Speechlessness: a Conceptual Framework

The phenomenon of speechlessness has hardly been considered in the literature from a psychological point of view. Previous research on speechlessness is limited to the fields of neurology, medicine or psychopathology. The present review aims to consider speechlessness from a psychological perspective distinct from pathology, and to highlight its observability and possible connections to existing research in the context of emotional cognition and processing. Search terms were developed and a comprehensive, systematic literature search was conducted in various databases based on previous scientific work on the understanding of non-speech, silence and speechlessness. Only results that examined the phenomenon of speechlessness from a non-pathological or non-neurological perspective were included. A total of N = 7 publications matching the inclusion criteria were identified. The results were used to develop a procedual model for the phenomenological definition of speechlessness. The developed model differentiates the observable phenomenon of speechlessness into a non-intentional, unconscious form and a intentional, conscious form. The present work suggests that meaningful emotions and their perception and processing is a core element in the emergence of speechlessness and provides a first, psychological, non-pathological explanation of speechlessness.

Silence and its effects on the autonomic nervous system: A systematic review

This systematic review explores the influence of silence on the autonomic nervous system. The Polyvagal Theory has been used as a reference model to describe the autonomic nervous system by explaining its role in emotional regulation, social engagement, and adaptive physiological responses. PubMed, Scopus, PsycInfo, EMBASE, and Google Scholar were systematically searched up until July 2023 for relevant studies. The literature search yielded 511 results, and 37 studies were eventually included in this review. Silence affects the autonomic nervous system differently based on whether it is inner or outer silence. Inner silence enhances activity of the ventral vagus, favoring social engagement, and reducing sympathetic nervous system activity and physiological stress. Outer silence, conversely, can induce a heightened state of alertness, potentially triggering vagal brake removal and sympathetic nervous system activation, though with training, it can foster inner silence, preventing such activation. The autonomic nervous system response to silence can also be influenced by other factors such as context, familiarity with silence, presence and quality of outer noise, and empathy.

Evaluating brain spectral and connectivity differences between silent mind-wandering and trance states

Trance is an altered state of consciousness characterized by alterations in cognition. In general, trance states induce mental silence (i.e., cognitive thought reduction), and mental silence can induce trance states. Conversely, mind-wandering is the mind's propensity to stray its attention away from the task at hand and toward content irrelevant to the current moment, and its main component is inner speech. Building on the previous literature on mental silence and trance states and incorporating inverse source reconstruction advances, the study's objectives were to evaluate differences between trance and mind-wandering states using: (1) electroencephalography (EEG) power spectra at the electrode level, (2) power spectra at the area level (source reconstructed signal), and (3) EEG functional connectivity between these areas (i.e., how they interact). The relationship between subjective trance depths ratings and whole-brain connectivity during trance was also evaluated. Spectral analyses revealed increased delta and theta power in the frontal region and increased gamma in the centro-parietal region during mind-wandering, whereas trance showed increased beta and gamma power in the frontal region. Power spectra at the area level and pairwise comparisons of the connectivity between these areas demonstrated no significant difference between the two states. However, subjective trance depth ratings were inversely correlated with whole-brain connectivity in all frequency bands (i.e., deeper trance is associated with less large-scale connectivity). Trance allows one to enter mentally silent states and explore their neurophenomenological processes. Limitations and future directions are discussed.

Increased relaxation, less boredom, and a faster passage of time during a period of silence in the forest

INTRODUCTION

There is growing evidence of the beneficial effects of exposure to nature on health and well-being. Time spent in nature can decrease stress, anxiety, depression, and improve mood. In the present study, we compared the experience of a short period of silence in the natural environment of a forest with the same amount of silence in a seminar room.

METHODS

We applied an intra-subject design with two 6:30-min sessions of silence in two different environments (forest, seminar room). The participants (n=41) were assigned to four groups. Two groups started with the indoor condition and two groups with the outdoor condition. After 1 week, the two groups were exposed to the other condition. Participants filled out personality-trait scales on meaning in life and belief in oneness with the world, as well as state scales assessing emotional reactions, relaxation, boredom, and the subjective sense of self, time, and space.

