Spatial terminology is used in anatomy to indicate precise, relative positions of structures in an organism. While these terms are often standardized within specific fields of biology, they can differ dramatically across taxa. Such differences in usage can impair our ability to unambiguously refer to anatomical position when comparing anatomy or phenotypes across species. We developed the Biological Spatial Ontology (BSPO) to standardize the description of spatial and topological relationships across taxa to enable the discovery of comparable phenotypes.dorsal_to into class descriptions .BSPO currently contains 146 classes and 58 relations representing anatomical axes, gradients, regions, planes, sides, and surfaces. These concepts can be used at multiple biological scales and in a diversity of taxa, including plants, animals and fungi. The BSPO is used to provide a source of anatomical location descriptors for logically defining anatomical entity classes in anatomy ontologies. Spatial reasoning is further enhanced in anatomy ontologies by integrating spatial relations such as The BSPO is currently used by projects that require standardized anatomical descriptors for phenotype annotation and ontology integration across a diversity of taxa. Anatomical location classes are also useful for describing phenotypic differences, such as morphological variation in position of structures resulting from evolution within and across species. Variation among anatomical phenotypes, whether across species or between mutant and wildtype model organisms, frequently involves changes in position and orientation of structures. Among fish species, for example, the position of the mouth may be ventral, dorsal, or terminal; bony vertebral processes may be oriented laterally or medially; pelvic fins may be located posteriorly or anteriorly relative to the abdomen. Computation across phenotypes thus requires a vocabulary of positional terms to understand the patterns of variation in the positioning of structures relative to others within and between organisms, and to understand the possible relationships to gene expression and regulation. Positional terms have long been used in anatomy to describe the spatial aspects of the impressive diversity of organismal forms of both plants and animals. For example, positions in animals are often described in relation to those of a bilaterally symmetrical animal Figure . Accordiknox), also play a central role in spatial developmental patterns[Arabidopsis, Caenorhabdites elegans, Drosophila, Danio rerio, Xenopus, mouse, etc.), there are taxon-specific differences in the application of spatial terms, such as to human anatomy, that render the development of a universal terminology complicated. Moreover, there are fundamental differences across the more than 35 animal body plans  and various plant growth forms  that present some very difficult axes to interpret. Despite these challenges, which we describe further below, the development of a set of spatial classes is necessary for query and description of phenotypes across species.In the past two decades the developmental and genetic underpinnings of positional axes have been investigated for model species, and highly conserved key patterning molecules have been identified across widely divergent taxa. Overlapping patterns of Hox gene expression, for example, are required for organization along the AP body axis in bilaterian animals. Wnt/β-cpatterns. Althougpart_of some ‘opercle’ (the latter class from an anatomy ontology). Because it is driven by research needs, the spatial terminology currently represented in BSPO is particularly developed for animals and, to a lesser extent, plants. However, BSPO is organized in a framework that is flexible enough to incorporate spatial terminology for other taxa .Here we describe the development of the BSPO, which contains 146 classes and 58 relations representing anatomical axes, gradients, regions, sections, sides, and surfaces that apply to whole organisms and their parts. The BSPO is integrated with other ontologies and is currently used by projects that require standardized spatial descriptors for anatomy ontologies, ontology integration, and phenotype annotation. For example, the free-text description “anterodorsal margin of opercle” can be represented formally as BSPO:‘anterodorsal margin’ a in BSPO represent various aspects of spatial organization and are partitioned into categories for anatomical axes (14 classes), anatomical surfaces (12 classes), anatomical regions , anatomical gradients (6 classes), and anatomical planes (7 classes) . Unlike the case in animals, there is generally no single primary organismal axis for a whole plant. Instead, axes are described for one or more modular organs that compose a plant, such as shoots (stems and branches), roots, and phyllomes  .In animals, the AP, DV, and LR axes Figures A, B are In defining ‘anterior-posterior axis’ in BSPO, we designate “anterior” as the end of the animal with a “head”. Interestingly, a head, however defined  and inversion of the Chordin/BMP/Tolloid pathway markers.Another orthogonal_to ‘sagittal plane’. The LR axis of many organisms is also modified in development and evolution. For example, flatfishes (order Pleuronectiformes) undergo a dramatic developmental change in the LR body axis. In ontogeny, the left or right side of the body comes in contact with the substrate, and one eye migrates to the other half of the head. Thus one side (left or right depending on the species) has two eyes and the side in contact with the substrate is referred to as "eyeless" or "blind". Description of this modified anatomy requires specialized terms to refer to the “blind side” and “eyed side” of the fish. Other structures typically located along the midsagittal plane, such as the dorsal fin, are displaced horizontally. Reasoning across flatfish and unmodified vertebrate eye morphologies may thus require specifying the spatial location (left or right side) of the blind or eyed side of the organism.In BSPO, the ‘left-right axis’ is defined as “An axis that extends through an organism from left to right sides of body, through a sagittal plane”, and it is Despite the modifications to the primary axes we describe above, larvae and adults of many animal taxa do in fact retain the ancestral bilaterian AP, DV, and LR axes, and many conserved molecular and genetic determinants of these axes have been described in model organisms. Few of the non-model taxa with the interesting deviations from symmetry described above have been investigated from a developmental or genetic standpoint, and thus much remains to be discovered and understood about axis specification.Several other primary organism axes are represented in BSPO. The ‘medial-external axis’ extends from an internal point towards the outside of the body or body part. This class is a superclass of ‘medial-lateral axis’ (ML) and ‘medial-radial axis’ (MR). In animals, the ML axis applies to the left or right sides of a bilaterally symmetrical animal. The ‘oral-aboral axis’ Figure C is defiIn plants, as mentioned above, the axes primarily relate to organismal parts and are generally defined relative to the direction of growth. The main axis of growth is typically the apical-basal (AB) axis, which is determined by the growth of an apical meristem or apical cell. In BSPO, we refer to this axis as ‘apical-basal axis relative to direction of growth’ to distinguish it from the ‘apical-basal axis relative to substrate’ (described below), which is applied to animal bodies. In Figure In animals, the ‘apical-basal axis relative to substrate’ is often applied to substrate-bound organisms such as Porifera, where the basal direction is towards the substrate. For bilaterian animals, this axis often refers to cell or tissue-level axes where one portion of the cell or tissue is adjacent to a substrate, such as a basal lamina or lamina propria, and the apical portion faces a lumen, for example an intestinal epithelial cell with its microvilli facing the lumen of the intestine.distal-less has a role in specifying the PD axis, and it is expressed in the distal portion of many appendages[In animals and plants, a ‘proximal-distal axis’ (PD) is used to describe the position of parts in relation to attachment to another part, such that parts closer to the plane of attachment  are proximal and those further away are distal Figure A. In anipendages. ProximaIn plants, “proximal” and “distal” should be applied to organs or organ parts that do not develop from an apical meristem (and therefore have no AB axis) such as vascular leaves, leaflets, petals, or sepals. The PD axis can also be used for organs with an apical meristem that branch from another organ, such as branches or lateral roots, but in these examples it is redundant with the AB axis. The ‘adaxial-abaxial axis’ (AA) is also important for leaves and other types of phyllomes, with adaxial being adjacent to the shoot axis  and abaxial being away from the shoot axis . If a leaf or other organ is held horizontally, the ‘adaxial-abaxial axis’ may be described as dorsal-ventral. The distribution of tissues varies along the AA axis in leaves, including characteristics of each surface, reflecting the different microclimates on the adaxial versus the abaxial sides of the leaf, such as sun exposure and humidity.Sanseveria, have an early developmental pattern in which growth of either the abaxial or adaxial leaf meristem is suppressed, to the effect that the opposite meristem  grows around to cover the entire surface of the leaf.Medial-external axes are also applied to parts of an organism. The ‘medial-radial axis’ in plants is used to describe organs or organ parts that are roughly circular in cross-section, such as stems, roots, and petioles, while ‘medial-lateral axis’ is used to describe laminar (flattened) plant parts such as many leaves and petals or some shoot axes  that expand through growth of marginal meristems. VariatiIn cases where the application of axis terminology is difficult, molecular determinants may be used as evidence for spatial reference of body parts. For example, the region of the fin or limb bud in vertebrates with a high concentration of sonic hedgehog (Shh) is posterior because Shh “posteriorizes” the phenotype. Note thThe traditional use of “superior” and “inferior” refers to parts that are the furthest or nearest to the substrate respectively. In BSPO, we define ‘inferior side’ and ‘superior side’ classes to support reference to the substrate. However, confusion can arise when these terms are applied to homologous structures across