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The early concept that the cerebral ventricles harbor the soul began to break down only in the Renaissance. Thanks to determined anatomical studies and physiological considerations regarding the role played by the cerebrospinal fluid, the function of the ventricles was reduced to merely being a receptacle for metabolic waste.
Friedrich Albert Lange was a German philosopher, political theorist, educator, and psychologist who outlined an objective psychology in the 1860s. This article shows how some of the most important worldviews of the nineteenth century (Kantianism, Marxism, and Darwinism) were combined creatively in his thought system. He was crucial in the development of neo-Kantianism and incorporated psycho-physiological research on sensation and perception in order to defend Kant's epistemological idealism. Based on a critique of phrenology and philosophical psychology of his time, Lange developed a program of a psychology without a soul. He suggested that only those phenomena that can be observed and controlled should be studied, that psychology should focus on actions and speech, and that for each psychological event the corresponding physical or physiological processes should be identified. Lange opposed introspection and subjective accounts and promoted experiments and statistics. He also promoted Darwinism for psychology while developing a socialist progressive-democratic reading of Darwin in his social theory. The implications of socialist Darwinism on Lange's conceptualization of race are discussed and his prominence in nineteenth century philosophy and psychology is summarized.
BACKGROUND: This article provides a descriptive overview of the implementation process of the Heart, Body, and Soul program. The program objective was to test strategies to reduce the prevalence of cigarette smoking among urban African Americans in East Baltimore. METHOD: This study constitutes a prospective randomized trial among inner-city African Americans designed to improve quit rates among church attenders. A random-digit-dialing survey was conducted to establish baseline levels of self-reported cigarette smoking, examine attendant attitudes, and determine the presence of known cardiovascular risk factors among community residents of the catchment area. A similar survey was conducted among churchgoers to establish a baseline. Twenty-two churches were recruited and randomly assigned to either intensive or minimal (self-help) intervention strategies. Baseline health screenings were held in all participating churches. Innovative culturally specific smoking cessation strategies mediated through lay volunteers from participating churches were implemented in the intensive intervention churches. RESULTS: Pastors of all churches were directly involved in all aspects of the planning and implementation process. A total of 29 volunteer lay smoking-cessation specialists were trained and successfully implemented the intensive interventions in churches. An additional 272 church members were trained to conduct their church's health screenings. CONCLUSION: The essential component of this successful implementation process were building trust and acceptance and providing the technical support to encourage smoking-cessation strategies. This description of the project is presented to assist others involved in church-based trials in urban African American communities.
Karo Batak ceremonial curing practices in urban Indonesia take place in a disputed zone of acts and meanings, in which neither social nor cultural coherence can be presumed by the analyst. Examining the therapeutic efforts of an urban Karo spirit possession cult aimed at curing the soul loss suffered by a young man, the Christian son of one of the cult's premier spirit mediums, this paper questions the relevance of the 'integrative model' in such cases, and suggests an alternative approach, looking at the sets of social, cultural and interpersonal tensions that run through the cult's practices and which, at the same time, those practices seek to contain.
To date, little attention has been paid to the cultural philosophies of experience which shape human behavior. The present paper contends that culturally constituted 'aesthetics' of everyday life underlies moments of health, illness and healing among Yolmo Sherpa of Helambu, Nepal. The author examines cultural understandings of bodily and social experience to show how implicit aesthetics--from values of harmony and balance to fears of loss and decay--shape the ways in which Yolmo manage and evaluate their lives and how they construe and experience incidents of 'soul loss.' An analysis of shamanic ritual suggests, in turn, that while themes of imbalance, fragmentation and deficiency haunt the body in illness, healing works to reinstate a visceral sense of harmony, completion and vitality. These values reflect pressing political concerns. The paper concludes that a phenomenology of embodied aesthetics requires an analytic approach distinct from current semiotic, intellectualist, or psychological paradigms.
We performed a cross-sectional study to evaluate the association of anemia with diastolic dysfunction and left ventricular hypertrophy (LVH) in outpatients who had coronary artery disease. Logistic regression was used to examine the association of blood hemoglobin (Hb) concentrations with diastolic dysfunction and LVH in 822 participants in the Heart and Soul Study who had normal sinus rhythm and preserved systolic function (left ventricular ejection fraction >/=50%). Using transthoracic echocardiography, diastolic dysfunction was defined as diastolically dominant pulmonary vein flow, and LVH was defined as left ventricular mass index >90 g/m(2). Anemia (Hb <13 g/dl) was present in 24% of participants (197 of 822). The prevalence of diastolic dysfunction ranged from 8% in participants who did not have anemia (Hb >/=13 g/dl) to 13% in those who had moderate anemia (Hb 11 to 13 g/dl) to 24% in those who had severe anemia (Hb <11 g/dl, p = 0.004 for trend). After multivariable adjustment, moderate anemia (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.1 to 3.6) and severe anemia (OR 6.6, 95% CI 1.9 to 24.9) remained strongly associated with diastolic dysfunction. In contrast, moderate anemia (OR 1.4, 95% CI 1.0 to 2.1) and severe anemia (OR 1.6, 95% CI 0.6 to 4.6) were not significantly associated with LVH. We found anemia to be strongly associated with diastolic dysfunction but not with LVH in this community-based sample of outpatients who had established coronary disease.
