Creating Alternative Reality: A Case Study.

The sense of reality that underlie political beliefs are created through a group process that emerges from the intersection of the psyches of leaders and followers. An alternative reality is constructed by the demagogue's assertions which express or channel unconscious needs. Antecedents of the contemporary American situation are evident in earlier populist and Fascist movements, the hallmark of which were an attack on all "truth" except that which reflects the power of the leader. Faults in the social field and demagogic techniques lead to alternative narratives and "facts" that are maintained with fervor. Reality is characterized by a lack of complexity or ambiguity. Emotional investment is intensified by primitive needs of the self. Cognitive dissonance and confirmation bias guarantee a resistance to reflection. Evidence and logic give way to wish, loyalty and power as the criteria for truth. Ultimately a clash of realities results in complex social trauma.

Pandemic psychoanalysis.

Our clinical practice is contextualized by a co-participant trauma constituted by a confluence of upheavals-pandemic, politics, an epistemological crisis, pervasive distrust of expertise and evidence. Psychoanalytic work, parallel to the external world, has become defamiliarized, if not, at sometimes unrecognizable. The affect on the frame and the boundaries of the therapeutic frame and of the psychoanalytic institution are explored with an awareness of the uncertainty of the future. The experience of the onset of the pandemic is discussed with awareness of an unknown future.

Postoperative Complications Following Repair of Acute Achilles Tendon Rupture.

BACKGROUND: Controversy remains regarding which patients with acute Achilles tendon rupture would best be treated nonoperatively and which might benefit from operative repair. The primary aim of this study was to characterize the overall incidence of-and specific risk factors associated with-postoperative complications that follow operative repair. We also evaluated the specific differences between complications after the use of an open or minimally invasive surgical (MIS) approach. METHODS: Retrospective chart review identified 615 adult patients who underwent operative repair for an acute Achilles tendon rupture between January 1, 2001, and May 1, 2016, at 3 level I trauma centers. Minimum follow-up was 3 months. Patient demographics, comorbidities, injury mechanism, procedural details, and surgeon subspecialty were collected. Assessed complications included wound healing issues, rerupture, hematoma, nerve injury, deep vein thrombosis, and pulmonary embolism. RESULTS: Seventy-two patients (11.7%) developed a postoperative complication. Risk factors included advancing patient age (odds ratio [OR], 1.04, P = .007), active tobacco use (OR, 3.20, P = .007), and specific subspecialty training (OR, 2.04, P = .046). No difference in overall complication rate was found between the open and MIS approaches (11.6% vs 13.2%, P = .658). A subgroup analysis among orthopedic subspecialties demonstrated that patients treated by trauma surgeons had increased rates of wound complication ( P = .043) and rerupture ( P = .025) compared with those treated by other subspecialties. Patients treated by trauma surgeons were also more likely to be younger or have a body mass index (BMI) > 30, although neither factor was found to be independently predictive for postoperative complications. CONCLUSION: Approximately 1 in 9 patients undergoing operative repair of an acute Achilles tendon rupture developed a postoperative complication. Advancing age and active tobacco use were independent risk factors for developing such complications. Differences in subspecialty training also appear to impact complication rates, but the potential reason for this discrepancy remains unclear. As controversy remains regarding which patients who sustain acute Achilles tendon rupture should be treated nonoperatively and which would benefit most from surgical repair, a better understanding of postoperative complication rates and associated risk factors may enhance the decision-making processes in treating these injuries. It is not clear whether MIS techniques are superior to traditional open repair in terms of postoperative complications. LEVEL OF EVIDENCE: Level III, retrospective comparative series.

Symptomatic venous thromboembolism after non-operatively treated foot or ankle injury.

The purpose was to assess the incidence and risk factors associated with symptomatic venous thromboembolism in patients undergoing below knee immobilization for non-operative foot or ankle injury. We included all foot and ankle patients between January 2005 and May 2016 who underwent non-operative management using below knee immobilization with cast, splint, brace, and/or boot. The primary outcome was the development of a venous thromboembolism within 90 days of immobilization initiation. Of 6,088 patients, twenty-three (0.38%) developed a venous thromboembolism. Risk factors for venous thromboembolism were age>50 years, unremovable immobilization, Achilles tendon rupture, Modified Charlson Comorbidity Index>2, patients on chemoprophylaxis, varicose veins, history of venous thromboembolism, known hypercoagulability disorder, and rheumatoid arthritis. Routine thromboprophylaxis after below-knee immobilization for non-operative foot or ankle injury may be beneficial in these specific subpopulations. These data can facilitate more substantive shared decision-making between providers and patients with respect to use of thromboprophylaxis. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

The lonely passion of the "people".

This paper explores the psychological sources of support for a leader, and unwavering belief in the illusions he promotes, which persists despite confrontation with reality. Lonely passion is an oxymoron. It is passion because of the intensity of the supporters' longing which is partially shaped by fear and loss. Their passion is lonely because they appear to be left empty with their love unrequited, having given their selves up and only having an illusion in return. It explores the effects of socio-economic disruption in creating or contributing to the development of a "social character" and threatening the integrity of the self. It explores the characteristics of the leader, including methods of manipulation, in eliciting passionate devotion. It uses Ferenczi's Confusion of Tongues situation as a model for understanding the relationship between leader and follower. The idealization of the leader as a power to be feared and a savior from the imagined threats he has created, and the dynamics of identification, masochism and victimization are invoked. The only remedy for the toxicity of the situation is empathy, which is understood in a historical as well as psychological context.