species where they may not retain the same relationship to the substrate. For example, the human superior vena cava is further from the substrate than the inferior vena cava, but in the mouse, these terms no longer reference differential distance from the substrate. For this reason, we do not recommend their use in defining axes or relations to axes, for structures that are likely to be compared across taxa.http://purl.obolibrary.org/obo/fao.owl)). Nonetheless, BSPO can easily accommodate the spatial terminology used to describe fungi, and some existing BSPO terms are applicable to fungal anatomy. For example, “lateral” is used in fungi, as in animals, to refer to the side of the organism[The BSPO does not yet have a complete terminology for describing the spatial dimensions of fungal anatomy, which could be integrated with existing anatomy ontologies for fungi . We also define non-transitive versions of these relations, e.g., immediately_dorsal_to and immediately_ventral_to as subproperties of the transitive forms. These are useful for specifying the order of serially arranged, contiguous structures such as the tagmata and segments of an arthropod body, the segments of an arthropod leg, or internodes of a plant stem.Fifty-eight relations have been specified for use with BPSO terms. For each axis in BSPO we define a pair of relations specifying relative position along the axis. For example, for the DV axis we have the relations Although the designation of the primary organism axes may appear straightforward, pronounced developmental and evolutionary changes in organ presence, morphology, and symmetry in many taxonomic groups have made these axes biologically difficult to interpret and thus made it correspondingly difficult to apply a standardized terminology. The evolutionary shift to pentaradial symmetry in the adults of extant echinoderms, starfish, brittlestars, sea urchins, sand dollars, and crinoids is one of the most spectacular examples. All echinoderm larvae are bilaterally symmetrical, but upon metamorphosis, little or no trace of the larval AP axis remains in the pentaradial adult. WhetherWithin plants, axis specification across species is fairly straightforward because of the association between axes and developmental patterns . Nonetheless, unusual developmental patterns, such as the adaxialization of cylindrical leaves (described above under “Axes of organism parts”) can obscure the normal axes used to describe plant structures. Thus, it is the precise specification of spatial terminology that allows for logical comparisons among forms that deviate from the norm.Anatomical investigation is frequently based on histological sections  to support a better understanding of three-dimensional structure. For example, long before the days of computerized image reconstruction, anatomists leveraged “coronal”, “horizontal”, “sagittal”, and “parasagittal” tissue sections to support inferred three-dimensional representation of anatomical entities within an animal. These are evident in numerous landmark atlases such as “The Rat Brain in Stereotaxic Coordinates” by Paxinos and Kauforthogonal_to ‘left-right axis’ , ‘radial plane’ , and ‘tangential plane’ Figure B. The ‘tThe Foundational Model of Anatomy (FMA) ontology for humaipsilateral_to holds between two structures on the same side of an organism; contralateral_to holds between two structures on the opposite sides of an organism. In contrast to the standard axial relations, these are not transitive, but they do hold the characteristic of being symmetric. If x is on the same side as y, then it must be the case that y is on the same side as x.In addition to the relations along anatomical axes described above, we specify a number of relations relative to anatomical planes. For example, relative to the sagittal plane, Unlike axes and planes that are “immaterial”, the anatomical topology classes in BSPO refer to the material regions, sides, and margins of anatomical structures. These are labeled and defined in BSPO relative to the axis classes. For example, subtypes of ‘anatomical region’ Figure  include part_of that specify which side of a bisecting plane a structure is part of. Where these reference the axes of the whole organism, they can apply to a side of either the whole organism or its substructures. For example, in_left_side_of can apply to the position of the heart relative to the whole organism, or apply to part of the heart, such as its left side. Where the referenced side only applies to some part of an organism, so do the relations. For example, in the long bones of limbs that have proximal and distal sides, the ‘proximal epiphysis of the femur’ can be defined as an ‘epiphysis’ that is in_proximal_side_of the ‘femur’. We also define property chains to propagate information about sides down the partonomy, so that, for example, if X part_of Y and Y in_left_side_of ‘heart’ then a reasoner can infer that X in_left_side_of the ‘heart’.Anatomical sides are defined with the non-transitive subproperties of intersects_midsagittal_plane_of. This relation applies to midline structures such as the single unpaired nostril of the hagfish, which is positioned along the midline of its head . This relation does not imply that the structure is unpaired, although this may often be the case. Structures to which the intersects_midsaggital_plane_of does not apply stand in a in_lateral_side_of relation to the whole. For example, in most vertebrates, the naris (nostril) is bilaterally paired, and it is thus declared in UBERON (the cross-species metazoan Uber Anatomy Ontology)[in_lateral_side_of a head. This relation does not imply, however, that the structure is paired. To indicate whether a structure is paired or unpaired, classes such as ‘bilateral’ from the Phenotype and Trait Ontology (PATO)[Some structures are not completely on one side or the other of a bisecting organismal plane but instead cross it. For example, the heart may asymmetrically span the midsagittal plane of an animal. For such cases, we define the relation: ntology),33 as bey (PATO) can be ubicoid, a maternal effect RNA that is translated in the fertilized egg and was discovered in Drosophila melanogaster in the 1980s  is expressed in a posterior to anterior gradient in the developing limb buds of vertebrates. The concentration of Shh is interpreted by the cells and influences the phenotypic outcome of digit morphology according to the gradient. An anat80s [anterior_to some XAO:‘hindlimb’.The classes and relations in BSPO uniquely represent the spatial aspects of anatomical entities and can be used to create class expressions to enable spatial reasoning. UBERON simplifies the specification of spatial patterns in taxon-specific anatomy ontologies by doing this, e.g., UBERON:‘forelimb’ BSPO:gy (XAO) referencpart_of ‘phyllome’ is specified in the ontology, but a more precise logical definition could be created by specifying that a ‘phyllome base’ is a BSPO ‘proximal region’ that is part_of a ‘phyllome’. The Gene Ontology (GO) also contains classes that could be defined in terms of BSPO classes and relations. For example, GO:‘AP axis specification’ is defined as “The establishment, maintenance and elaboration of the anterior-posterior axis. The anterior-posterior axis is defined by a line that runs from the head or mouth”. This class could also be formally related to BSPO: ‘anterior-posterior axis’.Pre-composition using BSPO classes can enhance the definitions of some classes in anatomy ontologies that refer to the spatial aspects of structures. For example, the Plant Ontology,38, a unb (a shoulder girdle bone) is represented by combining the following anatomical and spatial classes: ‘anatomical projection’ part_of some BSPO:‘posterior region’ and part_of some ‘cleithrum’. Spatial classes are also used to specify the region of a structure that varies in some quality; for example, BSPO:‘anterior margin’ part_of some ‘scapula’ is annotated as ‘concave’ or ‘straight’ using quality classes from PATO. BSPO is also used in post-composition for the annotation of gene expression in ZFIN  and usefin.org;.dorsal_to). This difference manifests itself in concrete ways when modeling the world using languages such as the Web Ontology Language (OWL). For example, “A is dorsal to B” (where A and B are instances) is asserted as a simple triple < A dorsal_to B>. However, to refer to this “dorsality” relationship , the relationship must be turned into an individual, i.e., a relational quality (reified relation). These spatial quality classes in PATO could be pre-composed with the relevant BSPO class. For example, ‘dorsalized’ is defined as a bearer's gross morphology containing only what are normally dorsal structures. This class could be formally defined by relating it to the BSPO class ‘dorsal region’.PATO is an ontology of biological qualities that contains a number of relational qualities representing spatial concepts. Formally there is a difference between these spatial qualities and BSPO relations: PATO relational qualities are classes  rather than relations as in BSPO  and part_of (BSPO: ‘anterior region’ and part_of UBERON: ‘maxilla’), along with other possible proposals.After spatial classes are identified at the syntactic level, BSPO is used to post-compose anatomical entities when pre-composed classes from an anatomy ontology, such as UBERON, are not available. For example, for the phrase “anterior margin of maxilla”, CharaParser would propose the expression BSPO:‘anterior margin’ and in_left_side_of and in_right_side_of relations  can be used to explicitly define this type of structure. This makes it possible for CharaParser to use the ELK reasoner[in_lateral_side_of some Thing) and . When CharaParser processes qualities that are in the relation_slim of PATO, such as ‘articulated with’ , it will understand that two entities are expected and then look into a list of bilaterally paired structures for possible matches for the two entities  and ‘clavicle blade’ and (in_right_side_of some ‘multi-cellular organism’)). Note that non-bilaterally paired structures can also use PATO relational qualities .Sometimes additional domain knowledge is needed to annotate a phenotype that is not obviously spatially related. For example, the semantics of the phenotype “clavicle blades articulate” is built on the knowledge that clavicle blades are bilaterally paired structures. The BSPO reasoner to find anterior_to entails that A is anterior to C. Similarly, we can also trivially infer that C is posterior_to A, using inverse axioms. Other more sophisticated forms of reasoning are not possible at this