Background. The aim of this study was to investigate the nature of the relationships between healers and their clients in Germany. Methods. An interdisciplinary research team performed semistructured interviews with healers and clients and participatory observation of healing sessions. All interviews were digitally recorded, transcribed, and analyzed using content analysis. Results. Fifteen healers and sixteen clients were included. The healer-client relationship was described as a profound and unique experience, which brought forth interpersonal and spiritual connections. The healers were seen as role models for healing to occur and support for being connected spiritually. The clients had to be open-minded and responsible. The importance of the healers' empathy was emphasized. Discussion. The relationship between healer and client can be seen as a triangular connection between client, healer, and a transcendent source which is not the case in typical patient-doctor relationships. The spiritual connection is also said to enhance the empathetic understanding of the healer. The personality and a partner-like attitude of the healer supported the client in giving a more positive meaning to his life, in reconnecting to his spirituality, and in taking responsibility. Future studies should address the role of spirituality in health care and the development of enduring healer-client relationships. The relationships between health care providers and health seekers are a topic of interest in various disciplines. Historically, the term “therapeutic relationship” derives from psychotherapy and is described as a special form of interaction between therapist and client. Beside the therapeutic method used, the therapeutic relationship is said to have an effect on its own on the outcome of the therapy . Rogers,In medical research, the doctor-patient relationship was historically doctor-centered . Today, Anthropological research, too, highlights the therapeutic impact of the relationship between healers and clients in ritual healing. Therein, the personality of the healer plays an important role –16. BefoThough all these disciplines put special emphasis on certain, slightly divergent aspects of the relationship, we can infer that the interaction between doctor/healer/therapist and patient/client is considered crucial for the healing/therapeutic process  and thatIn Germany, some healing techniques  have a long cultural-historical tradition . In the The aim of this study was to understand the growing field of contemporary healers and their clients in Germany and to learn about their subjective experiences, biographies, concepts, and motivations. To do so, we conducted a qualitative study integrating perspectives from medicine, medical anthropology, and religious studies. For the purpose of this paper, we focused on how healers and their clients describe and discuss their relationships. This discussion allows for a conceptualization of the healer-client relationship in German healing settings.A qualitative study based on semistructured interviews with healer and clients combined with participatory observation was conducted. To include different perspectives, the research team was interdisciplinary, composed of three physicians, two medical anthropologists, and one religious studies scholar who were all experienced qualitative researchers. The religious studies scholar had practiced healing; all the other researchers had no background in practicing spiritual healing. The whole team was involved in the development of the interview guidelines, recruitment process, data collection, and data analysis.The interviews were designed to elicit information on biography; motives to consult a healer or to heal; expectations and explanations of the healing process; concepts of health, illness, and healing; experiences during and perceptions of the healing sessions; and the participants' perceptions of the effects and outcomes. The interview guide was used to support the interviewers and allowed flexibility to vary and deepen particular aspects of interest. After the first interviews, the interview guide was critically reviewed by the research team and improved accordingly. This paper focuses on the statements of healers and clients about their relationships.Because the field of healers in Germany is very heterogeneous and not in general easy to access, a snowball sampling technique was used for recruitment . The resBoth interviews and healing sessions were digitally recorded and then transcribed verbatim. Materials were pseudonymised. Written memos of the interviews and participatory observations by the researchers added further information on the setting, nonverbal expressions of the interviewees, and the researchers' subjective experiences.The data was analyzed based on a directed qualitative content analysis  with theParticipants provided written informed consent and the study was approved by the ethics committee of Charité University Universitätsmedizin (EA1/238/10).In total, 15 healers and 16 clients were included in the study. The healers were 9 males and 6 females, with a mean age of 55 ± SD 7.9 years. One healer was a nurse, four healers were physicians, four were “Heilpraktiker” , and six had no medical or CAM education. All healers worked full time or part time as spiritual healers for already many years. For example, one of the physicians had stopped practicing conventional medicine; the other three physicians practiced both, conventional medicine and spiritual healing, but never in combination and at the same time. The “Heilpraktiker” often combined spiritual healing with other CAM methods. The healing techniques mainly used by all healers were laying on of hands and/or prayer healing. The healers reported that healing talents can be inborn, developed, or acquired during life. Mostly, the experience of a powerful event or a crisis prompted their transformations into healers . This transformation often took many years and was often accompanied and supported by other spiritual healers and teachers. However, some of the interviewees  talked about becoming a healer out of sheer interest and learning to heal by attending courses in spiritual healing .Of the 16 clients, 13 were female and 3 were male and they were on average 56 ± 13.8 years old. Three clients were working in health care, two in the media industry, one as a lawyer, one client was unemployed, and four were pensioned. All included clients knew their healers already for a longer time, sometimes years, and had a trustful relationship with them. Reasons for consulting a spiritual healer were mostly chronic somatic problems , serious illnesses , psychological problems , or social problems. In addition, we conducted and analyzed eight participatory observations of healing sessions. The data collection took place at the healers' houses or offices , at the houses of the clients (some interviews with clients), and at the research facilities of the Charité (very few of the interviews with clients).unique” contact. That contact was said to allow the sharing of emotions and visions and was often described as a spiritual experience. The personality of the healer was of high importance for the clients to build trust in the healer and in the sometimes challenging healing process. Moreover, the healers were frequently seen as role models for healing to occur and support for being spiritually connected. The clients, on the other hand, had to be generally willing to open up for this connection and to simultaneously take individual responsibility. Both healers and clients emphasized the importance of the healers' empathy.Throughout all interviews, the relationship between healer and client was characterized as a very special one, a relationship based on mutual respect and appreciation. The experienced relationship in the healing session was described by most healers and clients as a profound and “unique” relation between healer and client was said to start with the first encounter wherein a mutual understanding existed in being willing to engage in the healing process and to trust. Within the first contact it was already quiet pleasant. There was immediately such confidence … I think the chemistry has to be right … because you quite reveal yourself.”D_H2_K1, client: “Healers and clients described their relationship as “very deep” and repeatedly used terms like “energy flow,” “resonance,” and “fusion [Verschmelzung]” to describe the close and intense healer-client association during healing sessions. Sometimes, this bond evoked images and feelings shared by the healer and her/his client: Often I have the same images that the people also have, not similar, but exactly the same images.”C_H2, healer: “ I often experience his [the client's] problems in my body. That means if something hurts him somewhere … then I feel the same pain he feels.”D_H1, healer: “ And there an exchange takes place … from the energy of the healer to the person. An exchange, an act of love … on an energetic level … you connect a lot with somebody … one flow together.”A_H3, healer: “Repeatedly, healers and clients talked about “being touched.” That was meant not only in a physical way but also figuratively or metaphorically. One can be touched physically, emotionally, and spiritually. Mostly, the clients were first touched physically by the healer through the intuitive laying on of hands which subsequently was said to enable the “energetic” connection between them and could evoke various emotions in each of them. Sometimes, a healer's prayer “touched” (in the sense of reminded of) the client's memories from childhood and allowed a reconnection to his spirituality. Again this is said to happen mutually between healer and client.  I would only touch people where I have the feeling it is right. … In ninety per cent [of cases] the patients say afterwards: you touched me exactly there where I thought I needed it.”C_H2, healer: “ And many patients say, ‘the last time grandmother has prayed with me' … or your mother if you were ill, at your bedside, only for yourself. And that is exactly that what opens something up in the people … something very, very, very deep.”C_H2, healer: “ For me, it had to do with where I was touched, for example, if I were touched on the knee, I had the feeling as if … I'll call it - and I can't exactly define it - ‘healing energy' was flowing. … And when C_H2 touched my foot, for example, I have the feeling of the connection between the earth and the heavens, the connection simply to my faith!”C_H1_H2_K3, client: “The “ She [A_H2] has … an unbelievable power … and then, things always just go much easier. When I am at home on my own … and want to do such things … then it isn't that easy anymore … I don't know what it is about this woman, she has a power which is unbelievable.”A_H2_K1, client: “ C_H2 has so much knowledge! … that I have the feeling … here you are in good hands. That is like a stairway to God.”C_H1_H2_K6, client: “The healers saw themselves mostly as mediums or “channels,” as intermediaries who try to act without intention and follow the guidance of a higher order or being. Healers saw themselves as persons in contact with their intuition and a spiritual power. Identifying as a channel enables the healer also to allow a profound association with the client in the healing session while still staying personally detached.   “A good healer is just somebody who leads the energy through ….”D_H1, healer:  “you leave the personal level, our opinions, ideas and conditionings … and connect yourself … with the ocean of knowledge. You can call it also collective unconsciousness or the higher self. Call it as you want, if you want, call it God … and if you have a question, then the question pulls the answer … it does not come from a personal level, that is the decisive factor … It comes through you, you are a channel, and you receive the answer out of the ocean.”A_H3, healer:Often the healing session is experienced by the clients as a dream-like or trance-like state where the healer is seen as somebody guiding them through . C_H1_H  “… that I am there, just there and be at their [the client's] side, being a good friend, somebody who listens, who does not judge, who does not condemn.”C_H4, healer:  “The therapeutic relationship is very important … but that is -in the end- … empathy … no judgment, no intention.”A_H3_K1, client:Many healers reported that they have this profound empathetic understanding for their clients because of their intuitive, subtle, or clairvoyant perception.   “Maybe … I have the special talent for an extraordinary understanding for the patients. Not only for the patients, their sorrows and needs, but also for the illnesses they have … what an illness does to a person.”B_H3, healer:Following this intuitive, empathic understanding, verbal communication was often not necessary for the healers.   “If somebody says nothing, you hear what he wants to say.”C_H1, healer:Mostly, healers would speak with the clients during the healing session only because the clients were used to it and would become irritated if the healers remained silent. At the same time, the conversation prior to and after the healing session was seen as important by the healers. Thus, the clients would have the opportunity to share experiences or to clarify questions which arose in the wake of the healing session and which could help the client to better understand what had happened.The healer's empathy was very important for healers and clients alike. The term empathy, in this context, means something like giving one's full attention to the client, having an intuitive understanding of the client's personality and health history, and being present and open without having any prior judgments or intentions. “companions” and “counselors” in the clients' healing process. Thus, they tried to support their clients in activating and deploying their self-regulating forces. Because of the healers' own experiences of crisis, illness, and self-healing, the healers promoted their clients' hopes for healing and their belief in a solution for their problems. Despite the close relationship, the healers emphasized the importance of not influencing the client or building up dependency.  “I never would impose something on somebody.”A_H2, healer:  “… actually, I accompany him there … and sometimes I push him a little bit.”A_H3, healer:Many healers and clients emphasized the meaning of individual responsibility. For the clients, it was important not to be patronized, to be able to decide freely, and not to be told what they should or needed to do. Often, clients had already demonstrated independence in their choice of healer and often enough finding the right healer for them had already taken a long time.  “Eventually I find the therapists, and then we … look together … for the way. … but, in principle … I am the first one who initiates it, I am the last who decides it, because I must also carry the consequences.”A_H3_K1, client:  “I don't feel particularly influenced … like of a [psycho-] therapist … Here I am not told what to do as homework.”C_H1_H2_K3, client:According to the healers, the client's personal responsibility is an essential aspect of the healing. From the healer's perspective, healing is possible only if the client is ready to assume the responsibility for himself. Personal responsibility, in this context, would not mean that the client was to be blamed for his problems and illnesses. Rather, personal responsibility refers to the strength and courage to overcome fears and to actively participate in the healing process. Often people would not want to assume responsibility but would prefer to be told what to do in their lives. Many healers would not encourage such an imbalance in power but emphasized reciprocal responsibilities.  “… the willingness of some people to hand over the responsibility is just very big and therefore it needs strength [of the healer] to say, no, I don't take the responsibility, I leave it with you ….”D_H3, healer:The healers saw themselves asThe relationship between healers and clients during the encounters was described as profound and unique, wherein healer and client shared emotions and sensations and connected to a transcendent source. The personality of the healer supported the clients' hopes for healing and helped the clients to (re)connect to their own spirituality. The healers' empathy was emphasized by both healer and clients and was explained by the healers as a subtle, intuitive understanding of the other. The relationship was seen as partner-based. The healers were said to act as a companion to the client in his healing process. Clients had to be open for this profound connection to occur and at the same time to be willing to assume personal responsibility.One strength of this qualitative study is the inclusion of a range of spiritual healers and their clients from different settings , (religious) traditions, healing techniques, and professions. Another strength of this study is the interdisciplinarity in the research team, which included scholars in medicine, anthropology, and religious studies. That diversity permitted different approaches in the field. The same diversity contributed to various perspectives in the analysis. The interdisciplinary teamwork led to complex and time-consuming processes and a practicable balance had to be found between all aspects of the extensive data material and the interdisciplinary experts' assessments. a posteriori when the process of healing had already occurred and healers and their clients might have constructed new meaning and shared beliefs together. Furthermore, it should be considered that, basically in every interview study, words can be understood only as an abstraction of experience. Also in this study the interviewees reported repeatedly that it was difficult to find words for their experiences, feelings, and concepts concerning a spiritual experience.A limitation of this study is the selection for our sample as clients were included in this study by their healers. It is likely that they have chosen clients with whom they work well. Therefore, the reported outcomes and explanations might present a picture that describes only successful healing sessions and stories of clients that improved during the healing process. This means that our results possibly reflect the more positive aspects of healing processes and preclude failed stories. Furthermore our interviews took place “deeply touched” in a “unique” way. They were felt, seen, and understood by the healer and they spiritually (re)connected. That experience was characterized as very meaningful to the clients and was not found easily in normal life or in their experiences with conventional medicine. The connection to the spiritual/transcendent is said to directly influence the empathetic understanding of the healer and will be discussed in the following section.The statements of healers and clients about the importance of the relationship between them correlate to studies about doctor-patient relationships and therapeutic relationships in psychotherapy as described in the Introduction –4, 6–10. empathy is nowadays an inherent part of clinical and psychological research, historically there has been much debate about the origin of the term and its meaning. Interestingly, explanations of the German term “Einfühlung” While there are still debates about the definition [ “the ability (1) to understand the patient's situation, perspective and feeling …, (2) to communicate that understanding …, (3) to act on that understanding with the patient …” [Empathy was of high importance for the interviewees and encompassed subtle perception, awareness, presence, nonjudgment, and the company of the healer without imposing influence. Even though the term empathy ) relate he other . This nofinition , today itient …” : 9. Thattient …” . The clitient …” . Based otient …” .The importance of the personality of the healer is emphasized in this study and correlates with various anthropological studies about healers and their patients –16. In oThis partner-like approach of contemporary healers in Germany is possibly influenced by the current general discussion about paternalism versus partnership in health care , 44. ParThe client had to be willing to open up to this relationship and at the same time to be willing to assume personal responsibility. Critically, it should be noted here that the close relationship between healers and their clients could contradict independence, noninfluencing, and individual responsibility. Even if not expressed in our data, we must recognize that the healer setting is not immune from fostering dependence and that abuses of power may occur , 46. PosThe findings of our study also show the importance of spiritual questions related to health care. It is not only the relation to the healer that matters for the client, but also the client's relationship to the spiritual/transcendent. In this sense, Cox proposes that the existing biopsychosocial model should be extended to a “body-mind-spirit paradigm” in individual therapies . He seesThe results of this study stress the importance of and potential in the relationship between healer and client. In contrast to doctor-patient and therapeutic relationships, central to healer-client relationships were the shared experience in healing sessions and the triangular relation between client, healer, and the transcendent. The healers see themselves therein as a channel to the spiritual/transcendent which would allow them a subtle empathetic understanding of the client while staying personally detached. Furthermore, the personality and a partner-like attitude of the healer supported the client's efforts to give a different meaning to his problems and his life, to (re)connect to his spirituality, and to assume personal responsibility. In further studies, the question of how spirituality may be integrated in health care and how the healer-client relationships develop over time in the healing process could be of interest.


