Fever as a Cause of Hypophosphatemia in Patients with Malaria

Hypophosphatemia occurs in 40 to 60% of patients with acute malaria, and in many other conditions associated with elevations of body temperature. To determine the prevalence and causes of hypophosphatemia in patients with malaria, we retrospectively studied all adults diagnosed with acute malaria during a 12-year period. To validate our findings, we analyzed a second sample of malaria patients during a subsequent 10-year period. Serum phosphorus correlated inversely with temperature (n = 59, r = −0.62; P<0.0001), such that each 1°C increase in body temperature was associated with a reduction of 0.18 mmol/L (0.56 mg/dL) in the serum phosphorus level (95% confidence interval: −0.12 to −0.24 mmol/L [−0.37 to −0.74 mg/dL] per 1°C). A similar effect was observed among 19 patients who had repeat measurements of serum phosphorus and temperature. In a multiple linear regression analysis, the relation between temperature and serum phosphorus level was independent of blood pH, PCO2, and serum levels of potassium, bicarbonate, calcium, albumin, and glucose. Our study demonstrates a strong inverse linear relation between body temperature and serum phosphorus level that was not explained by other factors known to cause hypophosphatemia. If causal, this association can account for the high prevalence of hypophosphatemia, observed in our patients and in previous studies of patients with malaria. Because hypophosphatemia has been observed in other clinical conditions characterized by fever or hyperthermia, this relation may not be unique to malaria. Elevation of body temperature should be added to the list of causes of hypophosphatemia

Climate change, social dreaming and art: Thinking the unthinkable

Beyond the Scientific Fact The problem of how people can accept the reality of climate change and its effects on our daily lives is central in climate psychology. Scientific facts have proved remarkably ineffective in leading to necessary changes in lifestyle required on both an individual and a social level. For many, the facts are either traumatic or unacceptable. The requirement posed by global warming to change people’s deeply held desires for ever-increasing economic prosperity and the assumed concomitant wellbeing leads to shared and generalised disavowal and denial. In the world of climate change deniers or disavowers the status of scientific factual reality is a significant issue: the scientific facts backed by 97% of the scientific community are not ‘fact-enough’ for meaningful social change: information, debates, surveys, focus groups and suchlike fail to open the way to significant action. In the case of climate change we are in a zone of gut rejection: even if it is, it cannot be. Al Gore’s ‘inconvenience’ (Gore 2006) is more than that: it is something so inconvenient that it cannot be countenanced. Psycho-social approaches to climate change, therefore, tend to take a containing approach to people’s fears, traumas and deep concerns. For example, Randall and Brown’s (2015) ‘carbon conversations’ project provides practical and experiential psycho-social approaches designed to create contained spaces for reflection and transformation. Through conversation, according to Westcott (2016), there is a chance for denial and disavowal to be converted into hope and trust, without which climate anxieties are repressed and ignored rather than confronted. Such approaches have been positively evaluated by Büchs, Hinton and Smith (2015) who summarise the emotions that can be discussed through conversation related to climate change as fear and anxiety, grief, guilt, helplessness and feeling threatened in one’s identity/status (Büchs et al. 2015, p. 622). It is through the careful containment of shared conversations that people are given an opportunity to be released from the isolation, loneliness, guilt and even horror that scientific facts point to. These conversations change the nature and quality of the climate fact through each person’s relation to the facts. In a sense, the reality of the fact is given a potential for being re-experienced, almost as if it were not a factual entity in and of itself. Climate facts are thus subjectivised and their reality is found in the transactions between external and internal world experiencing. This chapter concentrates on a different way of knowing, focusing on the shared visual and affective aspects of people’s relationship to climate change. It uses the data from an art and social dreaming event to explore how the use of affect-laden images in a shared ‘unconscious’ context, hidden or unknown, can help us to recognize the reality of climate change. Social dreaming is a method that allows new knowledge to emerge in a gathering of people who share their dreams, associations and feelings together. The method creates a non-threatening, non-judgmental space where difficult thoughts and feelings can be expressed through images (Lawrence 2005; Manley 2014, 2018). In Social dreaming and the visual arts, the realm of worded communication is subsumed into a world of image and affect. Both involve what Donald Meltzer calls the ‘poetry of the dream’ whose role in thinking is that it ‘catches and gives formal representation to the passions which are the meaning of our experience so that they may be operated upon by reason’ (Meltzer 2009 p.47)