BACKGROUND: Control of hypertension is paramount in treating chronic kidney disease. The relationship between kidney function and blood pressure (BP) components has been studied in persons with diagnosed CKD, diabetes, or hypertension. Whether kidney function in the normal range is associated with systolic BP (SBP), diastolic BP (DBP), and pulse pressure is unclear. METHODS: We evaluated the association between kidney function and each BP component using cystatin C and 24-h creatinine clearance (CrCl) among 906 participants in the Heart and Soul Study. RESULTS: We observed that SBP was linearly associated with cystatin C concentrations (1.19+/-0.55 mm Hg increase per 0.4 mg/L cystatin C, P=.03) across the range of kidney functions. In contrast, using CrCl, SBP was significantly associated with kidney function only in subjects with CrCl<60 mL/min (6.4+/-2.13 mm Hg increase per 28 mL/min, P=.003) but not >60 mL/min (0.36+/-0.77 mm Hg per 28 mL/min, P=.64). Slopes differed significantly (for spline term P=.001). We found that DBP was not associated with cystatin C (0.34+/-0.40 mm Hg per 0.4 mg/L cystatin, P=.39) or CrCl (0.62+/-0.44 mm Hg per 28 mL/min clearance, P=.16). Pulse pressure was linearly associated with cystatin C (1.28+/-0.55 mm Hg per 0.4 mg/L cystatin, P=.02) and with CrCl<60 mL/min (7.27+/-2.16 mm Hg per 28 mL/min, P=.001). CONCLUSIONS: Both SBP and pulse pressure were significantly associated with kidney function across a wide range of cystatin C concentrations, even in subjects with presumably normal kidney function, by creatinine-based measures. Cystatin C may provide new insights into the association of CKD and hypertension, a relationship that may be an underappreciated barrier to hypertension control.
BACKGROUND: Echocardiograms routinely sample pulmonary regurgitation signals from which it is possible to measure end diastolic gradients; these correlate with pulmonary artery diastolic pressures. METHODS: We performed echocardiograms in 741 ambulatory adults with coronary artery disease who were recruited for the Heart and Soul Study. We compared indicators of cardiac status among individuals with normal (0-5.0 mm Hg) and elevated (> 5.0 mm Hg) end diastolic pulmonary regurgitation (EDPR) gradients. RESULTS: Of the 481 participants with measurable EDPR gradients, 21% had elevated EDPR gradients (> 5.0 mm Hg). EDPR gradients > 5.0 mm Hg were associated with higher New York Heart Association functional class (P = .002), higher brain natriuretic peptide (P = .002), fewer metabolic equivalents achieved on treadmill testing (P < 0.001), and higher left ventricular mass (P < 0.001). The EDPR gradient > 5.0 mm Hg had a sensitivity of 25% (95% confidence interval 20-30%) and a specificity of 86% (80-91%) for detecting at least one of the following: systolic dysfunction, diastolic dysfunction, or abnormal wall motion score. The EDPR gradient > 5.0 mm HG was statistically equivalent to the tricuspid regurgitation (TR) gradient > 30 mm Hg in terms of diagnostic value (area under the receiver operating characteristic curve equaled 0.58 for each test). The EDPR gradient increased the yield of pulmonary artery pressures from 61% (TR gradient alone) to 84% (P < .0001). CONCLUSION: The EDPR gradient provides valuable information independent of the TR gradient in evaluating pulmonary artery pressures and cardiac dysfunction.
