H. heidelbergensis evolved from H. erectus” (p. 12). These claims are marred by their selective review of the literature; the use of equivocal evidence as definitive support for their interpretation; and the lack of any evolutionary evidence regarding the computations and representations that mediate modern linguistic competence.Dediu and Levinson  link twointernal phonological, syntactic and semantic representations, and nothing in the fossil record is ever likely to tell us: (a) what those representations were like; or (b) whether the human brain had yet formed the necessary connections between, e.g., phonological representations and vocal output. This does not bode well for the type of argument Dediu and Levinson advance, but let us examine the evidence they present.Our language phenotype is a competence consisting of three systems—syntax, semantics, and phonology—that are internal to the mind/brain, along with two mediating interfaces, the first linking the representational/computational systems to external speech or sign, the second linking language to internal thought. The internal combinatorial computations are generative and rule-governed, engaging representations that are both language-specific and domain-general. Generalized claims such as Dediu and Levinson's require evidence for all of these processes. But most of them do not leave fossil evidence; and genetic clarification is unlikely given how poorly we understand simpler phentoypes. For example, though language is expressed through articulate speech today, the anatomical capacity for speech cannot by itself be taken as a proxy for language. The peripheral organs have to connect with the Homo neanderthalensis and Homo sapiens as evidence of conspecificity, minor gene flow is to be expected between closely related sympatric species . Because the phenotype is not specified at the required level of detail for evolutionary analysis, it is difficult to test their evolutionary claims. But this lack of detail does permit them to assert that language competence was likely among Neanderthals, due to nothing more than their large brains, cognitive complexity, and proclaimed conspecificity with modern humans. Still, hominids can be smart without implying modern cognition , among others, so the evidence is actually equivocal. The survey they themselves cite  genomic similarity among Neanderthals, Denisovans and modern humans, Dediu and Levinson present several gene-level commonalities as evidence for Neanderthal genomic compatibility with language, e.g., Dediu and Levinson conclude that (1) “saltationist” stories for language origin must be rejected; (2) language evolved incrementally; (3) gene-culture interaction greatly affected language's “design”; (4) a “deeper” historical linguistics is called for; and (5) modern human languages might not reflect the full space of language possibilities. All this is speculative to the point of irrelevance. (1) is contradicted both by the modern understanding of evolutionary patterns (Thompson, could be any evidence to support such claims. At the archaeological level, our core linguistic competence does not fossilize. As for molecular evidence, we are nowhere near identifying the relevant “language genotype” and they provide no “language phenotype” to guide us. For the present, abstinence from speculation may be the best remedy.In short, Dediu and Levinson's extraordinary claims are not supported by the evidence they present. More significantly, we doubt that there Robert C. Berwick, Marc D. Hauser, and Ian Tattersall contributed equally to the writing of this commentary.


This article aims to discuss the incorporation of traditional time in the construction of a management scenario for pink shrimp in the Patos Lagoon estuary (RS), Brazil. To meet this objective, two procedures have been adopted; one at a conceptual level and another at a methodological level. At the conceptual level, the concept of traditional time as a form of traditional ecological knowledge (TEK) was adopted.At the methodological level, we conduct a wide literature review of the scientific knowledge (SK) that guides recommendations for pink shrimp management by restricting the fishing season in the Patos Lagoon estuary; in addition, we review the ethno-scientific literature which describes traditional calendars as a management base for artisanal fishers in the Patos Lagoon estuary.Results demonstrate that TEK and SK describe similar estuarine biological processes, but are incommensurable at a resource management level. On the other hand, the construction of a “management scenario” for pink shrimp is possible through the development of “criteria for hierarchies of validity” which arise from a productive dialog between SK and TEK.The commensurable and the incommensurable levels reveal different basis of time-space perceptions between traditional ecological knowledge and scientific knowledge. Despite incommensurability at the management level, it is possible to establish guidelines for the construction of “management scenarios” and to support a co-management process. The socio-ecological approach has been widely used by several theorists of Human Ecology and Theory of commons  for the New studies in ethnography (or ethnoscience) have shown, since its emergence in the 1950’s, that TEK is an important source of information for the understanding of ecological processes ,8,9. AmoIn line with the second observed trend, a “swarm of researchers” has made a countercurrent intellectual effort to register, analyze, and reassess the TEK of traditional populations . SeveralDespite the great advancements in ethnosciences since the 1960’s and in research using TEK, starting from its naming and concept formation in the 1980’s ,19, therThis article discusses another possible and little explored solution: the incorporation of traditional time based on TEK in the construction of a local resource management scenario. Research for this case study was conducted is the Patos Lagoon estuary, located in the southernmost portion of Brazil. Despite several efforts in the study of traditional time see -27, thesa. The 2004 Joint Normative Ruling (INC 2004)b presently regulates fishing in the estuary. Among other regulations, INC 2004 imposes a fishing calendar for pink shrimp in the Patos Lagoon estuary. According to Kalikoski (2002), with the creation of the Forum of the Patos Lagoon (FPL), the pink shrimp fishing calendar was fashioned on the basis of scientific knowledge, and has engendered conflicts between government institutions and artisanal fisherman  the actors involved in carrying them out” (: 342). Cironment . In thisThe calendar is an instrument of system management. Since the Classical age, the calendar emerges as a way to tame natural time and to control human economic and social activities ,29. TherBased on the discussion above, we argue that the adoption of the perspective of “time as knowledge” , the con′S and Longitude 32°12′S). The lagoon receives freshwater from a 201.626 km2 drainage basin and in 971 km2 of its 10227 km2 surface, approximately 10% of its total size, there is mixing of water masses from different origins: freshwater from fluvial origin and sea water from the adjacent ocean [The Patos Lagoon, the world’s largest choked lagoon, is the dominant geographic formation of the coastal plains in southernmost Brazil. It measures 250 km long, 40 km wide, and 5 m deep on average and extends towards the Northeast-Southwest  of the Patos Lagoon is located at approximately 70 km from the estuary entry , and the central, deep, open water body (5 m deep), where the central navigation channel is located .A large fish biomass is associated with the high primary productivity in the estuary. The Patos Lagoon is the most important area for the rearing, reproduction, and feeding of a large portion of the existing fish of the southern coast of Brazil ,49. In tMugil platanus and Micropogonias furnieri) which spawn in the sea and use the estuarine environment as a larvae and juvenile breeding site (estuary-dependent species) and Netuna barba, which spends most of its life cycle in the sea and enters the estuary toward the limnic or pre-limnic zone (anadromous species) [Of these species, only three are commercially exploited by artisanal fishery: the species (species) .Farfantepenaeus paulensis) [On the other hand, the most economically important fishing resource for artisanal fishery in the Patos Lagoon estuary is the pink shrimp (ulensis) . After pulensis) .The four species cited above have life cycles associated with the hydrodynamic and meteorological variations of the estuary; additionally, their biomasses fluctuate seasonally ,51. In tIn 1967, the federal government, through the Superintendence for the Development of Fishing (Sudepe), passed the decree, law n° 221/1967, which established the concession of fiscal incentives to large companies in an attempt to make fishing a primary national industry . In the As a response to collapse of fish stocks, a centralized fishing resources management strategy was developed. Until the mid 1960s standards to regulate fishing in the Patos Lagoon were almost non-existent. After this time, laws meant to impose a specific fishing calendar and fishing techniques, such as those in practice since the late 1960’s,  were putThe Patos Lagoon Forum - FLP) [Due to the inefficiency of the centralized resource management strategy, in 1996 a co-management plan composed by different stakeholders  . SignifiAfter the decline of other resources, pink shrimp is presently the main fish resource explored by artisanal fishers. Although shrimp overharvesting is a controversial matter, scientific knowledge produced by researchers from the local university advises a fixed fishing calendar and specific fishing techniques to solve this supposed problem. Despite the formation of the Patos Lagoon Forum (i.e. a co-management scenario), the INC 2004 determines the present use criteria for artisanal fishing in the Patos Lagoon estuary and establishes both a fixed fishing calendar and the fishing techniques, all following the logic of scientific recommendations for the use of this resource -59.The above situation occurs because researchers understand that one of the goals of the Forum is “to provide the fishing community with information about the environment and biology, in addition to providing legal support for cooperative work;” furthermore, it is understood that civil society’s decisions must be “…supported by scientific knowledge and by government agencies” (: 593). Ast century see [On the other hand, in the second half of the 1990’s see -64 and itury see ,54,56, rtury see .The INC 2004 only permits fixed-net and stownet fishing techniques and has additionally restricted fishing to registered “andainas” (bamboo stakes fixed in the lagoon at a depth of up to two meters to which nets are tied); however, several other fishing techniques are still being used by fishers  in addition to capture in unregistered “andainas” . The samFrom this historical context of dissonance between the fishing calendar based on SK and introduced into law (INC 2004) and the calendar proposed by TEK, both within the from the realm of the Patos Lagoon Forum see ,56 and fphonemic (entonation), describes the behavioral system of a given culture within its own terms. In this case, the cognitive and linguistic categories of a traditional community are being studied. On the other hand, “etic” comes from phonetic (written language), which refers to the description of categories of scientific knowledge of nature [A wide literature review of main publications from the ethnosciences and natural sciences was conducted with the aim of establishing an emic/etic approach to the description of the pink shrimp life cycle and management practices in the Patos Lagoon estuary. The meaning of the word “emic”, which comes from f nature . In thisFrom the ethnoscientific literature that describes the TEK of the pink shrimp life cycle in the estuary, three articles have been selected ,56,58, ac. From “similar observation principles” of the incommensurable level(s), the “underlying principles of TEK and SK”  the “criteria for hierarchies of validity” are used to “compare” types of knowledge “because of their capacity to carry out certain tasks in social contexts delineated by particular logics,” and consequently establish different weights for specific types of knowledge. According to the same author, when there is an “epistemological problem”, relativism, in the absence of “criteria for hierarchies of validity” is an untenable practice because “no human practice could be accomplished” , the hypothesis of incommensurability at the resource management level will be tested. In this way, the hypotheses tests will “operationalize” the definition of the level(s) at which “qualitatively incompatible principles exist (: 58); inand SK” (: 06) emeand SK” (: 98). Aclished” (: 98). InThe fishers in the Patos Lagoon estuary intensely observe the new moon at the beginning of spring: “The new moon of September is in motion until December”. The first new moon in spring allows us to predict what spring is going to be like in a given year: if it is rainy during the new moon in Rio Grande do Sul, “spring is going to be rainy”. Heavy spring rains in RS result in large fluvial discharges during the entire season in the Patos Lagoon estuary, thus inaugurating what the fishers call a “freshwater year”. If it does not rain during the new moon, spring “is going to be dry”, resulting in low fluvial discharges in the estuary. The low fluvial discharges during spring give rise to two “year categories” depending on the preceding winter. First, if the winter was also dry, a “salty water year” starts; second, if the winter was rainy, the fluvial discharges in the Patos Lagoon estuary decrease in October, and the intrusion of “salty water tips” from the ocean occurs through December (at the latest) giving rise to a “mixed water year” . Severald enter the estuary from the ocean in association with “salt water tips.” [et al. (2001) register the intrusion of larvae (sub stage 6) associated with the intrusion of salty water, predominantly in the period also indicated by fishers [e[According to local fishers, it is at the unstable moment between the end of winter and the beginning of spring, between August and December, that the “casquinhas”r tips.” ,56,58,66 fishers ,81,83,84 fishers ,81,83,84ishers [e.et al. , using statistical analyses from rainfall and catch per unit of effort, have also noticed a negative correlation between high rainfall in the spring, the non-occurrence of Southern quadrant winds, and the abundance of shrimp [et al. (2004), the highest rainfall averages during spring take place in years when there are events such as a moderate to strong El Niño [The intrusion of larvae, starting in August, associated with salt water intrusion and Southern quadrant winds is documented by Calazans 1978) . If it i . If it f shrimp ,71,77. A El Niño . TherefoIn catch “years”, that is, in “salty water years” and in “mixed water years”, the larvae grow and reach a minimum size which the fishers consider “good”. The appearance of pink shrimp of a “good” size (around 9 mm) depends on the moment when the intrusion of larvae from the ocean has occurred. The shrimp that intrude first will subsequently reach a size “good” size earlier than those that intruded later on . Researcf. In the “breeding sites”, the shrimp reach a “good” size earlier than in any other ethnozone [On the other hand, according to the fishers, pink shrimp does not reach a size that is considered “good” at the same time throughout the entire estuary and, therefore, the fishers establish a zoning (ethno-zoning) in the estuary as follows: The shallow coves are considered “breeding sites”, the main estuarine body is the “passing place” and “the Lagoon” is considered the region above Ilha Novathnozone . The “brthnozone . Within thnozone ,88. Alththnozone . D’Incaog. However, there is some information in scientific literature that intersects with fishers’ observations. D’Incao (1982) registers high pink shrimp abundance in the Patos Lagoon estuary in areas with salinity levels lower than 10% and higher than 3%. Benvenuti (1978ab) reports pink shrimp movement from the shallow coves to deeper regions due drops in temperature in the fall, thus altering the composition of the benthic communities of shallow waters [According to the fishers, once the shrimp reaches a size considered “good”, “the shrimp travels up”, that is, it migrates from the shallow coves (breeding site) and from the shoals across the main estuarine body (‘passing place’) to reach the “mixed water” (similar to EMZ) at larger and deeper sites as it grows in size. On the other hand, this migratory movement down the upper estuary varies between the “mixed water year” and the “salty water year”: in the first one, the “mixed water” and the shrimp remain longer in the “passing places” and in the “breeding sites” next to the lower estuary; and in the second, the “mixed water” is in the “lagoon” and the shrimp “go to the lagoon” as soon as reaches a “good” size ,68. Thusw waters ,75,79.h.According to local fishers, shrimp returns to the adjacent ocean from March to June, with noted variations in migratory movements between “mixed water” years and “salty water years”. In “salty water years”, migration to the ocean occurs from the “lagoon” passing through the main estuarine body (‘passing places’) during the reproductive migration period. Shrimp reproductive migration occurs during the Southern quadrant calm winds in particular during the waning moon of April and May. Shrimp reproductive migration can take place earlier if rains occur before the waning moons of April and May . In the During the initial phases of the pink shrimp catch, fishers are accustomed to “good” sized shrimp . NeverthMoreover, the beginning of pink shrimp fishing activities in the Patos Lagoon estuary is not the same for all fishing communities. The beginning of fishing activities described above is based on the research by Moura (2009) in a fishing community whose traditional territory is located on a shallow cove (breeding site) of the lower estuary. Here, shrimp reaches a “good” size earlier than in other ethnozones . AccordiThe same flexibility that marks the beginning of fishing activities is also true for the factors that determine the closure of the pink shrimp catch season. In “salty water years”, the end of the catch occurs when “lagoon” shrimp (shrimp from upper estuary) begin their reproductive migration to the ocean . In any of the “years”, however, the end of the season can