How life did originate and what is life, in its deepest foundation? The texture of life is known to be held by molecules and their chemical-physical laws, yet a thorough elucidation of the aforementioned questions still stands as a puzzling challenge for science. Focusing solely on molecules and their laws has indirectly consolidated, in the scientific knowledge, a mechanistic (reductionist) perspective of biology and medicine. This occurred throughout the long historical path of experimental science, affecting subsequently the onset of the many theses and speculations about the origin of life and its maintenance. Actually, defining what is life, asks for a novel epistemology, a ground on which living systems’ organization, whose origin is still questioned via chemistry, physics and even philosophy, may provide a new key to focus onto the complex nature of the human being. In this scenario, many issues, such as the role of information and water structure, have been long time neglected from the theoretical basis on the origin of life and marginalized as a kind of scenic backstage. On the contrary, applied science and technology went ahead on considering molecules as the sole leading components in the scenery. Water physics and information dynamics may have a role in living systems much more fundamental than ever expected. Can an organism be simply explained by a mechanistic view of its nature or we need “something else”? Probably, we can earn sound foundations about life by simply changing our prejudicial view about living systems simply as complex, highly ordered machines. In this manuscript we would like to reappraise many fundamental aspects of molecular and chemical biology and reading them through a new paradigm, which includes Prigogine’s dissipative structures and informational dissipation (Shannon dissipation). This would provide readers with insightful clues about how biology and chemistry may be thoroughly revised, referring to new models, such as informational dissipation. We trust they are enabled to address a straightforward contribution in elucidating what life is for science. This overview is not simply a philosophical speculation, but it would like to affect deeply our way to conceive and describe the foundations of organisms’ life, providing intriguing suggestions for readers in the field. The origin of life is a fundamental conundrum for science. The main texture of any theoretical tenet about life encompasses only molecules and energy, as enabled agents to start life on earth somehow, although the way by which this occurred is still under debate. How molecules and energy interacted to originate life? And moreover, did chaos, i.e., our common idea of “disorder” and complexity, i.e., our usual idea of “organized order”, the only forces building up the living world? ,4,5,6,7.However, as life has the puzzling ability to self-replicating and self-organizing without an apparent ordered plan, a reappraisal on the role attributed to molecules and energy to highlight how life emerged should encompass a more dynamical, than mechanistic perspective, for example considering ordering, self-replicating mechanisms, such as dissipation, spontaneously emerging from the chaotic sink formed by the primordial soup. Actually, a major outstanding question we should address is “what is life” just in its core meaning. Life contains a huge component of chaos, therefore the idea of life as a mechanism might fail in its theoretical concept. Yet, a thorough definition is still far to be elucidated, if a mechanistic view holds the main tenet about its origin . In the A clear, sound definition of what fuels, supports and generates this self-assembling and self-organizing property, is yet far to be fully elucidated. Some researchers addressed this puzzling issue, without a true, encouraging success, yet. Maturana’s pioneering work on the concept of “autopoiesis” ,22,23, wWe do not know. Most probably, biology has to restart from a new standing point, a novel epistemology, re-shaping our way to describe the innermost texture of what “is able” to generate something that can evolve as a “life”, i.e., a living system. We have to thoroughly revise our way of modeling the chemical and physical interpretation of natural phenomena, so to introduce new intriguing concepts able to shed light on a more appropriate concept of life. Which are the intellectual tools we can adopt to define life in its deepest meaning?Actually, the simplest and commonest way to describe life, is a mechanistic perspective, borne from statistical chemistry, which funded many models able to elucidate the evolution of complex systems ,29. Whenex nihilo [x-space), i.e., nothing may be either a place completely empty or completely full and yet useless. This conceptual framework is fundamental to enable us, as biologists, in addressing new important speculations about life (see below).Chance and necessity are still considered fundamental engines of the autopoietic life, despite some controversial opinion about their antinomy in science . The Monx nihilo . The conOur introduction of concepts such as nothing, D-space and E-space, serves to weave a logical tale of how life most probably arose. x-space) [Nothing is an empty space (N0-space). From a philosophical point of view, a N0-space cannot be the theoretical place from which life commenced. Therefore, when is claiming that life started from “nothing” , this nox-space) . The concept of “nonsense” is usually misinterpreted in a teleonomical point of view, contrasting with an ordered idea of information . Since tx-space, as it has “no sense”, as it is meaningless either if the painting is within a correct orientation placement or alternatively is upside down. This circumstance can be also obtained if the painting is made by perfectly equal forms equally spaced each others . These examples are representations of three different start-points in the conceptual way to define how life started and what life is in its depth: 1) an event space without particles; b) a D-space; c) an E-space. The “nothing” on the canvas can be indifferently represented by a blank canvas or a completely uniform black canvas. On the contrary, if we spot ether the blank or the black canvas with a red stain, somewhere on the canvas, then the painting “earns” a movement feature, the painting is different depending on its orientation on the wall. Actually, we introduced a sort of “diversity” in the isotropic space, as well in the Nx-space, which we call “anisotropy”and the whole painting gained a “moving” perception. This quite naïve example would like to introduce to the standpoint concept that at the “beginning” of life, anisotropy might have started an evolutive pathway. The explanation how anisotropy probably contributed in bursting life, can be the following. The appearance of a “diversty” in an E-space, should create anisotropic particles with different degrees of freedom respect to any E-particle, so creating a cascade of events with increasing probabilities to form complexes and hence an evolutive pathway. Probably, life started and evolved when a disquisotropic element (a “diversity”) occurred in an E-space. The model works only if “something” disturbs a “Nx-space”, made by an E-space.A painting made by the simple, completely blank canvas can be considered a N0-space, i.e., with “none”, whereas a painting made by a highly crowded and raw jumble of color spots is an NWhat we are trying to develop further with this speculative tale? x-space”, from an evolutive meaning. The introduction of a disquisotropic particle substantially modifies the “Nx-space” to an evolutive dynamics; it introduces “anisotropy”, as the probability to form a pair E-D, is completely different from an E-E pair and can trigger further more complex interactions to be formed and to change dramatically the evolutive pathway of the whole system towards highest organization.An E-space is theoretically made by equal particles, which can undergo interactions leading to bonds and forming initial pairs. Particles with equal hallmarks and features (equisotropic) have the same probability to join as well as to detach, so they could not organize a developing system, as chance provides particles with the same probability to join or to detach each others. In this perspective, this E-space can be considered a “Nx-space), in evolutive terms.Starting from an ideal E-space, without replicating events, the evolutive route will reach inevitably a D-space, at last. The D-space is perfectly characterized by the existence, within the space, of elements completely or even slightly different each others, so to make us able in defining this space as the “space of the uniqueness”. At this point of our overview, no particle, based simply or solely on its disquisotropy is enabled to push ahead the evolutive system, because any particle within the system “might” do it, at least theoretically, and the system is blocked, from an evolutive orientation, it becomes a “nothing” , whereas the informational burden of a D-space has the highest Shannon’s entropy, being comparable to a crowded population of different and unique messages. The evolutive pathway of an E-space is hampered by probability, the one of a D-space by informativity. x-space” formed by a D-space, if funded only on chance and necessity. This can be explained.Yet, during the evolutive course, order can be formed. How does this happen? We will turn back to this concept further on, but order, with complexity, cannot avoid the final achievement of a “Nn = 1000 e k = 2 and