The handedness of Michelangelo Buonarroti

The handedness of Michelangelo Buonarroti (1475–1564), one of the greatest artists of all time, is still controversial. Although there is no doubt that almost all of his well‐attributed drawings were drawn with the right hand, the hatch marks of the shading going downward from right to left; it has been often neglected in the literature that he was an innate left‐hander. An unfairly unknown autobiography of Raffaello da Montelupo stated that Michelangelo, a natural left‐hander, trained himself from a young age to become right‐handed. The same biography also underlined that Michelangelo restricted the use of his left hand only to works requiring force such as hammering, carving, and chiseling marble. The sign of the wooden crucifix donated to Santo Spirito in 1492 and two autographic sketches by Michelangelo—one left alongside a poem in 1509, and the other in the dress of the Vittoria Colonna sketch in 1525—are useful tools for analyzing the artist's evolution from left to right handedness when drawing, writing, and painting. Clin. Anat. 31:645–647, 2018. © 2018 Wiley Periodicals, Inc.     

Michelangelo,the Last Judgment fresco,Saint Bartholomew and the Golden Ratio

Art and anatomy were particularly closely intertwined during the Renaissance period and numerous painters and sculptors expressed themselves in both fields. Among them was Michelangelo Buonarroti (1475–1564), who is renowned for having produced some of the most famous of all works of art, the frescoes on the ceiling and on the wall behind the altar of the Sistine Chapel in Rome. Recently, a unique association was discovered between one of Michelangelo's most celebrated works (The Creation of Adam fresco) and the Divine Proportion/Golden Ratio (GR) (1.6). The GR can be found not only in natural phenomena but also in a variety of human‐made objects and works of art. Here, using Image‐Pro Plus 6.0 software, we present mathematical evidence that Michelangelo also used the GR when he painted Saint Bartholomew in the fresco of The Last Judgment, which is on the wall behind the altar. This discovery will add a new dimension to understanding the great works of Michelangelo Buonarroti. Clin. Anat. 28:967–971, 2015. © 2015 Wiley Periodicals, Inc.     

More than a neuroanatomical representation in The Creation of Adam by Michelangelo Buonarroti,a representation of the Golden Ratio

Michelangelo Buonarroti (1475–1564) was a master anatomist as well as an artistic genius. He dissected numerous cadavers and developed a profound understanding of human anatomy. Among his best‐known artworks are the frescoes painted on the ceiling of the Sistine Chapel (1508–1512), in Rome. Currently, there is some debate over whether the frescoes merely represent the teachings of the Catholic Church at the time or if there are other meanings hidden in the images. In addition, there is speculation regarding the image of the brain embedded in the fresco known as “The Creation of Adam,” which contains anatomic features of the midsagittal and lateral surfaces of the brain. Within this context, we report our use of Image Pro Plus Software 6.0 to demonstrate mathematical evidence that Michelangelo painted “The Creation of Adam” using the Divine Proportion/Golden Ratio (GR) (1.6). The GR is classically associated with greater structural efficiency and is found in biological structures and works of art by renowned artists. Thus, according to the evidence shown in this article, we can suppose that the beauty and harmony recognized in all Michelangelo's works may not be based solely on his knowledge of human anatomical proportions, but that the artist also probably knew anatomical structures that conform to the GR display greater structural efficiency. It is hoped that this report will at least stimulate further scientific and scholarly contributions to this fascinating topic, as the study of these works of art is essential for the knowledge of the history of Anatomy. Clin. Anat. 28:702–705, 2015. © 2015 Wiley Periodicals, Inc.     

