Diverse origins of near-identical antifreeze proteins in unrelated fish lineages provide insights into evolutionary mechanisms of new gene birth and protein sequence convergence.

Determining the origins of novel genes and the genetic mechanisms underlying the emergence of new functions is challenging yet crucial for understanding evolutionary innovations. The novel fish antifreeze proteins, exemplifying convergent evolution, represent excellent opportunities to investigate the evolutionary origins and pathways of new genes. Particularly notable is the near-identical type I antifreeze proteins (AFPI) in four phylogenetically divergent fish taxa. This study tested the hypothesis of protein sequence convergence beyond functional convergence in three unrelated AFPI-bearing fish lineages, revealing different paths by which a similar protein arose from diverse genomic resources. Comprehensive comparative analyses of de novo sequenced genome of the winter flounder and grubby sculpin, available high-quality genome of the cunner, and those of 14 other relevant species found that the near-identical AFPI originated from a distinct genetic precursor in each lineage, and independently evolved coding regions for the novel ice-binding protein while retaining sequence identity in the regulatory regions with their respective ancestor. The deduced evolutionary processes and molecular mechanisms is consistent with the Innovation-Amplification-Divergence (IAD) model applicable to AFPI formation in all three lineages, a new Duplication-Degeneration-Divergence (DDD) model we propose for the sculpin lineage, and a DDD model with gene fission for the cunner lineage. This investigation illustrates the multiple ways by which a novel functional gene with sequence convergence at the protein level could evolve across divergent species, advancing our understanding of the mechanistic intricacies in new gene formation.

Mental health services in Gauteng, South Africa: A proxy evaluation using pharmaceutical data.

Background: South African legislation advocates for equitable access to mental healthcare services integrated into general healthcare settings. Mental, neurological, and substance use (MNS) disorders are often comorbid. Pharmacoepidemiology provides indirect evidence of service provision for conditions amenable to medicine treatment. Aim: The study aims to evaluate medicine procurement for MNS disorders at different service levels in the health system. Setting: The Public health sector, Gauteng province formed the setting for the study. Method: A secondary analysis of the Gauteng pharmaceutical database was conducted using Anatomic Therapeutic Chemical (ATC) and defined daily dose (DDD) methodology. Anatomic Therapeutic Chemical classes of medicines for MNS disorders were included. Defined daily doses and costs were calculated per 1000 population served by each facility and service level. Statistical comparisons were made using chi-square testing. Results: General healthcare settings accounted for 90% (R118 638 248) and specialised hospitals for 10% (R13 685 032) of expenditure on medicines for MNS disorders, procuring 94% (n = 49 442 474) and 6% (n = 3 311 528) of DDDs, respectively. Although district clinics procured 60% of DDDs, they procured the least per 1000 population served, whereas district hospitals procured the most. For almost all ATC classes, procurement differed significantly between municipalities at every service level and between specialised hospitals. Conclusion: In Gauteng province, most medicines for MNS disorders are procured by general healthcare services, but access to care may not be equitable. While population coverage at district clinics appears low, district hospitals may experience the greatest care burden. Research regarding quality of care at each service level is recommended. Contribution: This study provides insight into service provision for MNS disorders.

Complete genome sequence of Chlamydia psittaci АМК-16, isolated from a small ruminant in the Middle Volga Region, Russia.

We report the complete genome sequence of the Chlamydia psittaci АМК-16, recovered from the aborted caprine fetus during a case of chlamydia infection. This 1,152,497-bp genome with 7,552-bp cryptic plasmid provides novel insights into the genetic diversity of chlamydia agent strains particularly those causing the infection in small ruminants.

On Theoretical Edges and Exclusionary Borders: Towards a Genealogy of "Analyzability" in Jungian Psychoanalysis1.

An oft-repeated and largely unexamined assumption in Jungian psychoanalysis is the notion of "analyzability", that is, of an individual's ability or present capacity to think symbolically. It is often taught that if someone is unable to think symbolically, a depth analysis is not possible. Such an individual may be more aptly suited for supportive psychotherapy, the argument goes, an experience that may very well lead to the development of the ego's capacity for symbolic thought but is not, in and of itself, a Jungian analysis. While this sort of categorical thinking has, at times, crossed over into ontological claims about individuals and groups, the notion of analyzability encountered in psychoanalytic theory and praxis is often cloaked in facially neutral language. The impact, however, has been anything but neutral in effect. In this paper, I propose a softening of our theoretical edges through a genealogy of the category of analyzability within the broader history of psychoanalysis. Through this excavation, I explore the contingent nature of the category of analyzability, how it has constricted knowledge, perpetuated inequality, and, more broadly, obscured ways of knowing. In so doing, I recover the radically democratic potential that lies at the heart of Jungian psychoanalysis.