results in an approximate value of ≈499,500 combinations, without order and repetitions. The introduction of an order accounts on the following Equation (2):A possible calculation held on theoretical basis, showing that order changes the “chance-associated possibility”, can be attempted.And results to ≈999.000–1,000,000 variations, including if containing repetitions Equation (3): C with k = 1, according to Equation (1) are 21, if k = 2, C = 210, if k = 3, C = 1330. With k = 3 introducing order, variations are 7980. Order increases the number of variability inside the combinatorial process, so increasing, as variability, the Shannon entropy. So, if order is formed by chance and necessity, variability, within a D-space, increases Shannon’s entropy and enhances the possibility to reach an Nx-space, i.e., a non sense space coming from a complete D-space, if a dissipation mechanism does not occur (see below).An amount of 1000 particles is much too high to forecast a correct combinatorial value. If our particles moving and interacting in the Boltzmann space are only 21, then combinations This speculative description of how a dynamical evolution could start only accounting on chance and necessity, gives us the opportunity to assess that even anisotropy, though providing an ignition to the engine of life, cannot sustain an evolutive path without further dynamics such as dissipation.Dissipation is a dynamics that introduces replicative and reiterative mechanisms to build up inner order. Let’s come back, therefore, to the outstanding question: how life arose from the chemical crowded environment called prebiotic soup? Systems working within the thermodynamic balance and endowed of irreversibility can be simply considered as complex fluxes of matter and energy, where matter and energy enter the flux and degraded matter with heat leaves the flux, according to the second principle of thermodynamics. These are open, irreversible systems, working not far from the thermodynamic equilibrium and increasing entropy, whereas life dynamics works far from the thermodynamic equilibrium, though increasing as well total entropy outside the system ,42,43,44S is the Boltzmann’s entropy and ip is the probability of the microstate at the equilibrium, is similar toH is the Shannon’s entropy and ip is the probability of a defined message in the Shannon space [Dissipation is a concept born with the Nobel Prize for Chemistry Ilya Prigogine, which is widely used in many ecodynamic models, including life thermodynamics ,51,52,53on space . Howeveron space ,61. If lon space , the relon space ,63. OrgaIf replication occurs in an anisotropic space, then Boltzmann increases its entropy , whereas Shannon decreases its entropy, as a “single” message is highly reiterated, i.e., amplified. A simple explanation of this phenomenon can be gained by having a look to the Shannon’s entropy equation:H(X) = 4.39). Different symbols may exemplify a D-space. If, in the same space, we introduce a replication of a single, specific symbol, i.e., the letter “a” five times within a total number of 21 symbols (letters), then H(X) is reduced to 3.74. Again, with 10 replicated “a” on a total of 21 letters, H(X) = 2.95, with fifteen replicated “a”s H(X) = 1.60, with 20, H(X) = 0.28. Replication of a part in the Boltzmann space (amplification) reduces Shannon entropy in its space. Taking into account a string of 21 different symbols, such as for example alphabetic letters in a European  speaking language, Shannon’s entropy is particularly high  or disordered (amorphous state). Replications have a defined informational endowment in a dissipative system; they are not simply ordered things coming from thermodynamic (Boltzmann) dissipation but are major hallmarks of the Shannon space. Yet, whereas in the Boltzmann space the outside increase in entropy pushes onward the creation of an inner order, the “hidden” increase in entropy in the Shannon space, we called dissipative disquisotropy, occurs “inside” the system and therefore forces the system to be continuously dissipated from the inside. Briefly speaking, while during the replication of a component in the Boltzmann space, Shannon entropy is decreasing, at the same time an underneath increase in disquisotropic entropy creates a sink of positive Shannon entropy that compels the system to restart in its dissipation dynamics. This kind of dissipation allows the system in “staying alive”, whereas Boltzmann dissipation in “going ahead” towards an evolutive complexity.Let’s try to explain Most probably, we are initially in an anisotropic event space where both Boltzmann and Shannon spaces have high entropy. Replication of a defined particle, cycle or pattern occurs in this circumstance  may be oSo far, we have highlighted the fundamental role exerted by two intertwined dissipative systems the Boltzmann’s and the Shannon’s one, in moving onward, along the end orientation, the dynamics of organisms. Complexity has been defined as such product finally rising up from entropy reduction of increasing order. Fundamentally, in our overview of how life evolved, complexity, likewise order, may not necessarily have an intrinsic teleonomy. It arises from the simple need to dissipate felt by the living system . The mosTaking into account the synopsis held by per se but if “related” to “other”. A glass is used to drink but it can be used to collect sand, to make pleasant sounds, to help drawing a circle on a paper and so on. The information “glass” cannot be merely defined by its chemistry or shape or use: it “depends”, despite we know very well what a glass is. Therefore, if is informative only an event which is “related” to a dynamics, the “memory” is its reiterated form, therefore. Memory is not a collected file or a constant and fixed object but reiterated  information.Turning again to the event space where our fascinating history took place, a first distinction has to be made, i.e., between interactions and relations. Two particles in the Boltzmann space are in relation (related) when their mutual interactions change their respective degrees of freedom. This startpoint is important to introduce a possible explanation of why complexity arose in the evolutive history. Fundamentally, two interacting particles have maximal degrees of freedom, respectively, as freely moving and interacting in the Boltzmann space. When their interactions change the degree of freedom of each participating particle, then we can reach a “relation”. However, no particle is theoretically willing to lose its degree of freedom; therefore a relation can be formed “only” when the degree of freedom of a pair is higher that the single particle alone.This “compulsion” can be triggered by Shannon dissipation, as the “gain” in degree of freedom is quite only of informative nature. We can argue, therefore, that complexity, with an informative teleonomy, arises once Shannon dissipation occurs, never before. As the gain in degree of freedom “inside” the ordered complexity is the engine with which complexity grows up, a continuous informational shaping is held throughout any further Shannon dissipation, so to lead to a “kind” of complexity we categorize as “teleonomical” or “finally end oriented”. The relation emerges with a dissipative dynamics, when replications and Shannon dissipation, put those relations to be joined in a complex structure and/or function  dissipation was set, the chemical dissipative system turned onto a biological evolutive system, so generating order and complexity . This coThis “perspective” article was attempted to provide novel suggestions on a currently debated topic, which is still far to be fully elucidated, anyway. We focused onto fundamental keystones in the discussion about the origin of life, being absolutely aware that much more insights are needed, particularly by modeling sound mathematical approaches and experimental data able to highlight our speculations further. The question of this kind of attempt would remain on that of cause and effect, but seeking for a “cause” and an “effect” might be particularly hard in this context. Unless the precise cause and its effects are unambiguously identified, the topic remains speculative, but probably necessary, at this time, to move an original suggestion: it may burst a fundamental discussion about autopoiesis. The question on the origin of life should be reduced to the question: what exactly is the cause and what are their effects, in other words, the origin of causes and effects. This might appear as a crucial weakness in this paper. However, the causes of Shannon dissipation were somehow indicated but elucidating this mechanism needs much further insights to be earned. Modern physics seems to work deeper and deeper in the quantum mechanical formulation of reality, also the macroscopic reality, where the identification of clear causes and clear effects is ultimately impossible, if not at least fundamentally blurred.What is life? The gigantic question put by Schrödinger several years ago seems to lack a thorough and exhaustive definition, at last. In recent years, many fundamental theories have been reported and probably life emerged not merely by the random ability of chance and the mandatory pulse of necessity but by dissipative mechanisms, where probably information and thermodynamics are closely intertwined in a chaotic dynamic ultimately held by water. In this focused review, we tried to shed light on new incoming theories about the origin of life, hoping they find an attractive interest by readers engaged in this fascinating field.