be earlier if it rains in excess . AlthougThe scientific literature recommends that shrimp harvesting begin at a fixed date, the beginning of March, across the entire Patos Lagoon estuary. The literature cites two motives for this recommendation: 1 - to avoid high capture rates of shrimp reproductive matrixes that migrate to the ocean, and 2 - to allow fishing in the months when shrimp is in higher abundance. Abundance numbers are based on the statistical averages of annual series studied in the estuary ,88. D’Inet al. (2005) [et al. (2000) has also observed migration patterns and time variability in whale and fish stocks noted by TEK, but not predicted by SK [The dialog between TEK and SK allows us to observe similarities and differences in the two “realities” described for the pink shrimp migration cycle. One observed difference is that the first is holistic; it makes connections between several elements of nature . These connections are overlooked by the positivist SK. SK’s analytical-reductionist base and TEK’s holistic base have also been noted by authors, such as Berkes 1999) and Vieira 999 and V. (2005) , which wed by SK .Despite these differences, significant consonances are observed and show a likeness between the “realities” described by SK and TEK. These agreements allows us to trace two common and fundamental principles for the construction of “resource management scenarios”: the spatial heterogeneity  and the environmental variability and flexibility . These two principles will be the basis from which we discuss TEK-based management and SK-based management in the next section of this argument.Based on the previous discussions, we understand that fishers of the Patos Lagoon estuary construct calendars/time based on material references from nature (pink shrimp appearance and disappearance), which are linked to the framework of material references of estuarine-biological processes , which according to TEK favor shrimp occurrence. In this sense, in TEK there is a time/space overlap. According to Chesneaux (1989) and Giddens (1991), time located in its natural environment is flexible and irregular, and allows the ecosystem to “take its time” ,28. In tThe spatial heterogeneity observed can also be understood from the perspective of time in the natural environment. Trusler and Johnson (2008) argue that traditional human groups appropriate the heterogeneity of terrestrial landscapes because they manage resources that are dependent on potential seasonal catches . AchesonBased on variations in estuarine-biological dynamics, the fishers in the Patos Lagoon estuary construct their time/calendar for their respective fishing territories. According to Allut (2000), TEK allows the fisher to organize his world, and from this order, construct scenarios for actions that are both organized and adaptative to his surroundings and constantly changing . StewardAlthough SK and TEK display common ground regarding the shrimp migration cycle, SM guidelines present an entirely different management scenario from the management practices carried out by traditional fishing communities in the Patos Lagoon estuary. Researchers recommend pink shrimp capture permissions/prohibition across the entire estuary during the same time periods with fixed start and end capture dates . These recommendations are based on statistical averages that do not differentiate between different ecological domains; they also fail to consider the seasonal and inter-annual variations of shrimp life cycles in different domains , something that is accepted by INC 2004.In the case of SM and OM in the Patos Lagoon estuary, the technical and scientific modality of mediating reality through techno-social time abstracts estuarine-biological dynamics, which are described by scientific knowledge itself. The fixed time measurement, alien to natural rhythms, makes time empty  and is aAnother contradiction refers to the different ecological domains noted and the possible time variations we described in the previous section. According to its recommendations, SM standardizes the space of the Patos Lagoon estuarine and applies a fixed time management regime to all ecological domains. For Trusler and Johnson (2008), the standardization of biological and physical properties of a certain ecological domain pertains to Cartesian reasoning, which understands space as an abstract entity . In thisTherefore, we can say that at the level of resource management, there is incommensurability based on SK and TEK due to the incompatible concepts between the two forms of resource management. Traditional resource management obeys “ecological scenarios” constructed according to estuarine-biological dynamics in several ethnozones acknowledged by TEK. On the other hand, official resource management follows the recommendations of scientific studies which abstract the seasonal and inter-annual variability across distinct ecological domains as predicted by SK; this occurs through the use of statistical averages of pink shrimp abundance curves. Trusler and Johnson (2008) similarly show dissonances between the Gitksan Wet’suwetèn natives’ management and that recommended by the BC Forest service of Canada due to differences in concepts regarding the biophysical environment. For the former, the biophysical environment is appropriated and managed according to the “place” concept . However, for the latter, the environment is appropriated and managed according to the Cartesian reasoning of abstract space .The federal government chooses to adopt SK recommendations for pink shrimp management in the Patos Lagoon estuary. According to Berkes and Folke (1998), centralized management in institutional bureaucracies is characteristic of resource management based on Newtonian sciences . By chooet al. (2005), it is necessary to establish “criteria for hierarchies of validity” when an “epistemological problem” exists and interferes in human activity [Due to incommensurability at the management level, conflicts arise between fishers from several communities of the estuary and institutional bureaucracies see . To resoactivity . In thiset al. 005, it iBased on the presented arguments, it is possible to raise some hypotheses based on TEK for the investigation by SK as a first guideline for the construction of pink shrimp management scenarios. Thus, we see roles changing places, as TEK complements SK in several scientific bibliographies see ,10. In ta) To enrich scientific descriptions of the pink shrimp life cycle in the Patos Lagoon estuary by adding the following information: top/down estuary migration; biomass concentration in the “mixed water”/brackish water; the life cycle phase that involves the migration from the lower estuary embayment areas to the upper estuary; inter-annual variations in the migration cycle and in biomass distribution, especially when EMZ is closer to the embayment areas (‘mixed water year’) of the lower estuary or when it is farther than 70 km inside the estuary ; variations in spatial distribution and abundance due to rainfall during summer and/or fall; correlation between long drought spells and pink shrimp presence in the estuary once the indispensable conditions for larvae intrusion predicted by SK and TEK are met; correlation between the new moon and rainfall levels in the spring; correlation between the waning moon, winds, and pink shrimp reproductive migration.b) To change the scientific paradigm from positivism to holism: besides the correlation of a number of environmental factors, as cited in the previous section, other factors contribute to the shift from a more positivist science to a more holistic science; for instance, to broaden the focus to include the socio-ecological system, which allows for natural environment; to further delimit gaps in SK by means of TEK and acknowledge the existence of an ethical code in the TM. Therefore, a focus on the socio-ecological system is proved most adequate for natural resources management as compared to scenario that only includes the natural system.et al. (2000) and Ruddle (2000), TEK provides valuable information about stages in marine resources migration cycle, which may contribute to SK in the mapping of marine resources distribution and migration cycle in resource management scenarios [The cited ways in which TEK contributes to SK are also registered in the ethnoscientific literature ,16,18,19cenarios ,16,18. Icenarios ,16 and tcenarios . In “rescenarios .Besides the above recommendations for the natural sciences, we also have some recommendations for the interdisciplinary and social sciences. According to our literature review, we can observe some gaps in discussions of the traditional calendars of different fishing communities in the Patos Lagoon estuary. The available information comes predominantly from the lower estuary communities whose territories are limited to borders of the estuary. Thus, research on traditional calendars are needed in fishing communities whose territories encompass embayment areas, the main estuarine body of the upper estuary, and the flexible borders of the estuarine zone, such as communities at the northernmost part of the Patos Lagoon. These communities are often located near the EMZ. Moreover, little information exists for the southernmost communities, which are closer to break waters and where residents also fish in