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Recent advances in the treatment of cancer have led to greater longevity among men in reproductive ages with a 75% five-year cancer survival rate in boys aged 15 years or younger  and 66% among men aged 15–44 . There is increased recognition that quality of life including paternity is significant issues for cancer survivors. We will focus primarily on patients with testicular cancer and lymphoma that generally affects younger patients in the reproductive window with an excellent overall survival. However, one must realize in our modern society the age of desiring paternity has increased due to postponement of marriage as well as for other social reasons. Therefore, this chapter will focus not only on those who completed chemotherapy as children but adult cancer patients as well.
There has been a long history of conflicts, studies, and debate over how to both protect rivers and develop them sustainably. With a pause in new developments caused by the global pandemic, anticipated further implementation of the Paris Agreement and high-level global climate and biodiversity meetings in 2021, now is an opportune moment to consider the current trajectory of development and policy options for reconciling dams with freshwater system health.
We calculate potential loss of free-flowing rivers (FFRs) if proposed hydropower projects are built globally. Over 260,000 km of rivers, including Amazon, Congo, Irrawaddy, and Salween mainstem rivers, would lose free-flowing status if all dams were built. We propose a set of tested and proven solutions to navigate trade-offs associated with river conservation and dam development. These solution pathways are framed within the mitigation hierarchy and include (1) avoidance through either formal river protection or through exploration of alternative development options; (2) minimization of impacts through strategic or system-scale planning or re-regulation of downstream flows; (3) restoration of rivers through dam removal; and (4) mitigation of dam impacts through biodiversity offsets that include restoration and protection of FFRs. A series of examples illustrate how avoiding or reducing impacts on rivers is possible – particularly when implemented at a system scale – and can be achieved while maintaining or expanding benefits for climate resilience, water, food, and energy security.
Social media summary
Policy solutions and development pathways exist to navigate trade-offs to meet climate resilience, water, food, and energy security goals while safeguarding FFRs.
Premature termination is common among patients treated for depression with either pharmacotherapy or psychotherapy. Yet little is known about factors associated with premature treatment termination among depressed patients. in other hand, there is conflicting evidence about the influence of personality disorder on outcome in depressive disorders.
The present study assesses whether personality may predict the dropout of a psychotherapy group for patients with depressive disorder.
A personality disorders (PDs) self-report questionnaire based on the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II) was completed by 39 depressed outpatients. All patients attended a group-based CBT program for depression consisted of 10 weekly 90 minutes sessions. Patients were categorized in groups as completers vs. dropouts. Dropout was defined as attendance at less than 7 sessions. Differences between groups were tested using Student's t-test and in order to measure the specific contribution of personality on dropout a logistic regression analyses were performed.
Comparing treatment completers (67%) vs. dropouts (33%), groups differed significantly on number of items in schizotypal, narcissistic and borderline PDs. The dropout group scored significantly higher on these PDs than the completer group. Scores on borderline personality disorder emerged as a significant predictor of dropout.
Depressed outpatients with comorbid borderline traits are at higher risk of premature termination and may require modified treatment strategies.
The purpose of this study was to estimate the general population life-time and point prevalence of visual height intolerance and acrophobia, to define their clinical characteristics and to determine their anxious and depressive comorbidities.
A case-control study was conducted within a German population-based cross-sectional telephone survey. A representative sample of 2,012 individuals aged 14 and above were selected. Defined neurological conditions (migraine, Menière's disease, motion sickness), symptom pattern, age of first manifestation, precipitating height stimuli, course of illness, psychosocial impairment, and comorbidity patterns (anxiety conditions, depressive disorders according to DSM-IV-TR) for vHI and acrophobia were assessed.
The life-time prevalence of vHI was 28.5% (women: 32.4%, men: 24.5%). Initial attacks occurred predominantly (36%) in the second decade. A rapid generalization to other height stimuli and a chronic course of illness with at least moderate impairment were observed. 22.5% of individuals with vHI experienced the intensity of panic attacks. The life-time prevalence of acrophobia was 6.4% (women: 8.6%, men: 4.1%), point prevalence was 2.0% (women: 2.8%; men: 1.1%). VHI and even more acrophobia were associated with high rates of comorbid anxious and depressive conditions. Migraine was both a significant predictor of later acrophobia and a significant consequence of previous acrophobia.
VHI affects nearly a third of the general population; in more than 20% of these persons vHI occasionally develops into panic attacks and in 6.4% it escalates to acrophobia. Symptoms and degree of social impairment form a continuum of mild to seriously distressing conditions in susceptible subjects.
The interplay between psychological and ethical issues continues to shape and define the role and responsibilities of professionals in the field of ART. Advances in ART have brought the process of creating a child some distance from nature, enabling physicians to offer patients a variety of permutations in terms of conceiving and carrying offspring. Women can be stimulated to produce multiple oocytes, resulting in multiple births that would not otherwise have occurred. Patients can receive donor gametes – eggs and/or sperm or embryos – to create children who (from a genetic point of view) would not otherwise have been created and whose genetic makeup does not reflect their own.