Phylogeography, Genetic Diversity, and Management Units of Hawksbill Turtles in the Indo-Pacific.

Hawksbill turtle (Eretmochelys imbricata) populations have experienced global decline because of a history of intense commercial exploitation for shell and stuffed taxidermied whole animals, and harvest for eggs and meat. Improved understanding of genetic diversity and phylogeography is needed to aid conservation. In this study, we analyzed the most geographically comprehensive sample of hawksbill turtles from the Indo-Pacific Ocean, sequencing 766 bp of the mitochondrial control region from 13 locations (plus Aldabra, n = 4) spanning over 13500 km. Our analysis of 492 samples revealed 52 haplotypes distributed in 5 divergent clades. Diversification times differed between the Indo-Pacific and Atlantic lineages and appear to be related to the sea-level changes that occurred during the Last Glacial Maximum. We found signals of demographic expansion only for turtles from the Persian Gulf region, which can be tied to a more recent colonization event. Our analyses revealed evidence of transoceanic migration, including connections between feeding grounds from the Atlantic Ocean and Indo-Pacific rookeries. Hawksbill turtles appear to have a complex pattern of phylogeography, showing a weak isolation by distance and evidence of multiple colonization events. Our novel dataset will allow mixed-stock analyses of hawksbill turtle feeding grounds in the Indo-Pacific by providing baseline data needed for conservation efforts in the region. Eight management units are proposed in our study for the Indo-Pacific region that can be incorporated in conservation plans of this critically endangered species.

The Holocaust after 70 years: Holocaust survivors in the United States(.).

Over 70 years, there have been different narratives of the Holocaust survivors coming to the United States. Survivors' stories begin with an event of major historical significance. Difficulties in conceptualizing historical trauma, along with common distortions and myths about Holocaust survivors and their children are examined. This article proposes that it is impossible to discuss the consequences of extreme suffering without consideration of historical meaning and social context with which they are entwined. The evolution of the social representation of the Holocaust and the contradictions in clinical attributions to survivors and their children with consideration of the future is described. Attributions to survivors and their children with consideration of the future is described.

Urban vegetation for reducing heat related mortality.

The potential benefit of urban vegetation in reducing heat related mortality in the city of Melbourne, Australia is investigated using a two-scale modelling approach. A meso-scale urban climate model was used to quantify the effects of ten urban vegetation schemes on the current climate in 2009 and future climates in 2030 and 2050. The indoor thermal performance of five residential buildings was then simulated using a building simulation tool with the local meso-climates associated with various urban vegetation schemes. Simulation results suggest that average seasonal summer temperatures can be reduced in the range of around 0.5 and 2 °C if the city were replaced by vegetated suburbs and parklands, respectively. With the limited buildings and local meso-climates investigated in this study, around 5-28% and 37-99% reduction in heat related mortality rate have been estimated by doubling the city's vegetation coverage and transforming the city into parklands respectively.

Bodyguard of lies: the vicissitudes of deception among mad men and women.

The television series Mad Men is critically acclaimed despite grievous flaws as a drama. Its immense popularity is important psychological data and needs to be explored from the vantage of the dynamics of deception, including motivation, appeal and consequences for relationships and the self. The show's creator is inspired by John Cheever, the depth of whose complex characterizations is contrasted to the lures of the show. The parallel between the manipulations of authenticity inherent in advertising, the relationships between those who are involved in it and the relationship the show establishes with its audience is studied through two contiguous brief scenes that portray multiple reverberating deceits. These characters in these scenes are understood as creating both longing and disappointment at multiple levels. The psychic costs for both the deceivers, those deceived, as well as witnesses to the deception are fundamental.

The self in pain: the paradox of memory. The paradox of testimony.

Using the 7-year psychotherapy of a Holocaust survivor, this paper explores the sometimes contradictory aspects of approaches to trauma. Conceptualizing a "self in pain" as an alternative to contemporary conceptualizations of the traumatized person as having a damaged, dissociated or collapsed self leads to a corresponding alternative clinical approach. The paradoxes of traumatic memory and testimony necessitate an adaptational emphasis and the emergence of a "doubled" in contrast to a dissociated self. The decision to respect this "doubled" self involves a privileging of "reality" over "psychic reality" which then, paradoxically enables this patient to develop a phantasy life.

Psychoanalysis traumatized: the legacy of the Holocaust.

