Mother Nature and Father Time: Oedipal imbalance and the premature structuring of reality in the perversions

Mother Nature and Father Time are ever-present in the human story. Mother equals nurture, symbiosis and is chaos. Father stands for separation, lore, structure and culture. We need them both, but there is a toxic version of each: the Oedipal mother devours her infant in a perpetual symbiosis. The toxic father is violently intrusive. The psychoanalytic cure is based upon the restructuring of the Oedipal imbalances within the early object world. The technical challenges of one particular area of psychopathology; that of perversion, is instructive both for the treatment of such problems, as well as for psychoanalytic technique more generally. Perversion involves a series of compelling actions, an action narrative, which is used by the person afflicted as a solution to anxiety. I argue that the perverse enactment and its transference corollary represent premature attempts to introduce structure due to the terror of an intimate ego-to-ego engagement, because contact with the other and with the chaos of the internal world is experienced as potentially annihilating. I focus on the particular qualities of the superego in perversion, illustrated with a description of the psychotherapy of such a case. This elucidates the specific clinical pitfalls of working with such psychopathology. The perversion itself signifies the experience of a powerful (maternal) superego, more primitive, visceral and harsh than the (paternal) superego described by Freud as heir to the Oedipus Complex. This belongs to an early stage of development when nascent ego structures are tenuous. The notion of superego is broadened to include all aspects of our shared culture, not just the moral element described by Freud. Superego-to-superego contact is impersonal and relates to our shared culture and rituals; in the clinical context, the setting. This is different from ego-to-ego contact associated with emotional connectedness, the hallmark of good mothering and ultimately the aim of psychoanalytic treatment. Enactment in perversion indicates an attempt to prematurely structure reality in the absence of a reliable benign paternal object, and this is manifest in the here-and-now with the setting. This allows for safety, but at huge cost in terms of the capacity for object relating

Implicit measurement of violence related cognitions

OBJECTIVE: Violence-related cognitions may underpin many acts of violence, but explicit self-report measures of these cognitions may be inadequate to assess them fully due to their unconscious nature or due to deliberate dissimulation. We designed three versions of the implicit association test (IAT) that separately examined violence-related associations to valence (good vs bad), hedonic-value (enjoy vs dislike) and arousal (exciting vs boring) and examined if these were associated with greater levels of past criminal activity and self-reported violence. METHOD: The three IATs were administered to an offender sample (N = 108) with a history of serious offending and a diagnosis of Personality Disorder. Violence was assessed via the Proactive and Reactive Aggression Questionnaire and by examination of previous convictions. RESULTS: The IATs showed good to moderate reliability. The valence-IAT did not show any significant correlations to the measures of previous violence. The hedonic value-IAT showed positive relationships with official records of convictions, especially among participants without a conviction for homicide. The arousal-IAT was positively related to self-reported aggression in those without a conviction for homicide. CONCLUSIONS: The results show some promise that indirect techniques may be able to measure violence-related cognitions

Kinetic studies of HIV-1 and HIV-2 envelope glycoprotein-mediated fusion

BACKGROUND: HIV envelope glycoprotein (Env)-mediated fusion is driven by the concerted coalescence of the HIV gp41 N-helical and C-helical regions, which results in the formation of 6 helix bundles. Kinetics of HIV Env-mediated fusion is an important determinant of sensitivity to entry inhibitors and antibodies. However, the parameters that govern the HIV Env fusion cascade have yet to be fully elucidated. We address this issue by comparing the kinetics HIV-1(IIIB )Env with those mediated by HIV-2 from two strains with different affinities for CD4 and CXCR4. RESULTS: HIV-1 and HIV-2 Env-mediated cell fusion occurred with half times of about 60 and 30 min, respectively. Binding experiments of soluble HIV gp120 proteins to CD4 and co-receptor did not correlate with the differences in kinetics of fusion mediated by the three different HIV Envs. However, escape from inhibition by reagents that block gp120-CD4 binding, CD4-induced CXCR4 binding and 6-helix bundle formation, respectively, indicated large difference between HIV-1 and HIV-2 envelope glycoproteins in their CD4-induced rates of engagement with CXCR4. CONCLUSION: The HIV-2 Env proteins studied here exhibited a significantly reduced window of time between the engagement of gp120 with CD4 and exposure of the CXCR4 binding site on gp120 as compared with HIV-1(IIIB )Env. The efficiency with which HIV-2 Env undergoes this CD4-induced conformational change is the major cause of the relatively rapid rate of HIV-2 Env mediated-fusion