The origin of malnutrition in older age is multifactorial and risk factors may vary according to health and living situation. The present study aimed to identify setting-specific risk profiles of malnutrition in older adults and to investigate the association of the number of individual risk factors with malnutrition.
Data of four cross-sectional studies were harmonized and uniformly analysed. Malnutrition was defined as BMI < 20 kg/m2 and/or weight loss of >3 kg in the previous 3–6 months. Associations between factors of six domains (demographics, health, mental function, physical function, dietary intake-related problems, dietary behaviour), the number of individual risk factors and malnutrition were analysed using logistic regression.
Community (CD), geriatric day hospital (GDH), home care (HC), nursing home (NH).
CD older adults (n 1073), GDH patients (n 180), HC receivers (n 335) and NH residents (n 197), all ≥65 years.
Malnutrition prevalence was lower in CD (11 %) than in the other settings (16–19 %). In the CD sample, poor appetite, difficulties with eating, respiratory and gastrointestinal diseases were associated with malnutrition; in GDH patients, poor appetite and respiratory diseases; in HC receivers, younger age, poor appetite and nausea; and in NH residents, older age and mobility limitations. In all settings the likelihood of malnutrition increased with the number of potential individual risk factors.
The study indicates a varying relevance of certain risk factors of malnutrition in different settings. However, the relationship of the number of individual risk factors with malnutrition in all settings implies comprehensive approaches to identify persons at risk of malnutrition early.
Recently, regional dementia care networks (DCNs) have been established in Germany to provide timely support for persons with dementia (PwDs) and their families. There is a lack of research in this setting. This study was conducted to describe the burden experienced by informal caregivers over the course of one year when utilizing a DCN and the factors affecting potential changes in caregiver burden during that time.
The study was part of the DemNet-D project, a multi-center observational study of DCNs in Germany. Standardized questionnaires were administered during face-to-face interviews at baseline and at a one-year follow-up with PwDs and their informal caregivers who used a DCN. Based on qualitative data, four DCN governance types were identified and used in a multivariate analysis of burden categories.
A total of 389 PwD-informal caregiver dyads completed the follow-up assessment. At follow-up, the dyads reported significantly lower scores for burden in relation to practical care tasks, conflicts of need, and role conflicts. This change was associated with the PwD–caregiver relationship, the caregiver's gender and health status, and the PwD's socio-economic status. The governance structure of the DCNs was associated with change in one of the four burden categories.
Our data provide the first indications that different governance structures of DCNs seem to be similarly well suited to support network users and might contribute to reducing caregiver burden. However, further studies set in DCNs examining factors that mediate changes in burden are needed to draw strong conclusions regarding the effectiveness of DCNs. Gender differences and the PwD–caregiver relationship should be considered by DCN stakeholders when developing support structures.
Aber man kann Ideale nicht leben, sie schlagen in Widersinn um. Anderseits ist es unerläßlich, dass wir Dinge erfinden, die es nicht geben kann, um das Leben zwischen den Dingen, die es gibt, erträglich zu gestalten. Aber was bedeutet es, dass die Ideen keinen andern Zweck haben, als das, was ist, mit etwas zu durchsetzen, das nicht ist? Ich verbringe mein Leben damit u[nd] weiß nichts davon.
[But one cannot live ideals; they turn into their opposite. On the other hand, it is indispensable that we invent things that cannot exist, in order to make life amid those things that do exist bearable. But what does it mean that ideas have no other goal than infusing that which is with what is not? I spend my whole life on this, and know nothing about it.]
— Musil, Nachlass
The most extreme form in which the question posed by the enigmaticalness of art can be formulated is whether or not there is meaning. For no artwork is without its own coherence, however much this coherence may be transformed by its own opposite.
— Adorno, Aesthetic Theory
Gesang, wie du ihn lehrst, ist nicht Begehr, nicht Werbung um ein endlich Erreichtes; Gesang ist Dasein …
[Song, as you teach it, is not Desire, not seeking after something finally attained; Song is existence …]
Although Musil occasionally fantasized about what he might do after The Man without Qualities was finished, there is, in effect, no end in sight — not for the engaged reader who enters into Musil's intellectual labyrinth; not for the scholar who may try in vain to “finish” with Musil and go on to something els; no end to the author's textual variants, to the possibilities, the arrangements and rearrangements; and no definitive solutions to the questions earnestly posed by this sophisticated writer. Musil was halted in the endless task only by his sudden death, in mid-sentence, while re-visioning one of many versions of a chapter he had begun decades before.
This endlessness has often been read as a failure to reconcile, or come to closure, and this reading has often determined assessments of the relative success of important aspects of Musil's experiment. For example the heightened aesthetic and ethical experiences characterized by the exceptional state Musil called “the Other Condition” have been taken by many to be an escapist attempt to achieve a lasting harmonious union, the possibility of which he would later come to reject. This book argues against this view of failure, and contends that Musil's experimentation with narrative non-linearity and metaphor produced an existential model according to which aesthetic experience, as active, participatory word- and world-construction is the fundamental metaphysical and ethical activity of mankind.