Notre tente jungienne est peut­être grande et ses contours théoriques indispensables, mais que se passe­t­il lorsque nos contours théoriques se durcissent, devenant des frontières inhospitalières, des frontières servant à exclure et des zones d'occlusion? Une hypothèse souvent mise en avant et peu remise en question dans la psychanalyse jungienne est la notion d'« analysabilité ¼, c'est­à­dire de l'aptitude d'une personne, ou de sa capacité actuelle, à penser symboliquement. On enseigne souvent que si quelqu'un est incapable de penser symboliquement, une analyse en profondeur n'est pas possible. A une telle personne on proposerait plutôt une psychothérapie de soutien, une expérience qui peut très bien conduire au développement de la capacité de pensée symbolique de l'ego, mais qui n'est pas, en soi, une analyse jungienne. Alors que ce type de pensée catégorique a, en certaines occasions, rejoint des revendications ontologiques sur les individus et les groupes, la notion d'analysabilité rencontrée dans la théorie et la pratique psychanalytiques est souvent enveloppée dans un langage apparemment neutre. L'impact, cependant, a été tout sauf neutre dans ses effets. Dans cet article, je propose un assouplissement de nos frontières théoriques à travers une généalogie du concept d'analysabilité au sein de l'histoire plus large de la psychanalyse. À travers cette plongée, j'ai pour but d'explorer la nature contingente de la notion d'analysabilité, de voir comment elle a limité la connaissance, perpétué des inégalités et, plus largement, obscurci les modes de connaissance. Par cette démarche, je crois que nous pourrions nous rendre compte du potentiel radicalement démocratique qui se trouve au cœur de la psychanalyse jungienne.

Nuestra tienda junguiana puede ser amplia y sus bordes teóricos vitales, pero ¿qué ocurre cuando nuestros bordes teóricos se endurecen, agudizándose en fronteras inhóspitas, límites de exclusión y zonas de oclusión? Un supuesto a menudo repetido y en gran medida no examinado en el psicoanálisis Junguiano es la noción de "analizabilidad", es decir, de la habilidad o capacidad actual de un individuo para pensar simbólicamente. A menudo se enseña que si alguien es incapaz de pensar simbólicamente, no es posible un análisis en profundidad. Tal individuo, se argumenta, puede ser más adecuado para una psicoterapia de apoyo, una experiencia que puede muy bien conducir al desarrollo de la capacidad del ego para el pensamiento simbólico, pero no es, en sí misma, un análisis Junguiano. Aunque este tipo de pensamiento categórico se ha extendido, en ocasiones, a afirmaciones ontológicas sobre individuos y grupos, la noción de analizabilidad encontrada en la teoría y práctica psicoanalíticas suele estar envuelta en un lenguaje aparentemente neutro. Sin embargo, su impacto no ha sido neutro en absoluto. En este artículo, propongo suavizar nuestros bordes teóricos a través de una genealogía de la categoría de analizabilidad dentro de la historia más amplia del psicoanálisis. A través de esta excavación, propongo explorar la naturaleza contingente de la categoría de analizabilidad, cómo ha restringido el conocimiento, perpetuado la desigualdad y, más ampliamente, oscurecido las formas de conocer. Al hacerlo, creo que podríamos darnos cuenta del potencial radicalmente democrático que yace en el corazón del psicoanálisis Junguiano.

Unhinged: A Prospective Perspective on Being Unsafe1.

Given the unprecedented events unfolding around the globe over the past four years, psychoanalytic communities near and far have sought to ask and ventured to answer the question: What does psychoanalysis have to offer individuals, and the collective, as a way of seeing and being with the reality of what is? Taking up these questions in such a time as this, feels, perhaps inevitably, unsafe. Sometimes it can feel as if there is a silent and unspoken mandate to ensure safety at all costs when we seek to find a spirit of the depth's response to the spirit of the times. I propose that the work of psychoanalysis is grounded in nothing but the journey through that which is unsafe. This article will take up Ann Ulanov's notion that one's own evil is the hinge door into collective and archetypal evil. To become unhinged means to risk well-formulated understandings, theories, and modalities about being and becoming for the other and instead to allow the other to penetrate that which is unknown in ourselves, upending our well-formed theories and pressing us to take up our own lives in new and unpredictable ways.

Compte tenu des événements sans précédent qui se sont déroulés dans le monde entier au cours des quatre dernières années, les communautés psychanalytiques proches et lointaines ont cherché à poser la question suivante et à y proposer des réponses: qu'est­ce que la psychanalyse peut offrir aux individus, et au collectif, comme moyen de voir et d'être avec la réalité de ce qui est ? Aborder ces questions dans un moment comme celui­ci nous fait nous sentir en danger, et c'est peut­être inévitable. Parfois, on peut avoir le sentiment qu'il y a un décret silencieux et tacite d'assurer la sécurité à tout prix lorsque nous cherchons à trouver une réponse de l'esprit des profondeurs à l'esprit du temps. Je propose que le travail de la psychanalyse n'est fondé sur rien d'autre que le voyage à travers ce qui est dangereux, risqué. C'est, en effet, ce qu'implique la recherche d'une conversation active et vivante avec l'esprit des profondeurs et c'est ce qui distingue le travail de thérapie du travail de psychanalyse. Si nous nous enfermons dans des notions de sécurité, nous resterons liés à des notions similaires d'anonymat analytique et d'innocence, restant inconscients de notre propre implication dans les horreurs qui continuent d'aliéner, d'étouffer et d'isoler ceux qui sont en marge. Cette présentation reprendra la conception d'Ann Ulanov selon laquelle le mal d'une personne est la porte charnière du mal collectif et archétypal. Notre travail, individuellement et collectivement, est de descendre dans ce territoire dangereux à l'intérieur de nous­mêmes pour voir ce qui s'y est passé et ce qui reste à vivre dans les zones d'ombre. Devenir déséquilibré signifie mettre en doute des compréhensions, des théories et des modalités bien formulées sur l'être et le devenir pour l'autre et, à la place, permettre à l'autre de pénétrer ce qui est inconnu en nous­mêmes, bouleversant nos théories bien formées et nous poussant à prendre notre propre vie en main d'une manière nouvelle et imprévisible. En ce sens, la psychanalyse est intrinsèquement une forme d'activisme intérieur et extérieur. Ce qui est proposé ici est un regard sur la façon dont la psychanalyse, déséquilibrée, se déplace au­delà des murs sécurisants et au­delà des murs de la salle de consultation vers le monde au sens large.