A hidden rib found in Michelangelo Buonarroti's fresco The Creation of Adam

The fresco The Creation of Adam (1511), painted on the ceiling of the Sistine Chapel by the great genius of human anatomy Michelangelo Buonarroti (1475–1564), represents one of the most emblematic and best‐known scenes in the world. This fresco illustrates a key passage from the Book of Genesis: the moment when God creates the first man, Adam. Since its completion, this work has been intensively studied by many scholars of art, and by several anatomists, who have pointed out signs of anatomical representations contained in the scene. However, there is still some uncertainty regarding this famous scene, especially in relation to its complete iconography. In an attempt to understand Michelangelo's purpose better regarding this emblematic scene, this article presents unpublished evidence that the artist could have concealed within the figure of Adam the anatomical image of a rib which, according to traditional Biblical accounts, is iconographically associated with the origin of Eve, Adam's companion. Curiously, this hidden rib in Adam's body figure could be related to the traditional view of the origin of the first humans expounded in the Jewish Kabbalah. Clin. Anat. 32:648–653, 2019. © 2019 Wiley Periodicals, Inc.     

Case Formulation and the Therapeutic Relationship: The Role of Therapist Self‐Reflection and Self‐Revelation

This article examines the role of the therapist's self‐reflection and self‐revelation in case formulation. We believe that a collaboratively constructed case formulation must always be considered in the context of an evolving therapeutic relationship. Further, self‐reflection and self‐revelation on the part of the therapist are critical for a more elaborate and nuanced case formulation and for understanding the patient. This highlights the importance of attunement to the here and now and the evolving therapeutic relationship. From this attunement, the therapist's self‐reflection and self‐revelation can emerge further, which can lead to the patient's personal growth and increased self–other awareness. To illustrate our point, we present an integrative, relational model in the case of a patient who has been in treatment.     

Book Review: The Foundations of Immunology and their Pertinence to Medicine

We are in the era cursed with overspecialization. Charles Darwin's foundational Origin of Species, published in 1859, was accessible to the broadly educated individual. Starting with this statement, Peter Bretscher in his new book aimed at explaining foundational concepts of immunology to a broad public. His standpoint is that foundational ideas usually can be simply expressed. This book describes first how foundational concepts of immunology have evolved over the last two and a half centuries. The importance of self–non‐self‐discrimination by the immune system is acknowledged, and models for immunological tolerance are compared. A main focus concerns the understanding of immune class regulation. According to Bretscher's Threshold Hypothesis, a low antigen dose or low degree of foreignness results in Th1 immunity whereas a high antigen dose or high degree of foreignness induces Th2 responses. A novel vaccination strategy is proposed with an ultra‐low number of live, attenuated organisms. It is described in details how this approach may potentially be used to prevent or treat HIV infection, tuberculosis and cancer. The book is very well written in a clear, simple and stimulating style which makes it accessible not only to immunologists but also non‐specialists, teachers, medical students and clinicians. It will convince many that the immune system is not too complex to be understood. By Peter Bretscher. FriesenPress, 2016. 200 pp. ISBN: 978‐1‐4602‐9656‐1.     

“Osler Warned”: Was William Osler a Grave Robber While at McGill or Was He a Victim (or Perpetrator) of One Final Practical Joke?

Bodysnatching was an illegal way to procure cadavers for anatomical dissection before the existence of effective anatomy legislation. As knowledge of anatomy was fundamental to medical practice, many famous nineteenth century physicians turned a blind eye to this activity or even participated. Sir William Osler, perhaps the most revered physician of all time, received his medical degree from McGill University in 1872 and then served as pathologist at Montreal General Hospital from 1874 to 1884, where he began a career which culminated in him becoming both the first Professor of Medicine at Johns Hopkins and then Regius Professor at Oxford. Quebec had been slow to enact effective anatomy legislation, and most of the cadavers in the McGill anatomy laboratory were resurrected; Osler's close friend and Anatomy Demonstrator Francis Shepherd was convicted of this offence on several occasions. In 1940, a letter was discovered in the archives at the McGill's William Osler Library, purportedly written in 1880, accusing Osler of being a grave robber while in Montreal. My paper dissects the letter to assess its credibility in the historical context of Osler's early life and the fact that Osler was a lifelong notorious practical joker with his own pseudonym, Dr. Egerton Yorrick Davis, who helped with his pranks. The provenance of the letter is analyzed and the paper explores, using historical context and forensic handwriting analysis, whether this letter is a revenge‐motivated practical joke played on him by one of his famous colleagues or represents Osler's last practical joke for posterity. Clin. Anat. 31:632–640, 2018. © 2018 Wiley Periodicals, Inc.     