time. For example, the orthogonal_to relation has domain and range constraints (it holds between an axis and a plane), but it has no definitional axioms that capture the textual definition of crossing a plane at a right angle. Spatial extensions to OWL would be required to rigorously capture this meaning, but it is not clear what the use case for these advanced types of reasoning would be. One possibility would be the integration of classic description logic queries with geometric 3D model or anatomical atlas data. For example, asking for all genes expressed in epithelial cells dorsal to a plane formed by bisecting a particular organ. One possibility is to extend OWL using custom datatypes – this is possible using a system such as OWL-Eu[The BSPO is represented in OWL, which provides a limited number of constructs for characterizing relationship types. We make use of characteristics such as transitivity, superproperties, and domain/range constraints to allow for limited forms of reasoning. For example, if A is anterior to B, and B is anterior to C, then the transitivity characteristic of s OWL-Eu. For manThe BSPO supports unambiguous usage of positional terminology in the context of anatomical data and in the building of anatomy ontologies. BSPO also serves as a source of classes and relations for post-composition of anatomical entities, a requirement for the representation of morphological variation within and among species. To aid in its use, we include textual information indicating the ‘taxon-appropriateness’ of different classes and relationships in BSPO. In the future, we will also include taxon constraints and add The BSPO provides an ontological representation of anatomical position classes that can be used for spatial reasoning. For example, queries can be enabled to find structures that are proximal to one another, or to compare levels of phenotypic variation in dorsal vs. ventral regions. Particularly in light of the high level of conservation in gene pathways underlying these axes across species , the BSPO is critical to enable interesting queries across phenotypes at different anatomical positions.object properties in OWL) for the representation of anatomical axes, gradients, regions, planes, sides and surfaces  used in the BSPO are defined in the Relations Ontology[posterior_to) are exclusively defined in BSPO. The specific relations in the BSPO currently lack higher-level parents in the Relations Ontology. Some relations in BSPO are used to relate anatomical region classes to those of anatomical axis, such as ‘anterior side’ which has a starts_axis relationship to ‘anterior-posterior axis’ , and surface_of . Note that we define relations textually but we are unaware of a way to create a complete formal definition using OWL, which has limited capabilities for reasoning with relations.BSPO contains classes and relations .The original version of BSPO was derived from the FlyBase annotation qualifier section of the FlyBase controlled vocabulary (FBql). We retain cross-references to the original FBcv classes. An editor’s version of the ontology is maintained in OBO format and edited using OBO-Edit. Public aWe follow the Open Biological and Biomedical Ontologies (OBO Foundry) convention of referring to concepts as “classes” and the relationships between classes as “relations”, as opposed to “classes” and “object properties” in the Web Ontology Language (OWL). Throughout the text, classes are denoted in single quotes and relations in italics.bThe cleithrum is a bony element represented in the Teleost Anatomy Ontology[Ontology in relatOntology. These oOntology.The authors declare that they have no competing interests.All authors contributed to the ontology and the manuscript. WD, MAH, PM, and RLW developed the figures. All authors read and approved the final manuscript.


Studies have identified high rates and severe consequences of Internet Addiction/Pathological Internet Use (IA/PIU) in university students. However, most research concerning IA/PIU in U.S. university students has been conducted within a quantitative research paradigm, and frequently fails to contextualize the problem of IA/PIU. To address this gap, we conducted an exploratory qualitative study using the focus group approach and examined 27 U.S. university students who self-identified as intensive Internet users, spent more than 25 hours/week on the Internet for non-school or non-work-related activities and who reported Internet-associated health and/or psychosocial problems. Students completed two IA/PIU measures  and participated in focus groups exploring the natural history of their Internet use; preferred online activities; emotional, interpersonal, and situational triggers for intensive Internet use; and health and/or psychosocial consequences of their Internet overuse. Students’ self-reports of Internet overuse problems were consistent with results of standardized measures. Students first accessed the Internet at an average age of 9 (SD = 2.7), and first had a problem with Internet overuse at an average age of 16 (SD = 4.3). Sadness and depression, boredom, and stress were common triggers of intensive Internet use. Social media use was nearly universal and pervasive in participants’ lives. Sleep deprivation, academic under-achievement, failure to exercise and to engage in face-to-face social activities, negative affective states, and decreased ability to concentrate were frequently reported consequences of intensive Internet use/Internet overuse. IA/PIU may be an underappreciated problem among U.S. university students and warrants additional research. Each generation is more familiar with and more reliant upon the Internet. The number of U.S. Internet users increased 257% between 2000 and 2012 . WidesprAs Internet use has proliferated, so too have reports of IA/PIU. In the rapidly burgeoning literature in this area, different terms are used to refer to seriously dysfunctional patterns of excessive Internet use. At its most extreme, problem Internet use has been termed “Internet Addiction” or “Internet Dependency”, defined as the “inability to control one’s use of the Internet which leads to negative consequences in daily life , 11.” ThOther theorists conceptualize these symptoms differently. For these theorists, symptoms associated with Internet-related problems are labeled “Compulsive Internet Use.” Compulsive Internet use is conceptualized as more similar to obsessive-compulsive disorder than addiction . Still oA variety of instruments have been developed that purport to assess IA/PIU based on different conceptual frameworks. Many of these rating scales, questionnaires, and diagnostic criteria were adopted from DSM-IV-TR diagnostic criteria for substance dependence and pathological gambling disorder . ExampleThe facets of IA/PIU assessed across these measures largely overlap with different chemical dependency diagnostic criteria, such as salience , tolerance , withdrawal symptoms, lack of control, and use of the Internet to regulate mood . HoweverGreater exposure to the Internet may increase the likelihood of pathological Internet use and the incidence of Internet addiction. As many as 6% to 11% of Internet users in the U.S. are estimated to have IA/PIU . StudentRecent epidemiological studies indicate that IA/PIU affects approximately 1.2% to 26.3% of U.S. university students –31. The An extensive international literature has accrued documenting correlates and negative physical and psychosocial consequences associated with IA/PIU. Individuals who suffer from IA/PIU evidence more physical health issues, such as overweight and obesity due to lack of physical activity and sleep disorders , 37; menThe burgeoning literature indicates that many university students suffer from a variety of health and psychosocial problems due to IA/PIU. However, the majority of research concerning IA/PIU in U.S. university students has been conducted within a quantitative research paradigm. Though quantitative studies offer important clinical and research implications, they frequently fail to contextualize the problem of IA/PIU. Without this contextualization, specific clinical presentations, including triggers for and patterns of use, have gone unidentified. In addition, it is unclear from these quantitative studies which physical and psychosocial consequences individuals find the most adverse and therefore would be the most beneficial to target during treatment.In order to address this critical gap, our research team conducted an exploratory qualitative study to investigate a range of issues relating to IA/PIU including the natural history of IA/PIU problems; common affective, interpersonal, and situational triggers of intensive Internet use; preferred patterns of Internet activity; and adverse psychiatric, psychosocial, and health consequences of intensive Internet use. Findings of this qualitative research will provide a more detailed picture about IA/PIU in university students that may help us to contextualize the results from previous quantitative research and discover all relevant IA/PIU-related experiences in U.S. university students.We employed exploratory qualitative methods including four focus groups to obtain detailed descriptions of IA/PIU from 27 university students. Participant recruitment for the focus groups was conducted between March and April, 2012. Participants were allocated to one of four focus groups based on their availability. Ultimately each focus group consisted of 6–8 participants, and lasted approximately one hour. Descriptive data were collected during focus groups to describe participants’ sociodemographic and Internet usage characteristics.Focus groups are guided group discussions on one or more topics with participants who share similar experiences and/or who possess information and knowledge about the topics of discussion . We emplFocus group assessment materials consisted of 22 open-ended questions and a set of objective measurement instruments . The groYoung’s Diagnostic Questionnaire (YDQ)  and the The YDQ is adopted from the DSM-IV-TR criteria for pathological gambling disorder, consisting of 8 questions that assess signs and symptoms of IA/PIU including preoccupation, salience, tolerance, withdrawal symptoms, and impairment of psychosocial functioning . ParticiThe CIUS includes 14 items rated on a 5-point Likert-type scale, ranging from 0 (never) to 4 (very often). The CIUS assesses severity of compulsive/addictive Internet use behavior, including loss of control, preoccupation, salience, conflict, withdrawal symptoms, and Internet use for purposes of coping with problems and