Scoring protocols are summary statistics aggregating individual test or subscale scores to yield an overall informative measure. For the questionnaires used to assess the constructs postulated in the organismic integration sub-theory of self-determination motivation theory—in this sub-theory motivation is conceptualized as a continuum with polar and intermediate types of motivation that vary in the extent to which they are internal or external—, the scoring protocols are designed without taking into account the fact that intermediate motivation types may generally represent a mixture of internal as well as external motivation. Thus, in the process of weighting the subscale scores, the same weights are used in the protocols for the shares of internal and external motivation of a regulation type, thereby confounding the resulting overall measure, which therefore may lack interpretability. As a consequence, subsequent analyses based on such an aggregation measure may be distorted or erroneous. This can be important from a practical viewpoint, e.g., when investigating correlations of the measure with other more substantial variables of a theory or study.In this article, I use an example of a scoring function, the RAI (or SDI) index, commonplace in many areas of motivation research, to exemplify how adaptations can be made to accommodate biasing effects on the overall index value that may result from the confounding of internal and external motivation. The approach can even be generalized and applied to other scoring protocols, which can be adjusted for mixed or confounded internal and external motivation in an analogous manner, as exemplified in this article with the RAI index. Thus, I advocate adjusting for such effects by proper choice of a scoring protocol formula and of the weights used for the motivation types combined therein.Self-determination theory was proposed by Deci and Ryan  to do fractional arithmetic. However, while working on a fractions task, a person may value the activity more and more, and it may become part of one's self, thereby being gradually internalized. According to organismic integration theory behaviors can move from being purely extrinsic to being completely intrinsically motivated and these types of motivation regulation are ordered along a continuous scale called the self-determination continuum , identified regulation , and integrated regulation.Deci and Ryan  segmenteIdR, for instance, the extent to which this regulation can be viewed as internal and external, here represented by the model parameters πIdR1,  and πIdR2, , respectively, were computed based on the convex decomposition modelInR and external regulation ExR are the completely internal and completely external motivation poles of the theory, and the proportion weights πIdR1,  ≥ 0, πIdR2,  ≥ 0 with πIdR1,  + πIdR2,  = 1 are the parameters that were estimated from the data. Analogously, the extent to which the introjected regulation type IjR can be viewed as internal and external were computed in Ünlü and Dettweiler , also known as the self-determination index (SDI). For details, see Grolnick and Ryan  index, subsequently in its version for instruments assessing extrinsic motivation and intrinsic motivation, the inventory scores are weighted and combined to give a descriptive overall measure of the behavioral self-regulatory style. The formula isIdR and IjR vary in the extent to which they are internal and external, and the goal is to disentangle these and weight them separately. An adjusted RAI (or SDI) index can be defined asmean internal motivation and mean external motivation, i.e., I propose an adjusted variant of this scoring rule. The regulation types ttweiler :IM¯= represents the amount of internal motivation of identified regulation, and πIdR2, (IdR − 1) is the amount of external motivation. In sum, these mixture components do yield the overall variable identified regulation, i.e., πIdR1, (IdR − 1) + πIdR2, (IdR − 1) = IdR − 1.The original RAI index does not allow one to account for the extent to which the identified and introjected regulation types are internal and external. In the process of weighting the subscale scores, the same weights are used . In contrast, the alternative adjusted RAI is weighted according to the extent to which these regulation types are internal and external. For example, πTherefore, I conclude the traditional RAI scoring rule may generally lack interpretability. I suggest that, as a minimum requirement, the current RAI scoring rule, when used, should be compared to some adjusted variant of it (such as the introduced variant), and if possible, be studied in combination with other scoring rules as well.In self-determination motivation research, aggregated score statistics, in particular the RAI coefficient, have been used in theoretically substantial analyses as a substitute for the motivation inherent in a participant. For example, scoring protocols can be correlated with essential variables of a theory or study. It remains to be seen how robust or sensitive the derived fundamental statements or interpretations based on possibly confounded scoring protocols are, when adjusting or correcting adaptations are utilized in the manner I proposed with this article. Therefore, previous motivation studies could be reanalyzed, based on adjusted scoring protocol variants, aiming at replicating results or deriving similar or new findings. Future research into this issue is obviously needed, including systematic comparisons through in-depth real data applications. I think that this topic is an interesting and important one to pursue in future motivation research, particularly, to analyze, in light of these findings, previously published application studies on motivation.The author confirms being the sole contributor of this work and approved it for publication.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Katsushika Hokusai, one of the most prolific Japanese artists of the late Edo period (1615–1868), has been described as “cocky, quarrelsome, restless, aggressive, and sensational.” He obsessed with his art to the extent that he would move frequently rather than clean or repair his cluttered houses. During an artistic career that spanned 7 decades, he signed his works with more than 30 different names—typically in tandem with a shift in his artistic style and technique. Though this practice was common in Japan during his lifetime, Hokusai changed his name more often than any other major Japanese artist.Ukiyo-e or “pictures of the floating world”  school of printmaking. He is credited with expanding the range of subjects from traditional Ukiyo-e depictions of courtesans and kabuki actors to encompass landscapes and to include people from various social levels.During his mid-70s, he used as his signature “Gakyo Rojin, Manji” or “The Art-Crazy Old Man.” His humorous, astute self-characterization is supported by the fact that he left more than 30,000 varied works of art, including woodblock prints, travel and book illustrations, manga, and silk paintings. Hokusai is one of the outstanding figures and innovators of the Though the exact date of its publication is unknown, Hokusai’s defining work, “Thirty-Six Views of Mount Fuji,” was created from 1826 through 1833. Mt. Fuji, which is tied firmly into the cultural, spiritual, and social identity of Japan, had long served as inspiration for Hokusai and his art. In response to brisk sales of the initial set of 36, the artist expanded this popular collection to comprise 46 woodblock prints. Art scholar Sarah Thompson notes that the universal appeal of Hokusai’s works relates to his use of Western style perspectives and to “their strong internal structure. Many prints in the Fuji series explicitly contrast the strikingly triangular shape of the mountain with triangles, rectangles, trapezoids, or curved shapes formed by other elements of the design.”Included among the original series of 36 views is this month’s cover image “Yejiri Station, Province of Suruga.” In this gently humorous image, Hokusai captures the reactions of several travelers on a serpentine path through the rustling marsh grasses, caught off guard by a sudden squall. Some stoop and clutch their hats and clothes as others fruitlessly reach toward their papers and hats blowing skyward, mixing with the leaves stripped from the bending trees. The British Museum offers this description: “The silhouette of Mt. Fuji is drawn with a single line, providing a backdrop for the figures and trees battling the wind in the foreground. Bending their bodies and clutching at scarves and hats, all turn their faces away from us—as if we were the source of the blast that carries off the tissues that had been tucked into the woman’s kimono.”The element of surprise is central to Hokusai’s visual narrative. The Honolulu Museum of Art notes that Hokusai “focused on an instant of drama caused by a gust of wind. Fuji stands white and unshaken, affected neither by the wind nor the human drama.”Like the unseen wind in Hokusai’s print, severe respiratory disease outbreaks can be sudden, disruptive, and chaotic. Emerging or reemerging pathogens may trigger serious, widespread respiratory disease outbreaks—including adenovirus bronchitis, influenza, Legionnaires’ disease, Middle East respiratory syndrome, multidrug-resistant tuberculosis, and severe acute respiratory syndrome (SARS).To gain perspective on the nature of such threats, determining the etiology and understanding the clinical and epidemiologic characteristics of an outbreak is crucial. Surveillance systems—which are a basic component in the routine counting of disease cases—enable public health professionals to detect and investigate unexpected increases in these cases and prompt measures to control outbreaks, including those of emerging and reemerging respiratory disease. In a sense, surveillance systems embody the character of Mt. Fuji—which provides Hokusai’s travelers in “Yejiri Station, Province of Suruga” with a reference point during a storm—as they provide a constant, stable approach for outbreak investigations.