The child's active role in mother–child,father–child psychotherapy: A psychodynamic approach to the treatment of relational disturbances

The short‐term mother–child and father–child psychoanalytic psychotherapy assumes that children develop specific types of relationships with each parent, as well as with the parenting couple. The model integrates an intra‐psychic, object‐relational view with an interpersonal perspective to the treatment of relational disturbances in childhood. The same therapist meets with the mother–child, father–child dyads on a weekly basis, along with regular meetings with the parental dyad. The model focuses on the developmentally prelatency child's need for the active participation of both parents in the here‐and‐now shared experiences of the therapeutic process. The participants express, in interactions and in enactments, various contents and meanings of their specific patterns of relations. The therapist addresses the behaviours as well as the meanings of relations, thus promoting reflective understanding and experiential changes in self, other, and self‐other relations. The child's active and different participation with each parent is the main change‐promoting factor. The child uses mainly the medium of play to express his/her needs and to mobilize the therapist's help. The therapist's access to the different dyads is utilized to better understand the explicit and implicit relational themes. The therapist supports the co‐construction of new and different behaviour patterns and the co‐creation of additional meanings to representations. The setup fosters the child's active participation in each dyad's growth‐promoting changes.     

The Piggle: Decoding an Enigma

The Piggle, in its 40th anniversary year, was published after Winnicott's death. He treated this 2‐year 4‐month‐old girl over two and a half years. Yet, until recently, The Piggle has been ambivalently reviewed and minimally studied, despite elegant posthumous papers, a recent introduction to Winnicott's collected works and an interview with the ‘Piggle’ in adulthood. We show that Winnicott's technique and interpretations fall into three categories: (1) early Kleinian ‘deep’ interpretations; (2) an Anna Freudian approach with developmental considerations, respect for defences, the analyst as a new developmental object; (3) a Winnicottian attitude and interpretations that hew close to the manifest material and emphasize the environment–individual relationship and full‐bodied play. Winnicott's ‘interpretations’ include verbal interpretation, prosody, gesture, facial expression, body movements and contact. Winnicott details the child's reactions to the different interpretations. We close suggesting that Winnicott carried on dialogues, not only with the child, but also internal dialogues with former teachers (Klein/Riviere; Strachey as his first analyst and so connecting to the Freudians in the Institute of Psychoanalysis) and perhaps with Anna Freud as a colleague after her arrival in London in 1938. This is a manifestation of false versus true (analytic) selves. Understanding Winnicott's internal struggle with his former teachers/analysts, corrected by his responsiveness to the child's responses and suggestions, resulted in his bringing a truer self to this child's treatment and unravels The Piggle's enigmatic qualities.     

In‐session behaviours and adolescents' self‐concept and loneliness: A psychodrama process–outcome study

As adolescents spend many hours a day in school, it is crucial to examine the ways in which therapeutic practices in schools promote their well‐being. This longitudinal pilot study examined the contribution of school‐based psychodrama group therapy to the self‐concept dimensions and perceived loneliness of 40 Israeli adolescents (aged 13–16, 60% boys) in public middle schools. From a process–outcome perspective, we also examined the understudied trajectory of adolescents' in‐session behaviours (process variables) and its associations with changes in their self‐concepts and loneliness (outcome variables). Psychodrama participants reported increases in global, social, and behavioural self‐concepts and a decrease in loneliness compared to the control group. In‐session productive behaviours increased and resistance decreased throughout the therapy, but varied process–outcome relationships were found. The study suggests that conducting further research into the process–outcome relationships in psychodrama group therapy is warranted to pinpoint specific mechanisms of change. Suggestions for future studies are provided.     