dysphoric moods. Higher scores indicate greater severity of compulsive Internet use. The CIUS has an internal consistency reliability of approximately .90 . In thisThis study was approved by the University of North Carolina-Chapel Hill Institutional Review Board and performed in accordance with the Declaration of Helsinki. Written consent was obtained from all participants before the focus groups commenced.Our team used a purposive sampling strategy by recruiting participants who were graduate or undergraduate students enrolled at a large public university in the southeastern United States. Purposive sampling was chosen with the following goals in mind: to generate information-rich data about Internet use among students who self-identify as intensive Internet users, to identify triggers of Internet use among intensive Internet users, and to explore both physical and psychosocial consequences of intensive Internet use.A recruitment email was distributed via the university listserv. The university listserv includes all undergraduate and graduate students, exchange students, and recent alumni (graduated within the past 2 years). In the email the research team introduced the purpose of the study, study participation requirements, and identified the research team as social workers working for the School of Social Work. Participants responding to the recruitment email who were current graduate or undergraduate students enrolled at the university, self-identified as intensive Internet users, who reportedly spent ≥ 25 hours/week on the Internet for non-school or non-work-related purposes, and who experienced one or more physical and/or psychosocial problems caused by intensive Internet use were eligible for study participation. Physical and/or psychosocial problems were intentionally assigned a very low threshold for inclusion  to elicit wide variation in experiences with Internet use.More than 30 students responded to the email within two hours of the study solicitation and expressed a willingness to participate in the study. Several students revealed that they used the Internet > 40 hours per week for non-school or non-work-related reasons, and suffered multiple physical and psychological problems due to intensive Internet use. By responding to the initial recruitment email, thirty-nine students agreed to participate in the focus groups. The research team responded via email to schedule a focus group time with all 39 respondents, and confirmed that time with a second email. Twelve students failed to attend their scheduled groups for unknown reasons. Thus, four groups were held including 27 students. Participants were assigned to one of four group sessions based on their availability. Sample characteristics are reported in Four focus groups were conducted in a conference room on campus. Each focus group lasted approximately one hour. The number of participants attending each group ranged from 6 to 8, to assure that a wide range of ideas and opinions were represented. The last author facilitated all focus groups. The first author accompanied the last author and was responsible for taking notes during each focus group. The notes supplemented transcription data by capturing changes in participants’ “body language” or other nonverbal communication. The presence of multiple observers at group sessions allowed for observer triangulation to improve the reliability and validity of findings emerging from group discussions . Prior tAudiotapes of focus group sessions were transcribed verbatim, and checked for accuracy by all authors. No software was used to assist in the coding or transcription of data. Three analysts organized codes into umbrella codes and subcodes . First, codes were generated from the research aims and published reports that guided the research . Then, we reviewed and revised the theory-driven codes in context, providing codes with labels and definitions reflective of the raw data. Further, in accordance with DeCuir-Gunby et al.’s recommendations , the secEach of the study investigators independently reviewed and coded focus group transcriptions using the given framework to enhance the reliability and validity of study findings through analytical triangulation . Coding Participants described their current patterns of Internet use with respect to the daily amount of time they spent on the Internet and longest period they ever spent on the Internet in one continuous session of use. The amount of time students reported spending on the Internet daily ranged from 5 hours to “all day,” due to the widespread use of mobile devices  with data coverage . Many participants noted they could not accurately differentiate the amount of the time spent on the Internet for school work or work-related purposes from that for non-school/non-work-related purposes . The longest period of time participants reported spending on the Internet in one continuous session ranged from 3 hours to all day . During those sessions, participants described engaging in different activities including online shopping, video watching, and website browsing. Other participants described use of a specific application for a long period of time, including playing video games and watching videos  on the Internet.The age at which participants reported they first accessed the Internet ranged from 6 to 19, with an average age of 9 (SD = 2.7). The age at which participants reported they first thought they had a problem with Internet overuse ranged from 10 to 32, with an average age at onset of problems of 16 (SD = 4.3). Almost half  of the student sample scored five or more on Young’s Diagnostic Questionnaire (YDQ), and therefore scored above the suggested cut-off point for IA. Another 40.7% (N = 11) scored a three or four on the YDQ, reflecting the suggested cut off for sub-threshold IA. Virtually the entire sample exceeded the recommended cutoff for compulsive Internet use according to the Compulsive Internet Use Scale (CIUS). More than half  of students reported using the Internet to escape from problems or relieve a negative mood. As for negative consequences of intensive Internet use, 63.0% (N = 17) of students reported sleep deprivation; 44.4% (N = 12) reported they neglected school work and other daily obligations due to their intensive Internet use. The correlation between the YDQ and the CIUS was .79.Three overarching themes emerged from the focus groups relating to: a) factors triggering Internet use for non-school or non-work-related purposes, b) Internet-related activities, and c) consequences of Internet overuse. Theme 1: Factors triggering Internet use. This theme was characterized by the emotional, interpersonal, and situational factors that heighten college students’ desire to use the Internet for non-school/non-work-related purposes. Subthemes included: a) mood and feelings, b) boredom, and c) stress and escapism. Many participants noted that more than one of these factors contributed to their Internet overuse at different times.If I’m really depressed, I won’t get on Facebook, I don't want to talk to anyone. I won’t use anything like a social networking kind of thing, but I’ll definitely go on something like Tumblr to look at funny things for like an hour.For several participants, Internet overuse was triggered by strong feelings and moods. For some, the strongest urges came with positive emotions . For others, negative emotions were a bigger trigger . Regardless of the valence of the emotion, most participants noted that particular feelings and moods triggered desires to engage in specific Internet activities. “Nancy,” an Asian woman described her desire to use a particular Internet application as a coping mechanism for sadness:If I ever have a fight with somebody, or tension, or drama …I’ll just get on Facebook to see if they said anything about their mood, or anything about me in particular, or something like that.Other students found they used social media more at times of interpersonal conflict as a way of managing their anxiety about the conflict. While some participants reported “updating my status constantly,” others reported checking other’s status. “Jessie,” an African American woman, noted:I found out I go online more when I am sad than happy. When I am sad, I just want to talk to a friend from overseas via long distance calls or something. So I just chat with them online. And when I am happy, I don’t usually go online.Furthermore, participants had differing desires for use based on mood, with some having more awareness of these patterns than others. “Alice,” an Asian woman, discussed her own patterns of use since entering college, stating:Many participants reported that boredom triggered their desire to use the Internet. Students discussed the Internet as their primary strategy for coping with boredom. “Tom,” a white man, described his experience this way: “If I get bored, that’s the first thing I go to.” Others seemed to link the Internet to specific types of boredom relief . “Mike,” an African American man stated: “Whenever I feel bored, and if I feel stressed, I just get on the Internet to relax, maybe have a laugh or two.” For participants, including “Mike,” the Internet was a means of relief any time boredom arose due to easy access on mobile devices with data coverage: “I think when you get bored, you always want to log on to that thing; like riding the bus to the class, you feel bored, you don’t have friends, you just get on because you’re bored.”I think for me, like when I’m really stressed about school, when I need a break, or have a problem I usually go to the computer to get away from school, get away from the problem for an hour or two .In addition to moods, feelings, and boredom, school and interpersonal stressors triggered students’ desire to use the Internet. “Sue,” an Asian woman, reported a desire to “avoid things, so I get on the Internet. You don’t have to think about anything. You just watch and take it in.” For some, the Internet was a time-limited break:I’m like, if I’ve been on the Internet for 8 hours, and I haven’t done anything, I get stressed out and I tell myself like “how could you do this, waste this much time?” I get annoyed with myself, but then because I’m annoyed, I will look for something funny to laugh at .For others, time spent on the Internet was more difficult to control and ended up adding to their initial stress:Some participants noted the desire to escape obligations as a trigger for Internet use. “Sarah,” an Asian woman, described that desire in this way: “For me, like procrastination, I don’t want to do anything else, so I just, sometimes I just want to