Canada has been home to a longstanding public health crisis related to opioids, including an extensive mortality and morbidity toll in the face of substantive intervention gaps. Recently (2019), two extensive reports from preeminent federal authorities – the Chief Public Health Officer and the Mental Health Commission of Canada – have been tabled with detailed, core focus on the phenomenon of ‘stigma’ and its impacts on substance/opioid use and harms. The reports present extensive descriptions of the nature and effects, as well as a multitude of prescriptions for remedial measures and actions to “stop the cycle of stigma”. Closer reading of the documents, however, suggests substantial conceptual and empirical limitations in the characterization of the – multi-faceted and challenging – nature and workings of ‘stigma’ as a socio-political, structural or individual process or force, specifically as it applies to and negatively affects substance use and related outcomes, primarily the wellbeing of substance users. Concretely, it is unclear how the remedial actions proposed will materially alleviate stigma process and impacts, especially given apparent gaps in the issues examined, including essential strategies – for example, reform of drug user criminalization as a fundamental element and driver of structural stigma - for action that directly relate to the jurisdictions and privileged mandates of the report sources themselves as health and policy leaders. The commentary provides some concrete while subjective notes and observations on the dynamics of stigma as applies to and framed for substance/opioid use, as well as strategies and measures necessary to both tangibly address the material health and wellbeing of substance users, and related forces of stigma, in the distinct context of the opioid crisis in Canada. Canada has been entrenched in an unprecedented public health crisis related to opioids for far more than a decade . This crIn 2019 – at a recent peak-point of opioid mortality – two prominent, federal-level reports, 1) The Chief Public Health Officer’s (CPHO) Report on the ‘State of Public Health in Canada’ , 2) the Luoma provides some essential conceptual and practical characteristics of stigma. Stigma is produced and reproduced in many ways, including common ‘cultural practices’ of everyday life, and highly resistant to change. It can be helpful to distinguish between ‘organizational’ or structural level, and individual-level processes of stigma, both of which include  ‘prejudice’ and ‘discrimination’ as ways of enactment of stigma. For example, organizational/structural stigma, through related power processes, involves  policies or organizational rules, restrictions or opportunity barriers towards stigmatized group; whereas individual-level stigma can be divided into public  about a stigmatized group  as well as ‘self-stigma’  or negative outcomes experienced by the stigmatized individual themselves. A large variety of different strategies and approaches to reduce stigma have been identified and tried, with however limited demonstrated effects on reducing stigma .‘Stigma’ has been given distinct  attention in the psychoactive substance use realm, in part also related to the conflicting underlying social concepts or explanations  of ‘addiction’, and consequential implications for the social identities, status and interventions geared at the user . Luomo nBoth above-mentioned reports ascribe fundamental and sweeping cause-effect agency, as well as necessary remedial prescriptions to the phenomenon of ‘stigma’ as applied to the current public health crisis of substance/opioid use in Canada. For example, the CPHO’s report lays out in elaborate detail ; pp.23–5Similarly, the MHCC’s report  – includControlled Drugs and Substance Act (CDSA). Arguably, there is no more powerful and impactful social tool to create, and project stigma on a structural level, and its direct and indirect adverse consequences, than through criminalizing a specific behavior and the people such criminalization identifies and targets [An (if not the) essential root driver and determinant of ‘stigmatization’, or the enactment of a fundamentally divisive ‘us versus them’ disposition for psychoactive substance users – for example, opioid users in the specific context of the opioid crisis, but beyond involving other illicit substances in other contexts -- is the fact that such use is categorically defined as a  illegal. This is so the case in Canada specifically per definition of the  targets . The cri targets . The cri targets –17. Yet,Emergencies Act in Canada) in response to the opioid crisis that would have allowed considerably more flexible and substantive measures to address and reduce related health risks and adverse outcomes, including the massive overdose mortality toll [Similarly, there are other concrete, major intervention and policy actions – or gaps, rather – towards opioid-related public health measures along the lines of barriers and obstacles mentioned in theory that, for long, have been resisted by the very anti-stigma campaign protagonists. Tangibly, federal government authorities, for considerable time, have refused to formally call a ‘public health emergency’ . On thiThe respective CPHO and MHCC reports appear to present a questionably one-directional or simplistic perspective on the mechanics and nature of ‘stigma’. While the reports’ analyses suggest multiple ‘pathways’ or ‘layers’ of stigma, they essentially appear to suggest that ‘stigma’ is an exclusively negative force in functioning and outcomes, and brings on extensive harm in whatever it touches or affects; therefore, any available measures ought to be deployed for it to be ‘purged’ for its major, consequential harms to be reduced in desirable ways for general benefit. But the dynamics and workings of ‘stigma’, if considered more fulsomely, are much more complex, or multi-dimensional. For example, while surely there should not be genuine intent to negatively label, or categorically stereotype, drug users as ‘bad persons’, there are many behaviors – in the social realities of daily life, health, or substance use – that are widely recognized and agreed as factually unhealthy and undesirable, and therefore feature legitimate reason  to be negatively labelled. For example, ‘drinking and driving’, smoking in front of children, sharing injection paraphernalia, or stealing are generally agreed-upon risky or harmful behaviors which are – for education or prevention messaging or deterrence purposes – negatively labelled and so conveyed for arguably good reason , 25. It Specifically in the realm of the opioid crisis and its distinct evolution, there have been other, powerful forces of social ‘labelling’ or associations at work that may be (perhaps somewhat clumsily) referred to as ‘false’ or ‘reverse stigma’ ; these can be assumed to have led to at least as much, but likely far more, opioid-harms in the population as the genuine (adverse) ‘stigma’ drivers and effects laid out in the reports. As a key example, an essential causal driver of the opioid crisis, specifically as it unfolded in North America, has included the widespread, excessive medical availability, prescription and usage of potent opioid medications starting in the early 2000s. The vast increases in general population-wide opioid use, initially under the premise of improved population-wide pain care and featuring new - supposedly effective and side effect-free - opioid medications  aggressively promoted by pharmaceutical companies and facilitated by skewed prescription guidelines, insufficient regulation and prescriber practices alike, pushed large sub-populations into hazardous trajectories of opioid use, with many resulting in misuse, dependence or overdose deaths –29. LateThere is a sizeable, recent body of scientific literature – e.g., specifically including systematic reviews from the past decade – devoted to stigma, substance use and related interventions. Surprisingly, little of these evidence-based insights appear to be considered in comprehensive depth in either of the two documents. For example, while respective reviews find ample evidence for a common presence of negative attitudes and beliefs towards substance users among health professionals or policy representatives, and correspondingly ample accounts of such experiences and consequences among substance users themselves, other key elements of empirical knowledge on or understanding of ‘stigma’, and especially effective counter-actions appear to be much more restricted –34. ConcOne could be left with the distinct impressions, based on the above documents and statements, that the opioid crisis and its grave health and social toll in Canada are primarily a product of forces of ‘stigma’, and that implementing the suggested remedies will reliably guide and bring about much awaited, tangible improvement and solutions. While ‘stigma’ is a certainly present phenomenon and social dynamic in the substance use realm, and adversely affects substance users’ lives, behaviors and care in a multitude of ways, the above observations and remedies appear to be problematically narrow if not simplistic at key ends, while selective and featuring essential gaps in key elements and elaborations – especially also when considering their originating sources. These impressions sit uneasily, and warrant some basic while subjective consideration and comments as per the following brief summaries of main illustrative examples:There appears to be good reason for some sensible reflection or restraint to be applied on the above stigma-fighting campaign and action front, specifically as generously projected on the ‘opioid crisis’ in Canada. There is little doubt that ample stigmatizing forces and experiences exist and crucially work against the health and wellbeing of substance users in many ways, and should be tackled and alleviated. To which extent this can be most effectively achieved mostly by ‘language adjustments’, ‘resilience strengthening’ or similar efforts suggested, everyone may consider and guess for themselves – also since current scientific knowledge does not provide much conceptual clarity or substantive evidence what such efforts tangible mean or can accomplish in material reality. The dynamics and effects of stigma for substance use, and both meaningful and realistic ways towards addressing and working to resolve these, however, can be assumed to be much more complex and challenging than what the above-cited two documents and their - rather narrow, if not simplistic - accounts suggest. They may be so described, since they present only limited insights on the  causes or drivers of stigma for substance use, and possible promising and effective remedies for material and sustained change in the lives of those concerned . These factors require, and deserve, deeper and better examination and analysis for realistic contributions and improvements for the important stigma-related causes and issues at hand – especially from the leading and privileged authorities from which have put forward these reports. First and foremost, the quintessential causal role of the criminalization of illicit substance use (and thereby its users) for the pervasive production of structural stigma needs to feature prominent recognition, and related calls for change in such a campaign if sincerely committed to effective and material stigma reduction.en passant’-kind of ‘anti-stigma’ presentation and campaigning that avoids to name core causes and elements. One is that it can be dangerously seductive as a self-righteous, or serving platform on which now ‘stigma’ is staged as a convenient, general or principal ‘scapegoat’ for the opioid crisis, and its ongoing massive and persistent harms. Calling out, rejecting and fighting ‘stigma’ as a socially shared villainous force – akin, for example, to N. Christie’s ‘suitable enemy’ concept for illicit drugs [There appear, however, a couple of other latent risks or adverse effects associated with this kind of ‘it drugs  – is somit drugs . Much ofConcretely, after > 25,000 opioid-related deaths in merely a decade, Canada yet in 2020 lacks essential elements of a comprehensive, consistent and committed ‘public health emergency’ strategy, and essential public health interventions, including reliable, national ‘safer opioid distribution’ provisions, for at-risk opioid users. It is when these urgent, material remedy needs and action gaps are effectively addressed by the health and policy leaders in charge, we should devote resources to an improved, in-depth understanding and effective addressing of what may be the remaining elements of stigma in the real of substance use, and the people who use them.