the ocean.Once the above guidelines imposing limits to SK in the initial construction of “management scenarios” are taken into account, it is possible to trace two additional guidelines derived from the discussions thus far and from the two “criteria for hierarchies of validity” that have arisen from the interaction between SK and TEK. The first arises from the spatial heterogeneity existing in the Patos Lagoon estuary. The Patos Lagoon estuary should be seen and managed as an ecological mosaic. In the estuarine zone there are several ecological domains  which contribute to pink shrimp development during different life cycle phases. Thus, it is an error to adopt a closed fishing season for the entire estuarine body as SM prescribes. For the different ecological domains described, where the pink shrimp reaches a size considered “good” at different moments, there should be different permitted fishing seasons. The lower estuary embayment areas, for instance, are apparently the first ecological domains where pink shrimp reach a “good” size. Therefore, this community could be given permission to catch pink shrimp earlier than the other communities. In Mamirauá Sustainable Development Reserve, state of Amazonas, considered one of the icons in the participatory and adaptative resource management in Brazil, natural resources management obeys an environmental mosaic constructed from the heterogeneity of the ecological domains known by SK and TEK ,97.et al. (1994) and Acheson and Wilson (1996) say that the “parametric management” carried out by fishers through the physical-biological parameter variability responds to the environmental complexity. It keeps the environment inside a chaotic variation spectrum [i according to that meteorological and hydrodynamic conditions of the current year.The second guideline arises from the seasonal and inter-annual variability of estuarine-biological force mechanisms. According to SK and TEK, there are several environmental force mechanisms that influence the conditions allowing for the appearance of a “good” sized shrimp (or 9 mm) in variable inter-annual periods. Therefore, it is a mistake to adopt a fixed fishing calendar, according to what SM purposes. The permission or prohibition to catch shrimp should be flexible, being determined annually according to the appearance or disappearance of pink shrimp of a “good” size. In this case, the extension of the closed fishing season, and the 4-month closed season, fall short of considering the social and biological-estuarine context. An estuarine-biological context, in which both could be extended, for example, is the moderate to strong El Niño year  in which both kinds of knowledge acknowledge the non-occurrence of pink shrimp catches. Wilson spectrum ,98. At tIt is worth stressing, however, that the proposition of this “management scenario” for pink shrimp in the Patos Lagoon estuary does not replace the participation of traditional populations in decision making processes regarding management, as is recommended by the co-management bibliography see ,15,33. WFarfantepenaeus paulensis.The description of the relational dynamics of hydrodynamic processes and pink shrimp migration cycle in the Patos Lagoon estuary based on TEK and SK is compatible. Despite the compatibility at the knowledge level, TM and SM are incommensurable and point to distinct ways of using the resources of The incommensurability at the pink shrimp management level is due to the foundations used to construct traditional and scientific knowledge and management regimes. TEK and the TM are based on the construction of “ecological scenarios”, that is, on a perception of time-space located in the local ecosystem allowing for the adaptative insertion in a known natural instance. SK and the SM are based, on the other hand, on modern time-space perceptions that are guided by Cartesian reasoning that sees time in a homogeneous, dislocated/abstracted way within the Newtonian way of authoritarian resource management centralized in institutional bureaucracies.Despite the incommensurability at the management level, in the case of the Patos Lagoon estuary, it is possible to establish guidelines for the construction of “management scenarios”. These can be derived from the establishment of “criteria for hierarchies of validity” formulated from common principles that have emerged from the dialog between SK and TEK in the description of the estuarine-biological force mechanisms.Since TM entirely meets the “criteria for hierarchies of validity”, and consequently the proposed “management scenarios” are in accordance with TM, several hypotheses have been raised for SK, such that new hypotheses, information, and (un)certainties arise.Despite the “management scenario” proposition, it is recommended that the co-management process adopted by the Patos Lagoon Forum truly incorporate TEK in future public policies for the resource management in the Patos Lagoon estuary. This stands in opposition to the present authoritarian policy centered on institutional bureaucracies and positivist science.The results of this article should be used legitimate the discussions regarding the management of fishing resources in the estuary held by of the Patos Lagoon Forum. Such valorization is needed to move away from the authoritarian role that SK has played in guiding the official management of the INC 2004, and to construct new “resource management scenarios” with popular participation. The institutions in charge of institutional bureaucracies should be prepared to develop mechanisms to adapt official management plans, according to the timing flexibility and special heterogeneity highlighted by the “criteria for hierarchies of validity”. These emerge and can emerge hereafter from a working dialog between SK and TEK, which today only TM currently meets. Thus, the traditional resource management has a role to play from which it should never be alienated: maintaining autonomous and legitimate guidelines for the management of the territorial resources of artisanal fishers and fisher small-farmers in the Patos lagoon estuary.aPortaria n. 001, de 02 de janeiro de 1973. Governo Federal: Ministério da Agricultura - Superintendência do Desenvolvimento da Pesca (SUDEPE).bInstrução Normativa Conjunta nº 3 de nove de fevereiro de 2004. Governo Federal: Ministério do Meio Ambiente e Secretaria de Aquicultura e Pesca .cTwo assumptions derive from the theoretical base and the methodological procedures adopted in this article: 1 - regarding incommensurability at knowledge and management levels, there will be no “similar observation principles” because, according to Feyerabend (1962: 68/94), when theoretical perspectives provide incompatible descriptions of reality, they are mutually exclusive [xclusive ; 2 - regdIt is possible that “casquinhas” are equivalent to what science call pink shrimp post-larvae (from sub-stage 6 on), but investigations are necessary in order to confirm this.eIt is worth stressing that the hypothesis raised by D’Ìncao (1991) is based on Brisson’s (1977) study, which highlights the intrusion of shrimp post larvae all year round in Laguna de Aruana, Cabo frio (Rio de Janeiro) [Janeiro) ,99.fThe border established by the fishers as the beginning of the “lagoon”, the “lagoon’s mouth”, which would be on Ilha Nova, is located very close to the border established by the scientific literature, Ponta dos Lençóis and Ponta da Feitoria, for the end of the estuarine area of the Patos Lagoon. In both cases, the distance between the communication area of the Patos Lagoon and Ponta dos lençóis or the “lagoon’s mouth” would be approximately 70 km  [ion, see ). For thn print) ,68.gThe oversight of the scientific literature on the issue of down estuary migration probably occurs due to sampling patterns. Almost all the research on pink shrimp in the Patos Lagoon estuary has restricted its sampling to the shallow coves of the lower estuary see [uary see ,84,87,88hAfter pink shrimp reproductive migration from the estuary to the adjacent ocean, TEK and SK do not present certainties regarding reproduction areas and migratory routes. SK merely mentions Santa Catarina’s coast as a single possibility see [lity see .iLagoa do Peixe Forum is a local co-management forum. It can be stressed, however, that despite the existence of this forum and the adaptive character in pink shrimp management, the Park Administration, following attachment 10 D from the management plan see [plan see , developplan see ,101,102.The authors declare that they have no competing interests.GGMM has made substantial contributions to conception, design, data acquisition, analysis, and interpretation. He has also been as involved in drafting this manuscript and revising it critically for its intellectual content. Moreover, he worked in the acquisition of funding. DCK has made substantial contributions to conception and design as well has been involved in drafting and revising the manuscript for intellectual content. Moreover, she worked in the general supervision of the research group  and in the acquisition of funding. ACSD has made substantial contributions to the conception, design and interpretation of data and has been involved in drafting and revising the manuscript for its intellectual content. All authors have given approval for the publication of the final version.