Dados los acontecimientos sin precedentes que han tenido lugar en todo el mundo en los últimos cuatro años, las comunidades psicoanalíticas cercanas y lejanas han tratado de preguntarse y han intentado responder a la pregunta: ¿qué tiene el psicoanálisis que ofrecer a los individuos, y al colectivo, en términos de ver y estar con la realidad de lo que acontece? Abordar estas cuestiones en un momento como el actual puede resultar inevitablemente inseguro. A veces puede dar la sensación de que existe un mandato silencioso y tácito de garantizar la seguridad a toda costa cuando tratamos de encontrar una respuesta del espíritu de las profundidades al espíritu de los tiempos. Propongo que el trabajo del psicoanálisis no se basa en otra cosa que en el viaje a través de lo que es inseguro. Esto, de hecho, es lo que implica buscar una conversación activa y viva con el espíritu de las profundidades y es lo que distingue el trabajo de la terapia del trabajo del psicoanálisis. Si nos encerráramos en las nociones de seguridad, seguiríamos limitados por nociones similares de neutralidad analítica e inocencia, permaneciendo inconscientes de nuestra propia implicancia en los horrores que continúan ajenos, encerrando y aislando a aquellos que se encuentran en los márgenes. Esta presentación retomará la noción de Ann Ulanov de que el mal propio es la puerta de entrada al mal colectivo y arquetipal. Nuestro trabajo individual y colectivo es descender a este territorio inseguro dentro de nosotros mismos para ver lo que ocurrió allí y lo que permanece viviendo en las sombras. Perturbarse significa arriesgar comprensiones, teorías y modalidades bien formuladas sobre el ser y el devenir para el otro y, en su lugar, permitir que el otro penetre en lo que es desconocido en nosotros mismos, trastornando nuestras teorías bien formadas y presionándonos para que asumamos nuestras propias vidas de maneras nuevas e impredecibles. De este modo, el psicoanálisis es inherentemente una forma de activismo interior y exterior. Lo que se ofrece es una mirada sobre cómo el psicoanálisis, perturbado, traspasa los muros de la seguridad y va más allá de las paredes del consultorio analítico para adentrarse en el mundo en general.

War: Mentalization and Totalitarian State of Mind.

For most residents of Europe, war is a new experience in which they find themselves both as witnesses and participants. In this paper the war in Ukraine serves as an illustration and case example. Like any unfamiliar experience, war elicits profound emotional responses which can be so overwhelming that an individual may be unable to fully process them and to create mental representations of the reality of war. When the psyche becomes entrapped in an unprocessed state, without the capacity to derive meaning from it, this results in the "fossilization" of the psyche akin to what McGinley and Segal describes as a totalitarian state of mind. Subjectivity and individual differences come under collective or personal attack, or both. This state of being prioritizes the needs of the collective psyche over the individual psyche. The image of Gorgon Medusa, who transformed living people into "fossilized" ones, is presented as a metaphor of total identification with the collective dimension. In contrast, the psyche can reveal a creative approach to resolving war-induced trauma. This is depicted in the concept of the Alchemical Stone and its creation, which symbolizes a harmonious connection between the external and internal realms, the subjective and objective experiences, and the real and the imaginal dimension.

Pour la plupart des habitants de l'Europe, la guerre est une nouvelle expérience dans laquelle ils se retrouvent à la fois témoins et participants. Dans cet article, la guerre en Ukraine sert d'illustration et de cas exemplaire. Comme toute expérience qui sort de l'ordinaire, la guerre suscite des réactions émotionnelles profondes qui peuvent être si accablantes qu'un individu peut se trouver incapable de les traiter pleinement et de créer des représentations mentales de la réalité de la guerre. Lorsque la psyché se retrouve piégée dans un état qu'elle ne peut pas traiter, sans la capacité d'en tirer un sens, il en résulte une « fossilisation ¼ de la psyché, semblable à ce que McGinley et Segal a décrit comme un état d'esprit totalitaire. La subjectivité et les différences individuelles font l'objet d'attaques collectives ou personnelles, ou des deux. Cet état d'être donne la priorité aux besoins de la psyché collective plutôt qu'à la psyché individuelle. L'image de la Gorgone Méduse, qui a transformé des êtres vivants en êtres «fossilisés¼, est présentée comme une métaphore de l'identification totale à la dimension collective. En revanche, la psyché peut révéler une approche créative pour résoudre les traumatismes induits par la guerre. Ceci est représenté par le concept de la Pierre Alchimique et de sa création, qui symbolise un lien harmonieux entre les royaumes extérieur et intérieur, les expériences subjectives et objectives, et les dimensions réelles et imaginales.