OBJECTIVES: We compared the predictive ability of tricuspid regurgitation (TR) and end-diastolic pulmonary regurgitation (EDPR) gradients in outpatients with coronary artery disease. BACKGROUND: The TR and EDPR gradients, in conjunction with right atrial pressure, provide Doppler estimates of pulmonary artery systolic and diastolic pressures. We hypothesized that increases in TR or EDPR gradients in stable coronary artery disease would predict heart failure (HF) hospitalization or cardiovascular (CV) death. METHODS: We measured TR and EDPR gradients in 717 adults with completed outcome adjudications who were recruited for the Heart and Soul Study. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for HF hospitalization, CV death, all-cause death, and the combined end point. Multivariate adjustments were made for age, gender, race, history of CV or pulmonary disease, functional class, and left ventricular ejection fraction. RESULTS: There were 63 HF hospitalizations, 19 CV deaths, and 86 all-cause deaths at the 3-year follow-up. There were 466 measurable EDPR gradients and 573 measurable TR gradients. Age-adjusted ORs for EDPR >5 mm Hg predicted HF hospitalization (2.7, 95% CI 1.3 to 5.5, p = 0.006), all-cause death (2.5, 95% CI 1.4 to 4.4, p = 0.002), and HF hospitalization or CV death (2.7, 95% CI 1.4 to 5.2, p = 0.004). Age-adjusted OR for TR >30 mm Hg predicted HF hospitalization (3.4, 95% CI 1.9 to 6.2, p < 0.0001) and HF hospitalization or CV death (3.0, 95% CI 1.7 to 5.3, p = 0.0001). Multivariate adjusted OR per 5-mm Hg incremental increases in EDPR predicted HF hospitalization or CV death (1.9, 95% CI 1.01 to 3.6, p = 0.046) and all-cause death (1.7, 95% CI 1.05 to 2.8, p = 0.03). Multivariate adjusted OR per 10-mm Hg incremental increases in TR predicted HF hospitalization or CV death (1.6, 95% CI 1.1 to 2.4, p = 0.008). CONCLUSIONS: Increases in EDPR or TR gradients predict HF hospitalization or CV death among ambulatory adults with coronary artery disease.
The birth of scientific neuropsychology is traditionally considered to have taken place during the 19th century when disturbances or losses of specific mental functions were systematically correlated with post-mortem findings of localized cerebral pathology. Attempts at localizing psychic functions were of course made earlier, but they were usually not based on scientific observations with one notable and so far neglected exception. At the beginning of the 18th century the French surgeon François Gigot de La Peyronie systematically tried to correlate deficits of mental functions with autopsy findings. The methodological principles he formulated were sound and do not essentially differ from those used in modern scientific neuropsychology. His method was based on the systematic exclusion of those areas of the brain whose lesions are not associated with disruption of the faculties of the soul combined with the careful examination of cases where such association consistently exists. His conclusions were, however, disappointing from the modern point of view and he obviously failed to found a new scientific discipline. The reasons for this failure obviously lay in the dualistic presuppositions which made him look for the unique locus of mind-body interaction instead of localizing specific functions.
BACKGROUND: The Par-3/Par-6/aPKC complex is a key regulator of cell polarity in a number of systems. In Drosophila, this complex acts at the zonula adherens (adherens junctions) to establish epithelial polarity and helps to orient the mitotic spindle during asymmetric neuroblast divisions. In MDCKII cells, this complex localizes to the zonula occludens (tight junctions) and appears to regulate epithelial polarity. However, the in vivo role of this complex during vertebrate embryogenesis is not known, due to the lack of relevant mutations. RESULTS: We have positionally cloned the zebrafish heart and soul (has) mutation, which affects the morphogenesis of several embryonic tissues, and show that it encodes atypical protein kinase C lambda (aPKC lambda). We find that loss of aPKC lambda affects the formation and maintenance of the zonula adherens in the polarized epithelia of the retina, neural tube, and digestive tract, leading to novel phenotypes, such as the formation of multiple lumens in the developing intestine. In addition, has mutants display defects in gut looping and endodermal organ morphogenesis that appear to be independent of the defects in epithelial polarity. Finally, we show that loss of aPKC lambda leads to defects in spindle orientation during progenitor cell divisions in the neural retina. CONCLUSIONS: Our results show that aPKC lambda is required for the formation and maintenance of the zonula adherens during early epithelial development in vertebrates and demonstrate a previously undescribed yet critical role for this protein in organ morphogenesis. Furthermore, our studies identify the first genetic locus regulating the orientation of cell division in vertebrates.
BACKGROUND: One of the earliest steps in heart formation is the generation of two chambers, as cardiogenic cells deployed in the epithelial sheet of mesoderm converge to form the nascent heart tube. What guides this transformation to organotypic form is not known. RESULTS: We have identified a small molecule, concentramide, and a genetic mutation called heart-and-soul (has) that disrupt heart patterning. Both cause the ventricle to form within the atrium. Here, we show that the has gene encodes PKC lambda. The effect of the has mutation is to disrupt epithelial cell-cell interactions in a broad range of tissues. Concentramide does not disrupt epithelial interactions, but rather shifts the converging heart field rostrally. What is shared between the concentramide and has effects is a reversal of the order of fusion of the anterior and posterior ends of the heart field. CONCLUSIONS: The polarity of cardiac tube assembly is a critical determinant of chamber orientation and is controlled by at least two distinct molecular pathways. Combined chemical/genetic dissection can identify nodal points in development, of special importance in understanding the complex patterning events of organogenesis.