be entertained. I don’t want to do my homework.”Theme 2: Internet-related activities. This theme describes the online activities participants’ favored and the reasons for their enjoyment of those activities. Many participants engaged in multiple activities while on the Internet. Subthemes included: a) social media, b) school work, and c) other Internet activities.Most of the time I like to refresh my news feed on Facebook, or look at my followers on Twitter to see what everyone is talking about, and [if] people post a dramatic status [on Twitter], then I’ll go to look at their [Facebook] profile links and see what they’ve posted.Most participants reported using some form of social media. Social media includes applications like Facebook, Twitter, Pinterest, and Tumblr. Due to the accessibility of social media sites on mobile devices, many participants noted their use as part of their daily routine . The extent of daily use ranged from casual  to compulsive . The emergence of multiple social media sites gives users a variety of channels to connect with their peers. Some participants described use of multiple social media sites. “Sharon,” an African American woman, described her use this way:There are days that I’ve tweeted 100 times …I’ll get up and check Twitter, or when I get on the bus to class, I’ll check Twitter, or in class, I’ll check Twitter, and during lunch, I’ll check Twitter, and before I go to sleep I’ll check Twitter.Other participants like “Christian,” an African American woman, reported very intensive use of one site:Although some participants highlighted the importance of social media in their everyday lives, many were quick to point out the practical, work-related functions that the Internet fulfills. As “Christian,” an African American woman, astutely observed: “The Internet is not only Facebook and Twitter and Pinterest but also email, and Google, and the library database on the Internet.” In fact, many students reported that professors required students to use the Internet in completing their assigned class work, including writing blogs, taking online classes, and accessing virtual class materials. “Matt,” an Asian man, was very positive regarding the importance of the Internet to his education, stating, “My research requires specific information that the Internet provides pretty conveniently. For me, the quality of life is increased.” Other participants were ambivalent, stating that accessing school work/work-related materials on the Internet were both a help and a hindrance. “Christian,” an African American woman, noted: “You’re on Facebook, and Google, and your email, and Twitter, and you’re writing a paper, and you’re reading something. It’s just like moving constantly.” Universally, participants acknowledged the convenience and necessity of the Internet as a part of the collegiate environment. “Kate,” a white woman, stated: “I frequently use the Internet mostly for class and clarification of topics. Cut out the Internet completely, I don’t know how to survive in a university setting.”Zelda (a video game), or watching others online playing Zelda at the same time.” Other participants engaged in only one activity at a time, saying they preferred certain activities to others. Examples include news retrieval , online gaming , and video streaming . “Claire,” a white woman, reported that online shopping was particularly appealing, stating “I hate going to the mall, and hate trying on clothes, now I don’t have to. It’s just right there online.” Regardless of the activity, the subtheme “other Internet activities” highlights the widespread utility and appeal of the Internet, but also underscores the risk for potentially problematic Internet use.The final subtheme, “other Internet activities,” included recreational activities such as watching video streams, playing online video games, browsing entertainment, social networking, and news websites, posting on forums , and general searches. These activities were generally performed in conjunction with work and/or social media. “Angela,” an African American woman, reported “I listen to music on the Internet while I’m doing my homework, cleaning my room, or playing Whether students are using the Internet to enhance interpersonal connections and social networking, school work, or recreation, the Internet offers a variety of readily available options encouraging constant use. In fact, students noted that peers and professors facilitate and reinforce their Internet use, which therefore could be a potential risk for those who are more at risk of developing IA/PIU. “Kate,” a white woman, described the expectations of others this way: “For checking my email, it’s like I don't get joy from it, feels like I have to, I have to respond when someone at work emailed me, or I don’t know if I should have to.”Theme 3: Consequences of Internet overuse. The theme “consequences of Internet overuse” was characterized by participant descriptions of short- and long-term effects of Internet use. Subthemes included physical and mental health outcomes, psychosocial functioning, and work productivity. Though not all effects were negative, participants were more apt to point out negative consequences, particularly with regard to health and work.Participants discussed adverse health consequences as an effect of Internet overuse. A few participants reported general concerns regarding physical health. These concerns included sleep deprivation , lack of exercise , and poor posture . “Tom,” a white man, pointed out the intersection between mental and physical health, stating “I get down on myself, feel frustrated if I spend a whole lot time on the Internet one day, instead of doing something physical or go outside.”I think it makes me feel like blah after being on the Internet a long time, just like I feel like I wasted a lot of time. I think even sometimes I don’t have social interactions with people during long periods of the day, I got more irritable.Other students focused mostly on their experience of psychological symptoms. For some participants, anger and frustration were the most prevalent symptoms. “Heather,” an African American woman, reported: “The first thing of the day is to get on Facebook or Twitter. If I hear something stupid, it will annoy me the rest of the day.” Similarly “Lucy,” an Asian woman, noted a difference in her day-to-day irritability:Usually most people post the best part of their life actually, so half the time you’re going there, and just see like “Oh, I am having so much fun, and I am at the beach, partying with hot girls.” And you are like “I’m in my dorm room, and I’m… I’m working at McDonald’s.” I doubt… their life is… much better than mine. But when I’m already depressed, and get on the Internet and see that, I’m like “Yeah man, I suck.”Other participants reported experiencing sadness and depression after Internet use. For some, this sadness was sparked by comparing their current lifestyle to that which their peers had posted on social media. “Andrew,” a white man, elaborated by stating:I have this thing, like especially when I’m eating with someone, they pull out their phone and they start to check their Facebook, Twitter, or something like that, I’ll look at them and I’ll be like “really, you’re going to do it in front of me right now?”Student’s use of the Internet and subsequent health reports may be related to the specific Internet activities they are engaged in and to their patterns of Internet use. As “Heather,” an African American woman, pointed out: “If you’re a social person, then it [social media] adds to it. It’s like a faster outlet…But if you’re not, then instead you’re just watching.” Quotes such as this one highlight the dual or paradoxical effects of the Internet on social functioning. That is, the Internet can enhance a student’s social life; however, when used excessively and in ways that foster and reinforce social isolation, its use can diminish the quantity and quality of face-to-face social interactions. Some participants complained that their face-to-face interactions were hindered by their peer’s use of the Internet. “Nancy,” an Asian woman, explained her experiences this way:“Den,” an African American man, noted that reliance on the Internet for social interactions may lead to a lack of face-to-face communication skills: “When you’re behind the computer, you spend time making the perfect message… But when you’re face to face, [the person] is kind of socially awkward, not really there.” Furthermore, in a quote echoing the sentiments of many, “Lydia,” an African American woman, emphasized that Internet overuse negatively affected her relationship quality, stating: “I would go home, instead of talking to my aunt and cousins, I just sat on the couch, playing with my laptop or my phone. Don’t really socialize with anybody else. So I don’t really talk with anyone.”I felt like if you’re on Twitter, you’re like connected. If you’re on campus, everyone is close. But at the same time, Twitter makes it closer…I feel like you let people know what you’re doing more publicly, so they can hang out with you if you want to.Conversely, other participants noted positive social effects of Internet use. The Internet can facilitate connections to family, friends, and community supports. “Fred,” an African American man from focus group two, explained it this way:The Internet appeared to be especially important for participants in long distance relationships. “Angela,” an African American woman, described the benefits of using the Internet to keep up with family that lived far away, stating: “I think it’s helpful. There are a lot of family members that I haven’t really talked to…So I can just send a quick email and say ‘hey, how are you,’ instead of calling them.”Academic productivity, the final subtheme, describes how participants’ perceived the effects of Internet use on overall school work and productivity. Many participants noted the negative effects of Internet overuse on their general academic performance. “Lydia,” an African American woman, stated: “I feel like that if not for my Internet use, my grades could be 10 times better.” Some participants, like “Jessie,” an African American woman, related this to an inability to focus: “My ability to concentrate on one thing for a long time is seriously impaired… I can’t even focus for 2 minutes.” Other students noted that their work quality suffered due to procrastinating on the Internet. “Nancy,” an Asian woman, reported: “My school work suffered a lot from Internet use…being on the Internet is like you’re procrastinating so much, eventually you get to the point