Contra Caries Oral Health Education Program, a theory-based, promotora-led education program for low-income, Spanish-speaking parents of children aged 1–5 years, was developed. This article describes qualitative findings of the acceptability of curriculum content and activities, presents the process of refinement of the curriculum through engaging the target population and promotoras, and presents results from the evaluation assessing the acceptability of the curriculum once implemented.Latino children experience more prevalent and severe tooth decay than non-Hispanic white and non-Hispanic black children. Few theory-based, evaluated and culturally appropriate interventions target parents of this vulnerable population. To fill this gap, the Contra Caries Oral Health Education Program was then implemented with a separate but similar sample, and after completing the program, participants were administered surveys asking about acceptability and favorite activities of the education program. Data were entered into a database, checked for accuracy, open-ended questions were categorized, and responses to close-ended questions counted.Focus groups were conducted with low-income Spanish-speaking parents of children 1–5 years living in a city in an agricultural area of California. Interviews were digitally recorded, translated and transcribed, checked for accuracy and the resulting data was thematically coded and analyzed using a social constructionist approach. The N = 51), 105 parents attended the Contra Caries Oral Health Education Program, and 83 parents filled out surveys. Complete attendance and retention was high . This study found that their children’s oral health is a high priority. Parents were not only interested in, but actually attended classes focused on increasing their knowledge and skills with respect to early childhood oral health. The Contra Caries content and format was perceived as acceptable by parents. Strong opinions about curriculum content were expressed for including information on how caries starts and progresses, weaning from the bottle, oral health care for children and adults, motivational strategies for children’s tooth brushing, dental visits and cavity restorations.Twelve focus groups were conducted (Contra Caries Oral Health Education Program was acceptable to low-income, Spanish-speaking parents of children 1–5 years. Participating in the curriculum development and revision process likely played an important role in the parents’ high acceptability of the program.The  Early childhood caries (ECC), or tooth decay of the primary dentition, affects 28 % of children aged 2–5 years in the United States . ECC cauMexican American children are more likely than non-Hispanic white and non-Hispanic black children to have experienced ECC, have more affected teeth, more severely affected teeth, and more untreated decay , 7. RuraWhile it isn’t known exactly why Latino children experience disproportionately high prevalence and severity of ECC compared to non-Hispanic white and black children, initial research suggests that there are multiple inequalities experienced by this population including language and health literacy, access to and perceived need for oral care, rejection of tap water consumption, sugary drink and juice consumption, confusion around infant bottle use and late bottle weaning , 12–18.promotora, i.e., trained lay health educators from the local community, is a culturally appropriate approach to delivery of health interventions, and have been shown to be effective at creating behavior change for other  health conditions , we chose to locate this study in a rural setting, in a different geographic location than our previous ethnographic work, but with a similar Latino immigrant population. Figure We partnered with Community Oral Health Services, a community-based organization that focuses on providing dental services to underserved populations, co-locating in their office that is well situated in a predominantly Latino neighborhood of the community. This organization facilitated introductions to other community organizations for participant recruitment.Contra Caries curriculum were presented to the focus groups participants who were asked to give detailed feedback on what they liked, didn’t like, and how they would like to change things, both for content of the lessons and the format of the activities. Focus group inclusion (selection) criteria required participants be low-income, Spanish-speaking parents or caregivers of at least one child between ages 1 and 5 years. Participants were non-randomly recruited (convenience sample) from community festivals and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Focus groups lasted 2 hours, were held in community organization sites, and participants received a $25 gift card to a local supermarket for participation. Focus groups were conducted until we reached saturation on the key topics of interest. Discussion was recorded and the audiotapes transcribed verbatim, checked for accuracy, and observations of interaction during the groups were summarized as typed field notes. The resulting data was thematically coded and analyzed using a social constructionist approach, developing codes from the data  don’t really explain well about what they are going to do, how they are going to do it and the consequences that there are going to be.” Caregivers wanted to learn about their rights at the dental office, and when it is acceptable to ask questions and for more information. This discussion illustrates these points:<respondent5> When to know when a filling or crown is necessary.<interviewer2> Okay. Good.<respondent2> When is it okay to put those teeth, those ones they put when they have cavities, the silver ones at the front, are they silver?< interviewer2> When is it necessary, or at what age?<respondent3> When they need to be put.<respondent2> … what age they should put those on their teeth.<interviewer2> Cap them?<respondent2> Yes, because they put those on my son when he was two. He was very young and they didn’t explain what exactly they were going to do. When it came out that they had done that, he came out with marks from having his mouth open… marks on his face. We thought it was something more simple, but it wasn’t.<respondent3> They didn’t explain what they were going to do?<respondent2> No.Parents wanted very detailed information not just about what exactly was happening during the decay process but also what the corresponding dental treatment was. They wanted, for example, to know not just formal terms but exactly what a filling is, how it differs from a crown, and when a child might need one or the other, as explained here:“He was about four years old when they had to pull out his two front teeth, and they didn’t explain that to me either. He came out… with a lot of marks, but too much… on his face, and on his arms, maybe because it was tight, but they didn’t explain that. They just said that there was going to be some anesthesia and that he would be slightly drowsy, but that’s it. And they didn’t tell me that I couldn’t be there either. I wanted to go in but they told me that I couldn’t be there. They never told me that I couldn’t be there and that they were going to tie him up so that he doesn’t move, or that they were going to put something on him.”Participants also wanted a lot of detail around behavior management techniques some dentists use, such as what they called “tying down”  and sedation. These were areas of high anxiety for caregivers. Because many times parents were not allowed into the treatment rooms during their children’s dental treatments, they wanted to know what was happening to their children in the dental operatory, as this excerpt from the focus group explains:Contra Caries Oral Health Education Program involved 105 participants. They were mainly Mexican-born mothers and about half had graduated high school  filled out the posttest survey, but the first version did not include acceptability questions). Thirteen classes were held, with between 5 and 14 students in each class (mean 7.7). Each session took two hours, with classes held on weekdays, mainly in the mornings and a few in late afternoons. Despite asking people, especially parents with young children, to commit to attend a class at a set day and time for four weeks in a row, attrition was low. Overall, the retention rate was 90 %, with 89 % of retained participants attending all 4 sessions, and only 5 people missing more than 1 session. Reasons for missed sessions were illness of participant or one of their children, or work schedule conflicts. Most people who missed a session arranged to attend other classes to make up sessions. A strong majority (95 %) of respondents said they liked the class very much, 2 (2 %) participants said they liked it a little, and 2 (2 %) said “so-so”. No participants reported not liking it very much, or not liking it at all.A total of 105 participants attended the Participants were asked an open-ended question about their favorite class activity, allowing compound answers. The most commonly mentioned favorite class activity was learning the specific steps to brushing teeth, with about half of participants (53 %) listing tooth brushing generally, or a specific aspect of tooth brushing instruction such as how long to brush for, or how to hold or move the toothbrush. Six parents specifically valued aspects of instruction related to managing children, such as using dolls as learning models, or tactics to motivate children’s interest and cooperation in brushing . The next-most popular class activities were flossing (16 %), all activities (16 %), a review game covering all topics (11 %), sugar and nutrition labels (10 %), and decay process (9 %).promotoras as the educators.Open-ended questions were also asked about class format. Class size was a common topic of both satisfaction and dissatisfaction . But the familiar, convenient location and time of class were listed often as things liked about the class, as was the sharing and social nature of the activities, and the use of Contra Caries Oral Health Education Program content and format was perceived as highly acceptable.This study found that their children’s oral health is a high priority for low-income Spanish-speaking