Computing plays an important role in genetics (and vice versa). Theoretically, computing provides a conceptual model for the function and malfunction of our genetic machinery. Practically, contemporary computers and robots equipped with advanced algorithms make the revelation of the complete human genome imminent--computers are about to reveal our genetic souls for the first time. Ethically, computers help protect privacy by restricting access in sophisticated ways to genetic information. But the inexorable fact that computers will increasingly collect, analyze, and disseminate abundant amounts of genetic information made available through the genetic revolution, not to mention that inexpensive computing devices will make genetic information gathering easier, underscores the need for strong and immediate privacy legislation.
In addition to the well-publicized problems with reimbursement and manpower in electrophysiology, there is a less well publicized crisis brewing in regards to physicians' social and mental health. The last decades have witnessed tremendous increases in divorce, alcoholism, substance abuse, and suicide among physicians. While the causative factors involved are complex and varied they are, in part, related to a loss of the "soul" in modern medical practice. The following paper tries to address the factors behind this loss and suggests ways to correct it.
Neither literary critics nor historians of science have acknowledged the extent to which Bram Stoker's Dracula (1897) is indebted to late-Victorian neurologists, particularly David Ferrier, John Burdon-Sanderson, Thomas Huxley, and William Carpenter. Stoker came from a family of distinguished Irish physicians and obtained an M.A. in mathematics from Trinity College, Dublin. His personal library contained volumes on physiology, and his composition notes for Dracula include typewritten pages on somnambulism, trance states, and cranial injuries. Stoker used his knowledge of neurology extensively in Dracula. The automatic behaviors practiced by Dracula and his vampiric minions, such as somnambulism and hypnotic trance states, reflect theories about reflex action postulated by Ferrier and other physiologists. These scientists traced such automatic behaviors to the brain stem and suggested that human behavior was "determined" through the reflex action of the body and brain-a position that threatened to undermine entrenched beliefs in free will and the immortal soul. I suggest that Stoker's vampire protagonist dramatizes the pervasive late-nineteenth-century fear that human beings are soulless machines motivated solely by physiological factors.
This article describes the evaluation of the HIV/AIDS communication aspect of the multi media Soul City health promotion intervention in South Africa. The intervention consists of a television and radio drama and print material. The evaluation was multifaceted with a before and after national survey and a national qualitative study. In the before and after survey change was measured and then multiple regression analysis was performed to assess the variables associated with the change. The qualitative study consisted of focus group discussions, which were analysed thematically. The studies show that there are numerous instances of community change and how the change is mediated at the community level. The studies also describe the change at a number of levels of the described behaviour change model for individuals.
Thomas Willis's description of the intercostal nerves has not received much attention by historians of medicine. Yet the intercostal nerves are of paramount importance for his neurology. Willis explained that via these nerves, which connect the brain to the heart and lower viscera, the brain controls the passions and instincts of the lower body. In other words, Willis believed that the intercostal nerves mediate a kind of rationality and that therefore they make a human a rational being. Willis's theory, I argue, must be seen in the context of the early modern mind-body problem. In the second part of the article I discuss how Oxford theologian Samuel Parker took up Willis's argument while stating that the intercostal nerves are the most important instruments (reins) of the soul. They control the bodily passions so that humans can transform into more virtuous beings. The explanation of the intercostal nerves offered by Willis and Parker fits the Anglican optimism about the abilities of human reason as well as about the moral potential of humankind.
BACKGROUND: Cystatin C is a marker of kidney function that may also be associated with inflammation. In this study, we compared the relative strengths of association of cystatin C and estimated glomerular filtration rate (eGFR) with inflammatory biomarkers. METHODS: We measured serum cystatin C and creatinine in 990 outpatients with coronary artery disease enrolled in the Heart and Soul Study. GFR was estimated (eGFR) by the abbreviated Modification of Diet in Renal Disease (MDRD) equation. We compared the associations of serum cystatin C and eGFR with C-reactive protein (CRP) and fibrinogen, after adjustment for 24 h creatinine clearance. RESULTS: Cystatin C concentrations had moderate correlations with CRP (r=0.15, P<0.001) and fibrinogen (r=0.26, P<0.0001); eGFR had similar correlations with CRP (r=-0.17, P=0.01) and fibrinogen (r=-0.25, P<0.001) among persons with eGFR 60 ml/min (r=0.04, P=0.32; r=-0.03, P=0.38). Quartiles of cystatin C were strongly and directly associated with CRP (P=0.02) and fibrinogen (P<0.007) after multivariate adjustment. However, these associations disappeared after adjustment for creatinine clearance (P=0.26 and 0.23, respectively). CONCLUSIONS: Cystatin C concentrations have moderate associations with CRP and fibrinogen that are not independent of creatinine clearance. Although a gold standard of kidney function is lacking, this analysis suggests that cystatin C captures an association of mildly impaired kidney function with increased inflammation.