Male GPs' views on men seeking medical help: A qualitative study

Objective . Analysis of health service statistics reveals that men tend to under‐use primary health care services. Previous research has suggested that men view illness as a form of weakness and have negative views about men who seek medical help. It has also indicated that some men believe that male General Practitioner (GP)s hold similar views, a factor which may influence their own tendency to self‐refer. This study aims to explore male GPs' experiences of their male patients' patterns of self‐referral and to identify factors that may negatively influence doctor–patient relationships. Method . Semi‐structured interviews were carried out with 10 male GPs (ages=35–53). These were audiotaped and subjected to interpretative phenomenological analysis to identify relevant themes. Results . For all participants, managing service demands were seen as a major challenge. Analysis of these GP's accounts suggested that they see men's self‐referral as being primarily influenced by the need to conform to masculine gender roles and a number of ways that men accessed services in a way congruent with this were identified. This study also explored how participants' own adherence to gender roles may itself influence the doctor–patient relationship. Conclusion . This study suggests that, like other men, male GPs may have ambivalent attitudes towards male self‐referral and that this may influence their interactions with male patients.     

A Psychoanalysis of Being: An Approach to Donald Winnicott

This paper offers a brief résumé of Winnicott's approach to psychoanalysis through a reading that emphasizes his interest in the capacity to be as a fundamental acquisition of human subjectivity. This interest continued throughout his life. The paper argues that it is closely related to his interest in analytic communication and the emphasis in his paper ‘Communicating and not‐communicating leading to a study of certain opposites’ of the importance clinically of the patient's right not to communicate and the analyst's acceptance of it. It refers briefly to the richness of the arena opened up by his idea of the incommunicado self and its implications for both theory and practice. Three clinical vignettes are included to demonstrate Winnicott's way of working.     

Self‐reflection and self‐practice in training of Cognitive Behaviour Therapy: an overview

The present paper deals with a developing training element in cognitive behaviour therapy (CBT), the self‐practice of therapeutic techniques and the self‐exploration of the person of the therapist. Initially, the current status of this training element in CBT is discussed, and a short note on its terminology is presented. Then an overview of the most important objectives of self‐practice and self‐reflection in CBT, and the concepts and methods of practice of this element is given. The concepts focus on two major aims, the self‐exploration of the person of the therapist within and beyond his or her therapeutic practice, and the self‐application of therapeutic techniques (= self‐practice). In the second part of the paper empirical studies related to the outcome of self‐reflection and self‐practice on the development of the therapist and her or his therapeutic practice are reviewed. The few empirical studies show that trainees experience in their own view substantial professional and personal gains from this training tool, with the professional impact being more important than the personal one. The most important outcomes evaluated by subjective data from the trainees are improvements in self‐insight and self‐awareness and a better understanding of the therapist's role and the therapeutic change process. Additionally, a better understanding of CBT methods and of general therapeutic skills, such as empathy and role‐taking‐competencies, are reported by the trainees. The paper comes to the conclusion that self‐exploration and self‐practice are important components of CBT training. Consequences and recommendations for its integration into training courses for CBT are discussed as well as the necessity for more research in this area. Copyright © 2002 John Wiley & Sons, Ltd.     

Understanding and Using Enactments to Further Clinical Work: A Case Study of a Man Unable to Experience Intimacy

This article examines the value of working within enactments–affectively charged, unconscious remnants of painful, past experiences played out in the novel context of the therapeutic relationship–to further the work of psychodynamically oriented therapy in the treatment of a HIV‐positive Hispanic gay male in his early 30s with a history of relational trauma. Through clinical vignettes, I highlight how relational uncertainty and its vicissitudes–vulnerability, doubt, safety, and trust–have triggered mutual dissociation in the context of enactment. At times, this has disrupted our ability to communicate honestly and relate intersubjectively. By working within affectively charged enactments, we have expanded our capacities to accommodate to relational uncertainty and used the tension of ambiguity within our relationship to permit the emergence of a shared space for recognition and self‐discovery.     