Psychoanalysis is a survivor of the Holocaust. It was founded and flourished in central European centers that would be destroyed by the Nazis. A core group of refugees who lived through persecution and exile were instrumental in rebuilding their movement on alien shores. They had no opportunity to mourn the loss of their culture or their leader, Freud, whose death was overshadowed by the cataclysmic upheaval around them. Though its trauma has been dissociated, it is represented in psychoanalytic ideas and enacted in institutions within the context of delayed or incomplete mourning. For example, authoritarianism in psychoanalytic institutions will be explored as a reliving of the trauma of both fascism and exile, and not merely typical group psychology. Further evidence of the impact of dissociated trauma includes the astonishing scotoma for actual events in treatment of Holocaust survivors; the extreme privileging of infantile fantasy over reality, and attention to childhood neurosis at the expense of adult catastrophic events.

Landscape discontinuities influence gene flow and genetic structure in a large, vagile Australian mammal, Macropus fuliginosus.

Large vagile mammals typically exhibit little genetic structuring across their range, particularly when their habitat is essentially continuous. We investigated the population genetic structure of a large vagile Australian macropodid, Macropus fuliginosus, which is continuously distributed across most of southern Australia, using nine highly polymorphic nuclear microsatellite loci. Five distinct genetic units were identified across the range, four on the mainland and one on Kangaroo Island. In addition to the predicted historic Nullarbor Plain Barrier, two unexpected mainland barriers to gene flow were identified. Both were associated with landscape discontinuities (Swan River, Flinders Ranges), which appear within the dispersal capabilities of M. fuliginosus. Typical of large vagile mammals, M. fuliginosus displays high genetic diversity (with the exception of an insular population) and weak genetic structuring (within genetic units). However, the expansion of M. fuliginosus from southwestern Australia during the Pleistocene has resulted in significantly reduced genetic diversity in eastern populations. No significant sex-biased dispersal was detected, although differences in habitat, densities and climatic conditions between the eastern and western regions of the range appear to influence dispersal with the effects of isolation by distance only evident in the west. These results suggest that the biogeography of southern Australia is more complex than previously thought and reveal that seemingly minor landscape features can significantly impact genetic structuring in large vagile mammals.

Found in translation: discussion of Galdi and Cohen.

Papers by Galdi and Cohen are appreciated and discussed. Trauma is seen as occurring in a culturally based matrix of meanings. Galdi and Cohen's case material is discussed in terms of the cultural symmetry and contrast between patient and therapist. The assault of trauma on meaning through mechanisms of dissociation, alienation and psychic numbing is explored. Therapy is examined as the restoration of meaning through the creation of a relationship through the shared language of empathy.

The genetic structure of Australasian green turtles (Chelonia mydas): exploring the geographical scale of genetic exchange.

Ecological and genetic studies of marine turtles generally support the hypothesis of natal homing, but leave open the question of the geographical scale of genetic exchange and the capacity of turtles to shift breeding sites. Here we combine analyses of mitochondrial DNA (mtDNA) variation and recapture data to assess the geographical scale of individual breeding populations and the distribution of such populations through Australasia. We conducted multiscale assessments of mtDNA variation among 714 samples from 27 green turtle rookeries and of adult female dispersal among nesting sites in eastern Australia. Many of these rookeries are on shelves that were flooded by rising sea levels less than 10 000 years (c. 450 generations) ago. Analyses of sequence variation among the mtDNA control region revealed 25 haplotypes, and their frequency distributions indicated 17 genetically distinct breeding stocks (Management Units) consisting either of individual rookeries or groups of rookeries in general that are separated by more than 500 km. The population structure inferred from mtDNA was consistent with the scale of movements observed in long-term mark-recapture studies of east Australian rookeries. Phylogenetic analysis of the haplotypes revealed five clades with significant partitioning of sequence diversity (Phi = 68.4) between Pacific Ocean and Southeast Asian/Indian Ocean rookeries. Isolation by distance was indicated for rookeries separated by up to 2000 km but explained only 12% of the genetic structure. The emerging general picture is one of dynamic population structure influenced by the capacity of females to relocate among proximal breeding sites, although this may be conditional on large population sizes as existed historically across this region.

Teaching engineering ethics using role-playing in a culturally diverse student group.

The use of role-playing ("active learning") as a teaching tool has been reported in areas as diverse as social psychology, history and analytical chemistry. Its use as a tool in the teaching of engineering ethics and professionalism is also not new, but the approach develops new perspectives when used in a college class of exceptionally wide cultural diversity. York University is a large urban university (40,000 undergraduates) that draws its enrolment primarily from the Greater Toronto Area, arguably one of the most culturally diverse cities in the world, embracing the largest percentage of Canada's immigration. Among the area's five million inhabitants, 50% identify themselves as a visible minority born outside Canada, while over 100 languages and dialects are spoken daily. Although students admitted from this international pool have usually been exposed to western attitudes during secondary education and are rapidly assimilated into Canadian culture, responses to specific ethical issues are strongly influenced by their prior culture. Two and three-part scripts for case studies based on NSF or original scenarios were written to illustrate issues such as gifts, attitudes towards women and ethnic minorities, conflict of interest, whistle-blowing, sexual harassment, individual rights, privacy, environment, intellectual property, and others. Following the presentation, the actors lead group discussion based on previously specified questions. Once the initial shyness and reluctance of some cultures has been overcome through the building of rapport, students have written original scripts based on hypothetical or prior personal situations. The method is now being adopted in a short course format to assist the professional integration of foreign trained engineers.