Para la mayoría de los habitantes de Europa, la guerra es una experiencia nueva en la que se encuentran tanto como testigos y como participantes. En este artículo, la guerra en Ucrania sirve como ilustración y ejemplo de caso. Como cualquier experiencia desconocida, la guerra provoca profundas respuestas emocionales que pueden ser tan abrumadoras que un individuo puede ser incapaz de procesarlas completamente y de crear representaciones mentales de la realidad de la guerra. Cuando la psique queda atrapada en un estado, sin posibilidad de elaborar y sin la capacidad para hallarle un sentido, se produce una "fosilización" de la psique similar a lo que McGinley Segal describe como un estado mental Totalitario. La subjetividad y las diferencias individuales son objeto de ataques colectivos o personales, o ambos. Este estado de ánimo prioriza las necesidades de la psique colectiva sobre la individual. La imagen de la Gorgona Medusa, que transformó a las personas vivas en "fosilizadas", se presenta como una metáfora de la identificación total con la dimensión colectiva. Por el contrario, la psique puede revelar un enfoque creativo para resolver el trauma inducido por la guerra. Esto se representa en el concepto de la Piedra Alquímica y su creación, que simboliza una conexión armoniosa entre los reinos externo e interno, las experiencias subjetivas y objetivas, y las dimensiones real e imaginal.

Prescriptions of homeopathic remedies at the expense of the German statutory health insurance from 1985 to 2021: scientific, legal and pharmacoeconomic analysis.

The prescription of homeopathic remedies at the expense of the statutory health insurance (SHI) system in Germany has been criticized for years due to a lack of evidence. Now, on the planned abolition of the reimbursement of homeopathic medicines in Germany, the debate on this topic has been reignited. The aim of this paper is to show the costs and their development over time incurred by homeopathic remedies in the healthcare system from 1985 to 2021. For this purpose, 15 selected homeopathic medicines were chosen from the drug prescription report (Arzneiverordnungsreport) and analyzed with regard to their development of DDD (Defined Daily Dose) using data from the Wissenschaftliches Institut der Ortskrankenkassen (WidO, Scientific Institute of the General Local Health Insurance Funds) and compared with their respective rational pharmacological alternatives. The price comparison was based on the DDD costs and the pharmacy retail price of the smallest packaging in each case. The clinical study situation for the preparations was also analyzed. For this purpose, the clinical studies provided by the manufacturer and those on PubMed were divided into evidence levels and analyzed. In addition, the presentation of homeopathic remedies on company websites, in online pharmacies, in specialist information and package leaflets was analyzed with regard to side effects, interactions, indication, and information on the alleged effect/proof of efficacy. In many media, information on homeopathic medicines remained incomplete, and non-compliance with the Therapeutic Product Advertising Act (Heilmittelwerbegesetz) was noted. Naming of the products if often very suggestive, too. Manufacturers' claims of efficacy go far beyond what can be considered proven in terms of evidence-based medicine and the quality of most clinical studies is poor. Homeopathic remedies are on average significantly more expensive than their rational pharmacological alternatives. Furthermore, DDD costs have continued to rise over the years analyzed. In aggregate, from a pharmacoeconomic, legal, and scientific perspective, abolition of reimbursement of homeopathic medicines in Germany at the expense of the SHI system is well justified.

Treatment Cost Along With Pattern of Disease and Therapy in the Intensive Care Unit of a Tertiary Care Teaching Hospital in India.

Background The intensive care unit (ICU) represents an important platform for conducting drug utilization analysis using defined daily dose (DDD)/100 bed-days and the financial burden of treatment as patients are seriously ill and are often suffering from chronic critical illnesses. Therefore, in this study, we evaluated the drug utilization patterns and cost of treatment in the ICU. Methods A retrospective observational analysis of the medical records obtained for the medical ICU of an apex tertiary care teaching hospital in central India was conducted for a period of three years from 2017 to 2019. All the patients admitted to the medical ICU during the study tenure were included in the study. Patients hospitalized in neonatal intensive care unit (NICU), pediatric intensive care unit (PICU), and surgical ICU were excluded from the study. The socio-demographic and clinical data, utilization of different classes of drugs, WHO-Anatomic Therapeutic Chemical (WHO-ATC) classification, DDD/100 bed days, hospital stay, etc. were analyzed. A partial pharmaco-economic analysis of the average cost of admission to patients was done. Results Data from 280 patients was assessed. The mean age was 47 ± 19.18 years and 58% were males. Antibiotics and injections were prescribed to 96% and 97.5% of the patients, respectively, during their ICU stay (median: seven days). Antimicrobial drugs were most frequently prescribed (n=1096, 68%); the most common were beta-lactams and carbapenems, followed by drugs acting on the central nervous system (5%) and cardiovascular system (4.3%). Cefoperazone/sulbactum, ceftriaxone, and piperacillin/tazobactam were the most utilized antibiotics with 8, 16, and 6 DDD/100 bed-days, respectively, while proton pump inhibitors, analgesics, and anti-epileptics were the most frequently prescribed non-antimicrobial drug class. The median cost of treatment per ICU admission was Indian Rupees (INR) 23,347 (IQR 12,552- 65,524). Conclusion Drug utilization assessment provides crucial information for understanding the usage of drugs in the settings of the ICU, and should be conducted regularly to help in the proper planning and implementation of rational drug use. Treatment costs reflect the high economic burden seen in ICU admissions.

In Memory of Anthony Stevens: A Career Retrospective with Emphasis on His Formative Role in the Archetype Debate.