The Deeply Understanding of the Self‐Healing Mechanism for Self‐Healing Behavior of Supramolecular Materials Based on Cyclodextrin–Guest Interactions

Cyclodextrin (CD)‐based host–guest interactions are one of the important supramolecular interactions and have been playing significant role in the design of self‐healing materials due to high selectivity and dynamic equilibrium. However, a deeper understanding of the self‐healing mechanism is still rare, although self‐healing materials based on CD–guest interactions have many advantages. This study provides a first step for the fundamental understanding of the influence factors on self‐healing behavior of materials containing CD–guest complexes. It is found that the healing motifs are CD–guest interactions. Sufficient polymer chains mobility, a small amount of water, and high inclusion constant (K ) of host–guest interactions are also essential to the self‐healing process. The threshold of K value is around 10² M⁻¹.

     

A Prerequisite of the Poly(ε‐Caprolactone) Self‐Induced Nanohybrid Shish–Kebab Structure Formation: An Ordered Crystal Lamellae Orientation Morphology of Fibers

The shish–kebab structure has been extensively applied in many fields; however, the formation mechanism is still an open question. In this study, different electrospun poly(ε‐caprolactone) (PCL) fibers are applied as the shish material in a self‐induced crystallization process, and two different self‐induced crystal structures are obtained. The PCL fibers with an ordered crystalline morphology lead to an induced crystalline structure with the crystal lamellae perpendicular to the fiber axis. However, the PCL fibers with a disordered structure induce a complicated (less ordered) crystalline lamellae morphology. Investigation of the surface crystalline structure reveals that the self‐induced nanohybrid shish–kebab (SINSK) structure follows a lattice matching and epitaxial growth mechanism. The internal crystalline structure of PCL nanofibers plays a dominant role in the formation of the SINSK structure. This study may prove helpful in screening materials for formation of the SINSK structure.     

Polyvinyl Alcohol‐Based Thermogel with Tunable Gelation and Self‐Healing Property

Injectable thermogelated hydrogels with self‐healing and multi‐responsiveness are emerging as a class of significant “smart” materials because of their many potential applications. However, there are only very limited precedents that combine thermogels with self‐healing and tunable functions. In this work, it is demonstrated that N‐alkyl substituted carbamate modified polyvinyl alcohol with borax as a crosslinker enables a variety of tunable and dynamic thermogelation properties. As far as it is known, this is the first polyvinyl alcohol–based thermogel system. This system characterizes shear thinning, multiple responsiveness, and dynamic gelation features. Systematic investigation suggests that these features collaborate to contribute to attractive injectability, quick self‐healing ability, and tunable thermogelation behavior. A stepwise in situ gelation and carbon dioxide–triggered release are demonstrated.     

Assessment of polycyclic aromatic hydrocarbon exposure,lung function,systemic inflammation,and genotoxicity in peripheral blood mononuclear cells from firefighters before and after a work shift

Firefighting is regarded as possibly carcinogenic, although there are few mechanistic studies on genotoxicity in humans. We investigated exposure to polycyclic aromatic hydrocarbons (PAH), lung function, systemic inflammation and genotoxicity in peripheral blood mononuclear cells (PBMC) of 22 professional firefighters before and after a 24‐h work shift. Exposure was assessed by measurements of particulate matter (PM), PAH levels on skin, urinary 1‐hydroxypyrene (1‐OHP) and self‐reported participation in fire extinguishing activities. PM measurements indicated that use of personal protective equipment (PPE) effectively prevented inhalation exposure, but exposure to PM occurred when the environment was perceived as safe and the self‐contained breathing apparatuses were removed. The level of PAH on skin and urinary 1‐OHP concentration were similar before and after the work shift, irrespective of self‐reported participation in fire extinction activities. Post‐shift, the subjects had reduced levels of oxidatively damaged DNA in PBMC, and increased plasma concentration of vascular cell adhesion molecule 1 (VCAM‐1). The subjects reporting participation in fire extinction activities during the work shift had a slightly decreased lung function, increased plasma concentration of VCAM‐1, and reduced levels of oxidatively damaged DNA in PBMC. Our results suggest that the firefighters were not exposed to PM while using PPE, but exposure occurred when PPE was not used. The work shift was not associated with increased levels of genotoxicity. Increased levels of VCAM‐1 in plasma were observed. Environ. Mol. Mutagen. 59:539–548, 2018. © 2018 Wiley Periodicals, Inc.