Web-based climate information resources for malaria control in Africa

Malaria remains a major public health threat to more than 600 million Africans and its control is recognized as critical to achieving the Millennium Development Goals. The greatest burden of malaria in Africa occurs in the endemic regions where the disease pathogen is continuously present in the community. These regions are characterized by an environment that is conducive to interactions between the Anopheles mosquito, malaria parasites and human hosts, as well as housing of generally poor quality, which offers little protection from mosquito-human contact. Epidemic malaria tends to occur along the geographical margins of endemic regions, when the equilibrium between the human, parasite and mosquito vector populations is occasionally disturbed and a sharp but temporary increase in disease incidence results. When malaria control measures are inadequate, as is the case in much of sub-Saharan Africa, the disease distribution is closely linked with seasonal patterns of the climate and local environment. In the absence of good epidemiological data on malaria distribution in Africa, climate information has long been used to develop malaria risk maps that illustrate the boundaries of 'climatic suitability for endemic transmission.' The best known of these are produced by the Pan-African-based MARA Collaboration. This paper describes the development of additional malaria suitability maps which have been produced in an online, interactive format to enable temporal information (i.e., seasonality of climate conditions) to be queried and displayed along with spatial information. These maps and the seasonal information that they contain should be useful to the malaria control and health service communities for their planning and operational activities

Study protocol: NITric oxide during cardiopulmonary bypass to improve Recovery in Infants with Congenital heart defects (NITRIC trial): a randomised controlled trial

Introduction Congenital heart disease (CHD) is a major cause of infant mortality. Many infants with CHD require corrective surgery with most operations requiring cardiopulmonary bypass (CPB). CPB triggers a systemic inflammatory response which is associated with low cardiac output syndrome (LCOS), postoperative morbidity and mortality. Delivery of nitric oxide (NO) into CPB circuits can provide myocardial protection and reduce bypass-induced inflammation, leading to less LCOS and improved recovery. We hypothesised that using NO during CPB increases ventilator-free days (VFD) (the number of days patients spend alive and free from invasive mechanical ventilation up until day 28) compared with standard care. Here, we describe the NITRIC trial protocol. Methods and analysis The NITRIC trial is a randomised, double-blind, controlled, parallel-group, two-sided superiority trial to be conducted in six paediatric cardiac surgical centres. One thousand three-hundred and twenty infants <2 years of age undergoing cardiac surgery with CPB will be randomly assigned to NO at 20 ppm administered into the CPB oxygenator for the duration of CPB or standard care (no NO) in a 1:1 ratio with stratification by age (<6 and ≥6 weeks), single ventricle physiology (Y/N) and study centre. The primary outcome will be VFD to day 28. Secondary outcomes include a composite of LCOS, need for extracorporeal membrane oxygenation or death within 28 days of surgery; length of stay in intensive care and in hospital; and, healthcare costs. Analyses will be conducted on an intention-to-treat basis. Preplanned secondary analyses will investigate the impact of NO on host inflammatory profiles postsurgery. Ethics and dissemination The study has ethical approval (HREC/17/QRCH/43, dated 26 April 2017), is registered in the Australian New Zealand Clinical Trials Registry (ACTRN12617000821392) and commenced recruitment in July 2017. The primary manuscript will be submitted for publication in a peer-reviewed journal. Trial registration number ACTRN12617000821392.</p

Use of Remote Sensing for Monitoring Climate Variability for Integrated Early Warning Systems: Applications for Human Diseases and Desert Locust Management

A number of the major human infectious diseases (like malaria and dengue) and Desert Locusts that still plague the developing world are sensitive to inter-seasonal and inter-decadal changes in environment and climate. Monitoring variations in environmental conditions such as rainfall and vegetation helps decision-makers at Ministries of Agriculture and Ministries of Health to assess the risk levels of Desert Locust outbreaks or malaria epidemics. The International research institute for climate and society (IRI) has developed products based on remotely sensed data to monitor those changes and provide the information directly to the decision-makers. This paper presents recent developments which use remote sensing to monitor climate variability, environmental conditions and their impacts on the dynamics of infectious diseases (malaria) and Desert Locust outbreaks

The triarchic model of psychopathy and antisocial behavior: results from an offender population with personality disorder