In many communities around the world, informal caregivers of older adults with dementia represent an essential, yet often underappreciated, source of long-term care. The present study aimed to determine the personal experiences of such caregivers, which could be instrumental for developing means of improving the quality of care for both care receivers and their informal caregivers.Five semi-structured focus-group discussions were held. The participants (n = 31) were all informal caregivers of older adults with dementia. The focus-group discussions were audio-recorded and transcribed verbatim. An inductive approach was used, and thematic data analysis was applied.Four thematic categories were identified: learning caregiving through personal experience; implications of caregiving on social wellbeing; caregivers’ contradictory emotions regarding care delivery; and addressing challenges regarding care provision.This study revealed, among the informal caregivers, a variety of experiences, contradicting feelings, and problem-solving strategies relating to the care of older adults with mental disorders. Becoming an effective caregiver involves professional and psychological development. Developing caregiving skills, supportive environment and positive attitude can help facilitate providing care. Caregiving largely impacts the emotional, physical, and social wellbeing of the person; thus, comprehensive approaches are needed to prevent burnout and associated social disadvantages. In low- and middle-income countries, a large amount of the care provided for individuals with chronic diseases and/or disabilities is administered by informal caregivers . This trA recent study conducted in the Netherlands revealed that informal caregivers of people with dementia experience a higher caregiving burden than do regular-care caregivers . Other sIn Lithuania, as in many Central and Eastern European countries, informal caregiving based on the Semashko model  has traditionally played a significant role in long-term care provision . The SemResearch on health- and social-care environments in Lithuania commenced following the initiation of healthcare reforming the 1990s, after the collapse of the Soviet Union. However, these early studies were mostly confined to assessment of the basic needs of people with disabilities, with the role of informal caregivers being underappreciated or disregarded entirely. The experience of informal caregivers in Lithuania has been academically examined as recently as approximately 2006; however, informal caregivers of patients with dementia have only been considered in a very small number of studies, which were also small in scale , 22. NevInformal caregiving for older adults with dementia can be considered a sensitive and complex phenomenon that requires in-depth, large-scale analysis that encompasses a range of cultures and contexts. Further, development of national policies for long-term care for older adults with dementia requires an assessment of informal caregiving, as this service represents an essential aspect of the care system. The present study aimed to further clarify such caregivers’ experiences caregiving for older adults with dementia, which could be instrumental for identifying means of improving the quality of care provided for such adults and for highlighting the need for protective policies for their informal caregivers.This study forms part of an ongoing large-scale, multi-directional, 3-year (2017–2020) project titled “Integrated Health Care for Senior Mental Health: Developing an Intersectoral Cooperative Care Model, “which is financed by the Lithuanian Research Council (S-MIP-17-121). Our research team aims to comprehensively identify the health-care- and social-care-related needs of Lithuania-based older adults with dementia and their family caregivers. Furthermore, we also seek to identify means of optimizing the use of available health- and social-care resources in a manner that improves such patients’ wellbeing. The underlying aim of the project is to improve health- and social-care provision for older adults with dementia and their informal caregivers by establishing horizontal cooperation links among professionals from different sectors. In particular, by focusing on both care receivers and informal caregivers, the issues identified in this area can be considered to be comprehensively representative.The scope of the present paper concerns comprehensive in-depth research into the personal experiences of informal caregivers for older adults with dementia, as well as the impact their caregiving role has on certain aspects of their own lives. A previous study has analysed informal caregivers’ experiences regarding the Lithuanian system of care for older adults with dementia .Our team of researchers chose a qualitative research approach in which informal caregivers’ experiences were investigated as a phenomenon, and sought to gather data by holding focus-group discussions, which would help us to obtain a more in-depth understanding of the experiences and personal insights of the participants. The study was performed in Kaunas, the second largest city in Lithuania; Kaunas is located in the center of the country and has socioeconomic indicators that are similar to the national averages. The Kaunas Regional Biomedical Research Ethics Committee approved this study on 2018-04-23 (No. BE-2-47).The participants were informal caregivers who were the sole individuals providing special care or nursing to cohabiting relatives with dementia who were aged 65 years or over. Inclusion criteria for the focus group participants were: the care receiving patient was 65 years of age or older; the patient was diagnosed with Alzheimer’s disease or dementia; the patient was nursed at home; caregiver was a family member  or a close friend; care receiver and caregiver were living together. Exclusion criteria for the focus group participants were: the care receiving patient was undergoing an active treatment, such as chemotherapy, surgical interventions or other; the patient was nursed at the institutional caring home; the patient was receiving palliative care.To recruit such individuals, we focused on two large public clinics in Kaunas City , identifying suitable patients who were served by these clinics and, by extension, their informal caregivers.As the first step of our research, we contacted family physicians and psychiatrists affiliated with the two large primary healthcare centers and informed them of our study. We then asked them to identify eligible patients who were nursed by informal caregivers, and to request the caregivers’ consent to be contacted for participation in the study. Consequently, a list of all informal caregivers (n = 98) who agreed to participate in the study was created. Our researchers then contacted the informal caregivers via telephone and invited them to participate in the study. A total of 94 informal caregivers were invited to participate ;of these, 31 agreed. Among the most frequent reasons for refusing to participate were difficulties regarding leaving care receivers alone and an inability to find a replacement carer; other reasons included unwillingness to discuss the care receiver in a group discussion with other participants, and poor health on the part of the caregiver. Participation was on a voluntary basis; no reward for participation was offered or provided.The participants were informed of the objectives and the course of the study, as well as their rights and entitlement to terminate their participation at any time. Participants then signed an informed consent form and completed an anonymous questionnaire that obtained details such as their age, gender, relationship with the care receiver, and the length of time they had been providing care. For confidentiality reasons, participants were asked not to mention any given or family names during the discussions.Five semi-structured focus-group discussions were held in January–April 2018. Each focus group comprised 5–9 participants and two researchers. Five participants took part in the first focus group, six in the second, nine in the third, five in the fourth and five in the fifth. Groups were homogenous whereas all participants provided daily caregiving for a dependent person with dementia and all of them were family members of younger generation . Each discussion was audio-recorded. The structure of the discussion was monitored by the researchers, who asked four pre-prepared open questions, but the participants could also discuss other aspects and were encouraged to share any experiences they thought were relevant. The four prepared questions were: (1) “What type of specialists/individuals do you think are directly involved in the care/supervision or coordination of the person you care for?” (2) “How would you evaluate the present care of the person you nurse—can you name any positive and negative aspects?” (3) “In your opinion, what are the basic needs of your care receiver that, if met, would ensure proper, more effective, and better care, overall?” (4) “What is your personal experience as a caregiver? “At the end of each discussion, we asked an additional question: “Are there any other aspects of your experiences that have not been discussed that you think are important to mention?” The focus-group discussions lasted 45–70 min, depending on the size of the group and the depth of discussion that occurred in response to the additional information provided by participants. Saturation of the theme was reached after the fourth focus-group discussion, as the fifth focus-group discussion provided no new content; consequently, the data collection was stopped after the latter discussion.After the five focus-group discussions had been completed, the audio recordings were transcribed verbatim. Two independent researchers systematically reviewed the entire dataset and coded the data by selecting the closest coding terms for the words used by the participants. Later, each researcher’s coded transcripts were compared with the others, and this showed that the majority of the codes were similar. Any coding differences that were found were resolved through securing common consent among the researchers. Thematic categories were composed by grouping similar codes, and these were then formulated into main themes. The data analysis was based on the inductive approach and the thematic analysis strategy  with theIn the quotations presented in "There were 31 participants in this study  learning caregiving through personal experience; (2) implications of caregiving on social wellbeing; (3) caregivers’ contradictory emotions regarding care delivery; and (4) addressing challenges regarding care provision.The informal caregivers developed a set of specific care competencies over the course of their caring practice, ranging from logic-based organization of care  to nursing-care provision  and dietary supplements . Some focus-group participants indicated their active involvement in the adjustment of treatment (certain self-medication behaviour towards medication administration), which may change the initial treatment prescribed by the physician:She [the care receiver] was prescribed sticking patches [for pain management]. These had some effect, but she developed spasms […], so I decided to discontinue the treatment and removed the patch. Maybe there was an overlap of medicines? […] later, they prescribed morphine. Once her pain had subsided, she no longer needed the morphine, so I stopped giving it to her. […] for Parkinson’s […] she takes two kinds of medicine—two tablets in the morning and two in the evening. On days when I notice that she is not trembling, I reduce her intake by one tablet. Then, I give her pills for dementia, for her confusion, which I cut in half [regulates the dose] (G4).The focus-group participants reported experiencing anxiety, as a result of their relative inexperience, when interacting with existing care resources, which led to inadequate usage of these resources—“one does not know to what one is entitled—what we can get” (G1).We […] learned too late that there are such things as [day] centers. That a bus comes and takes them [the care receivers]. They can draw and write there; they need communication (G2).The caregivers also expressed worries regarding deficiencies in their caregiving skills and felt that there is a need for formalized educational activities to help them address various issues that arise during caregiving.Well, I am doing something here [providing care]. However, you do something and sometimes wonder whether you are doing it well […]. But you cannot know everything. If, somehow, you could be instructed, could get basic training […], have someone explain it plainly to you. Maybe […] there is some kind of methodology [for providing certain types of care] […]. They [formal caregivers] could give demonstrations and say “do this” or “do that” […] (G2).Caregiving competencies were obtained through many means. The focus-group participants indicated that experience, even if fragmented, was the most widespread means of gaining a better understanding of the care process.You do not even know what you need, in the sense that there are many types of tools [for caregiving].I cannot even imagine what else is needed.Unless you have already [cared for] a person, you really do not know [what to do when providing care]. It [the caregiving] seems to be ok as it is (G4).The discussion revealed that the participants attached a high level of significance to medical professionals’ roles in terms of providing information, advice, or tutorials concerning the pathogenetic disease process, care strategies, and the administering of specific procedures: “they showed us exercises and told us what to do” (G4). Social communication with peers also seemed to be an important source of information that increased the participants’ knowledge regarding care resources: “I only learned of it from other people” (G1).Informal caregivers’ educational backgrounds and professional experience in the medical field seemed to have a strong effect on their care approach, which indicated that these factors could represent important considerations in regard to enhancing the organization of informal care and improving the results of nursing care.My mother… she had a stroke three years ago. She is 82 now. So, she could not speak or walk and could not communicate. I am a speech therapist, so I began teaching her [to speak] step-by-step, one syllable after another. And now […] I can at least understand what she wants to say (G3).You know, I am a nurse anaesthetist. So, I can do infusions, if I think one is needed, or give some medication […]; maybe it is easier for me. I consult with the doctor, he gives me prescriptions, and I administer them (G5).Providing care for older adults with dementia is often a permanent, 24-h job that substantially affects the daily life of the caregiver: “I have practically no personal life” (G4). The participants emphasized that caregiving involves being on virtually permanent standby, including during the night.You have to listen all the time. Always be on standby (G4).The nights were probably the hardest (G3).Participation in the job market while performing caregiving is virtually impossible as a result of the absence of a supporting network for caregivers in Lithuania. Exclusion from the labour market has a negative effect on caregivers’ income and also shortens their work record, which will eventually have an impact on their income in the future, as the pension provided by the state depends on the years spent in the labour market.I am delighted that I can be with my mom all the time, but I am also very sad that it is a job. It is my job. And, you know, it is hard work, exhausting. But I do not receive a salary and cannot include it on my work record (G3).Sad, very sad […], because my years of work experience were all for nothing and… What will I get as a pension? It is ok, for now, there is my mother’s pension […] but later? What will I do? (G1).During discussions, the focus-group participants expressed a broad spectrum of emotions, often ambivalent, ranging from indifference—“just living, and that is it” (G5)—to highly positive or negative emotions.I really find it hard. And I love my aunt, she is family. But, sometimes coming home… it seems… you do not want to do it [provide care] anymore. It is like that; that is my experience (G5).The study participants frequently mentioned their love for their parents and grandparents, and that their caregiving gave them a chance to return the care they had received during their lifetimes and to strengthen existing relationships: “[…] we are pushed into some kind of circle. […]…the love for our parents does not end” (G2). Informal caregivers sometimes perceived, based on the changing dynamics of their relationship, caring for their loved ones as evidence of their maturity.When a person you are close to, your mother, who was an example to you during your lifetime—she lived an active life, did such miraculous things … I thought, “God,, I could never do the things she did” … And then she became disabled. Then, I felt pity for myself; that it was over; I was no longer a child. Sometimes I would ask her, “Do you know who I am?” She would say—“Yes, I know … you are my daughter.” Am I your daughter or am I your mommy now? (G2).The study participants had a common perception that they were of absolute importance in the lives of the care receivers—“I am her only contact with the outside world in every regard” (G3). Sometimes, sense of complete competence or even omnipotence in relation to care was expressed: “I cannot trust the care of my mom to anyone, because I know that nobody will look after her better than I do” (G5). On the other hand, the focus-group participants also highlighted negative feelings, such as isolation, loneliness, and anger.My emotions … they change suddenly … I become angry. Sometimes, I feel unwillingness and apathy for no reason at all (G2).The participants often expressed a sense of suffering as a result of being completely restricted, or even trapped, by their situation: “Like a prisoner; actually, my mother’s hostage” (G4). Some focus-group participants reflected on their own lives, which were dominated by, or even neglected to maintain, their caregiving role.For example, I cannot work normally. I cannot go to work, I have lost my income because I cannot leave her. […] it is not normal. From a moral point of view, yes, it [providing care] is a child’s obligation…but she is 65 and I am 42 […]. But that is life; you have to make sacrifices (G5).Such emotional tensions relating to caregiving could also lead to a deterioration of mental and physical health. Holding responsibility for the care often means that caregivers’ individual needs are neglected, and this can also be accompanied by feelings of anxiety and blame that not everything possible regarding caregiving is being done.You become furious for a moment, but then you yell and yell […]. I unload my emotions because they [doctors] told me to. You should not keep them inside, because your blood pressure will go up to 200. My cardiologist said so—“you can yell.” (G2).When she had to go to a nursing hospital, she [the care receiver] said that we [the caregivers] wanted to get rid of her (G2).Caregiving is highly demanding and causes one to reallocate priorities relating to personal and family life, which can lead to conflicts and a deterioration of family relationships.My husband feels very angry and annoyed about the situation, but […], who else should provide care, if not the relatives […] (G5).The focus-group participants shared their experiences regarding coping with the challenges of caregiving. Adopting a positive attitude towards the situation, securing temporary respite, finding time for communication with other people, and ensuring one’s privacy were reported to be essential measures for the prevention of burnout.It is a must, a must, that someone substitutes for you for some time on at least one day a week, Saturday or Sunday, or else you will become sick (G5).On the other hand, study participants also emphasized the importance of support from family members, and from health- and social-care professionals.My husband and I provide care together, so it does not become too difficult. We let each other take time off when needed. But, if you are alone, then it is very hard (G5).The nurse really helped by giving advice […]. When you get such support, how can I put it? You feel better (G2).When discussing means of enduring the complex situations associated with caregiving, the participants emphasized the need for professional help from psychologists. Furthermore, it also seemed that support groups could exert a positive influence.My opinion now is that if you see a person who is providing care for a person with disabilities […] who needs special needs or nursing, you must also ask about the condition of the relatives. The people who are living in the same home, and who are also caregivers. “How are you?” […] “Do you need any help?” […] yes, we do find other caregivers [to substitute for a time], we struggle through […]. But our psychological life […]; we should visit a psychologist or somebody (G2).I think everyone needs a psychologist. And I probably do, too (G5).After sitting here [in the focus-group discussion] and listening… Jesus, thank God that I am not the only one living like this (G1).We talked, we complained [during the focus-group discussion]. No one else would have understood (G5).Caregivers emphasized the difficulties they experienced when communicating with professionals from the health-care system. Informal caregiving has not been integrated into the Lithuanian healthcare system and is somewhat disregarded—the focus-group participants did not feel like members of the health- and social-care network, but rather as isolated individuals fighting against the network. They mentioned several hurtful interactions with the health-care system.If such a situation occurs [the need for hospital treatment], we go to the emergency department. And there … it is scary. You are left alone; you are completely alone and the situation there is terrible for you […] because the attitude is outrageous. […] And if you show a little bit of knowledge and stand up for the person [the care receiver], you immediately receive negative comments and questions: “maybe you are a doctor, since you are asking all these questions?” Specifically, in my case… I usually say, “I am not a medic; however, I nurse my two parents, so I need to be somewhat interested in medicine.” […] If you find a humane doctor, only then will you find some compromise (G2).I am feeling tired because I have not had a vacation […] for nine years; not a single day off. Really. … She [the care receiver] was admitted to the hospital and the doctor [said]: “you just want to have a vacation.” No support, just negative comments… (G5).The present study, examining informal caregivers of older adults with dementia, revealed a variety of experiences, contradicting emotions, and problem-solving strategies relating to caring for such individuals. Four main themes of informal caregivers’ experiences were identified: (1) learning caregiving through personal experience; (2) implications of caregiving on social wellbeing; (3) caregivers’ contradictory emotions regarding care delivery; and (4) addressing challenges regarding care provision.Our findings show that informal caregivers obtain their caregiving knowledge through personal experience and social networks. They seldom receive instruction from health-care providers, and are highly involved in care management, including the correction of medication regimes. However, cases when they must exceed the limits of their competence may result in negative implications regarding the quality and outcomes of care. Moreover, fear of incompetence and ignorance regarding care resources can also evoke psychological distress among caregivers. The focus-group participants expressed a need for formalized training relating to caregiving; several previous studies have reported similar findings: a study performed in the United States revealed that a caregiver-support program provided caregivers with valuable clinical knowledge and essential skills ; while oOur results showed that the caregivers’ social wellbeing was negatively impacted by their difficult work situations. The development of caregiver-training programs should also facilitate caregivers’ inclusion as members of the health- and social-care team, as their input in such care is essential. Further, specific policies that acknowledge caregivers’ work, facilitate their work-life balance, and prevent further social inequality are needed , 27. OurThe present results suggest that becoming a caregiver can cause a significant transformation in one’s personal life, including a change in work-life balance and family relationships and a deterioration of emotional and physical health. These findings are consistent with the results of previous studies . AlthougThe growing concern regarding the informal approach towards delivering long-term care means that a reshaping of existing care systems is necessary. First, the need for formalization of informal caregivers’ status has become evident . SeveralThe present research revealed personal and sensitive details regarding the experiences of informal caregivers of older adults with dementia. A more in-depth analysis of this area would be useful for fostering the improvement, development, and organization of care for older adults, which should accommodate the needs of both the care receivers and the informal caregivers.Research on long term care for older patients with dementia is still missing not only in Lithuania but in other Eastern European countries as well . ReflectThis study has several limitations. Our participants were approached through family physicians and psychiatrists; therefore, it is possible that informal caregivers of patients who are on the records of the social welfare sector would have reported different experiences.Data suggests, that typical care providers for patients with dementia are their spouses or children . HoweverFurther, we may also have missed some of the more negative experiences of target informal caregivers, as some of the caregivers we approached were unable to participate in the study as a result of an inability to find a replacement caregiver for their care receiver.Becoming a caregiver involves professional and psychological development, but also requires a relevant educational background, a positive attitude, and a supportive environment. Furthermore, this role can foster contradictory feelings and differing problem-solving strategies regarding the care of older adults with dementia. Informal caregiving largely impacts caregivers’ emotional, physical, and social wellbeing. Therefore, in order to ease the burden of caregiving and prevent burnout and social disadvantages, a comprehensive approach to supporting such individuals is needed.


