Alienation, recovered animism and altered states of consciousness

Alienation is the feeling that life is 'meaningless', that we do not belong in the world. But alienation is not an inevitable part of the human condition: some people do feel at one with the world as a consequence of the animistic way of thinking which is shared by children and hunter-gatherers. Animism considers all significant entities to have 'minds', to be 'alive', to be sentient agents. The animistic thinker inhabits a world populated by personal powers including not just other human beings, but also important animals and plants, and significant aspects of physical landscape. Humans belong in this world because it is a web of social relationships. Animism is therefore spontaneous, the 'natural' way of thinking for humans: all humans began as animistic children and for most of human evolutionary history would have grown into animistic adults. It requires sustained, prolonged and pervasive formal education to 'overwrite' animistic thinking with the rationalistic objectivity typical of the modern world. It is this learned abstraction that creates alienation--humans are no longer embedded in a world of social relations but become estranged, adrift in a world of indifferent things. Methods used to cure alienation and recover animistic modes of thinking involve detachment from the social systems that tend to maintain objectivity and rationality: for example, solitude, leisure, unstructured time and direct contact with nature. Many people also achieve similar results by deliberately inducing altered states of consciousness. Animistic thinking may emerge in meditation or contemplation, lucid dreaming, from self-hypnosis, when drowsy, in 'trance states' induced by repetitious rhythm or light, or when delirious due to illness, brain injury, psychoses, or intoxication with 'entheogenic' drugs--which is probably one reason for the perennial popularity of inducing intoxicated states. However, intoxication will typically damage memory processes making it harder to learn from any spiritual experiences; and even mild states of cognitive impairment may be dangerous in situations where skilled or responsible behaviour is required. Despite these constraints and limitations, recovering animism through seeking altered states of consciousness could already be considered a major world spiritual practice.     

Measuring revolutionary biomedical science 1992-2006 using Nobel prizes, Lasker (clinical medicine) awards and Gairdner awards (NLG metric)

The Nobel prize for medicine or physiology, the Lasker award for clinical medicine, and the Gairdner international award are given to individuals for their role in developing theories, technologies and discoveries which have changed the direction of biomedical science. These distinctions have been used to develop an NLG metric to measure research performance and trends in 'revolutionary' biomedical science with the aim of identifying the premier revolutionary science research institutions and nations from 1992-2006. I have previously argued that the number of Nobel laureates in the biomedical field should be expanded to about nine per year and the NLG metric attempts to predict the possible results of such an expansion. One hundred and nineteen NLG prizes and awards were made during the past fifteen years (about eight per year) when overlapping awards had been removed. Eighty-five were won by the USA, revealing a massive domination in revolutionary biomedical science by this nation; the UK was second with sixteen awards; Canada had five, Australia four and Germany three. The USA had twelve elite centres of revolutionary biomedical science, with University of Washington at Seattle and MIT in first position with six awards and prizes each; Rockefeller University and Caltech were jointly second placed with five. Surprisingly, Harvard University--which many people rank as the premier world research centre--failed to reach the threshold of three prizes and awards, and was not included in the elite list. The University of Oxford, UK, was the only institution outside of the USA which featured as a significant centre of revolutionary biomedical science. Long-term success at the highest level of revolutionary biomedical science (and probably other sciences) probably requires a sufficiently large number of individually-successful large institutions in open competition with one another--as in the USA. If this model cannot be replicated within smaller nations, then it implies that such arrangements need to be encouraged and facilitated in multi-national units.     

Collaborating with the consortium: the development of a foundation in critical care skills programme

This paper outlines the role and function of NHS education and training consortia and how one consortium is addressing the issues of supporting practitioner-led, practice-based training initiatives in critical care. In late 1997 the consortium sought to identify current problems with recruitment and retention of competent critical care nurses, access to training and development and to examine the quality and appropriateness of current pre- and postregistration training related to the critical care areas. A number of issues were identified, with the need for a Foundation in Critical Care Skills Programme' for junior nurses as the principle short term priority. A programme supported by the local consortium, in collaboration with seven NHS trusts' critical care areas (totalling 27 different departments/units), has been developed, incorporating skills workshops, completion of open learning materials, assessments of core competencies and the submission of a portfolio of evidence in support of a professional award (ENB Certificate). The importance and value of collaboration in the development of this practitioner-led consortium-supported venture is highlighted.     