This paper celebrates the life and legacy of psychiatrist and Jungian author Anthony Stevens, who passed away at age 90 on July 13, 2023. It outlines Stevens's origins as a research fellow in Greece, where his work on infant attachment led to a lifelong dedication to establishing the biological and evolutionary foundation of psychiatry. It details his instrumental role in the debate about the theory of archetypes and describes the current state of the literature including the responses and reactions to Stevens's biological innatist position. The paper concludes with a career retrospective in which Stevens's major works are introduced and briefly described.

Cet article célèbre la vie et l'héritage du psychiatre et auteur jungien Anthony Stevens, décédé à l'âge de 90 ans le 13 juillet 2023. L'article décrit les origines de Stevens en tant que chercheur en Grèce, où ses travaux sur l'attachement du nourrisson l'ont conduit à se consacrer toute sa vie à établir le fondement biologique de la psychiatrie, dans une perspective évolutionniste. L'article détaille son rôle important dans le débat sur la théorie des archétypes et décrit l'état actuel de la littérature, y compris les réponses et réactions à la position biologique innéiste de Stevens. L'article se termine par une rétrospective de sa carrière, dans laquelle les œuvres majeures de Stevens sont présentées et brièvement décrites.

Este artículo celebra la vida y el legado del psiquiatra y autor Junguiano Anthony Stevens, quien falleció a los 90 años el 13 de julio de 2023. Describe los orígenes de Stevens como investigador en Grecia, donde su trabajo sobre el apego infantil lo llevó a una dedicación de por vida para establecer los fundamentos biológicos y evolutivos de la psiquiatría. Detalla su papel instrumental en el debate sobre la teoría de los arquetipos y describe el estado actual del arte, incluyendo las respuestas y reacciones a la posición biológica innatista de Stevens. El artículo concluye con una retrospectiva de su carrera en la que se presentan y describen brevemente las principales obras de Stevens.

Research on the volatility, phase transitions and thermodynamic stability of five organochlorine compounds.

The present investigation describes the experimental evaluation of relevant physicochemical properties of five organochlorine compounds (OCs), including some that are related to their environmental mobility. The vapor pressures of (2,4'-Dichlorodiphenyl)dichloroethane (2,4'-DDD, CASN:53-19-0), 1,1-Dichloro-2,2-bis(4-chlorophenyl)ethane (4,4'-DDD, CASN:72-54-8) and 2,2-Bis(4-chlorophenyl)acetic acid (4,4'-DDA, CASN:83-05-6), as well as of the bactericide Nitrapyrin (CASN:1929-82-4) and of the rodenticide Crimidine (CASN:535-89-7) were determined at different temperatures. The Knudsen mass-loss effusion technique was employed to determine the sublimation vapor pressures of the referred compounds, apart from Crimidine. For the latter compound, a static method using a capacitance diaphragm manometer enabled the measurement of vapor pressures of both condensed (crystalline and liquid) phases. This technique was also used to measure the vapor pressures of the crystalline phase of Nitrapyrin over a larger temperature range, as well as its vaporization vapor pressures. The results of the standard molar enthalpies, entropies, and Gibbs energies of sublimation for all five compounds and of vaporization for Crimidine and Nitrapyrin, at reference temperatures, were derived. For these two compounds the phase diagram representations of the (p,T) results, in the vicinity of the triple point, were obtained. DSC analysis enabled the determination of the crystalline heat capacities of the five OCs studied and also of their temperatures and enthalpies of fusion. Gas-phase thermodynamic properties were estimated using quantum chemical calculations. The thermodynamic stability of the compounds studied was evaluated and compared in the crystalline and gaseous phases, at 298.15 K, in consideration with estimated results of the standard Gibbs energies of formation. Combined with other physical and chemical properties, the results derived from this study can be used to predict the mobility, and environmental fate of these pollutants.

Therapy for the Dead: Working Clinically with Jung's Black Books and The Red Book.

With the 2020 publication of the facsimile edition of The Black Books, we have an opportunity to study the layers of C. G. Jung's creative writing process for the first time. In this paper, I explore Jung's practice of active imagination in relation to his fantasy dialogues with the dead during two specific episodes in 1914 and 1916. I discuss Jung's concept of the collective unconscious corresponding to the "mythic land of the dead" and I show how this idea develops in The Black Books and The Red Book, or Liber Novus, culminating in Septem Sermones ad Mortuos. I describe my work with a patient, who, in an early session, said she felt like the "living dead". I recount how the patient's experience of her own internal world began to change as we were able to wonder about the inner world of the patient's late mother and, together, to imagine her mother's lament. I consider the use of imagination when working with the concept of "therapy for the dead" (Hillman & Shamdasani, 2013, p. 164) in the context of intergenerational trauma.

Avec la parution des reproductions des Livres Noirs en 2020, nous avons pour la première fois la possibilité d'étudier les différents niveaux dans le processus d'écriture créative de C.G. Jung. Dans cet article, j'explore la pratique de Jung d'imagination active en lien avec ses dialogues imaginaires avec les morts pendant deux épisodes spécifiques ; en 1914 et 1916. J'étudie le concept de Jung d'inconscient collectif correspondant au 'pays mythique des morts' et je montre comment cette idée est développée dans les Livres Noirs et le Livre Rouge, ou Liber Novus, et culmine dans Septem Sermones ad Mortuos. Je décris mon travail avec une patiente qui, dans une des premières séances, exprima qu'elle se sentait comme un « mort-vivant ¼. Je raconte comment l'expérience que cette patiente avait de son monde interne commença à changer lorsqu'il nous fut possible de nous intéresser au monde intérieur de sa mère décédée et d'imaginer ensemble la lamentation de sa mère. Je réfléchis à l'usage de l'imagination quand on travaille avec le concept de « thérapie pour les morts ¼ (Hillman et Shamdasani, 2013, p.164) dans le contexte de traumatisme intergénérationnel.

