Practicing Medicine in the 20th Century Africa. Albert Schweitzer hospital of Lambarene

Lecture at Indiana University Center for Global Health (Internists MD)

Norm enforcement in the city revisited: An international field experiment of altruistic punishment, norm maintenance, and broken windows

In laboratory experiments, people are willing to sanction norms at a cost—a behavioral tendency called altruistic punishment. However, the degree to which these findings can be generalized to real-world interactions is still debated. Only a small number of field experiments have been conducted, and initial results suggest that punishment is less frequent outside of the lab. This study replicates one of the first field experiments on altruistic punishment and builds ties to research on norm compliance and the broken windows theory. The original study addressed the enforcement of the anti-littering norm in Athens. We replicate this study in Bern, Zurich, and New York City. As an extension, we investigate how the experimental context (clean vs littered) impacts social norm enforcement. As a second extension, we investigate how opportunity structure impacts the maintenance of the anti-littering norm. Findings indicate that norms are universally enforced, although significantly less than in the standard laboratory experiment,and that enforcement is significantly more common in Switzerland than in New York. Moreover, individuals prefer more subtle forms of enforcement to direct punishment. We also find that enforcement is less frequent in littered than in clean contexts, suggesting that broken windows might not only foster deviant behavior but also weaken informal social control. Finally, we find that opportunity structure can encourage people to maintain norms, as indicated by the fact that people are more likely to voluntarily pick up litter when it is closer to a trash bin.

[Old and new interventional therapies in the treatment of symptomatic benign prostate hyperplasia (BPH)]

Benign Prostatic Hyperplasia is a common entity among the aging male population. Its prevalence is increasing with age and is around 80% in the over 80-years old. The androgen-estrogen ratio changes in favor of the estrogens, which leads to a growth of prostatic tissue, presenting histologically as hyperplasia. BPH can cause irritative or obstructive symptoms or both. Nowadays we speak of bladder storage or bladder voiding symptoms, summarised as LUTS (Lower Urinary Tract Symptoms). LUTS has a structural and a functional component, the structural being caused by the size of the adenoma itself the functional depending on the muscle tone of the bladder neck and the prostatic urethra. To investigate LUTS, we use validated symptom scores, sonography for residual urine and eventually a urodynamic evaluation. There are 3 grades of BPH. The indication for an interventional therapy is relative in BPH II, and absolute in BPH III. Prior to treatment, other diseases mimicking the same symptoms, have to be ruled out and adequatly treated. Electro-resection of the prostate (TUR-P) remains the standard therapy and the benchmark any new technology has to compete with. TUR-P has good short- and longterm results, but can be associated with a considerable perioperative morbidity, and the learning curve for the operator is long. The most promising of the newer techniques is the Holmium-Laser-Enucleation of the prostate (Laser-TUR-P), showing at least identical short- and median-term results, but a lower perioperative morbidity than TUR-P For several minimally-invasive techniques, indications are limited. TUMT TUNA, WIT and laser-coagulation all produce a coagulation necrosis of the prostatic tissue by thermic damage with secondary tissue shrinking. Urodynamic results however, are not comparable to TUR-P or Laser-TUR-P, and significantly more secondary interventions within 2 to 5 years are required. Minimal-invasive techniques present a favorable alternative for younger patients without complications of BPH, and for older patients with relevant comorbidities, and can usually be performed under local anaesthesia. The morbidity is low and further therapies remain possible later, if necessary.

Early metacognitive abilities: The interplay of monitoring and control processes in 5- to 7-year-old children

The goal of the current investigation was to compare two monitoring processes (judgments of learning [JOLs] and confidence judgments [CJs]) and their corresponding control processes (allocation of study time and selection of answers to maximize accuracy, respectively) in 5- to 7-year-old children (N=101). Children learned the meaning of Japanese characters and provided JOLs after a study phase and CJs after a memory test. They were given the opportunity to control their learning in self-paced study phases, and to control their accuracy by placing correct answers into a treasure chest and incorrect answers into a trash can. All three age groups gave significantly higher CJs for correct compared to incorrect answers, with no age-related differences in the magnitude of this difference, suggesting robust metacognitive monitoring skills in children as young as 5. Furthermore, a link between JOLs and study time was found in the 6- and 7-year-olds, such that children spent more time studying items with low JOLs compared to items with high JOLs. Also, 6- and 7-year-olds but not 5-year-olds spent more time studying difficult items compared to easier items. Moreover, age-related improvements were found in children's use of CJs to guide their selection of answers: although children as young as 5 placed their most confident answers in the treasure chest and least confident answers in the trash can, this pattern was more robust in older children. Overall, results support the view that some metacognitive judgments may be acted upon with greater ease than others among young children.

How Teresa and Maria Margaretha migrated to Nordstrand: Translation of Relics and Transformation of a German Island into a Catholic Dutch enclave in the 17th century

When on 26 May 1662 the founding first stone was laid for a new church on the island Nordstrand at the coast of Schleswig, relics of Teresa of Avila (1515-1582) and of the Dutch Carmelite abbess Maria Margaretha ab Angelis (1605-1658) were inserted. This church was built for Dutch dyke builders who were called to reconstruct the island after its destruction by flood in 1634; coming from a Catholic background and from the Dutch Republic which was at war with Spain at that time, the dyke builders and their families were guaranteed religious freedom in the Lutheran duchy of Holstein. In this paper, the reasons for the choice for the Spanish mystic Teresa of Avila and for the Dutch Carmelite abbess Maria Margaretha are discussed. The latter patroness was never beatified but had died in the smell of holiness; after her death several miracles were ascribed to her. It is understandable that migrants brought relics of their appreciated holy persons who would remind them of their homeland. The paper will first shortly introduce the two patronesses of the church. In the second part, the reasons for this choice will be discussed. Behind this translation of relics not only spiritual reasons played a role. The function of the translation of the saints was first to keep up geographical and political connections with the old country (both Spain and the Netherlands), secondly to perpetuate personal-familial relationships (esp. with Maria Margaretha), thirdly to strengthen the confessional identity in a non-Catholic environment. Fourthly the transfer brought a certain model of Christian life and reform to the new place of living, which in the second part of the 17th century became marked as “Jansenist”. The paper shows the transformation of the island into an enclave of Dutch Catholic culture.