Emergency department staff and susceptibility to pertussis: A seroprevalence study

Objective: To determine the proportion of ED staff who are susceptible to pertussis. There was evidence that some winter leave in southern Tasmania might be a reason of pertussis infection among unimmunized staff. This results in loss of individual earning and loss of availability of staff during the peak demand periods in the ED. There is evidence in the literature that underdiagnosis and undertreatment of pertussis occurs worldwide. Methods: All ED staff were approached to participate in this seroprevalence study. A self‐completed questionnaire was used to record pervious immunization history for pertussis. Blood samples were collected and analysed to detect and quantify immunoglobulin G and immunoglobulin A titres for pertussis. All confidence intervals (CI) are at 95%. Settings: The Royal Hobart Hospital and the co‐located Hobart Private Hospital. Results: Ninety‐seven of 106 eligible staff took part in the present study, a participation rate of 92% (CI 84–96). Ninety‐one of 97 subjects (94%, CI 87–98) believed that they had been immunized for pertussis in childhood; six subjects had either not been immunized or were unsure (6%, CI 2–13). Twenty‐three subjects (24%, CI 16–33) had been immunized as adults. There was serologic evidence of recent infection for 21 participants (22%, CI 14–31). Thirty‐one participants (32%, CI 23–42) were susceptible to pertussis on the basis of low immunoglobulin G titres. Conclusion: ED staff should routinely be offered booster immunization for pertussis.     

经紫外线预照射移植猪皮片覆盖烧伤创面时间的观察

目的:观察经紫外线预照射移植猪皮片对烧伤创面覆盖时间的影响。方法:选择2004-01/2005-12四川攀枝花钢铁有限责任公司职工总医院烧伤科收治的需要植皮的烧伤患者35例,患者均知情同意。按随机数字表法分为2组,紫外线预照射组18例,对照组17例。紫外线预照射组使用的猪皮片经过40W紫外线预照射,波长为253.7nm,灯管距猪皮30cm,照射时间2h;对照组使用的移植猪皮片未做紫外线预照射。将移植猪皮片真皮面覆盖于切削痂创面上,加压包扎,用手术刀片打洞以利引流。观察整体猪皮片的存活时间,在术后5,10,15d取0.2cm×0.3cm大小的整层猪皮制成匀浆,检测相关生化因子水平:应用双抗体夹心酶联免疫吸附法测肿瘤坏死因子α含量,应用鲎法测内毒素含量,应用黄嘌呤氧化酶法测超氧化物歧化酶活性,应用硫代戊巴比妥酸法测丙二醛含量。移植猪皮片出现外观苍白,与创面分离,融解脱落均视为失效。结果:35例烧伤患者全部进入结果分析,无脱落。①紫外线预照射组猪皮平均烧伤创面覆盖时间为(18.3±2.4)d,显著高于对照组(13.7±3.1)d(P<0.05)。覆盖猪皮术后15d,紫外线预照射组有3例移植猪皮片失效,对照组有9例移植猪皮片失效。②随时间延长,两组患者覆盖猪皮片局部组织匀浆肿瘤坏死因子α、内毒素、丙二醛含量均呈升高趋势,术后10d和15d紫外线预照射组显著低于对照组(P<0.01)。两组患者覆盖移植猪皮片局部组织匀浆超氧化物歧化酶活性随时间延长均呈下降趋势,术后10d和15d紫外线预照射组显著高于对照组(P<0.01)。结论:紫外线预照射新鲜猪皮用于覆盖烧伤创面能明显延长创面保护时间,其作用途径可能与减轻局部组织脂质过氧化反应程度及炎性因子水平有关。     

Nine novel L1 CAM mutations in families with X-linked hydrocephalus

Mutations in the gene for neural cell adhesion molecule L1 are responsible for the highly variable phenotype found in families with X-linked hydrocephalus, MASA syndrome, and spastic paraplegia type I. To date, 32 different mutations have been observed, the majority being unique to individual families. Here, we report nine novel mutations in L1 in 10 X-linked hydrocephalus families. Four mutations truncate the L1 protein and eliminate cell surface expression, and two would produce abnormal L1 through alteration of RNA processing. A further two of these mutations are small in-frame deletions that have occurred through a mechanism involving tandem repeated sequences. Together with a single missense mutation, these latter examples contribute to the growing number of existing mutations that affect short regions of the L1 protein that may have particular functional significance. Hum Mutat 9:512–518, 1997. © 1997 Wiley-Liss, Inc.     