Con la publicación de la edición facsímil de Los libros Negros en el año 2020, tenemos la oportunidad de estudiar por primera vez los diversos niveles del proceso creativo de escritura de C. G. Jung. En este artículo, exploro la práctica de la imaginación activa de Jung en relación con sus diálogos con los muertos durante dos episodios específicos en 1914 y 1916. Examino el concepto de inconsciente colectivo de Jung correspondiente a la "tierra mítica de los muertos" y muestro cómo se desarrolla esta idea en Los libros Negros y en El libro Rojo, o Liber Novus, culminando en los Siete Sermones a los Muertos. Describo mi trabajo con una paciente que, en una de las primeras sesiones, dijo sentirse como una "muerta viviente". Cuento cómo la experiencia de la paciente de su propio mundo interno empezó a cambiar cuando pudimos empezar a preguntarnos por el mundo interno de su madre fallecida y, juntas, imaginar el lamento de su madre. Considero el uso de la imaginación cuando se trabaja con el concepto de "terapia para los muertos" (Hillman & Shamdasani, 2013, p. 164) en el contexto del trauma intergeneracional.

Mental health services in Gauteng, South Africa: A proxy evaluation using pharmaceutical data

Background: South African legislation advocates for equitable access to mental healthcare services integrated into general healthcare settings. Mental, neurological, and substance use (MNS) disorders are often comorbid. Pharmacoepidemiology provides indirect evidence of service provision for conditions amenable to medicine treatment. Aim: The study aims to evaluate medicine procurement for MNS disorders at different service levels in the health system. Setting: The Public health sector, Gauteng province formed the setting for the study. Method: A secondary analysis of the Gauteng pharmaceutical database was conducted using Anatomic Therapeutic Chemical (ATC) and defined daily dose (DDD) methodology. Anatomic Therapeutic Chemical classes of medicines for MNS disorders were included. Defined daily doses and costs were calculated per 1000 population served by each facility and service level. Statistical comparisons were made using chi-square testing. Results: General healthcare settings accounted for 90% (R118 638 248) and specialised hospitals for 10% (R13 685 032) of expenditure on medicines for MNS disorders, procuring 94% (n = 49 442 474) and 6% (n = 3 311 528) of DDDs, respectively. Although district clinics procured 60% of DDDs, they procured the least per 1000 population served, whereas district hospitals procured the most. For almost all ATC classes, procurement differed significantly between municipalities at every service level and between specialised hospitals. Conclusion: In Gauteng province, most medicines for MNS disorders are procured by general healthcare services, but access to care may not be equitable. While population coverage at district clinics appears low, district hospitals may experience the greatest care burden. Research regarding quality of care at each service level is recommended. Contribution: This study provides insight into service provision for MNS disorders.

Pacing mode survival in patients with single chamber atrial pacemaker for sinus node dysfunction.

BACKGROUND: Single chamber atrial pacemaker should be sufficient for patients with sinus node dysfunction (SND) with normal atrioventricular (AV) conduction. However, most patients undergo dual chamber pacemaker implantation because of concern of new onset AV block. The annual incidence of new AV block has been reported from 0.6 to 4.4 % in various studies. OBJECTIVES: Our aim is to assess mode survival in sinus node dysfunction with normal AV conduction patients implanted with AAIR. METHODS: Patients who underwent single chamber atrial pacemaker implantation for SND with normal AV conduction between January 2014 and December 2021 were followed up for pacemaker device change, new onset AV block, bundle branch block, atrial fibrillation (AF), lead complications, reoperation and mortality rate. RESULTS: A total of 113 patients underwent single chamber atrial pacemaker implantation for SND during the study period. Mean age was 55.6 ± 12.7 years. During a mean follow up of 48.7 ± 24.9 months, none of the patients required pacemaker device change to VVIR/DDDR. Nine patients underwent reoperation, 5 for lead dislodgment, 1 for high threshold, 1 for pocket site erosion and 3 for pulse generator change. None developed AV block or AF with slow ventricular rate. Only 4 patients developed AF (3 paroxysmal,1 permanent). There were 3 deaths during follow up and none were sudden deaths. CONCLUSION: Single chamber atrial pacing is an acceptable mode of pacing in patients with SND in developing countries. Development of AV conduction abnormalities is rare in this relatively younger population.

Evaluating the effectiveness of the Ministry of Health restriction policy on seasonal antibiotic consumption trends in Saudi Arabia, 2016-2020.