Protection-Against-Schizophrenia” (PaSZ) model, which grades the risk for developing schizophrenia as a function of an individual's visual capacity. We review two vision perspectives: (1) “Absent” vision or how congenital blindness contributes to PaSZ and (2) “perfect” vision or how aberrations in visual functioning are associated with psychosis. First, we illustrate that, although congenitally blind and sighted individuals acquire similar world representations, blind individuals compensate for behavioral shortcomings through neurofunctional and multisensory reorganization. These reorganizations may indicate etiological explanations for their PaSZ. Second, we demonstrate that visuo-cognitive impairments are fundamental for the development of schizophrenia. Deteriorated visual information acquisition and processing contribute to higher-order cognitive dysfunctions and subsequently to schizophrenic symptoms. Finally, we provide different specific therapeutic recommendations for individuals who suffer from visual impairments  and individuals who suffer from visual deterioration . Rather than categorizing individuals as “normal” and “mentally disordered,” the PaSZ model uses a continuous scale to represent psychiatrically relevant human behavior. This not only provides a scientific basis for more fine-grained diagnostic assessments, earlier detection, and more appropriate therapeutic assignments, but it also outlines a trajectory for unraveling the causes of abnormal psychotic human self- and world-perception.The causes of schizophrenia are still unknown. For the last 100 years, though, both “absent” and “perfect” vision have been associated with a lower risk for schizophrenia. Hence, vision itself and aberrations in visual functioning may be fundamental to the development and etiological explanations of the disorder. In this paper, we present the “ Protection-Against-Schizophrenia” (PaSZ) model by reviewing human visual functioning from two perspectives: (1) “Absent” vision or how congenital blindness contributes to PaSZ and (2) “perfect” vision or how aberrations in visual functioning are associated with an increased risk for psychotic symptomatology. Grading the risk for developing schizophrenia as a function of an individual's visual capacity, we argue that (early) diagnostic and interventional approaches need to be specific to the patient's visual capacity. On the one hand, individuals who suffer from visual deterioration  may reduce their risk for developing schizophrenia through an improvement in visual capacity. On the other hand, individuals who suffer from visual impairment  may, in fact, reduce their risk for schizophrenia through a decline in visual capacity .Current models of developmental trajectories of schizophrenia emphasize the prognostic value of subclinical disease expressions. In his inspirational or Insel  describeprognostic or prodromal]Thus, current diagnostic criteria and etiological models of the disease may be indicative of only ultimate disease stages. Even more problematic, the “Schizophrenia” by Bleuler .increase in visual impairment and a decrease in visual deterioration may contribute to lowering a person's risk for schizophrenia.Finally, in the third part – the therapeutic perspective – we review interventional implications of the PaSZ model. Specifically, we show how both an “Suppose a man born blind, and now adult, and then taught by his touch to distinguish between a cube and a sphere of the same metal, and the same bigness, so as to tell, when he felt one and the other, which is the cube, which is the sphere. Suppose then, the cube and the sphere placed on a table, and the blind man to be made to see. Query, whether by sight, before he touched them, he could distinguish, and tell, which is the globe, which is the cube?”  WHO, , visual and schizophrenia. Whereas it is important to keep in mind that the absence of proof  is not proof of absence, the protection mechanism appears specific to blindness  and to schizophrenia   receptor channels in the visual cortex may account for cognitive functioning that is insusceptible to psychosis in the blind. However, this point of view may be incomplete because functional reorganization in visually deprived individuals also occurs in brain areas other than the visual information processing sites of sighted individuals .On the other hand, amodal mental representations, e.g., how the idea of a “tree” is represented in the brain, are independent of their perceptual source  , Sadato et al. , 1998 weThese results led us to postulate the following two assumptions: first, neurofunctional plasticity in congenitally blind individuals includes reorganization in non-visual cortical areas, which has been confirmed, for example, in lingual and posterior fusiform gyri  by the right ear compared to the left. In fact, it has been observed that left frontal lobe lesions diminish the advantage of the right ear .These findings imply the following. First, patients with schizophrenia attribute less weight to visual information and are not able to integrate visual information as well as healthy sighted individuals. This means that patients' deficient performances on higher-order cognitive tasks, therefore, can be accounted for by lower-level visual aberrations. Second, patients' visual channels are still “open.” Hence, they are unable to obtain cognitive and neurofunctional reorganization in the same way as blind individuals. This suggests that PaSZ may be available in two directions. On the one hand, if patients learn to put Aberrant visual information processing  information cannot process this information adequately and thus may suffer from deficient amodal representations of the world. Scientifically, visual scanning deficits and oculomotor deteriorations are related to higher-order cognitive dysfunctions  and social cognition Adolphs, , as wellBecause multisensoriality and amodality, as well as self and world representations have already been discussed for blind individuals, there are two things to note. First, the neural sites for multisensory integration may differ between patients with schizophrenia and blind individuals. This would mean that dissimilar neurofunctional processes are conducted. These processes and sites may represent good candidates for early detection markers and possible interventions for schizophrenia. Second, blind individuals and patients with schizophrenia have something in common regarding multisensory integration: they assign less weight to visual information. Blind individuals do so due to the absence of visual input; patients with schizophrenia may do so because they have deficits in visual information acquisition and processing. However, the underlying neurofunctional processes differ and may be an indication of the protective mechanisms of blindness. Interestingly, there is a strong association between oculomotor function and multisensory integration  may be more beneficial for an individual with visual impairment who never had “normal” visual skills in the first place. By contrast, an improvement in a person's visual capacity  may be more beneficial for an individual with visual deterioration, that is, who had at some point developed “normal” vision. However, the difference between those two therapeutic approaches may not be clear cut as there is, until now, no clear agreement about (1) how much aberrations of visual functioning corresponds to the highest risk for schizophrenia and (2) whether or not an increase in visual impairment  actually corresponds to a decline in visual functioning.So far, we have presented evidence for why the relative risk of developing schizophrenia is allegedly zero for congenitally blind individuals and for individuals with supernormal visual capacities. According to the PaSZ model, the risk of developing schizophrenia increases from both ends of the visual capacity continuum  toward a “peak risk” Figure . Thus, dacquisition  of the affected individuals. We argue that the understanding of the causes of schizophrenia and its development can be derived from a continuous vision-based model. And in this review, we presented evidence for this point of view from the “blindness” and the “vision” perspective, ultimately deriving interventional recommendations.The ability to see appears necessary but not sufficient for schizophrenia symptoms to develop. The PaSZ model provides a In the “blindness” part, we provided clues about what protects visually impaired, that is, congenitally blind individuals from psychosis. While blind individuals have cognitive experiences that are similar to sighted individuals, they show alterations in cognition , neurofunctioning , and multisensory integration . In fact, these considerations raise the question of how much visual information processing is actually necessary for a person to become vulnerable to psychosis. Or, in other words, how little visual impairment is still protective against manifesting psychotic episodes. Future studies should investigate this and other questions regarding candidates for schizophrenia-specific developmental trajectories. In line with these assumptions, we already hypothesized in a former work that tasks that tap into multisensory integration and full-body motor and navigational control may improve discrimination rates between different disease stages  of patients with schizophrenia would be found on the “visual impairment” rather than the “visual deterioration” side. In addition, future research should identify vision- and cognition-related disease stages and determine the time point at which (or the time period in which) interventions may be most important and most effective.and improvements in visual capacity (deterioration) may increase PaSZ. We formulated treatment options, including vision training, with regard to visual information acquisition  and processing . In fact, cortical functional reorganization appears to be most crucial for successful interventions and may be induced by neurofeedback or sensory substitution. Hence, whereas patients would undoubtedly profit from being trained to improve and put more weight on visual functioning, we argue that learning how to decline and put less weight on visual functioning – the way  blind individuals do – may lead to an even stronger protection against psychosis.In the “therapeutic” part, we proposed interventional