parents. They were not only interested in, but actually regularly attended classes for parents focused on increasing their knowledge and skills with respect to early childhood oral health. promotora-based education is well-received in similar populations on other health-focused topics  We made attempts to minimize potential bias from recruitment limitations through reaching out to a variety of community settings, for example in Phase 2 both daytime recruitment to apartment complexes to reach stay-at-home parents, as well as recruitment from a daycare center which serves working parents. Whatever bias remained in our recruitment strategy limits the generalizability of our results, thus we caution readers that care should be taken when generalizing to Latinos with another socio-economic status, geographic location, or migration history. Finally, participants were offered compensation for the time they spent participating in the intervention and research procedures. It is possible that this compensation inflated attendance rates, although we limited the payment per class attendance to only $5.00 per class to attempt to minimize this. Future, larger and randomized studies of the curriculum would be desirable in order to test efficacy of the curriculum at improving oral health related knowledge and behaviors, as well as the cost and benefit of widespread implementation of the program.Like all research, this study has limitations. Social desirability bias is definitely a potential factor to consider, especially with survey answers after the intervention. Participants may have been hesitant to criticize the program, although we attempted to mitigate this by having research staff and not the Contra Caries Oral Health Education Program was acceptable to low-income, Spanish-speaking parents of children 1–5 years and attendance, retention, and acceptability of the program were high. Participating in the curriculum development and revision process likely played an important role in the parents’ high acceptability of the program. Additional research into efficacy and cost-effectiveness of the program is warranted.Latino parents are interested and motivated to learn about improving their children’s oral health. Important topics include how caries starts and progresses, adult and children’s oral hygiene including motivational techniques for children, and dental treatments and restraints. The


For example, our findings as well as some clinical data and experimental results obtained from different animal species, do not support unidirectional CSF circulation but strongly suggest that there are cardiac cycle-dependent systolic-diastolic to-and-fro cranio-spinal CSF movements. These are based on: a) physiological oscillations of arterial and venous blood during cranio-spinal blood circulation; b) respiratory activity, and c) body activity and posture. That kind of complex CSF movement could explain the observed distribution of many different substances in all directions along the CSF system and within central nervous system tissue. It seems that efflux transport systems at capillary endothelium may be more important for brain homeostasis than the removal of metabolites by CSF flow. Thus, when discussing the CSF dynamics we suggest that a more appropriate term would be CSF movement rather than CSF circulation.Brinker  Thus, they state that: For example, Klarica et al. failed to reproduce the historical experiments of Dandy[, since no circulation of CSF was found along a plastic cannula introduced into the aqueduct of cats[. Subsequent experiments demonstrated that the CSF pressure is not increased during first hours after the occlusion of aqueduct of Sylvius[. Since they furthermore showed that following its intraventricular injection radioactive water is almost completely absorbed in the ventricles and does not reach the basal cisterns[, they concluded that choroid plexus is not the major site of CSF production and that no direct CSF circulation according classical understanding exists. Instead they proposed a model that assumes CSF production and absorption occurs at the level of the capillaries[. Furthermore the view of Klarica et al. that CSF production and absorption just depend on hydrodynamic and osmotic gradients is not substantiated by current cellular and molecular biology findings. In fact, the proposed model does not consider the complex regulation of water movement between the brain compartments as discussed above. Finally, as in the original experiments of Dandy, the experiments of Klarica et al. may be criticized since they are surgically invasive and therefore results should be interpreted cautiously”.Brinker et al. have des of Dandy, since nt of cats. Subsequf Sylvius. Since t cisterns, they copillaries. Further2O in the lumbar region. This does not support the traditional CSF “circulation” along the cranio-spinal CSF space because CSF can only flow from a region of higher to a region of lower CSF pressure [We did not attempt to reproduce the experiment of Dandy . Quite tpressure .3H-water reached a concentration several times higher in the plasma at the confluence of the sinuses than that in cisternal CSF and arterial plasma [3H-water is absorbed from the brain ventricles into periventricular capillaries which drain into the confluence.Based on our experimental results and literature data, we proposed a new hypothesis (“model”) of CSF physiology . We wishl plasma . Thus, i“…water flux into CSF in AQP-1, AQP-4 knockout mice utilizing H217O JJVCPE imaging to test the hypothesis that water movement within the pericapillary (Virchow–Robin) space is critical for CSF volume homeostasis (Orešković and Klarica hypothesis). The result clearly demonstrated that water influx into CSF is regulated by AQP-4, known to be responsible for water homeostasis of the pericapillary space, and not by AQP-1 found in the choroid plexus, strongly supporting the Orešković and Klarica hypothesis”.It is true that our research has not been conducted at the molecular or cellular level, but that is because we were investigating this phenomenon at the level of systems physiology -11. Howevice-versa, as was repeatedly shown in many publications [The subarachnoid CSF and nervous parenchyma are separated from each other by a layer of thin pial cells without specialized intercellular junctions , so thatications -20. Evidications .But if there is no unidirectional CSF “circulation”, as is proposed by our hypothesis, in what way would one describe CSF dynamics? Since the CSF is 99% water, it would be logical to expect that dynamics of water should represent the dynamics of CSF, because, by definition, circulation is a unidirectional flow of volume. However, CSF/water volume is slowly carried bidirectionally along all CSF spaces by the systolic-diastolic to-and-fro displacement ,10. ThisAll other substances in CSF  are distributed in all directions throughout the entire CSF system, and between CSF and CNS tissue, i.e. in the direction of “circulation” (out of the ventricles), as well as in the opposite direction (from SAS into the ventricles) ,6,8,10. Therefore, in interpretation of experimental results it is very important to distinguish the movement of CSF/water on one hand, and the distribution of substances inside the CSF system on the other. The main misunderstanding relating to the study of CSF “circulation” has been made by (mis)interpretation of experimental results in which the two physiological processes (movement of CSF and distribution of substances) have not been differentiated, and when substance distribution has been used as a marker of “circulation”. Namely, the monitoring of certain substances in CSF system will reveal nothing about the “circulation” of CSF, but only about the distribution of that substance within the CSF.When discussing the dynamics of CSF, the term “circulation” of CSF should be avoided, and a more appropriate term “movement” of CSF would be advisable. Also, there is no sensible experimental evidence to consider CSF as a third circulation.AQO: Aquaporin; BBB: Blood brain barriers; CNS: Central nervous system; CSF: Cerebrospinal fluid; ISF: Interstitial fluid; SAS: Subarachnoid space.The authors declare that they have no competing interest.Both authors contributed equally to this work and have read and approved the final version of the manuscript.


These normative dimensions, whilst often remaining ‘hidden’ and inarticulate, influence the way in which biologists practice their profession. In this paper, I explore what happens when different versions of these implicit normative frameworks collide. To do so, I will focus on a case study from the field of ecological genomics as it has evolved in one particular country, namely the Netherlands. During an important inaugural meeting, the director of one of the most sizeable Dutch ecogenomics centres gave a presentation in which he introduced the term ‘nature mining’. Part of the audience immediately embraced the term, but others were very reluctant. This mixed response is generally explained as a culmination of growing tension about the future direction of the field: due to new funding demands, a shift had occurred from fundamental research to research more interested in ‘valorisation’.Every field of science, but especially biology, contains particular conceptions of nature. These conceptions are not merely epistemological or ontological, but also have normative dimensions; they provide an In addition to this current interpretation, I will argue that the turmoil caused by the use of the term ‘nature mining’ also reveals a more fundamental difference between the various parties involved in the Dutch ecogenomics community. This term is part of a vocabulary that emphasises the beneficial ‘goods’ produced by nature. Whereas part of the audience saw no harm in this commodification of nature, others had difficulties with the reduction of nature to a reservoir to be exploited using the latest technologies. I will conclude by arguing that, although at present, the core of Dutch ecogenomics research reflects a more or less instrumental attitude towards nature, the field also harbours other interpretations of nature as a significant and meaningful order. For instance, ecogenomics might further develop the image of land as a ‘collective organism’, as proposed by Aldo Leopold. You and the land are one.”ExcaliburIt is inconceivable to me that an ethical relation to land can exist without love, respect, and admiration for land, and a high regard for its value. By value, I of course mean something far broader than mere economic value; I mean value in the philosophical sense Leopold , 223.In the 1940s, ecologist and forester Aldo Leopold (1887–1948) worked on a book that continues to stir millions of readers to this very day: “A Sand County Almanac”, published posthumously in 1949. The almanac contains a collection of essays in which the author sets forth his views on “the delights and dilemmas of one who cannot […] live without wild things” . Leopold concludes his almanac with a plea for a ‘land ethic’, an admonition to enlarge “the boundaries of the community to include soils, waters, plants, and animals, or collectively: the land” .ethos, a framework for moral orientation. These normative dimensions, whilst often remaining ‘hidden’ and inarticulate, influence the way in which biologists conduct their research and practice their profession. On certain occasions, however, normative aspects may suddenly rise to the surface, notably when moral clashes occur and biologists are confronted with conflicting images of nature .man the conqueror In his work as a conservationist, Leopold noticed a ‘chasm’ similar to the one just described. In his view, the divide between different conceptions of nature was common to many specialized fields, such as forestry, agriculture, and wildlife management. In all these divides, Leopold argued, we can recognise the same basic ‘paradoxes’:d Next, I will analyse why ‘nature mining’ turned out to be such an explosive and provocative term. Finally, I will argue that, although at present, the bulk of Dutch ecogenomics research reflects a more or less instrumental attitude towards nature, the field – in particular the metagenomic approach – also harbours other interpretations of nature as a significant and meaningful order, which could support a more humble and respectful approach to natural systems. A genomic approach to ecology might, for instance, cultivate the image of land as a collective organism, as proposed by Leopold.I will use Leopold’s ‘paradoxes’ as a starting point to explore the different conceptions of nature within the Dutch ecogenomics community. I will start by giving an overview of the developments that preceded the aforementioned ecogenomics research meeting.e in the Netherlands. NGI called upon researchers to submit project proposals for the creation of a network of large-scale genomics centres. In response to this call, the Genomics for Ecology, Toxicology and Sustainable Technology Innovation Center (Gnettic) wrote a grant application letter envisioning the establishment of a centre of excellence in ecological genomics, “a novel, integrative field of science, combining ecology, microbiology, environmental & soil sciences and molecular biology”  as an independent taskforce to set up a “world-class genomics infrastructure” Brouwer , 1. The g The ambition of Gnettic wasto develop a set of genomics-based tools […] that can be used to analyze ecological systems, identify possible threats of contamination to the environment and human health, and to guide industrial production processes towards sustainable development” .The participants submitted their letter of application, dated 23 September 2002, under the following heading: “Eco-genomics: the multidimensional analysis, experimentation and management of ecological systems for sustainable development”  were, in general, very labour-intensive. Moreover, they could only measure a limited number of targets at a given moment. The applicants argued that, in order to develop effective strategies for the sustainable production of animal and plant resources, major innovations were necessary. Genomics-based technologies enabled such innovations, “as they have the advantage that a multitude of targets can be evaluated at the same time with great responsiveness” .metagenomics and the organism-centred approach  in 2003. Brouwer was appointed as its director. The NGI-funded programme was entitled “Assessing the living soil: An ecogenomics approach to explore and unlock sustainable life-support functions of soils.” The consortium was to receive substantial funding, amounting to 1.8 million euros a year for the period of 2004–2009. Brouwer and his partners believed that the goals of EC would be best met by substantial investments in basic academic research: “research within the cluster is largely fundamental, for the simple reason that we know so very little about the living component of soil in particular” . This focus on academic demands disappointed non-academic partners, “who felt they could contribute little to the composition of the board or to the EC’s research agenda. However, most did not complain as the EC funding was an additional opportunity to link their R&D activities to basic academic research” . His successor Colja Laane, who had a background in industry, put a much stronger emphasis on ‘valorisation’, i.e. the process by which scientific knowledge is made profitable for society:k it had difficulties employing “the knowledge to effect positive changes for society” , in which the ‘science-based’ focus of the 2004–2009 period was replaced by a more practical focus with a strong emphasis on “innovative aspects and valorization opportunities” (Brouwer LINC received a follow-up grant of 3MEUR for 2009–2013 (compared to a budget of 11MEUR for 2004–2009).NGI’s shift in emphasis put the consortium’s members in a difficult position. The mid-term review of EC, which took place during the second half of 2006, had already pointed out that “achieving interdisciplinarity and […] realizing the societal mission” cultivable microorganisms. Citing Brouwer again, “unleashing these hidden treasures will create a huge potential for applications in the fields of sustainable chemistry, alternative energy, in biorefineries, and in bio-construction materials” . Such alternative test systems were necessary in chemical industry for the safety assessment of large numbers of existing chemical compounds.The new focus of ECO Brouwer , 2. ThirLINC, but rather as the continuation of the fundamental research project that was initiated by EC. PEEG’s financial sources were different from those for ECOLINC: for the 2009–2014 period, it received a funding of 1MEUR from the Netherlands Organisation for Scientific Research (NWO), enabling four PhD projects to be carried out .The consortium’s move from basic ecogenomics research to a more practical approach was not welcomed unanimously. Whereas the industrial partners were happy with the “new market opportunities”, some of the academic partners “fundamentally disagreed with a focus on economic valorization” . Its founding was not only considered a strategic move to calm things down, but also an effort to remain attractive for the financing parties. For indeed, to ensure continued funding, the Dutch ecogenomics community needed to come across as a robust and solid party . NERO described its mission as follows:LINC as “two intertwined research programs”  at the end of the meeting. Others – notably the ecologists associated with PEEG – were very reluctant. In spite of their efforts to emphasise the importance of “extending fundamental ecogenomics knowledge”  direction of Dutch ecogenomics research; they also show a more fundamental difference between NERO’s rank and file. NERO had united researchers coming from different branches of the biological sciences: ecologists with a “comprehensive way of looking at the earth’s fabric of life” Worster , x, moleversus man the biotic citizen; science the sharpener of his sword versus science the searchlight on his universe; land the slave and servant versus land the collective organism .man the conqueror In the introduction, I explained that Leopold wrote about a ‘chasm’ between different images of nature as early as in the 1940s; he observed a divide which he considered to be common to many specialised fields, such as forestry, agriculture, and wildlife management. Each of these fields can be divided into a group that “regards the land as soil, and its function as commodity-production,” and a group that “regards the land as a biota, and its function as something broader” Leopold , 221. InIn the following sections, I will use Leopold’s ‘paradoxes’ as a guideline for exploring the different conceptions of nature existing within the Dutch ecogenomics community.technocratic and human-centred image of nature. It echoes the question: how can we exploit nature to meet human needs? . In the field of environmental ethics, the interpretation of nature as a mere means to human ends is said to reveal an instrumental approach to nature . She describes Bacon’s line of thought as follows:Due to the Fall from the Garden of Eden […], the human race lost its ‘dominion over creation’. […] Only by ‘digging further and further into the mine of natural knowledge’ could mankind recover that lost dominion. In this way, ‘the narrow limits of man’s dominion over the universe’ could be stretched ‘to their promised bounds’ .The image of nature as a slave and servant became dominant during the Scientific Revolution and the rise of a market-oriented culture in early modern Europe. In her famous book “The Death of Nature” 1989), philosopher and historian of science Carolyn Merchant argues that in the Renaissance era, a different image of nature was still prevalent. Inspired by ancient Greek philosophers such as Anaxagoras (500–428 B.C.) and Theophrastus (370–278 B.C.), the Earth was viewed as a living organism and nurturing mother. This image had functioned as a normative constraint against the mining of Mother Earth: “One does not readily slay a mother, dig into her entrails for gold or mutilate her body” .Merchant thus claims that in Bacon’s view, God had not forbidden the ‘inquisition of nature’. Enslaving nature was, on the contrary, according to His plan: “Nature must be ‘bound into service’ and made a ‘slave’, put ‘in constraint’ and ‘molded’ by the mechanical arts. The ‘searchers and spies of nature’ are to discover her plots and secrets” . Merchant explains that