Background: Understanding antibiotic consumption patterns over time is essential to optimize prescribing practices and minimizing antimicrobial resistance. This study aimed to determine whether the antibiotics restriction policy launched by the Saudi Ministry of Health in April 2018 has impacted antibiotic use by assessing changes and seasonal variations following policy enforcement. Methods: Quarterly sales data of J01 antibacterial for systemic use in standard units were obtained from the IQVIA-MIDAS database, spanning from the first quarter of 2016 to the last quarter of 2020. Antibiotics consumption was measured in defined daily doses per 1,000 inhabitant per day- in a quarter (DDDdq). A comparative analysis of antibiotic consumption pre- and post-policy periods introduction was conducted by computing the average consumption values for each period. Statistical comparison of the mean differences between the two periods were then made using independent samples t-test, Mann-Whitney U Test where needed. Time series analysis was employed to estimate the projected antibiotic consumption in the post-policy period if the restriction policy had not been implemented, which was then compared to actual consumption values to evaluate the effectiveness of the restriction policy. Results: During the pre-policy, there were seasonal trends of the total and oral antibiotic consumption through quarters, with higher consumption observed in the first and fourth quarters. In contrast, parenteral antibiotic consumption did not appear to follow a clear seasonal pattern. Following the restriction policy, there was a significant reduction in total and oral antibiotic use, with mean reductions of -96.9 DDDdq (p-value = 0.002) and -98 DDDdq (p-value = 0.002), respectively. Conversely, a significant increase in parenteral antibiotic consumption was observed with a mean increase of +1.4 DDDdq (p-value < 0.0001). The comparison between the forecasted and actual models showed that the actual antibiotics consumption for total, oral, and parenteral were lower than the corresponding forecasted values by 30%, 31%, and 34%, respectively. Conclusion: Overall, our analysis of antibiotics consumption from 2016 to 2020 displays great success for the policy implemented by the Saudi Ministry of Health in significantly reducing the total and oral use of antibiotics. However, future studies are needed to explore the increased consumption of the parenteral antibiotics as well as the persistent high consumption patterns during the fall and winter months even after the implementation of the restriction policy.

A New Interlaminar/Interspinous and Facet-Joint Stabilization System in Lumbar Degenerative Disk Disease: 2 Years of Results.

INTRODUCTION: In lumbar degenerative disk diseases (DDDs), we include a wide range of lumbar pathologies. Lumbar spinal stenosis with or without spondylolisthesis is a common cause of lower-limb pain in elderly patients. The surgical treatment of lumbar DDD consists of the decompression of the neural structures or the decompression and fusion of the involved motion segment. Unfortunately, rigid spinal implants followed by fusion cause increased stresses on the neighboring spinal segments, often leading to adjacent segment degeneration. The aim of this paper is to present a new system for interlaminar/interspinous and facet-joint stabilization and fusion. MATERIAL AND METHODS: From March 2018 to June 2021, 175 patients with severe lumbar back and/or leg pain were operated on with this device after the failure of conservative treatment for a minimum of 6 months. For this study, we considered 75 available patients with a minimum follow-up time of 24 months. Patients rated their back pain and leg pain on a visual analog scale (VAS) after surgery and at the last follow-up; also, the postoperative consumption of analgesic drugs was investigated. Finally, patients were asked whether they would undergo this kind of surgery again or recommend it. The device is designed to promote a better and more efficient intervertebral fusion: Bone Ingrowth technology allows the system to achieve the best response from the bone tissue. RESULTS: All procedures were performed without any complications. A reoperation was required in five cases (6.7%) because of implant failure. In one case, a spinous process and unilateral articular process fracture occurred. In four cases, a subcutaneous ISCHIA (one case) or FILICUDI (three cases) pullout was observed. Significant improvements following lumbar surgery were observed when evaluating the postoperative VAS values, analgesic drug consumption levels, and patients' satisfaction ratings. Evident fusion was seen in 58 of 75 patients (77.3%). CONCLUSIONS: Our interspinous/interlaminar and facet-joint implant solution, associated with bone grafting, provided vertebral fusion in most stenotic patients with Grade I DS undergoing bilateral microdecompression (BMD) or bilateral decompression via the unilateral approach (BDUA). A higher number of patients and a longer follow-up will certainly be required to completely validate these new devices, but this minimally invasive surgery (MIS) is currently very encouraging and satisfactory.

Is air pollution joint prevention and control effective in China-evidence from "Air Pollution Prevention and Control Action Plan".

This paper examined the effect of air pollution joint prevention and control on pollution emissions in China. Specifically, based on the panel data of 290 cities from 2007 to 2021, taking the implementation of the "Air Pollution Prevention and Control Action Plan" as a natural experiment, the difference-in-difference-in-difference (DDD) model was used to explore the effect of air pollution joint prevention and control on haze pollution. Results show that air pollution joint prevention has a significant impact on pollutant emissions either as a whole or as a single pollutant. In terms of individual urban agglomeration, whether the Yangtze River Delta or the Pearl River Delta urban agglomerations, the air pollution joint prevention and control policy has a significant impact not only on the overall reduction of pollutant emissions but also on the reduction of single PM2.5 or industrial sulfur dioxide emissions alone. Environmental regulations have also achieved the effect of haze control in general and have a significant impact on the reduction of PM2.5 or industrial sulfur dioxide emissions. Environmental regulations also significantly reduced PM2.5 emissions in these three urban agglomerations. These findings provide a scientific basis and essential reference for understanding the implementation effect of regional joint prevention and control policies comprehensively and objectively.

Overview of Availability, Cost, and Affordability of Antibiotics for Adults in Jordan: An AWaRe Classification Perspective.