strategies that resulted from the “blindness” and the “vision” perspectives. Decisively, declines in visual capacity (impairment) In this context, it has to be kept in mind that not all patients suffering from schizophrenia show visual dysfunctions and not all individuals with visual dysfunctions develop schizophrenia. On the one hand, this could be due to the fact that the PaSZ model may only apply to a specific subgroup of patients/individuals. For example, the influence of monocular vision, neurofunctional compensatory mechanisms, and genetic effects need to be investigated in the future. Further, it would be interesting to characterize specific subgroups along etiological dimensions. On the other hand, however, this may also indicate that the current diagnostic  criteria for schizophrenia are too coarse in order to dissociate between different etiological factors. Hence the PaSZ model may provide a fine-grained tool that assesses psychotic symptomatology on the basis of developmental trajectories in much greater detail than current diagnostic procedures. This would result in greater diagnostic precision and, in turn, better therapeutic assignments for affected individuals.vision, determines our ways of thinking and how we experience the world (Halfwassen, Overall, this review stresses that although the ability to see makes us human Hegel, , it alsoThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Double burden of diseases in low– and middle–income countries (LMICs) is well recognised. However, proper understanding of the need for a joint intervention against both infectious diseases and non–communicable diseases (NCD) has arisen only recently . In 2008On the other hand, communicable diseases are still difficult to control, especially in young children, even though most of the necessary tools and knowledge about their prevention, treatment and control are available . Those tRecently, it became increasingly apparent that, in addition to ‘double burden of disease’ affecting LMIC populations, there is also ‘double burden of malnutrition’, consisting of undernutrition among children and overnutrition in adults. A driving force behind the shift from undernutrition in childhood to overnutrition in adulthood in LMIC was the rapid increase in economic development, globalization, and urbanization, leading to tremendous changes in lifestyle marked predominantly by changes in diet and physical activity and under– and overnutrition occurring simultaneously among different population groups. This was recognised recently in FAO's document on double burden of malnutrition in six LMIC: China, Egypt, India, Mexico, the Philippines and South Africa . Great dExamples of simultaneous occurrence of undernutrition in deprived parts of the population and obesity among more affluent were well recognized in many countries, but these recent changes tend to result in the opposite manifestations of malnutrition even within a single household. For instance, an underweight child and an overweight mother within the same household were observed in 11% of the households in rural areas in Indonesia and 4% in Bangladesh . The figAlmost two decades ago Barker proposed his ‘fetal origins hypothesis’, stating that “fetal undernutrition in middle to late gestation, which leads to disproportionate fetal growth, programmes later coronary heart disease” . His hypFetal origins hypothesis is also known as ‘thrifty phenotype’ hypothesis, as opposed to ‘thrifty genotype’ hypothesis, which should also be mentioned here. History of modern humans, dating to the last 120 000 years, was characterised primarily with long periods of food insecurity and scarce resources among hunter–gatherer populations, and only occasional and short–lasting circumstances of abundance. Due to such environmental conditions, early people developed thrifty genotype, enabling them to survive starvation periods and to maximally harness rare opportunities of abundance, storing the energy for upcoming famine. In modern times, dramatic changes resulting in increased food availability led to predisposition to obesity and diabetes type 2 .Today's food abundance in high–income countries is marked with loss of seasonality for almost all foods and many fashionable movements in dietary practices, like the ‘Zone diet’, the ‘raw food diet’, the ‘Paleo diet’, the ‘Atkins diet’, the ‘Cactus diet’, the ‘blood type diets’ and many more. Some of those diets seem to be based on unbalanced nutrients and may even generate opposite effects from those desired. Scientific evidence for the effectiveness and appropriateness of any of those diets is insufficient at best.Scientific inquiry in food and nutrition practices and their effects is well established, which is perhaps best noted in 63 different journals referenced in the National Center for Biotechnology Information Databases (NCBI) having the word ‘food’ or ‘nutrition’ in the journal’s name. A review of the research focused on food safety and security during the last decade showed a steadily growing interest and almost 40–fold increase in the number of citations of the published papers between 2000 and 2010 .2 per decade in women worldwide and by 0.4 kg/m2 per decade for men [The analysis of the scientific literature on adult obesity and cardio–metabolic risk revealed a U–shaped correlation between the birth weight and the risk for the disease outcome . This me for men . More th for men .There is ample scientific evidence on the effects of overweight and obesity on health, ranging from local tissue inflammation to atherosclerosis, myocardial infarction, diabetes, hypertension, hyperlipidemia, some forms of cancer, locomotor problems, gout, urinary stones formation, gallbladder disease, sleep disorders, excessive sweating, and others. Obese people also suffer from social stigmatization and isolation, which can easily lead to depression  and overPoverty remains the most important reason for stunting and wasting, which are the most commonly used indicators of malnutrition among children. However, recent findings from the USA described the link between poverty and obesity, mediated through affordability of unhealthy foods. Obesity in North America is significantly more prevalent in poor neighbourhoods and among groups with lower education and income, suggesting inequitable access to healthy foods. This trend is mainly driven by the prevalent consumption of grains, added sugars and fats, which are inexpensive, good–tasting, convenient and low–cost . In the The burden of malnutrition is enormous. In 2009, over a billion people were reported as food insecure and 180 million children were reported being undernourished . At the Described mechanisms and trends highlight a ‘double burden of malnutrition’ as an important driver of the double burden of disease. On one hand, undernutrition in fetal life and among children predisposes to infectious diseases, but also increases the NCD burden, mainly through overweight and obesity and related co–morbidities. On the other hand, overnutrition in pregnant overweight women closes the circle. Since the abundance of literature is supporting these findings in developed countries, the real question is what the future holds for the developing countries? This problem should be given greater attention, so that a scenario for the future of mankind that was very intelligently portrayed in WALL–E movie is avoided .


Controversy remains about possible dengue hemorrhagic fever during the epidemic. Aedes albopictus mosquitoes and the frequent warnings of a possible reemergence of dengue fever in Europe.During the late summers of 1927 and 1928, a biphasic dengue epidemic affected the Athens, Greece, metropolitan area; >90% of the population became sick, and >1,000 persons  died. This epidemic was the most recent and most serious dengue fever epidemic in Europe. Review of all articles published by one of the most influential Greek daily newspapers (I Kathimerini) during the epidemic and the years that followed it did not shed light on the controversy about whether the high number of deaths resulted from dengue hemorrhagic fever after sequential infections with dengue virus types 1 and 2 or to a particularly virulent type 1 virus. Nevertheless, study of the old reports is crucial considering the relatively recent introduction of  Aedes aegypti mosquitoes, the epidemic probably involved dengue virus type 1 (DENV-1) and type 2 (DENV-2)  epidemic of 1927–1928 in Greece, which first affected the Athens area, was the most recent dengue epidemic in Europe. Transmitted by Greece in 1927 lagged behind other countries in development. For example, most roads in Athens were unpaved; electric service was intermittent; a citywide sewage system was nonexistent; and the potable water supply was rudimentary, often forcing residents to store water in containers. Moreover, the population of the metropolitan Athens area, like the remainder of the country, had increased markedly because of the exchange of populations between Turkey and Greece after the war between the 2 countries and the defeat of Greece in 1922  was affected. On the basis of the current definition of pandemic, the term epidemic is used here to describe the events of the summers of 1927 and 1928.By focusing exclusively on all 561 items published in 1 daily newspaper during the epidemic, this review compares reports from 83 years ago with today’s knowledge. I chose the fully digitized archives of the Athens newspaper Η Καθημερινή (I Kathimerini) , which “...protects you from the awful Dengue Fever, because it eradicates immediately the mosquitoes, which transmit it....” While publishing more jokes during the next few weeks and further advertisements for FLY FUME, I Kathimerini did not mention the DF epidemic until August 1928, when an article reported that the epidemic during the fall of 1927 had resulted in 3,000 cases with 0 fatalities; a few days later, the number of ill persons was reported as 75,000. Moreover, the second article suggested that many of these DF cases were initially mistaken for the yearly recurrence of “3-day fever,” which was known to be transmitted by phlebotomine sandflies. In August 1928, citing an unnamed physician, I Kathimerini reported that the previous year’s epidemic had started in mid-August in a middle-class household in the center of Athens through a young woman in whom DF