for Bacon, miners and smiths were the models for a new class of explorers, astreasure at human disposal:The application of metagenomics approaches […] will greatly extend our ability to discover hitherto hidden functional capabilities of (un)cultivable microorganisms. Unleashing these hidden treasures will create a huge potential for applications in the fields of sustainable chemistry, alternative energy, in biorefineries, and in bio-construction materials Brouwer , 2.The term ‘nature mining’ cannot easily be disconnected from its association with disruptive mining practices. Yet, this association was amplified with other, similar elements in the vocabulary used by Brouwer. As mentioned before, he refers to the soil as a o, as if it goes without saying that nature itself will benefit from our biotechnological interventions. Thus it was the “particular combination of terms, as well as the distinctive ways in which these terms [were] interpreted and related to each other” . However, although this interpretation does not evoke images of slavery or the ‘raping of mother earth’, the approach to nature still seems primarily instrumental. By comparing the soil to a database, “the natural world [is presented] as something that is passive and malleable in relation to human beings”  from the Earth, it seeks to extract valuable ‘software’ (tangible knowledge) “adrift in the flood of data” .How has the Dutch ecogenomics field developed since the memorable research meeting in February 2008? As we have seen, NERO has had trouble keeping the different fractions of the Dutch ecogenomics community together from the very start. In June 2014, NERO will organise the 6LINC and PEEG have drifted even further apart. ECOLINC has put the valorisation issue even higher on its agenda. In 2010, it became part of the BE-Basic Foundation , “an international public-private partnership that develops industrial bio-based solutions to build a sustainable society.”q Brouwer is a key member of its leadership team, together with chemical engineer Van der Wielen , a policy-driven research fund. Officially, the BE-Basic programme would come to an end in 2015, but because of its success, it will continue until mid-2017.Compared to the situation in 2008, ECOr Wielen . Earlierr The vocabulary of the BE-Basic team reminds us of Brouwer’s speech during the first National Ecogenomics Day: nature appears as a resource for exploitation without constraint genomic mining”, seeks to develop and apply “high-throughput approaches and tools to explore and mine the metagenome.”LINC’s move towards valorisation? The five-year NWO-funding will expire in 2014. In 2010, members of PEEG started to collaborate with international colleagues in the European Collaborative Research programme ‘Ecological and Evolutionary Functional Genomics’ (EuroEEFG). The programme, which was terminated in May 2013, was funded by the European Science Foundation (ESF) and consisted of “eight collaborative research projects, spanning all kingdoms of life and various levels of biological organization .”t The main goal of this collaboration was to bring about “a more successful scientifically-based management of ecological resources” .And what has become of PEEG, the fundamental research programme that was developed out of discontent with ECOAnother ESF-funded project joined by (former) members of PEEG is the Conservation Genomics (ConGenOmics) Research Networking Programme. In this programme, the function of ecosystems is clearly understood “as something broader than mere economic value” Leopold , 223. ThLINC and PEEG have developed up till now, remind us of one of the ‘paradoxes’ mentioned by Leopold. In the BE-Basic programme – currently the core of Dutch ecogenomics research – , science appears as the sharpener of the researcher’s sword . Apparently, this instrumental language can be part of the rhetoric of sustainability.The ways in which the research programmes of ECOsearchlight for spotting complex ecological processes . At the present time, the usefulness of metagenomics to solve various complex human problems seems to encourage an instrumental approach to nature. However, this does not necessarily need to be so: the field also harbours other interpretations of nature as a significant and meaningful order, which could form the basis for a more humble and respectful approach to natural systems. For instance, metagenomics might cultivate the image of land as a  Leopold , 205. Tr Leopold , 189. Menurturing mother  oppositions.dIn concert with my interviewees, I have decided to mention the researchers and institutes involved, by name. This not only makes my analysis verifiable, but also enhances the tangibility and liveliness of the discussion.eNetherlands Genomics Initiative [http://www.genomics.nl/Home/NGI/History.aspx] – accessed 13 September 2013.fOther key participants were Nico van Straalen, professor of animal ecology at VU University Amsterdam; Hans Westerhoff, professor of microbial physiology, also at VU; Hans van Veen, head of the department of microbial ecology at the Netherlands Institute of Ecology; Jan Kammenga, assistant professor at the laboratory of nematology of Wageningen University.gThe term ‘ecological genomics’ was introduced by the Israeli biology professor Eviatar Nevo , the single-organism approach has recently succeeded in shifting its emphasis from research on traditional model species to ecologically-interesting species, e.g. the water flea Daphnia Pulex.jNetherlands Genomics Initiative [http://www.genomics.nl/News%20archive/24%20April%202008.aspx] – accessed 13 September 2013.kDuring the 2004–2009 period, EC generated 510 scientific publications .qBE-Basic Foundation [http://www.be-basic.org/] – accessed 2 September 2013.rBE-Basic Foundation [http://www.be-basic.org/research/hte-metagenomic-mining.html] – accessed 2 September 2013.sBE-Basic Foundation [http://www.be-basic.org/research/hte-metagenomic-mining/new-robust-enzymes-for-bioplastic-production.html – accessed 2 September 2013.tEuroEEFG [http://www.nioo.knaw.nl/euroeefg] – accessed 16 September 2013.uThis Gaian perspective is not only applicable to natural ecosystems, but also to our human bodies. Metagenomics has demonstrated that our bodies consist for 90 per cent of microbial, rather than ‘human’ cells. As a result, metagenomics encourages as to conceive ourselves as collective organisms or ‘supraorganisms’ as well (Turnbaugh & Gordon et al.


AbstractPerisphaeria Burmeister, 1838 results from a mistake by Perisphaeria is an incorrect spelling by Burmeister referring to Perisphaerus Serville, 1831. Perisphaeria as proposed by Burmeister and as the senior synonym of Hyposphaeria Lucas, 1863, which is valid. The subfamilial name Perisphaeriinae based on Perisphaeria should be corrected to Perisphaerinae Brunner von Wattenwyl, 1865 based on Perisphaerus; but note Princis’ Perisphaeriinae is based on his Perisphaeria Burmeister. The taxa involved are listed.The incorrect generic name  Perisphaeriinae and its type genus Perisphaeria are unavailable. Perisphaeria was never proposed as a new genus, but is an incorrect spelling of Perisphaerus Serville, 1831 by Périsphère Serville, 1831, i.e. an unjustified emendation of Perisphaerus, by Burmeister  is Perisphaeria Serv., and doubted their ability to roll into a ball as described by Serville, whilst Perisphaerus. Thus Burmeister must have his Perisphaeria attributed to Serville was in fact Perisphaerus. Thirdly, Perisphaeria is not an emendation of Perisphaerus according to the rules of the Code  and Latin (sphaera); therefore Perisphaerus is a result of incorrect Latinization by Périsphère the moment he proposed it. Subsequently he realized that and re-Latinized the French name in a later paper , though an exception is Perisphaeria to Burmeister. However, he gave Perisphaera Serv. as a synonym, which suggests that Fischer understood well the concept of them but cited an incorrect spelling with its author instead of the original spelling with its author. Perisphaeria as the same name as Perisphaera Serville, but suggested that they cannot refer to each other, i.e., he disputed the extension of its scope. Lucas stated that Perisphaera should be restricted to the Asian species which can roll into a ball. Lucas proposed a new genus Hyposphaeria Lucas, 1863 to include African species that do not roll into a ball and included species described by Burmeister. Perisphaeria Serville as valid and provided synonyms including Perisphaera and/or Perisphaerus; it is inferred from this that they accepted Burmeister’s spelling to be the valid name of the genus proposed by Serville, and that Perisphaeria and Perisphaeriidae were once in prevailing usage. Hyposphaeria, while Perisphaeria Serville. However, they did not adopt Hyposphaeria since they believed species in this genus should be placed in various genera. Hyposphaeria as a valid name and included four species in it, with Hyposphaeriastylifera  designated as type species.Before PageBreakPerisphaerus Serville, 1831 is a valid name and includes the ‘rollable’ species, mostly from the Oriental Region, with Perisphaera and Perisphaeria as unavailable spellings, although the latter spelling was once enlarged in its scope and widely used. Hyposphaeria Lucas, 1863 is a valid name and includes the African ‘unrollable’ species, of which the early ones were described under Perisphaeria by Perisphaeria Burmeister by Perisphaeridae Brunner v. W., 1865 is a valid family name based on Perisphaerus Serville. Perisphaeriidae Brunner v. W. is unavailable since it was based on Perisphaeria Serville. The Perisphaeriidae used by Princis has the same spelling but is not identical since this name was based on Perisphaeria Burmeister which is a consequence of his misunderstanding.In summary, Princis’ erroneous revision of the names mentioned above should be no longer adopted.Serville signed his name as J. G. Audinet-Serville in his published works and some authors attributed the scientific names established by him to Audinet-Serville; however, cockroach taxonomists (e.g. those mentioned above) prefer Serville in citation and authorship of names, and as such this convention is followed to avoid ambiguity. The abbreviation Brunner v. W. for Brunner von Wattenwyl is used for brevity.