This paper examines an intersection between ecological psychology and the enactive approach brought about by studying sense-making in relation to a behavior setting in Hong Kong and adopting a focus on embodied action and gesture. A cosmetics pop-up store embedded in a downtown shopping mall provides the basis for a case study involving a two-pronged analysis. I first use Barker’s behavior setting theory to describe the publicly accessible structure and dynamics of the store, which reveals a bounded spatiotemporal entity with several interdependent behavior–milieu parts. I then analyze video recordings of my research participant encountering, entering, and exploring this environment. Following an enactive-informed micro-ethnographic approach to embodied communication, I examine her movements, postures, gestures, and language use as she joins the behavior setting. These fine-grained descriptions of her embodied actions provide an empirical basis to analyze enactive sense-making. On the one hand, they disclose the affective and emotional experience of perceiving relevant affordances in the environment, and on the other hand, they show the specificity of sensorimotor abilities required to join the setting’s standing pattern of behavior. Jubilee Plaza now? Hint: !Guess what’s happening in Jubilee Plaza AB2! Don’t forget to bring along your BFF to our pop-up store to try on our newest collection and enjoy the sweetness overload selfie moment!Let’s fall in love with everything cherry blossom! Enter the first stop of a romantic cherry blossom world with us by passing through the magical pink walkway at Jubilee Plaza AB2First Stop: March 12–18 at Fragrant Mall 4/F AtriumSecond Stop: March 25–31 at Jubilee Plaza mall.1 This giant of the cosmetics industry  was inviting Hong Kong customers to join “a romantic cherry blossom world… by passing through the magical pink walkway.” The post encouraged people to come with their friends, enticing them with the opportunity to try on the brand’s latest makeup and take selfies with the “sweetness overload”  to investigate questions that he believed had been wrongly “excised” from psychology: “How do environments select and shape the people who inhabit them? What are the structural and dynamic properties of the environments to which people must adapt?” , p. 4.behavior settings, defined as “highly structured, improbable arrangements of objects and events which coerce behavior in accordance with their own dynamic patterning”  at some locale”  has been recognized for its potential to complement the enactive approach  character of the built up environment “out there” on the one hand, and the claim that individuals enact the significance of the world through sense-making behaviors rooted in the organism’s individuation on the other hand . McGann 3 And yet, the case can be made that strands of embodied communication research are fruitfully bridging the ecological/enactive divide. Micro-ethnographic research into human communication in particular is characterized by rich descriptions of sense-making behaviors analyzed in relation to specific ecological environments and niches  What are the structural and dynamic properties of the behavior setting? And (b) What sense-making behaviors are revealed through the actions of individuals as they join and explore this setting? The next section introduces the data and clarifies the case study methodology.Building on enactive-informed micro-ethnographic studies of human communication in specific ecological environments, this paper takes the research participant’s encounter with the Pink Cosmetics pop-up store at the My recordings and images of interactive episodes in the Pink Cosmetics pop-up store are taken from a video-recorded corpus of everyday life in Chinese settings. Central to this corpus is a Chinese woman who gave informed consent to become a key participant in the research and allowed me to record her in a range of social and professional interactions. In filming, I have aimed to follow a micro-ethnographic approach to human action and interaction, recording with a single hand-held digital camera, guided by conventions in multimodal interaction research , notes taken from many conversations that I have had about this store with the research participant following the data collection, the website of the Jubilee Plaza mall, and finally, my experience of passing through this atrium and shopping in the mall over a 12-month period.This case study could be considered as “extreme” , meaningTo answer the research questions, I adopted a two-pronged analysis. I first applied Barker’s criteria to describe salient aspects of the structure and dynamics of the settings, then examined the video recordings of my key participant exploring this setting to analyze her visible bodily actions as evidence for enactive sense-making.zooming in zooming out , (b) anchored to a particular milieu complex; (c) at particular time–space loci; (d) with behavior and milieu synomorphic; (e) and with milieu circumjacent to behavior ((a) a standing pattern of behavior  over 220,000 square feet of office space.” Like “the churches, the schools, and the courthouse” observed in Midwest by The c). They each involve a “standing pattern” of behavior, meaning the activities among people in that spatiotemporal locale are to some extent interdependent (attribute a). In each case, we can identify a unique milieu (attribute b). As per d and e). Meaning, not only does the spatiotemporal boundary of the individual store provide a boundary for or “enclose/environ” the pattern of behavior observed therein (attribute e), but also, following d). If any one of these attributes was lacking for the individual stores, they would likely cease to operate. Meanwhile, the mall would continue to function (hence being classed as a “multiple-setting synomorph”).Each of the outlets in the mall is anchored to a particular location that opens and closes according to operating hours (attribute c) and other attributes of behavior settings merit further discussion.Before examining the dynamics of the Pink Cosmetics pop-up store (Barker’s other tests for determining a behavior setting), the store’s structural peculiarities in terms of its time–space locale .The location of the pop-up store in the atrium in them” , p. 27. Built into the design of the Pink Cosmetics pop-up store, furthermore, were outward-facing video screens relaying the company’s advertisements, which predictably screened images of female models with seemingly immaculate complexions, alternating with images of the company’s product .en passant the way that such environments take part in “largely unobtrusive and unnoticed disciplining of the body” : namely, a soda fountain, the pharmacy, and the variety department. The question was whether these behavior–milieu parts were separate behavior settings or parts of the drugstore setting. As Barker noted: “Structurally, they are discrete, but dynamically they are so interdependent in their functioning” , p. 22, To establish the interdependence between the behavior–milieu parts of a setting, Nine behavior–milieu parts can be clearly identified and labeled inside the pop-up store. While The interdependence measures to be evoked here mainly concern behavioral objects and mechanisms, that is, “the degree to which… the synomorphs use the same or similar behavior objects” and “the same kinds of behavior mechanisms occur in the synomorphs” , p. 40. To start, one set of parts with interdependent behavior objects and mechanisms and where similar action patterns can be observed are the animated video kiosk , the priFor example, the animated video kiosk  was a liA similar behavioral object, mechanism, and action pattern were in place at the printed animated photo station . InhabitIn these two parts of the setting, the function of ecological objects was to capture and augment the inhabitant’s self-image to furnish those inhabitants with that image of themselves, who could then evaluate their personal appearance before either redoing the image or sharing it online. In terms of their framing and filtering, as well as the poses they captured, these images were similar to those being relayed in the advertising displayed around the setting recall , creatinThe third part of the setting which showed clear interdependence with the video kiosk and the animated photo booth was the photography stage . This waJoining the Setting”).via clothing, grooming, adornment” . After nodding her head (^^^^), she replies “yeh ” . I check her familiarity with the brand (lines 3–4), then ask about its reputability (line 5). She replies with details about the brand’s offerings and its standing in relation to designer labels (line 6). As she mentions the product “” (cosmetics), she makes a gesture across her forehead. The timing of the gesture in relation to speech is indicated with underlining in the verbal transcript, while the gesture is visualized in the accompanying frame grab . I ask her “ame grab .” (cosmetics), I interpret this gesture as an enactment of applying makeup. The suggestion is that integral to her initial experience of the store is the relevance of certain embodied actions. Note that while she addresses gaze, speech, and gesture to her addressee, her torso remains oriented or “torqued” toward the setting , her gaze is directed to the camera, she is smiling, but her hands gesture toward the entrance and trace the outline of an arc . This is expressed with a slight lean backward, frown, and repeated