within the mitochondrial derivative by an electron-opaque process. A sheath of spirally-orientated cortical microtubules starting from the tip of the head runs to the tip of the tail under the cell membrane. In addition, a second sheath of tubules occurs in the tail region, these tubules also run parallel to each other, but in the opposite direction to the microtubules of the outer sheath.The possible relations between the structures observed and the motility of the spermatozoa are discussed; in addition, some phylogenetic comments are attempted.Abbreviations c — cerebrum - com — cortical microtubules - cop — copulatory organ - fm — foldings of the mitochondrial membrane - l — lattice - mid — mitochondrial derivative - mt — microtubules - n — nucleus - ne — nuclear envelope - ph — pharynx - pn — protonephidium - rp — ribbon-like nuclear process - te — testis - tt — testis - tt — tip of the tail - vi — vitellarium - vs — vesicula seminalis     

“Third‐wave” cognitive and behavioral therapies and the emergence of a process‐based approach to intervention in psychiatry

For decades, cognitive and behavioral therapies (CBTs) have been tested in randomized controlled trials for specific psychiatric syndromes that were assumed to represent expressions of latent diseases. Although these protocols were more effective as compared to psychological control conditions, placebo treatments, and even active pharmacotherapies, further advancement in efficacy and dissemination has been inhibited by a failure to focus on processes of change. This picture appears now to be evolving, due both to a collapse of the idea that mental disorders can be classified into distinct, discrete categories, and to the more central attention given to processes of change in newer, so‐called “third‐wave” CBTs. Here we review the context for this historic progress and evaluate the impact of these newer methods and models, not as protocols for treating syndromes, but as ways of targeting an expanded range of processes of change. Five key features of “third‐wave” therapies are underlined: a focus on context and function; the view that new models and methods should build on other strands of CBT; a focus on broad and flexible repertoires vs. an approach to signs and symptoms; applying processes to the clinician, not just the client; and expanding into more complex issues historically more characteristic of humanistic, existential, analytic, or system‐oriented approaches. We argue that these newer methods can be considered in the context of an idiographic approach to process‐based functional analysis. Psychological processes of change can be organized into six dimensions: cognition, affect, attention, self, motivation and overt behavior. Several important processes of change combine two or more of these dimensions. Tailoring intervention strategies to target the appropriate processes in a given individual would be a major advance in psychiatry and an important step toward precision mental health care.     

Über Beziehungen der Kernä Quivalente von Schizophyten zu den Mitochondrien höher organisierter Zellen

Zusammenfassung In den Zellzentren von Schizophyten können außer Desoxyribonukleinsäure — die den kernäquivalenten Charakter der Organelle begründet — Ribonukleinsäure, Phosphate und Lipoide nachgewiesen werden. Das Vorhandensein dieser Stoffgruppen macht Beziehungen der Zellzentren zu den Mitochondrien höher organisierter Zellen wahrscheinlich. Desoxyribonukleinsäurekomplexe der Kernäquivalente und Phosphatkörper der Mitochondrienäquivalente haben — obwohl Komponenteneines Organells — eine gesonderte ontogenetische Entwicklung.Der gemeinsame Ursprung der phylogenetischen Entwicklung von Zellkern und Mitochondrien bzw. von diesen ableitbaren Zellorganellen (Plastiden) wird als möglich angesehen. Die Rolle dieser Organelle als Organisationszentren erscheint durch die aufgezeigten Zusammenhänge unter neuen Gesichtspunkten.Mit 2 Textabbildungen.     

Adolescents' Utilisation of Psychiatric Care,Neighbourhoods and Neighbourhood Socioeconomic Deprivation: A Multilevel Analysis

Mental health problems among adolescents have become a major public health issue, and it is therefore important to increase knowledge on the contextual determinants of adolescent mental health. One such determinant is the socioeconomic structure of the neighbourhood. The present study has two central objectives, (i) to examine if neighbourhood socioeconomic deprivation is associated to individual variations in utilisation of psychiatric care in a Swedish context, and (ii) to investigate if neighbourhood boundaries are a valid construct for identifying contexts that influence individual variations in psychiatric care utilization. Data were obtained from the Longitudinal Multilevel Analysis in Scania (LOMAS) database. The study population consists of all boys and girls aged 13–18 years (N=18,417), who were living in the city of Malmö, Sweden, in 2005. Multilevel logistic regression analysis was applied to estimate the probability of psychiatric care utilisation. The results from the study indicate that the neighbourhood of residence had little influence on psychiatric care utilisation. Although we initially found a variation between neighbourhoods, this general contextual effect was very small (i.e. 1.6 %). The initial conclusive association between the neighbourhood level of disadvantage and psychiatric care utilisation (specific contextual effect) disappeared following adjustment for individual and family level variables. Our results suggest the neighbourhoods in Malmö (at least measured in terms of SAMS-areas), do not provide accurate information for discriminating adolescents utilisation of psychiatric care. The SAMS-areas appears to be an inappropriate construct of the social environment that influences adolescent utilisation of psychiatric care. Therefore, public health interventions should be directed to the whole city rather than to specific neighbourhoods. However, since geographical, social or cultural contexts may be important for our understanding of adolescent mental health further research is needed to identify such contexts.     

Familial occurrence of 18q-

Summary An unusual segregation of the partial long arm deletion of a chromosome 18 is reported. This aberration was found in the feeble-minded mother and in her 4 daughters. The fifth child has XXY-Klinefelter's syndrome. The carriers of 18q — in this family reveal small stature, microcephaly, and mental deficiency in the range from feeble-minded to severe imbecility. Other characteristic features commonly found in patients with 18q — syndrome, as mid-face retraction, downward slanting mouth, heart defect, and atretic ear canals were not observed.