Genetic background determines the extent of atherosclerosis in ApoE-deficient mice.

Two strains of ApoE-deficient mice were found to have markedly different plasma lipoprotein profiles and susceptibility to atherosclerosis when fed either a low-fat chow or a high-fat Western-type diet. FVB/NJ ApoE-deficient (FVB E0) mice had higher total cholesterol, HDL cholesterol, ApoA1, and ApoA2 levels when compared with C57BL/6J ApoE-deficient (C57 E0) mice. At 16 weeks of age, mean aortic root atherosclerotic lesion area was 7- to 9-fold higher in chow diet-fed C57 E0 mice and 3.5-fold higher in Western diet-fed C57 E0 mice compared with FVB E0 mice fed similar diets. Lesion area in chow diet-fed first-generation mice from a strain intercross was intermediate in size compared with parental values. The distribution of the lesion area in 150 chow diet-fed second-generation progeny spanned the range of the lesion area in both parental strains. There were no correlations between total cholesterol, non-HDL cholesterol, HDL cholesterol, ApoA1, ApoA2, ApoJ, or anti-cardiolipin antibodies and lesion area in the second-generation progeny. Thus, a genomic approach may succeed in identifying the genes responsible for the variation in atherosclerosis susceptibility in these 2 strains of ApoE-deficient mice, which could not be explained by measured plasma parameters.     

Enteric viral infections as a cause of diarrhoea in the acquired immunodeficiency syndrome

Background and aims The role of non-cytomegalovirus (CMV) enteric viral infection in causing diarrhoea in patients with human immunodeficiency virus (HIV) is poorly understood. We aimed to investigate the prevalence of these infections in acute and chronic diarrhoea. Methods Stool specimens from 377 HIV-infected patients presenting with diarrhoea were studied prospectively for evidence of non-CMV enteric viral infection. Patients with diarrhoea underwent investigation for gastrointestinal pathogens, including electron microscopic examination of stool for enteric viruses. We collected data on patients in whom enteric virus was identified and examined the association of enteric virus infection with diarrhoeal symptomatology. Results Eighty-nine (10.3%) stool specimens from 60 (15.9%) HIV⁺ individuals were positive for coronavirus (n = 13, 22%), rotavirus (n = 11, 18%), adenovirus (n = 30, 50%) and small round structured viruses (n = 5, 8%) or dual infection (n = 2, 3%). Thirty-four of 52 (65%) patients available for analysis had acute diarrhoea, and 18/52 (35%) had chronic diarrhoea. Twenty-three of 52 (44%) patients had a concurrent gut pathogen. After exclusion of concurrent pathogens enteric viral infections were found to be significantly associated with acute as opposed to chronic diarrhoea (P = 0.004). The presence of adenovirus colitis was significantly more likely to be associated with chronic diarrhoea (15/21 cases) than adenovirus isolated from stool alone (9/23 cases) (P = 0.03). There was a trend towards an association between adenovirus colitis and colonic cytomegalovirus infection (P = 0.06). Conclusion Enteric viral infection is strongly associated with acute diarrhoea in patients with HIV. Light microscopic examination of large bowel biopsies can identify adenovirus colitis which is significantly associated with chronic diarrhoea, and in addition may facilitate gastrointestinal co-infection with CMV.     

Chronic erosive herpes simplex virus infection of the penis, a possible immune reconstitution disease

Objective To report a novel clinical presentation: a chronic erosive herpes simplex virus (HSV) infection of the penis which developed in AIDS patients following the commencement of highly active antiretroviral therapy (HAART). The lesions were unresponsive to antiviral treatments which had previously been effective, and this could not be accounted for in terms of increased antiviral resistance.
Design Detailed case-note review and investigation of three cases which presented at two large HIV units in London.
Methods Review of all histology with immunohistochemistry for HSV, HSV drug susceptibility assays, tissue typing and measurement of in vitro lymphocyte functional activity against HSV.
Results The histology of the lesions was the same in each case, with the presence of HSV on immunohistochemistry and an unusual prominence of plasma cell and eosinophils in the inflammatory infiltrate. HSV-specific lymphoproliferative responses were normal in two cases, but subnormal in a third case. All individuals shared the HLA class I molecules B72 and Cw0202 and the class II allele DRB4.
Conclusion We believe this to be a previously unreported adverse consequence of HAART, the result of partial immune restoration, reminiscent of the the recently described syndrome of immune recovery vitritis.