that ‘I need to get this done…’ You’re just not all the way there.” Generally, students reported that while the Internet was necessary for school, the consequences of Internet overuse were antithetical to their school goals.This study investigated a range of issues relating to IA/PIU in U.S. university students including the natural history of Internet overuse problems; common affective, interpersonal, and situational triggers of intensive Internet use; preferred patterns of Internet activity; and adverse psychiatric, psychosocial, and health consequences of intensive Internet use. This study did not attempt to determine the prevalence rate of Internet addiction in U.S. university students. Instead, we intended to provide rich and detailed descriptions of students’ experiences with intensive Internet use/Internet overuse by directly quoting participants’ words in the focus groups. Further, the qualitative themes that were generated from focus group discussions contextualized relevant findings from previous quantitative studies.Many students acknowledged that it was difficult to accurately calculate the total amount of time they spent on the Internet per day because unlimited data plans on mobile devices  mean Internet is constantly available. However, students were still able to self-report consistently and accurately across both self-report qualitative and standardized measures, validating both qualitative and quantitative results. Many students stated they could not accurately differentiate the amount of the time spent on the Internet for school or work-related purposes from that for non-school/work-related purposes. Some studies have suggested a positive association between the total amount of time spent on the Internet and IA/PIU in university students , 56; howQualitative findings demonstrated that negative emotions , boredom, and stress associated with social- and work-related obligations were common emotional and situational triggers for many students to engage in intensive Internet use. Unfortunately, use of the Internet as a coping strategy for negative psychological states may also perpetuate these states in the long-term. Research suggests that use of the Internet as a coping mechanism may be similar to self-medication with alcohol and other psychoactive drugs . TheorisStudy participants reported a variety of adverse health and psychosocial consequences related to intensive Internet use. Many students failed to exercise and engage in face-to-face social activities because of the excessive amounts of time they spent on the Internet. Prior research has linked Internet use to weight gain and obesity  and theoExcessive/problem use of social media sites in youth and emerging adults have been examined and documented –64. ManySeveral quotes from this study indicate that access to the Internet has lowered students’ thresholds for boredom such that individuals become bored more quickly and have increased difficulty concentrating on imperative, school/work-related tasks. Theorists have conjectured that excessive Internet use may affect brain function in ways that reduce the ability to concentrate . Also, pAdditionally, contrary to much of the reported literature , particiUltimately, this study created almost as many questions as it answered. Specifically, this study’s findings shed additional light on several previous findings that have been highlighted in the literature as unclear, or otherwise exploratory in nature. For example, almost the entire sample  first accessed the Internet prior to entering college ; and many students didn’t self-identify as having problems associated with intensive Internet use until their late teens/after entering college. Some previous findings have suggested that the number of years using the Internet was associated with IA/PIU , 56; howIn addition, this study highlights some of the similarities between IA/PIU and other behavioral addictions. It is truism in the substance abuse and mental health fields that early onset of substance use portends a more problematic course and poorer prognosis than later onset . HoweverAs mentioned previously, students in this study spent many hours on social media sites. The amount of time spent on social media sites may suggest habit formation rather than addictive properties, although previous studies have suggested that students found Facebook was addictive . FurtherStudy limitations include the small sample size, single site location of the investigation, and exploratory nature of the findings. These factors all may limit the generalizability of results. The recruitment email that was sent to the entire student body of the university was used as a screening tool; however, it is possible that students self-selected into the study and may have differed from students with IA/PIU problems who declined to respond to the recruitment email. Additionally, the standard measures for IA/PIU used in this study do not have clinical or empirical cutoff scores established for distinguishing between IA/PIU and normal Internet use. Therefore, we are relying on participants’ own self-reflections and self-reports, which are subjective in nature.Despite these limitations, the university where this research was conducted is not unlike many other large public universities and the study sample was diverse with respect to race and gender. Further, participants’ self-reflections and qualitative responses regarding their own perceived problematic Internet use add depth to findings and help to contextualize previous research results related to IA/PIU in university students, including the natural history of PIU, triggers and patterns of IA/PIU, and consequences of IA/PIU. Many of the students we studied were emphatic about the harms they had suffered due to intensive Internet use/Internet overuse. It is likely that most students at risk for or suffering from IA/PIU problems in the U.S. receive no specific preventative or treatment interventions for their Internet overuse problems. Although a substantial body of international literature has accrued identifying adverse consequences of IA/PIU in university students, university campus health care and other health care agencies struggle to identify IA/PIU in university students and provide treatment due to a lack of clinical diagnosis tools and appropriate interventions , 23. We S1 Document(DOCX)Click here for additional data file.S1 Table(DOCX)Click here for additional data file.S2 Table(DOCX)Click here for additional data file.S3 Table(DOCX)Click here for additional data file.


In attempting to understand how the use of medicinal plants is symbolically valued and transformed according to specific cosmologies, we gain valuable insight into the ethnopharmacologial practices, in terms of the major role played by healers, as custodians of local ethnobotanical knowledge, but also as ritual masters.Thus, the goal of this paper is to understand how medicinal plants are used differently depending on a combination between the healers’ field of expertise and personal history on the one hand, and the diversified religious and symbolical frameworks on the other.This essay is based on intense ethnographical research carried out amongst the Nalu people of Guinea-Bissau. Methods included participant observation and semi-directed interviews with six locally-renown healers (four men and two women). The progress of their work and the changes operated within the sets of beliefs associated with ethnopharmacological practices were registered by means of repeated field visits.A total of 98 species and 147 uses are accounted for, as well as a description of the plant parts that were used, as well as the methods of preparation and application according to the different healers’ specialized practices. At the same time, this research describes those processes based on pre-Islamic and Muslim cosmologies through which medicinal plants are accorded their value, and treatments are granted their symbolic efficiency.Medicinal plants are valued differently in the pre-Islamic medicine and in the medicine practiced by Islamic masters. The increasing relevance of Islam within this context has affected the symbolic framework of ethnopharmacological practices. Nevertheless, the endurance of those processes by which symbolic efficiency is attributed to local treatments based on plants is explained not only by the syncretic nature of African Islam, but also by the fact that patients adopt different therapeutic pathways simultaneously. In the West African rural contexts we can observe the daily collection and distribution of vegetable products for medicinal use. In poor countries, where public health systems are under-resourced, the practices of traditional medicine are of great importance. This is certainly the case of Guinea-Bissau , 2.The Guinea-Bissau traditional medicinal systems are largely based on the use of plants for pharmacological use. Some studies on medicinal plants have been carried out in different ethnic groups, namely Fulani  and BijaThis paper aims to present the uses of medicinal plants in the context of Nalu people (southern Guinea-Bissau) based on an ethnobotanical framework that focuses on the connection between plant uses and symbolic aspects. The proposed goal is to understand rationalities, cognitive processes and behaviors involving ethnopharmacological practices, while striving not to take local knowledge out of context, but instead to reflect on how it was generated, transformed, and connected to specialized practices and cosmological beliefs . As Ingoper se.On the other hand, this paper places its main focus on the healers, as detainers of ethnopharmacological knowledge and guarantors of the population’s survival. Thus, the main focus will be the subjects and their experience of the treatment and cure processes, rather than the medicinal plants Local treatment and cure processes include: cultural representations of health and illness; local healers’ knowledge; nature and world-view perceptions shared by healers and patients; rituals and symbols that legitimize the efficacy of treatments. These elements must be taken together to understand the emic processual efficacy . Said prBased on these assumptions, the present work addresses two main questions: a) to what extent does the Nalu healers’ use of the same plants vary according to their expertise and personal history; b) what role do cosmological perceptions and religious beliefs play in the use of medicinal plants.Our goal is not providing a description of the ritual or magical uses of plants, but rather of the magical processes that confer symbolical