symptoms developed 2 days after she arrived from Alexandria, Egypt.On August 2, 1928, when the second epidemic had been ongoing for several days, I Kathimerini began publishing frequent articles mentioning DF. An article in early September mentioned that the first 3 DF cases in 1928 had appeared in mid-July in the center of Athens among construction workers. This article also criticized the medical authorities for not issuing directions and for not taking any palliative and prophylactic measures despite the fact that “whole families stay in bed” or “big factories are forced to stop work.” The first real medical facts were published several weeks later in late August.The headline of a long article appearing on August 15 was “25,000 Athenians are burnt by DF” and continued “... science remains speechless in front of the mysterious disease.” It described the symptoms of DF and mentioned a common prescription . The article concluded that “all measures and drugs suggested by [medical] science are symptomatic and not therapeutic.” It also reported that “those [persons] injected with 606 and Bismuth did not get DF” .sic]. Isolation of the DF “microbe” was unsuccessful, leading to the opinion that the transmitting mosquito might be poisonous. The vector was identified in different articles as Stegomyia fasciata mosquitoes, an old name for Ae. aegypti mosquitoes.The sic] acid, well sterilized [sic] should prevent cardiac diseases, especially myocarditis, ensuing from DF.”On August 24, some of the effects of the epidemic on society were reported for the first time. For example, the Athens–Piraeus Railroad used fewer trains, half the judges of the Athens Lower Court were absent, and the armed forces draft was suspended. Although more fatal cases were reported, hemorrhagic DF-like illness was not described, and deaths were attributed to older age or preexisting diseases. Some articles suggested that residents were afraid the epidemic might be yellow fever, but medical authorities explicitly denied this concern because “no patient ever showed any symptoms of hemorrhage” (the term σύμπτωμα in Greek covers both symptoms and signs). However, Cardamatis . A common theme was that DF was associated with environmental degradation, and general measures for other diseases, such as cholera, should successfully curb the epidemic. The British power company performing public works and digging in Athens was accused of “providing breeding sites” for mosquitoes. Authorities seemed to be aware that only control of mosquitoes would help alleviate the epidemic and suggested that any “ditch should be covered as soon as possible and petroleum and/or lime should be used in order to prevent mosquitoes from breeding.” City authorities were advised to “wash the streets regularly and swamps should be dried the soonest possible.” These proposed measures were accompanied by proposals to “brush one’s teeth regularly” and take the drug “emostyrol.” Finally, several clergymen’s suggestion that “prayers and litanies would help end the epidemic” was made public.On August 25, I Kathimerini reported the first cases outside the Athens area. Persons who had traveled to their birthplaces to vote in the general elections a few days earlier were held responsible for transporting the disease. On August 28, an article appeared that described what was then generally known about DF without citing the source of the information. Until that date, this article was 1 of only 2 scientifically sound articles describing the disease and its treatment. Additional articles contained amateur advice about how to cure DF . Development of an efficient drug also was reported (an “iodine solution per os” without further details), later followed by a letter from the chemist who developed it, cautioning that success achieved might have been purely coincidental.Stegomyia mosquitoes, and the “microbe” had no relation to Spirochaeta (an association between DF and syphilis was considered possible by many physicians) or Plasmodium laverani.More scientifically sound articles appeared in September. For example, the Minister of Health, an established pediatrician, explained how the “microbe” remained in Greece throughout the year; he had seen 1 DF case himself, 3 months before the new outbreak. He also explained that, after the acute phase, patients were expected to have lifelong immunity against dengue. Dr. Georges Blanc, head of the Hellenic Pasteur Institute, who was in France at the beginning of the epidemic, returned to Athens and granted an interview in which he tried to correct several statements. Moreover, a report signed by him and the health authorities also described facts about DF and its mode of transmission. I Kathimerini published a summary: the vector was One article cited a different newspaper claiming that the epidemic was not in fact DF but, rather, yellow fever. Two unnamed physicians asked for their opinion were cited as saying that if the disease were yellow fever, mortality rates would have been much higher. Initial reports on the epidemic in mid-August claimed that, compared with 1927, the new DF outbreak was much more malignant, on the basis of the lack of deaths reported during the previous year. I Kathimerini acknowledged the possibility that some deaths might have occurred in 1927 but, because of the previous ill health of the patients, could have been attributed to other causes.The second month of the outbreak saw qualitatively different articles. Small news pieces about the everyday effects of the epidemic appeared frequently: entrance examinations to the universities were postponed, the army draft was deferred, theaters were closed, spouses and children were sent to resorts far from Athens, courts were closed because of the lack of judges and jurors, and the mode of taxation was changed to address lower income. Brief articles reported numbers of DF cases from Athens and elsewhere, including non-Greek cities such as Smyrna (now Ismir), Copenhagen, and Berlin, attributed to travelers from Greece. In mid-September, I Kathimerini reported that the epidemic was clearly weaker: “... the crowd at the horse races was again high after several weeks of low attendance.” On the same day, a 12-word item bore the headline, “ONLY TWO DEATHS!” On September 22, I Kathimerini published a report of the Ministries of National Economy and Health about the total number of deaths caused by the epidemic, aimed at calming foreigners wishing to travel to Greece. The numbers were corrected slightly a few days later, but the overall picture did not change . I KathiThe end of the epidemic saw a new kind of article about a potential reappearance in the following year. In a letter to I Kathimerini, a physician claimed that several patients bitten by infected mosquitoes late in the fall would become sick only in early spring. Therefore, in addition to mosquito control measures, an absolute isolation  of the first patients of 1929 should prevent a new spread.Stegomyia mosquitoes should suffice: covering any kind of water container and sewage-connected pipe or container and removing stagnant water from houses, kitchens, washing places, and flower pots.On October 29, I Kathimerini published a final report of the Nomiatros, the highest medical authority in the Νομός  of Attica; he claimed that DF could become endemic to Athens, but the fact that most persons living in the metropolitan area got sick and became immune, combined with the enhanced mosquito control measures that would be initiated, led him to conclude that DF would not be a real threat during the following years. That same day, I Kathimerini claimed that efficient measures against Throughout the winter of 1928–29, sporadic articles citing DF, usually about unrelated matters, appeared in I Kathimerini. An often-recurring advertisement stated that many persons developed a hernia because of the “awful dengue disease,” and true relief from it could be found only in the “incomparable invention” of a Mr. Em. Rousos. Additionally, a short advertisement said, “Against Dengue, Life Savers [candies] triumphed; they act the same way against the flu.”Stegomyia mosquitoes as the vector and lifelong immunity against DF, the scientists claimed that they also had produced an efficient vaccine; however, it was not to be used commercially. The vaccine had been tested, according to the newspaper, on members of the leper colony on the small island of Spinalonga and on patients of a public psychiatric hospital near Athens.In May 1929, a series of articles in I Kathimerini described several findings and conclusions of investigations led by the Hellenic Pasteur Institute. In addition to confirmation of On July 7, 1929, I Kathimerini cited Ministry of Health officials as saying that no new DF case had appeared in Athens; only 2 days later, I Kathimerini reported that a person suspected to have DF was brought to the hospital. On July 21, three presumed DF cases were reported from Thessaloniki, the second largest city in Greece, ≈300 km north of Athens. Isolated cases of diseases resembling DF were reported sporadically throughout Greece but were never confirmed. Of those, the most important ones are ≈30 cases on the island of Syros in August 1931, of which a few supposedly were fatal. Yellow fever and an unknown spirochete infection were again discussed by the public ; the unknown pathogen was declared to be transmitted by unidentified mosquitoes. To positively diagnose the disease, 3 psychiatric patients in Athens were inoculated with infected blood. One of the 3 who had not acquired DF 3 years earlier became sick with signs and symptoms of DF; the other 2, who had acquired DF during the epidemic, remained healthy. (Relatives of the first patient later sued the leader of the Hellenic Pasteur Institute team for attempted homicide. I Kathimerini did not report the outcome of this lawsuit.) Four months after these experiments, Institut Pasteur in Paris stated that the disease cases on Syros were caused by a spirochete.,conditio sine qua non for the appearance of dengue hemorrhagic fever (here DENV-1 and DENV-2). This notion was contradicted by another serologic analysis that indicated only DENV-1 was involved in the epidemic , such as the recent chikungunya epidemic in northern Italy (,The third issue is, of course, whether such a devastating epidemic could recur. The social conditions, including medical sciences and health care, now differ substantially from the late 1920s, and recurrence of an epidemic of such an extent and magnitude is unlikely in Greece or elsewhere in Europe. On the basis of present standards, in the absence of