pointing gestures to the arch . Using a think-aloud protocol, I remind her that if she wants to say anything she should feel free to do so (line 1). After about 2 s (line 2), she evokes a previous trip to a mall in a different part of the city (line 3). Her recollection is initially vague with hesitations and restarts, as she alternates gaze between the cherry blossom archway and the camera (shifts in her gaze direction are indicated in the transcript between double parentheses). When she eventually recalls having seen “f an arc . She thethe arch .Next Stop Hong Kong, this display came replete with a “Japanese train station, traditional Tori, and beautiful cherry blossom to welcome in the New Year” , however, X’s second utterance involves sense-making behaviors that appear to disalign with the setting. Recall that after evoking its similarity, she says “but maybe Hong Kong people really like this kind of flower.” Bearing in mind that pointing gestures can single out referents and transform them into objects of care , her co-The couple in the archway finishes taking photos and proceeds into the store. The archway is empty and becomes available for or “affords” entering by our participant. The next section analyzes her passage through this archway and subsequent exploration of the setting.An overview of our participant’s exploration of the setting is offered in In addition to showing the research participant’s trajectory around the store, this simple reconstruction of X’s path illustrates the population interdependency that was discussed earlier, offering an example of the high degree to which this inhabitant entered different parts of the setting.The archway is decked out with pink cherry blossom and lit up by several powerful floor lights. As shown in X’s embodied action as she enters the cherry blossom archway is remarkable and strikingly different to both the assured pace with which she first approached the setting cf.  and her ” (oh here we can take a picture). I ask her if she would like to take a picture (line 2). After a pause (2 s), she says: “” , then turning and walking away from the stage (and visibly no longer smiling), she says “”  (line 3).X emerges from the archway into a congested space where a group of three women are queuing in front of the photography stage. She compensates, doubles back, and finds an alternative route, navigating the store’s infrastructure to a place where she can view the stage. Having established a clear view on this stage, she momentarily stands still and watches a woman posing for photographs. She then turns to the camera and initiates a dialogue (Transcript 3). Smiling, she points at the stage where the woman is posing for pictures  and says7This short interchange sheds light on further sense-making behaviors. For instance, conversation analytical work has shown that the linguistic marker “oh” can indicate “that its producer has undergone some kind of change in his or her locally current state of knowledge, information, orientation, or awareness” , p. 299.After a quick look into the animated video kiosk (where we will return later), X arrives at one of the stalls displaying the store’s product range of cosmetics. Recall that these stalls are equipped with brightly lit mirrors and manned by beauty consultants. In the video, we see several people around the stall using the mirrors to apply lipstick, which they have selected from a range of testers. When a space frees up, our participant approaches the stall, scans the product display, then looks into one of these mirrors for a duration of 4 s. Slowing the video of this mirror-looking episode down, a smooth sequence of actions can be identified. 8. While the hands in double touch are often “accounted for in terms of intentionality of conscious acts” and “operative intentionality (the ‘I can’),” pop!) seems functionally unnecessary. Unless it is a biomechanical consequence of moving the lips in that way, the lip-smacking might index the relations of enjoyment and affective perception mentioned by Lehtinen. It could also simply mark the ending of the episode. After this pop, X seems satisfied with the appearance of her lips and returns to browsing the products on display.9The participant’s evaluation of lipstick application at the display stall invites a discussion of the interplay between functional and affective aspects of sense-making behaviors. Recalling the oft-quoted passage on “double sensations” from After spending a few minutes at the cosmetics display stall, X continues to explore the store and eventually arrives back in front of the cherry blossom archway, which is somewhat congested . Rather Our participant’s return to the cherry blossom archway is revealing. When seen for the second time, the cherry blossom archway presumably still affords the action of entering, but X does not engage with that affordance on this revisit. Instead, she first adopts another posture that projects an observer stance . Althoug10As for the posing action itself, X’s full-bodied, leaning-sideways-with-pout gesture is very common among the poses for photos in China, belonging to a number of stock gestures that get reproduced on such occasions. According to the research participant X, her leaning-sideways pose imitates the posture of a waddling duck and is supposed to be “cute.” Puckering the lips with this gesture is also according to her “just being cute,” but could be recognized as a manifestation of the more conventionalized “duck-face” gesture or meme.” , and smiling, dips to put herself in the frame  is further evidence that she has been invited to assess her appearance, with which she seems astonished. Her dip is an immediate solution: “expert craftsmen will normally immediately distinguish the relevant possibilities for action in situation within their familiar practices” ( (Chinese TikTok). X’s performance is automatically replayed on the screen. As she watches herself, she starts to smile and tilts her head  and its associated action patterns (gesturing the application of makeup), (b) judged the store’s brand (“not one of those very good ones”), (c) experienced feelings of familiarity from the settings in a different time–space locale , and (d) evoked cultural explanations for the appearance of the setting , while her facial expression and gestures marked distinctions from her own preferences. As she then entered and toured the store, her visible bodily action (including language) manifested a roller-coaster ride of dispositions and emotions, ranging from disapproval and aversion to amusement, surprise, delight, then dismay and astonishment. Analysis of this participant’s embodied activity revealed the range of thoughts, feelings, memories, and attitudes that she experienced upon encountering the setting. These included a series of multimodal utterances with which she (a) identified the product on sale  and moving beyond the analysis of the participant’s multimodal utterances, several patterns of behavior in the data could be identified that involved more kinesically complex sequences of embodied actions patterned in relation to structures in the environment. These occurred more specifically in response to the activities invited by different behavior–milieu parts of the store , and gesturing/dancing for the different cameras . Perceiving such behaviors as sensorimotor schemes . While some sensorimotor schemes in the current data “are rather widespread across the species” and across different environments, such as our participant’s standing in line, back-tracking, etc., “others are acquired as part of our sociocultural milieu,” which would be the case for the archway-twirling, posing, and evaluating/improving of one’s appearance invited by this setting . potentiating” and “affective allure” of the setting’s structure and dynamics (p. 977). The behavioral objects, mechanisms, and action patterns in this particular setting  exaggerate both the normative dimension of sense-making actions within a behavior setting and the embodied know-how required of inhabitants to fully join or “penetrate” a setting’s standing pattern of behavior.The sensorimotor schemes which are most closely related to the sociocultural milieu seem crucial to understanding the sense-making/behavior setting relation. They highlight what Jubilee Plaza must already know: “Retail is no longer about buying products but rather it’s about providing an experience that consumers delight in”12. Notwithstanding the limitations of my case study, I offer the Pink Cosmetics pop-up store as an example of the cognitive and technological environments being shaped by novel forms of consumerism and screen culture and the sociocultural specificity of the sense-making behaviors that such environments invite. If Roger Barker and the inhabitants of 1950s Midwest were suddenly introduced to the behavior setting studied here, we might wonder how their sense-making behaviors would differ.Finally, this case study shows what specialists in the design and implementation of pop-up stores like those in The datasets generated for this study will not be made publicly available. The video recordings on which the analysis is based contain material that would be inappropriate to make open access.The study of video recorded interaction sampled here was reviewed and approved by the University of Nottingham Ningbo China. The research participant gave informed consent.The author confirms being the sole contributor of this work and has 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.