A number of related changes have evolved over the past 25 years: the development of a truly national disaster mental health service in Israel; progress in the science of risk, resilience and evidence base care for those suffering from traumatic stress related disorders; and the development of conceptual models of population level disaster mental health response in the context of emergency management systems such as the Incident Command System.In a recent IJHPR article, Bodas, et al. report on the dynamic history of disaster mental health response in Israel, which informed by the all too numerous real world events affecting the region. What is most striking is that the system now in place reflects true “lessons learned” in that problems and issues identified in incidents informed deliberative planning, and the current system reflects many iterations of “lessons observed and learned”. There appears to be commitment across sectors of government in Israel that the mental health consequences of disasters and terrorism are important and a priority. This is advanced thinking and sound policy.As the system in Israel continues to evolve, additional possibilities are offered for further consideration, based on the author’s US-centric experience, to advance emergency response systems in Israel, the Middle East and around the world. The recent IJHPR paper by Bodas and colleagues  providesSince it began in the 1980’s, the emergency mental health system in Israel has evidenced considerable change and growth in terms of service delivery settings, coordination, payor/funding mechanisms, scope of services and levels of care. These authors describe in detail how these changes have been influenced by real world events, including the threat of ballistic missile attack involving chemical weapons during the first Gulf War. Other changes were seemingly influenced by changes in organizational structures, distribution of responsibility between local communities and various components of the national government. In its current formation, the system appears to provide a multi-tiered response, focused on on-site services by local teams, support centers that provide services to those presenting, and resilience promotion activities via NGOs and other settings.This commentary will consider the following aspects of the evolution of the emergency mental health system in Israel: process of change, funding, models and range of services, locations, and timing.What is particularly fascinating to a non-Israeli reader is how the model has been significantly influenced by numerous real world events and how those responsible for the emergency mental health system have adopted a true “lessons learned” approach. For example, following the deployment of the Iron Dome missile defense system, a reduction in direct help seeking was observed, alongside an increase in so called “hotline” use. This required training of the call takers to identify those at higher risk for serious psychological consequences, and such training was then duly provided. Indeed, among numerous innovations, perhaps the most notable is the process innovation of adapting the national emergency mental health system following large scale events.In many countries, there are “after action” reports and/or large scale recommendations for change. Yet the impact of these after action reports and commission reports is often hard to see in larger countries. Some of the changes in Israel reported by Bodas and colleagues have been sustained and others determined to be less so, so that this candid report is also strikingly refreshing and perhaps unique. In Israel, there seems to be deliberative planning that takes into account issues that truly become lessons learned that produce change and not merely ‘lessons observed’.Once the emergency mental health planners in the United States and elsewhere recognized the need to go beyond single session debriefing for trauma victims and to include longer, evidence based, interventions , the need to secure special funding for these services became evident. Timely trauma care can provide substantial benefits to the individual, their families and society as a whole, as been observed with timely care for depression in the United States . Howeverhttp://www.phe.gov/Preparedness/legal/boards/nprsb/Documents/nsbs-dmhreport-final.pdf). It is not year clear to what extent the US Affordability Care Act (ACA) will also address financial barriers to trauma care. In the US, the major NGO providing disaster mental health services, the American Red Cross, does not typically provide definitive care and services are restricting to 2 crisis intervention sessions and up to 2 follow up sessions. Solving the payer issue to facilitate access to evidence based care remains a challenge.In the United States, since the late 1970s, a novel federal disaster mental health program provides financial support to states following a presidentially declared disaster and is known as the Crisis Counseling Program. However, this program does not typically provide for professional care and those needing professional care after a disaster still face significant financial burdens. Following 9/11, an extension of the Crisis Counseling program called “Enhanced CCP Services”, and more recently the “Specialized Crisis Counseling Services Program”, has expanded on the original non-professional services model and provided a larger array of services. Research on these expanded CCP services found beneficial effects , and sugThe article by Bodas and colleagues describes various changes over time in the provision of types and levels of care. For example, in the 1980’s, before research on the lack of salutatory effects of single session debriefing became known, that approach was widely utilized, along with undefined “mental health aid”. Following these findings, other approaches, including notably CBT, have been increasingly deployed. What is not clear however is the extent to which even more recent findings of meta-analyses  and conshttps://iab.gov/Uploads/IAB%20Stress-Related%20Mental%20Health%20Issues%20White%20Paper.pdf, http://www.cdms.uci.edu/PDF/resilience-workshop.03222012.pdf, [Another known population with significant natural resilience, but also elevated risk, is the responder population. It is not clear from the Bodas et al. article how they are served in the Israeli emergency mental health system—either in services provided by the Home Front Command or elsewhere. This may be a gap requiring further work. In the US, a model known as ‘Anticipate. Plan. and Deter: building responder resilience’ is one example of a model for providing a comprehensive, stepped care approach to responders and health care workers in particular .Although the article describes many changes in the programs, many of these appear structural and locational. Beyond the description of use of CBT and non use of Benzodiazepines, it was not clear exactly what type of CBT is being offered, when it is offered, how providers are trained in these models, how this training is funded and if children are also being served with CBTs.It is not clear exactly what type of CBT is being offered, how providers are trained in these models, how this training is funded and if children are being served. The range of services appears comprehensive, but the article is lacking in sufficient detail to permit further conclusions. For example, the word “resilience” is used frequently to describe program elements and in the “current model” it refers to “on-going efforts to promote public resilience during routine times through resilience centers and other NGOs”. However there is no specific operationalization provided on exactly what “efforts to promote public resilience” means, if it has evidence of effectiveness, and how it is delivered and to whom.http://www.apa.org/pi/families/resources/task-force/child-trauma.aspx). In addition, there is a phenomenon that can be separate from anxiety disorders including PTSD and is known as traumatic grief [Further, care is described as being provide in a “stigma free” manner, but how is this determined? “Stigma free” is most likely a goal, not a current outcome. Rates of utilization, compared to population level estimates of new incidence or point prevalence of post disaster disorders are not presented, so it is not clear to what extent services are achieving population level “reach” to those at risk. Available epidemiological reviews suggest that between 30–40 % of the population can be at risk for a disorder following a disaster. Often times these outcomes reflect comorbid presentations of PTSD plus another disorder such as depression. However, most of the services seem directed to “anxiety” or distress, not clinical depression or PTSD. The latter can be part of the outcome trajectories for some persons experiencing trauma, including young children, as our diagnosistic systems increasingly recognizes changes in the expression of PTSD in children 6 and under (ic grief –24. In cThe foci of the evolution of services appear to be related to location of services, with the exception of the addition of tele-health services when the threat of injury while seeking mental health care became a further barrier. More information on these exciting efforts that are “resilience” focused, i.e. pre-event and “public” focused is needed. Indeed, emerging efforts in the United States and elsewhere have begun to focus on models of stepped care which involve early evidence-based mental health triage, brief acute phase intervention for those at risk, with symptoms and desiring care followed by reassessment and then provision of a full course of Trauma Focused CBT, in the case of children for example. In the disaster and terrorism situation, an example of this approach is the so-called “National Children’s Disaster Mental Health Concept of Operations –27. RathGiven the unique nature of the threats encountered and the population distribution coupled with surge demands in hospital emergency departments, the Israeli emergency mental health program has evidenced great changes in locations of care—all informed by lessons learned from real world events. Innovations such as co-locating services with hospital emergency departments were attempted, but then modified or discontinued. Since the observation that many high-risk individuals are present in hospital ED’s, it is not clear whether the discontinuation of the use of these the modified ED sites has been beneficial. It is also unclear why ambulances were seemingly used to transport individuals with primary anxiety unless they also were physically injured and required ambulance transport. This may reflect Israel-specific cultural or organizational considerations.Despite changes over time, the basic model seems to a variant of a stand-alone mental health clinic. referred to as “resilience centers” or by some other terms, they represent largely stand alone clinical settings. One wonders to what extent the inclusion of other settings such as primary care, schools, shelters, work settings and among responders of various types have been included and whether adequate attention has been given to coordination between these settings. Although tele-health is mentioned, other innovations in disaster mental health might be considered to further improve access to care and population level “reach”, which remains elusive in the US  and appaThe system of disaster mental health in Israel has demonstrated considerable growth and evolution in the last 25 years and reflects collaborations across many different levels and partners. At its most important, the article by Bodas et al. outlines a national commitment and recognition of the psychological impact of chronic conflict and terrorism. The emergency mental health program has evidenced multiple changes and demonstrates an aggressive “lessons learned” process. Challenges such as timing, service delivery settings, models of care, payor/funding and coordination issues were reviewed. As the program moves forward into the future, recommendations include broader inclusion of “disaster systems of care” , 27 to i