Antimicrobial resistance (AMR) poses a global public health threat, with rates directly linked with consumption. The World Health Organization (WHO)'s AWaRe classification aims to guide antibiotic use, and is influenced by drug availability, affordability, and economic policies. In Jordan, a high proportion of consumed antibiotics belong to the 'Watch' category. Data from the WHO's AWaRe classification, the Essential Medicines List, and the Jordan Food and Drug Administration were analyzed. Antibiotics for adults were classified, their costs per defined daily dose (DDD) were determined and their affordability assessed. In 2023, 43 injectable and 43 oral antibiotics for adults were registered in Jordan. 'Watch' antibiotics were the most common. 'Access' antibiotics had the lowest cost/DDD. 'Reserve' antibiotics were the most expensive, with few generics. Injectable antibiotics had a negative correlation between cost and the number of alternatives. Affordability was higher for oral antibiotics compared with injectable ones. 'Reserve' antibiotics were generally unaffordable. This study highlights the need to promote 'Access' antibiotics over other categories by encouraging the registration of missing 'Access' antibiotics and adjusting the prices of 'Watch' and 'Reserve' antibiotics. Competition among generics can lead to lower prices, increasing affordability and accessibility. We emphasize the importance of the AWaRe classification in guiding antibiotic use in Jordan.

Pharmacoepidemiological Analysis of Antibacterial Agents Used in a Provisional Hospital in Aktobe, Kazakhstan, in the Context of COVID-19: A Comparison with the Pre-Pandemic Period.

In the context of the global spread of Coronavirus Disease 2019 (COVID-19), the issue of evaluating and optimizing the use of antibacterial drugs becomes especially relevant. The coronavirus pandemic has provided a unique opportunity to study the dynamics of the consumption of antibacterial agents and their impact on public health. The rational use of antibiotics is a key aspect of the fight against antimicrobial resistance, which makes this study particularly important. The aim of this study was to assess changes in the consumption of antibacterial drugs among patients hospitalized with COVID-19 during the peak of the 2020 pandemic and compare them with data from 2019 prior to the pandemic. This study collated data on antibacterial drug consumption in a regional hospital in Aktobe, which served a large population of patients during the pandemic. A pharmacoepidemiological study was conducted using the Anatomical Therapeutic Chemical (ATC)/Defined Daily Dose (DDD) methodology. The pharmacoepidemiological study using the international ATC/DDD methodology revealed a concerning pattern of irrational consumption of antibacterial drugs, including cephalosporins, azalides, second-generation fluoroquinolones, and systemic aminoglycosides in Aktobe. Among antibacterial drugs during the pandemic, the most significant increase in consumption was from the group of cephalosporins (19,043 DDD/100 bed-days). The share of their consumption was 35.4% of the total consumption of antibacterial drugs. Pharmacoepidemiological studies using the international methodology ATC/DDD showed an alarming picture of irrational consumption of antibacterial drugs of the group of cephalosporins, azalides, fluoroquinolones, and aminoglycosides in Aktobe, and, in this case, excessive use of the identified antibiotics raises concerns about the possibility of increasing the problem of resistance to microbes.

Transient loss of atrial capture: the "atrial pacemaker stunning" phenomenon.

Atrial loss of capture in the chronic phase after implantation may be permanent due to various causes, e.g. technical lead problems or increased scar tissue formation around the lead tip. However, it may also be transient after atrial ischemia in the context of occlusion of the right coronary artery. In this case, it may be preferable to wait for recovery, which may take up to 45 days, instead of immediately performing an atrial lead revision.

Antibiotic use and consumption among medical patients of two hospitals in Sierra Leone: a descriptive report.

BACKGROUND: Although one of the main drivers of antimicrobial resistance is inappropriate antibiotic prescribing, there are limited resources to support the surveillance of antibiotic consumption in low-income countries. In this study, we aimed to assess antibiotic use and consumption among medical patients of two hospitals in different geographic regions of Sierra Leone. METHODS: This is a cross-sectional study of adult (18 years or older) patients receiving medical care at two hospitals (34 Military Hospital-MH and Makeni Government Hospital-MGH) between March 2021 and October 2021. After admission to the medical or intensive care unit, patients were sequentially recruited by a nurse from each hospital. Demographic and clinical characteristics and information on the dose of antibiotics, their routes, and frequency of administration and duration were collected using a questionnaire adapted from previous studies and encrypted in EpiCollect software (Epic, Verona WI). A physician reviews and verifies each completed questionnaire. Data analysis was done using STATA version 16. RESULTS: The mean age of the 468 patients evaluated in this study was 48.6 years. The majority were women (241, 51.7%) and treated at MGH (245, 52.0%). Clinical diagnosis of bacterial infection was made in only 180 (38.5%) patients. Regardless of the diagnosis, most (442, 94.9%) patients received at least one antibiotic. Of a total 813 doses of antibiotics prescribed by the two hospitals, 424 (52.2%) were administered in MH. Overall, antibiotic consumption was 66.9 defined daily doses (DDDs) per 100 bed-days, with ceftriaxone being the most commonly used antibiotic (277, 34.1%). The ACCESS and WATCH antibiotics accounted for 18.9 DDDs per 100 bed-days (28.2%) and 48.0 DDDs per 100 bed-days (71.7%), respectively. None of the patients were prescribed a RESERVE antibiotics. The antibiotic consumption was lower in MH (61.3 DDDs per 100 bed-days) than MGH (76.5 DDDs per 100 bed-days). CONCLUSION: Antibiotic consumption was highest with ceftriaxone, followed by levofloxacin and metronidazole. Given the high rate of consumption of antibiotics in the WATCH category of the AWaRe classification, there is a need to initiate surveillance of antibiotic consumption and establish hospital-based antibiotic stewardship in these settings.