It is often observed that married women have a later age of natural menopause (ANM) than unmarried women; however, the reason for this association is unknown. We test an original hypothesis that sexual frequency acts as a bio-behavioural mediator between marital status and ANM. We hypothesize that there is a trade-off between continued ovulation and menopause based on the woman's chances of becoming pregnant. If a woman is sexually inactive, then pregnancy is impossible, and continued investment in ovulation would not be adaptive. In addition, we test an existing hypothesis that the observed relationship is because of the exposure to male pheromones. Data from 2936 women were drawn from 11 waves of the Study of Women's Health Across the Nation, which is a longitudinal study conducted in the United States. Using time-varying Cox regression, we found no evidence for the pheromone hypothesis. However, we did observe that women who reported to have sex weekly during the study period were 28% less likely to experience menopause than women who had sex less than monthly. This is an indication that ANM may be somewhat facultative in response to the likelihood of pregnancy. By the  million , with me million . While i million –20 and e million –11.One puzzling association reported in epidemiological literature is the relationship between marital status and menopause timing, in which married women attain menopause later than never married or divorced women ,14,21–231.1.(i) H1: increased sexual frequency lowers the risk of entering menopause; and(ii) H2: exposure to male pheromones delays menopause.We acknowledge that this study is largely correlative, but nonetheless, if positive results are found in favour of H1, then we would suggest that menopause timing could be facultative and that the within- and between-population differences in ANM are somewhat adaptive.Currently, there is no clear reason why married women experience a later menopause, and we propose a functional reason for this relationship. Here, we test the two following hypotheses:2.2.1.Data from 2936 women were drawn from the Study of Women's Health Across the Nation (SWAN), which is an on-going community-based, multi-site, longitudinal cohort study currently being carried out in the United States of America, specifically designed to collect data on the biological and psychosocial changes that occur alongside the menopause. Despite being a community-based sample, SWAN is thought to be the largest, most diverse and most representative study currently available to research aspects of the menopausal transition . Criteri2.2.2.2.1.Menopause timing was the primary variable of interest within the study. Biomedically, a woman is defined as having experienced menopause once she has experienced 12 months of amenorrhoea in the absence of external influence over menstruation  . SWAN pr2.2.2.(i)‘during the past 6 months, have you engaged in sexual activities with a partner?’ ;(ii)‘during the past 6 months, how often, on average, have you engaged in each of the following activities: sexual touching or caressing; oral sex; sexual intercourse?’ ; and(iii)‘on average, in the last 6 months, how often have you engaged in masturbation (self-stimulation)?’ .For each woman, the maximum amount of sexual activity from any of the aforementioned questions was taken as being her sexual frequency. For example, if a woman reported having intercourse ‘once or twice a month’, but oral sex ‘daily’, ‘daily’ was recorded as her sex index. Sexual activity other than intercourse was used to create the sex index as the hypothesis is predicting that cues from sex will result in a trade-off, and the underlying mechanism of sexual touching, oral sex and masturbation could all signal possible pregnancy to the body. Owing to the small amount of responses in some of the categories they were aggregated into three new categories, with ‘less than monthly’ comprising of women who reported to not have had any sex in the past six months, as well as those who responded ‘not at all’ or ‘less than once a month’ within the sexual activities questions. ‘Monthly’ sex was used to code women who have engaged in any form of sexual activity ‘once or twice a month’; and ‘weekly’ if a women reports engaging in any form of sexual activity ‘about once a week’, ‘more than once a week’ or ‘daily’.To test the first hypothesis, we looked at ANM in relation to sexual frequency. A time-varying ‘sex index’ was derived from the woman's responses to questions about her sex habits, which included:2.2.3.As there is no direct measure of male pheromone exposure, we use male household presence as a proxy of male pheromones. Three variables were derived from SWANs questions regarding household composition. Firstly, a binary variable was created based on whether the respondent reported living with a romantic male partner, such as a husband, boyfriend, fiancé or similar. A second binary variable was made which then coded whether the woman lived with any male , and this was also included as a continuous variable that counted the number of males living in the house.2.2.4.Marital status was included as a covariate when looking at the relationship between sexual frequency and ANM, based on previous literature isolating it as being associated with menopause timing. It was not included when testing the pheromone hypothesis owing to the high degree of collinearity with male household presence. To create this variable, women's responses to questions regarding their relationship status and living arrangements were used, with women subsequently being coded as ‘divorced, separated or single’, ‘married or in a relationship’, or ‘widowed’.Additional variables were selected based on existing research looking at what influences ANM. Time-varying covariates included the woman's smoking habits  –20 and b2.3.survival [survminer [Time-varying Cox proportional hazards modelling was used to conduct an event history analysis, which is a powerful method of regression modelling that allows the isolation of precise effects over the risk of an event (i.e. the menopause) happening . Unlike survival , and sururvminer .2.4.b–g). We use the Akaike information criterion (AIC) to compare model fit, in which the model with the lowest AIC value best fits the data. The models were then weighted based on how much their AIC value increased compared to the best fitting model, with a decrease in AIC value of two or greater implying a better model fit [a, base;b, base + marital status;c, base + sexual frequency;d, base + sexual frequency + marital status;and the models listed below compared to test H2:a, base;e, base + whether the woman lives with a male partner;f, base + whether the woman lives with a male;g, base + total number of males living in household.A base candidate model was created which included all the aforementioned covariates , with the variables of interest being subsequently added to the models : 2.70). Owing to the requirements to be part of SWAN, no one had yet entered the menopause, but 46% were in early peri-menopause, and 54% were pre-menopausal. Across the 10 years of follow-up interviews used within this study, 1324 (45%) of the 2936 women experienced a natural menopause at an average age of 52 (s.d.: 2.59).At the entry to the study, most women were either married or in a relationship (78%), and 68% of women lived with their partner. The most frequent pattern of sexual activity was weekly (64%), and there was a wide range of oestradiol readings, with an average level of 55.05 pg/ml (interquartile range (IQR): 33–89). Non-Hispanic Caucasian women were most represented within the sample as 48% of women identified as being such, in addition to the majority of women being educated to above a high school level . The median BMI was 27 (IQR: 23–32), with 59% being overweight or obese, and most women reported to having never smoked regularly (57%). Women on average had two children (s.d.: 1.42) and experienced menarche at the age of 13 (s.d.: 1.67). We present full descriptive statistics of the baseline cohort in the electronic supplementary material, table S1.3.2.d the relationship between sexual frequency and ANM was maintained ; however, there is now a suggestion that married women have an increased risk of entering menopause  .Unadjusted Cox models testing the relationship between ANM and sexual frequency suggest that women who have more frequent sex during the pre- and peri-menopause have a lower risk of entering menopause, with women engaging in sexual activity weekly being at the lowest risk : 0.65–0.84) . Furthermore, simply having a male in the household also appears to have no relationship with ANM, regardless of whether this was modelled as looking at whether a male was present in the household or not , or if it looked at the number of males in the household  .To test whether exposure to male pheromones delay ANM, we looked at male–female cohabitation as a proxy. In line with the previous relationship found between marital status and ANM, prior to adjustment, living with a male partner was not associated with ANM , with similar results being found following adjustment in model 3.4.a, e, f and g, the base model a which included none of the household composition variables was found to best fit the data.We present model selection results in a–g and just the models testing the sexual frequency hypothesis a–d, models c and d were found to best fit the data, both of which include sexual frequency, adding further support to the notion that ANM is associated with sexual frequency. Results from the best model d, are presented in When comparing all models 4.While women often stop reproducing many years prior to the menopause , the perThis study did not replicate findings from previous research that married women enter menopause later. In fact, following complete adjustment, the converse was found, with women who were married or in a relationship having an increased risk of entering menopause compared to divorced, separated and single women. Conflicting results regarding marital status' effect on ANM have been found elsewhere (e.g. ), and onAnother reason for this difference may be the cultural setting of previous studies. For example, research originating from Iran found that ever married women experience a later menopause than those who never married . HoweverEvidence supporting the notion that ANM associated with sexual frequency during the pre- and peri-menopause was found. Even following complete adjustment, results still indicated that women who engage in sexual activity weekly or monthly have a lower risk of entering menopause relative to those who report having some form of sex less than monthly. If we interpret these results from a fitness-maximizing framework, it may be the physical cues of sex signal to the body that there is a possibility of becoming pregnant, and therefore an adaptive trade-off may occur between continued energetic investment in ovulation and reproductive cessation. During ovulation, the woman's immune function is impaired making the body more susceptible to disease ,29. HencIt should be noted that there may be a bidirectional relationship between the physical condition of the woman when approaching the menopause and sexual engagement. As oestrogen levels decline, women are more likely to experience vaginal dryness and discomfort, making them less inclined to engage in sex . This st5.This paper demonstrates that sexual frequency is associated with ANM and is also, to our knowledge, the first formal test of the hypothesis that male pheromones have an influence over ANM. While only a proxy of male pheromones was used, no association between male cohabitation and menopause timing was found, indicating that male–female cohabitation is not the driving force behind the relationship between marital status and menopause timing and that pheromones probably do not influence ANM. We did not replicate the findings from previous research showing that simply being married is associated with a later ANM, most likely owing to the variable cultural and temporal settings of previous studies. However, we did demonstrate that increased sexual frequency during the pre- and peri-menopause decreased the risk of experiencing menopause. While causation cannot be conclusively inferred, we hypothesize that this relationship is the result of an adaptive trade-off relative to the likelihood of pregnancy when approaching the menopause. Of course, the menopause is an inevitability for women, and there is no behavioural intervention that will prevent reproductive cessation; nonetheless, these results are an initial indication that menopause timing may be adaptive in response to sexual behaviour.