Robert Musil, known to be a scientific and philosophical thinker, was committed to aesthetics as a process of experimental creation of an ever-shifting reality. Musil wanted, above all, to be a creative writer, and obsessively engaged in almost endless deferral via variations and metaphoric possibilities in his novel project, 'The Man without Qualities.' This lifelong process of writing is embodied in the unfinished novel by a recurring metaphor of self-generating de-centered circle worlds. The present study analyzes this structure with reference to Musil's concepts of the utopia of the Other Condition, Living and Dead Words, Specific and Non-Specific Emotions, Word Magic, and the Still Life. In contrast to most recent studies of Musil, it concludes that the extratemporal metaphoric experience of the Other Condition does not fail, but rather constitutes the formal and ethical core of Musil's novel. The first study to utilize the newly published Klagenfurt Edition of Musil's literary remains (a searchable annotated text), 'The World as Metaphor' offers a close reading of variations and text genesis, shedding light not only on Musil's novel, but also on larger questions about the modernist artist's role and responsibility in consciously re-creating the world. Genese Grill holds a PhD in Germanic Literatures and Languages from the Graduate School and University Center of the City University of New York.
In the Viennese Kunsthistorisches Museum, where Robert Musil surely must have wandered during his years in the Austrian capital, the Egyptian rooms are dominated by the figures of the sibling lovers Isis and Osiris, and, as one would expect, by artifacts representing the Egyptian fascination with the themes of death and resurrection. One of the many depictions of the corn god Osiris is accompanied by a tiny hunting arrow in the shape of a back bone, which, the inscription reads, was, in larger size, often affixed to the backs of mummies. This amulet is, on its own, the hieroglyph for “duration.” When upright, however, the caption explains, the hieroglyph changes its meaning to “resurrection.” Duration, in other words, within the context of an agricultural mythos of death and regeneration, comes to mean resurrection. A vitrine labeled simply “Magic,” contains statuettes of enemies with bound arms, tiny male figurines with gigantic phalli, women figurines exposing their genitals, examples of metaphoric ritual magic ensuring the continuation and maintenance of the agricultural cycle. A prostrate Osiris figure is described as a “mummy resurrected to life with aroused penis.” Just around the corner we find a Death-papyrus that reads: “There are three kinds of eternity, the kind that constantly renews itself, the kind that is always changing, and the kind that constantly is,” reminding us of Musil's Isis and Osiris poem, which, he wrote, contained the novel “in nucleo” (T, 847).
Humans both desire and tire of the security and inevitability of senies-gleichen geschieht (the selfsame happens) and long for and fear its equally inevitable interruption. This tension is palpable, again and again in seemingly infinite variation, in both the themes and the experimental techniques of Musil's novel. Its complications are expressed only in part by Ulrich's confession to his sister Agathe, “Ich habe auch das unstillbare Streben in mir, die Erlebnisse wiederholbar zu machen. Aber in dem Augenblick, wo sie es sind, ist die Welt materiell und langweilig. Du hast gestern ein Wort gesagt, das mich ergriffen hat: Alles, was wir tun, ist unwiederholbar …” (MoE, 1645; I also have this irrepressible striving in me to make experiences repeatable. But in the moment when they become repeatable, the world is material and boring. Yesterday you said something that moved me: everything that we do is unrepeatable …).
One may agree with Agathe that nothing we do is repeatable. Or one may believe that there is nothing new under the sun, while still believing that human innovation or choice and will can contribute something to the status of reality; or believe that at bottom “das Ding an sich” is a priori constant but also acknowledge that human subjectivity inhibits a communal agreement on what any given thing is. As is philosophically current, one may argue instead that any seemingly common or shared truth, essence, or experience is nothing but a social construct, invented by the “power elite” to enforce conformity to a value system “privileging” its own interests.
Musil began writing the different versions of the chapter “Atemzüge Meines Sommertags” (Breaths of a summer' day) as early as 1937 or even 1934; and, in an almost perfect circling, he was still working on the chapter on 15 April 1942, the day he died. In these chapter drafts, which feature what appears to be a profusion of more metaphors per paragraph than in any other section of the novel, Ulrich and Agathe continue their “holy conversations.” These conversations are part of an epic deferral of physical consummation in their gated garden, which comes to represent an island excepted from normal time and space, a sort of shimmering framed still life. All still lives, Ulrich explains, in one of the many “Umschreibungen” (circuitous rewritings) that he essays in order to both approach and avoid their significance, paint “die Welt vom sechsten Schöpfusngstag; wo Gott und die Welt noch unter sich waren, ohne den Menschen!” (MoE, 1230; the world of the sixth day of creation, when God and the world were still by themselves, with no people!, MwQ, 1325). This is practically the image of their garden, cut off from society, its requirements, its morals, its temporal and spatial laws. And yet there are two people in the picture, in their garden. These two people, although separated from the world by their garden fence, by the special mission that they have assigned themselves, and their exceptional state of shimmering stillness, are both alive — circling, fountaining — moving within an enclosed area.