efficacy on the medicinal plants which are not used in ritualized cures. Even though healers and patients alike share a common worldview, the precise and detailed features of said processes, or in other words, the specific actions performed by healers to endow the plants with symbolical efficacy, are in most cases not known to the patients.This means that while a study focused on the plants and the observation of their therapeutic uses reveals two distinct types of plants used in the African medicinal systems – non ritual plants, used in non-religious treatments, and ritual plants used in ritualistic treatments e.g. , 20), wh, wh20]),On the other hand, we argue that the means used to confer symbolical efficacy upon the treatments using medicinal plants, are different for Nalu healers who summon non-Muslim supernatural entities and those who invoke the words of the Quran.The Nalu people inhabit Guinea-Bissau and Republic of Guinea. The community under analysis is located in Guinea-Bissau in the Cantanhez National Park Fig. .Fig. 1Lon’koi); new slash-and-burn field (kakoi); savannah (m’báké); mangrove (n’kim); rice-swamp (n’dále) and palm tree grove (n’búm) ).djambakus ; marabouts (Muslim medicine-men); and even ordinary members of the social group, especially the elderly.Our observations enable us to assert that in the Nalu communities, different agents coexist in the treatment of different illnesses: healers who are specialized in the treatment of specific ailments, mostly physical disturbances, without resource to divination; irán sicknesses”. Iráns are supernatural beings that populate the Nalu imagery, and irán diseases are disturbances, most of them of psychic nature, believed to be provoked by these spirits.Despite the fact that any “classification of sicknesses” is constructed and reconstructed according to context, and that the links between nosological symptoms and categories - as between kinds of sickness and therapeutics -, are not reciprocal , 16, 30,iráns), which is essential to their cosmological explanation of the world and nature, whereas for Muslim medicine-men (marabouts) the effectiveness of the remedies resides basically in its association with the “sacred word” of the Quran.In the treatment and cure of the illnesses, different symbolic and cosmological frameworks are called forth, both pre-Islamic and Muslim beliefs. Healers summon the power of the spirits , following the very same process that was theorized by authors who examined African medicine, such as Augé  and FassOne hundred and forty seven different uses derived from ninety eight species were shared by healers. They are listed and ordered by healer and by the sicknesses treated by the plants used Table .Table 1Pn’fol . But only a few amongst the elder members can identify the ailments that these plants can cure, and only healers know which parts of the plants must be used, as well as the specific combinations, preparation and dosing that apply in each particular circumstance.There are certain medicinal plants known to all the Nalu including the children, such as The knowledge displayed by various healers is similar in terms of the number of medicinal specimens (23 plants on average), with the exception of Hajia Bintu Camará, who only mentioned eight plants. The treatments performed by Hajia Bintu, an elderly woman who had been a midwife, were essentially intended for the village members, especially pregnant women and children. Her medicinal practice relied on her skills and reputation as a midwife, having perfected herself in the prophylactic use of medicinal plants on pregnant women and new-born infantsIn his turn, Usumane Cassamá was still a young man when we first started our investigation, still in the first stages of his practice as a healer. He had learnt the use of plants from his father, who had meanwhile passed away, and started being called upon to prepare medicines, mostly by his village relatives. In the course of the following years, his reputation grew. All the other healers - Arafan Sané, Dgibi Camará, Fatu Bangorá and Tcherno Camará -, were already celebrated healers who treated patients from different villages or even distant regions.Learning the ability to heal using plants develops differently in each case. Some healers start by learning those medicinal uses of plants known as “household remedies”, since they constitute the secret of a given lineage. The efficacy of these medicines is imbued with an ancestral symbolic significance, as will be shown below.But there is also another way to obtain knowledge of medicinal plants: learning from other healers. Any individual, of any age or gender can seek a healer and ask to be apprenticed, which he/she may agree to in return for a fee, whether in money or goods. Healers who know certain household remedies can also increase their knowledge by learning new skills, thus increasing the number of diseases they can cure.Thus, specialization derives from an individual’s expertise in the treatment of specific diseases with the use of certain plants, in addition to possessing specific knowledge on the combination of vegetable ingredients to make medicines. As healer Arafan Sané would say: “All plants are medicinal. All plants are good for curing, we need to know them, some people know some plants, and other people know others”.n’fankok (Paullinia pinnata) used to treat “child weakness” (Fatu Bangorá), to fight scabies (Usumane Cassamé), and in the treatment of child diarrhea (Hajia Bintu Camará).n’tonkindjá (Ficus sur) used for lower back aches (Arafan Sané), failure to menstruate (Fatu Bangorá) and for stomach aches (Tcherno Camará e Dgibi Camará).n’fol  used against intestinal parasites (Arafan Sané), constipation (Hajia Bintu Camará), stomach aches (Tcherno Camará e Dgibi Camará) and in the treatments that accompany pregnancy (Fatu Bangorá).Here are three examples of medicinal plants that, like many others, were used in various ways by different healers:In terms of plant-picking habits, all healers follow a common principle: harvesting the vegetable elements needed for preparing medicine causing the least possible damage to the plants. Thus, while picking roots for instance, only a sufficient portion of the root is cut so as not to compromise the plant’s survival, just as in the collection of tree bark, the least damaged barks are chosen. These practices are just as much in accordance with a practical concern with the preservation of natural resources, as with an ontological respect for non-human beings, providing a basis for sustainability and contributing to the preservation of biodiversity.marabout and thus followed Muslim practices.The collection of the medicinal plants used by Tcherno Camará and Dgibi Camará was carried out together with both healers. However, as it will soon become clear, the symbolical proceedings involved in the treatments used by each of these two healers were totally different, since Tcherno Camará relied on pre-Islamic symbolical elements while Dgibi Camará is a We can therefore claim to have found two kinds of specialization; one specialization consisting in the knowledge of the medicinal characteristics of plants, and the another in the symbolic efficiency of the treatments that implied the use of plants.The healer Fatu Bangorá is an old woman who specialized in assisting pregnant women and curing children’s diseases, besides treating a large number of adult ailments. She learned some of these medicines from her mother, but there was a specific episode that drew her to this activity. Her mother became gravely ill, and a healer from different ethnic group (Sussu), who lived the Republic of Guinea and was visiting the region, was the only one to hit upon the right treatment. When she saw this, Fatu decided to “buy his medicines”, or in other words to learn from him in exchange for payment in goods. From that moment on, she has been collecting different knowledge on medicinal plants from many other healers, not the least because, as she explained, she “had many children and sickness can fall upon us unexpectedly”.foie kumbé (“big wind”). In this situation, women “expel blood during pregnancy and later die during childbirth, along with the infant” (very likely corresponding to situations in which the placenta is not securely attached). She uses the leaves of mékinha (Crossopteryx febrifuga), n’sansan (Cassia sieberiana), n’sokor (Vitex madiensis) and urém (Landolphia dulcis), dried and macerated in cold water. The resulting liquid is drunk by the women daily, starting in the third month of pregnancy.She uses a broad range of plants Table . One exaWhen the baby is born, it is washed with the same medicine and also begins to drink it. When the breastfeeding period ends, the mother takes the child to the house of the healer, who will proceed with a symbolic ceremony. In this so-called “law of the remedy”, Fatu cuts off a small lock of the child’s hair, thus marking the end of the preventive period. As an expert in the treatment of childhood diseases, the pregnant mothers assisted by her, essentially make use of her services when their children become ill.Despite not belonging to a lineage of traditional medicine experts, this healer gained recognition. The means by which she acquired knowledge of medicinal plants was not a ritual learning, neither was it based on any kind of magical initiation. Nevertheless, there are symbolical elements connected with some of the treatments, and they are marked by ritualistic practices, as in the example shown.mesinhos di casa (“household remedies”) – secrets about the use of certain plants that are passed down from parents to children, from grandparents to grandchildren. Arafan Sané and Tcherno Camará, now deceased, were two such healers. As such, they shared their knowledge of medicinal plants, but only within the boundaries of what they considered not to have a secret character. In spite of this, after several months of fieldwork, they explained the ritual procedures that accompanied most of his treatments. And they also revealed their fear that, in light of current cultural changes, their knowledge would not endure in future generations.Some healers anticipate and cure with n’tak (Bridelia micrantha). Its root was collected, scraped and cut into pieces, which were placed in a pot .Such medicines must be prepared at home to be efficient, because their strength and efficacy lies in their having been supplied to humans by supernatural beings. Phytotherapeutic knowledge belongs to a given lineage, who obtained it in exchange with the supernatural beings In exchange, they received