The triarchic model posits that psychopathy is a combination of phenotypes related to boldness, meanness, and disinhibition. We examined how each of these phenotypes of psychopathy related to past violence and antisocial behavior and to behavior within the prison. The sample consisted of men (n = 108) with a history of serious offending and a diagnosis of personality disorder at the point of admission to a prison serving as a therapeutic community. We took four indices of violence and antisocial behavior, (a) self-report of lifetime proactive and reaction aggression, (b) criminal convictions prior to admission to the prison, (c) exclusion from the prison within 12 months due to rule breaking, and (d) behavior within the first 12 months of admission to the unit. The constructs of the triarchic model, as assessed by the triarchic psychopathy measure (TriPM), were strong predictors of self-reported aggression, with disinhibition being related to both proactive and reactive aggression, whereas boldness was related to proactive aggression alone. Past criminal convictions were also associated with disinhibition, except for convictions for violent behavior. Both meanness and disinhibition were predictive of exclusion from the prison within 12 months for rule-breaking behavior and of aggressive behavior within the prison. The triarchic model of psychopathy is associated with past antisocial behavior and is predictive of antisocial behaviors within the prison, and the different constructs of the triarchic model are associated with different manifestations of antisocial behavior. The TriPM holds great promise for improved assessment and enhanced understanding of psychopathic personality within institutions and can facilitate offender management via improved phenotypic analysis of boldness, meanness, and disinhibition

The Triarchic Model of Psychopathy and Antisocial Behavior: Results From an Offender Population With Personality Disorder

The triarchic model posits that psychopathy is a combination of phenotypes related to boldness, meanness, and disinhibition. We examined how each of these phenotypes of psychopathy related to past violence and antisocial behavior and to behavior within the prison. The sample consisted of men (n = 108) with a history of serious offending and a diagnosis of personality disorder at the point of admission to a prison serving as a therapeutic community. We took four indices of violence and antisocial behavior, (a) self-report of lifetime proactive and reaction aggression, (b) criminal convictions prior to admission to the prison, (c) exclusion from the prison within 12 months due to rule breaking, and (d) behavior within the first 12 months of admission to the unit. The constructs of the triarchic model, as assessed by the triarchic psychopathy measure (TriPM), were strong predictors of self-reported aggression, with disinhibition being related to both proactive and reactive aggression, whereas boldness was related to proactive aggression alone. Past criminal convictions were also associated with disinhibition, except for convictions for violent behavior. Both meanness and disinhibition were predictive of exclusion from the prison within 12 months for rule-breaking behavior and of aggressive behavior within the prison. The triarchic model of psychopathy is associated with past antisocial behavior and is predictive of antisocial behaviors within the prison, and the different constructs of the triarchic model are associated with different manifestations of antisocial behavior. The TriPM holds great promise for improved assessment and enhanced understanding of psychopathic personality within institutions and can facilitate offender management via improved phenotypic analysis of boldness, meanness, and disinhibition

The association of clinical indication for exercise stress testing with all-cause mortality: the FIT Project

INTRODUCTION: We hypothesized that the indication for stress testing provided by the referring physician would be an independent predictor of all-cause mortality. MATERIAL AND METHODS: We studied 48,914 patients from The Henry Ford Exercise Testing Project (The FIT Project) without known congestive heart failure who were referred for a clinical treadmill stress test and followed for 11 ±4.7 years. The reason for stress test referral was abstracted from the clinical test order, and should be considered the primary concerning symptom or indication as stated by the ordering clinician. Hierarchical multivariable Cox proportional hazards regression was performed, after controlling for potential confounders including demographics, risk factors, and medication use as well as additional adjustment for exercise capacity in the final model. RESULTS: A total of 67% of the patients were referred for chest pain, 12% for shortness of breath (SOB), 4% for palpitations, 3% for pre-operative evaluation, 6% for abnormal prior testing, and 7% for risk factors only. There were 6,211 total deaths during follow-up. Compared to chest pain, those referred for palpitations (HR = 0.72, 95% CI: 0.60-0.86) and risk factors only (HR = 0.72, 95% CI: 0.63-0.82) had a lower risk of all-cause mortality, whereas those referred for SOB (HR = 1.15, 95% CI: 1.07-1.23) and pre-operative evaluation (HR = 2.11, 95% CI: 1.94-2.30) had an increased risk. In subgroup analysis, referral for palpitations was protective only in those without coronary artery disease (CAD) (HR = 0.75, 95% CI: 0.62-0.90), while SOB increased mortality risk only in those with established CAD (HR = 1.25, 95% CI: 1.10-1.44). CONCLUSIONS: The indication for stress testing is an independent predictor of mortality, showing an interaction with CAD status. Importantly, SOB may be associated with higher mortality risk than chest pain, particularly in patients with CAD