Playback Theatre (PT) is an improvisational form of theatre in which a group of actors “play back” real life stories told by audience members. In PT, a conductor elicits moments, feelings and stories from audience members, and conducts mini-interviews with those who volunteer a moment of their lives to be re-enacted or “played” for the audience. A musician plays music according to the theme of each story, and 4-5 actors listen to the interview and perform the story that has just been told. PT has been used in a large number of settings as a tool to share stories in an artistic manner. Despite its similarities to psychodrama, PT does not claim to be a form of therapy.We offered two PT performances to first year medical students at Baylor College of Medicine in Houston, Texas, to bring the students a safe and fun environment, conducive to sharing feelings and moments related to being a medical student. Through the moments and stories shared by students, we conclude that there is an enormous need in this population for opportunities to communicate the many emotions associated with medical school and with healthcare-related personal experiences, such as anxiety, pride, or anger. PT proved a powerful tool to help students communicate. The first year of medical school is both a daunting and a defining time for future physicians. In the United States, many medical programs tend to be somewhat sequestered, high-pressure environments , 2 that The PT activities were offered as part of Compassion and the Art of Medicine, a first-year elective course at Baylor that explores the roles of art in the healing process and the development of compassion in the medical education setting. The typical course enrollment is 50–75 students, and topics discussed include 1) international health, 2) patients’ or family members’ experiences with illness and doctors, 3) medical education as an art form, 4) compassionate physician role models and their experiences, and 5) balance of career with personal and family life.In this setting, we sought to explore PT as a means of enhancing communication among students. We believe PT is intrinsically different from other extracurricular stress-reducing activities , as the primary goal is to facilitate the sharing (and receiving) of personally relevant, real-life experiences.Playback Theatre was created in the 1970s by Jonathan Fox, a therapist and theatre performer in New York, as a way to explore personal stories through the art of theatre . In mostHouston Playback Theatre (HPT) was formed in 1996 and has performed in a wide array of venues – such as schools, churches, community centers, museums, and theatres. The performance themes have ranged from the most sensitive  to the relatively light . Over two years, HPT has provided two one-hour performances for the Compassion and the Art of Medicine course.PT performances are designed and structured to ease the audience into sharing and thoughtful participation. At the beginning of a performance, actors introduce themselves by sharing moments from their lives – which are then immediately “played back” by the other actors. This models what is expected from the audience, and the tone of the performance is set by these introductions.For the Compassion and the Art of Medicine performances, the HPT actors introduce themselves with personal experiences related to medicine. In PT, it is crucial that performers form “connections” with the audience; thus, it is helpful that several of the HPT actors are involved in health care as researchers, providers, or educators. As a result, it was possible to have a broad range of introductory moments that helped the actors bond with the audience of medical students.After introductions, a PT performance moves to “short forms” in which the conductor elicits moments or feelings from audience members, and the actors play these on the spot, using various improvisational techniques. The third and usually major part of a PT performance is “stories.” Once audience members have warmed up to the idea of sharing a personal story, volunteers from the audience are invited to come to the stage, sit by the conductor, and tell their stories. After a brief interview, the conductor transitions the focus to the actors, who play the story on the spot. A typical performance has 3–4 stories told by different volunteers.Lastly, the PT performance closes with a sharing of feelings elicited by the performance. This tends to reinforce the commonality of life experience and gives everyone time to reflect on the themes of the performance. Audience members often feel that the stories shared onstage resonate with their own stories, even if they did not volunteer to share theirs aloud during the performance.In PT, the success of a performance is reflected in the range of stories told by the audience. Although funny stories are appreciated, a truly successful PT performance should include stories that elicit various emotions. In a medical education context, we expect PT to have three positive effects: First, it should offer a meaningful but entertaining experience, filled with laughter and emotion, which, in and of itself, is a welcome break from the stresses of academic study. Second, reflecting upon life through art should add meaning to personal stories – such as enriching or reinforcing students’ motivations to pursue medical careers . Lastly, telling personal stories could be therapeutic, as demonstrated in written and oral recounts of past traumatic events .One student told about her first stethoscope experience – and the feeling of “Now I am a real doctor” once she clearly identified a heartbeat.Another student “responded” with his own first stethoscope experience: not being able to find a pulse. The ensuing enactment was humorous, but it relayed an underlying sentiment of failure that the actors captured and played back.A student told of witnessing a physician listing an array of physical problems to an elderly woman , who responded by repeatedly complaining of her hair loss – suggesting that the doctor was not really “listening” and was downplaying the patients’ concern for her changing image.A student recounted how her grandfather was so proud about her being a medical student that he changed his mind about being buried – deciding instead (despite some religious doubts) to bequeath his body to a medical school. Her grandfather's decision, in turn, gave her an added respect for the cadavers in the dissection lab. She was better able to “humanize” who this person may have been, including his or her stories and the fact that someone must have loved him or her.A student told of a trip to his home country when he was 10 years old, including feeling sick and experiencing a different health care system. Despite a humorous undertone, it relayed the importance of family heritage to him. More importantly, the story illustrated cultural differences in the health care system, but also similarities in the caring attitudes of medical personnel.One student shared how she had conflicting emotions about becoming a doctor: She was very excited but was forced to leave her job as a teacher – where she was making a difference in the community. So, when the time comes to apply for off-site rotations, she planned to request placement in this same community. After the performance, an academic administrator confessed to one of the actors, “When that student shared this moment, I saw her in a new light. I didn't know she was a teacher before. I always try to place students where they request to be, but I can see now why being in that particular community would be especially important to her.”As a cursory means of exploring the positive impacts of communication among medical students, we reviewed the stories shared – as well as students’ reactions to the performance. From this, is seemed apparent that PT offered a safe place to freely share personal experiences – something visibly lacking in the medical curriculum. Below are selected “moments” shared by first-year medical students:“The performers of this lecture showed me that the means of healing or of encouraging healing does not necessarily need to be solely derived from pills and ointments, but can also incorporate the arts.”“I gained some insights into how some non-medicinal practices could have a significant impact on the well-being of an individual, and possibly on the doctor–patient relationship.”“It was absolutely amazing to see the actors, directed only by spoken words, accurately capture the feelings embedded in each story.”The following are comments from students who attended the HPT performances:The stories freely shared by participating audience members, we believe, reflected a welcomed enhancement in both reflection and personal communication among these students. Given the high-stress environment in which medical students are immersed, PT shows promise in easing some of the pressure – and providing a semblance of balance to students’ lives. By sharing their experiences, students may feel less isolated and better able to recognize their reactions and feelings in others. Perhaps more importantly, PT provides a venue for the nourishment of a student community and, specifically, a student community based on mutual respect.Strategic placement of PT performances within the medical curricula might foster students’ compassion and understanding. For example, an emerging part of modern medical training is early clinical experience – including empathy, an understanding of the impact of disease on patients, more confidence when talking to patients, and the development of communication skills . We beliLastly, sharing a personal experience and witnessing others’ experiences through art can solidify meaning in a manner that is completely contrary to the memorization of “factoids.” Thus, PT could become a mechanism to aid in medical students’ professional identity development. Although we believe that offering such opportunities early is important, perhaps having a PT experience closer to graduation would be equally beneficial to revisit and reinforce students’ personal values and beliefs about medicine.