protection of the supernatural beings – protection for men and for the natural space. They were also given knowledge of plants:iráns would have lived in the territory founded by the lineage ancestors; they were entities in whose name the healer worked to make his treatments produce the desired effects. This healer was supported by seven iráns. To explain this he used a drawing . It is he who presided to the nalu’s masculine initiation rite (before Islamization), and continues to embody a talisman (cotton yarn) protecting people from the evils that may arise within Nalu territory. Around Baken Kantchadáber stood the “Guardian iráns”: Mangbenkar, his son, in the Canábene forest by the river, living in a small tree n’koia,  where a large snake or swarm of bees are often seen; Banam, near the village of Arafan (Sogobol), in a huge n’kauuê ; N’taxanból, in an orchard near the village of Sogobol, in a n’tisebá tree ; Iaulin, near the village of Catomboi, in a termite mound; Kondor, in the area of Iembérem, in a large n’kauuê; and Tukudu, also in Iembérem, in a large n’bim iráns make their entrance. In this drawing, the figure represented inside the circle would be Mangbenkar. When the healer was on a journey to treat sick people in other villages, he would summon the resident iráns in these areas. For example, when he went to Iembérem, he called for Kondor and Tukudu’s help. In his words, he “worked with both of them”.The figures he started drawing represent the The power of “household remedies” therefore resulted from the efficiency invested on them by supernatural entities, in a process through which the healers possess the knowledge of their ancestors, but derive their power from the geniesdjambakus; and trained to be a nurse in a public nursing course taken after Guinea-Bissau’s independence (1974). The knowledge of modern medicine that he brought to his healer activity was mainly in terms of Portuguese disease terminology. Patients appeared at his doorstep, mostly seeking a cure for malaria, venereal diseases, “belly” aches or eye diseases. Men also commonly brought up impotence problems, while women sought a cure for lack of menstruation and infertility. To solve all these conditions, he resorted to a wide range of plants , is a sculpture which may assume two different shapes: one resembles the bust of a woman, and the other – which is predominant in the region in question - resembling a turtle, whose function is to protect houses and their inhabitants, with their power also bearing influence on the fertility of women and fields. The other, called N’tomon , has the appearance of a stylized bird, and is connected with pre-Islamic rituals used to solve matters of justice, requests for individual blessings  and also governs matters connected with the fate of lineages.Intervention by the u people , 33. OneN’tomon conferred upon them. Many of these sculptures disappeared with colonization, some of them being initially appropriated by European museums or African Art markets, and later losing their importance with Islamization. Unlike Tcherno, who owned several N’tomon sculptures, in Arafan’s village there no longer existed any sculptures. Nevertheless, he maintained the rituals of pre-Islamic origin that conferred symbolical efficiency to his treatments, even carrying them out on the site where a sculpture had previously stood. Today, both of their children continue their work. Arafan’s son, Iafai Sané, uses his knowledge of medicinal plants learned from his father in the treatment of patients from neighboring villages. Given that he was still young when his father died - thus not having completed his initiation in Nalu ritual proceedings, and consequently not having mastered all the secrets -, he is only fit to perform part of the ritual tasks. Tcherno’s son, Amará Camará, substitutes his father completely, becoming locally acknowledged healer and ritual master.These healers were also ritual masters, and therefore the efficiency of their treatments was not based solely on their knowledge of the features of vegetable medicines, but also on the strength that The religious transformations inherent to the growing importance of Islam, and the cultural changes implied by the modernization of Guinea-Bissau’s economic standards, have marked the life of the Nalu over the last decades , 34, 35,marabouts, as well as to the local nurses working for the healthcare system. In other words, “the whole symbolical and therapeutic range is used to ensure effectiveness of the cure. The different axioms are not perceived as contradictory, and the only governing rationale is that of the cure” e cure” , 37) lea leamarabMarabouts perform different activities. They are educated in the complex Islamic mystical system; in numerology and astronomy . The. TheMaramarabouts differ from those of other healers, not just because the treatments are always accompanied by Quranic prayers, but also because the medicines used in many of them are prepared from vegetable elements mixed with nás (sacred water obtained by washing a wooden tablet on which passages of the Quran are inscribed with vegetable pigments)The medical practices of these Dgibi Camará underwent a long Quranic education, and his use of medicinal plants concurs with the Muslim practice system. He was the pupil of a Muslim master from a different ethnicity (Djacanca), from whom he learned the Islamic writing, religion and magic, as well as the uses of many medicinal plants. Nevertheless, his knowledge was completed with extensive teachings in traditional medicine from an old Nalu healer.marabout has some simple uses for medicinal plants that don’t imply ritual procedures. N’sansan (Cassia sieberiana), for instance, is used for body aches. However, most medicines are prepared with nás. As he explained:nás is made, given to the sick person, who then makes an infusion with the medicine: it is boiled and the nás is added, and then it is drunk. It is like when you cook rice on which you put the garnish. The medicine is the rice, and the nás is the garnish. If you cook only the rice, you can eat it but it has no flavor, but when you add the nás, the medicine increases its power.”“A medicine is mixed with God’s name, with the Quran’s name; the This nás increases the power of n’bukui bark (Bauhinia thonningii) used, amongst other things, to cure hemorrhoids; or n’sópsóp leaves (Annona muricata) used for stomach aches, or even the treatment of swollen limbs (probably Filariasis) using parts of several plants such as n’txamborta (Diospyros heudelotii) and n’fakat (Hibiscus sterculiifolius).Thus, the marabout, Dgibi is also a specialist in the treatment of diseases with religious or magical causes. In Islamic terms, these diseases are attributed to the intervention of genies (jinn) and setani (satan), the name for devil, as witnessed among other African Muslim societies . Th. Thmarabmarabouts, as well as amongst the sick who seek their services. Nevertheless, with the progressive Islamization there has been, on the one hand, a reinterpretation of non-natural etiologic categories and the substitution of pre-Islamic supernatural entities by Islamic genies [marabouts to the detriment of masters who follow traditional pre-Islamic rituals, especially in the treatment of diseases of magical-religious nature.Therefore, the perception of diseases is similar amongst healers and c genies , 44. On This study demonstrated the importance of symbolic aspects in the use of medicinal plants, agreeing with the conclusions reached by other studies on the treatment of sickness in West Africa, as for example the work by Fainzang, where it is stated that “(…) the therapeutic discourse affirmed the treatment’s validity, leading to eventual intervention by the sacred to legitimate it; the cure was more recommended for its magic (symbolic) value than for its intrinsic value” iráns) participate in a complex network of social relations.In the pre-Islamic worldview prevailing within Nalu’s traditional phytotherapy system, the concept of medicinal plants is part of a specific cosmology. In general, natural beings, whether animals or plants, are seen as elements of the world at the same level as humans in a holistic and systemic vision of the universe . The difIt can be stated that amongst the Nalu, medicinal plants occupy a different place in the pre-Islamic medicine and in the medicine practiced by Islamic masters. Knowledge of plants’ pharmacological action will be similar in every respect, but they differ in the symbolical means used to render them efficient. The Muslim practitioner seizes divine energy, allowing himself to be penetrated by its supernatural efficiency. It is easy to understand that this quasi-sacramental value conceded to the reading of the Quran has drifted to more practical uses since the first generations of Islam, and that the versicles have come to be used for purposes of healing or divination , 49. Theiráns. Given that plants with beneficial properties were an offering from the iráns to the forefathers, plants themselves possess a magical and symbolical power. Plants’ medicinal value stems from a bond established through human lineages, which includes both the living and their ancestors [In the healing practices based on pre-Islamic conceptions, plants are mediators for the power of ncestors , in a limarabout’s power is also mediated by the strength of Islamic genies, these do not possess the autonomy of pre-Islamic genies. Thus, it is as if the material means found in the vegetable elements had lost part of their symbolic meaning and value to the power of the new medium afforded by the sacred writingsWithin Muslim practices, medicinal plants become simply a material instrument, and the magical effect lies with the reproduction of the sacred text, in a direct divine intervention. Although the In conclusion, in the Nalu healing systems under analysis, we found a similar degree of knowledge and use of medicinal plants amongst healers who follow a non-Islamic cosmology and healers who perform Islamic ritualistic practices. Distinctions in the use of medicinal plants are drawn according to the healers’ field of expertise, gender, personal history and individual learning careers. Nevertheless, the non-Muslim and Muslim procedures involved in the bestowal of symbolic efficacy on treatments differ and are supported by distinct ontologies: to the former, plants possess an intrinsic value derived from the bonds linking human and superhuman entities, while for the latter plants relinquish that value to the relation established directly by humans with God, mediated by Holy Scriptures.