RESULTS

Participants felt significantly more relaxed and less bored in the forest compared to indoors. They experienced time less intensely, judging it to pass faster and to last shorter in the forest. Regarding trait variables, the higher the search for meaning, the higher oneness beliefs in participants. The higher oneness beliefs, the more positive participants felt during silence in the forest.

DISCUSSION

Interest in nature-assisted therapy is increasing in the healthcare sector. Exposure to silence in the natural setting of a forest could prove to be an effective complement to interventions applied in nature-assisted therapy, such as forest therapy.

Gold nanoparticles (AuNPs) can rapidly deliver artificial microRNA (AmiRNA)-ATG6 to silence ATG6 expression in Arabidopsis

KEY MESSAGE

We establish a fast and efficient transient silencing system that facilitates functional studies of some genes, whose knockout leads to plant lethality. In plants, the generation of loss-of-function mutants is crucial for studying gene function. Artificial microRNA (AmiRNA) technology is a more targeted and effective tool for gene silencing. Gold nanoparticles (AuNPs) can bind nucleic acids and deliver them into animal cells. Here, AuNPs are used in combination with AmiRNA technology in plants. We found that AmiRNA-autophagy-related proteins (ATG6) can be delivered to cells by AuNPs to achieve the effect of ATG6 silencing. It is worth noting that on the 10th day there is still a silencing effect. Similar to the atg5 lines, silencing of ATG6 significantly reduced plant resistance to Pseudomonas syringae pv.maculicola (Psm) ES4326/AvrRpt2. Interestingly, ATG6 silencing and ATG5 mutation in NPR1-GFP (nonexpressor of pathogenesis-related genes) lines significantly reduced plant resistance to Psm ES4326/AvrRpt2, suggesting that autophagy is also involved in NPR1-regulated plant immune responses. In summary, we establish a fast and efficient transient silencing system that facilitates functional studies of some genes, whose knockout leads to plant lethality.

Exploring the Effect of Silence on Auditory Network Regions in Young Female Adults who Experience Temporary Tinnitus on Exposure to Silence

OBJECTIVES

To examine the differences in auditory evoked cortical responses that may underlie the tendency of some people to perceive tinnitus. The study hypothesis is that the mean ALR and P300 amplitudes in normal hearing adults who perceive temporary tinnitus after exposure to sustained silence will be larger than the mean ALR and P300 amplitudes in normal hearing adults who do not perceive temporary tinnitus after exposure to sustained silence.

DESIGN

This was a prospective cross-sectional study. The approval for the study was obtained from the IRB and COVID ramp up committee of University of North Carolina Greensboro (UNCG). Participants completed comprehensive hearing screening and preand postsilence ALR and P300 recordings were obtained. After the first ALR/P300 recording participants were exposed to ten minutes of silence. Participants completed a Qualtrics questionnaire to report any tinnitus perception that emerged during silence exposure. Absolute N1, P2 and P300 waveform amplitudes and latencies were identified and were entered into an SPSS spreadsheet for data analysis.

RESULTS

Thirty adult females with normal pure tone hearing thresholds and no history of persistent tinnitus were included in the study. The mean age of the participants was 22.5 ± 3.9 years. When exposed to silence, eight (26.7%) participants perceived temporary tinnitus. N1 and P300 waveforms were smaller in amplitude and faster in latency in the tinnitus perception group; however, the ALR and P300 waveform latencies and amplitudes did not statistically differ significantly between the participants who perceived temporary tinnitus in silence and those who did not (p>0.05). The difference in waveform morphology between the tinnitus perception group and the non-tinnitus perception group revealed a greater difference in P300 amplitude after exposure to silence.

CONCLUSION

Differences in ALR and P300 latencies and amplitudes were observed between the tinnitus perception group and non-tinnitus perception group, with smaller P300 amplitudes appearing in the group perceiving tinnitus. While the results did not statistically significant, this pattern may reflect a mismatch between the neuronal response in the auditory cortex (N1 and P2 amplitudes and latencies) and the neuronal activity in the modulatory network regions (P300).

Effect of AKT silence on malignant biological behavior of renal cell carcinoma cells

BACKGROUND

As the most common malignant tumor of primary renal tumor, renal cell carcinoma (RCC) is the highly invasive disease with high mortality. AKT is a serine/threonine kinase that play a critical role in the phosphoinositide 3-kinase (PI3K) signaling pathway, and it is an attractive target for RCC treatment. The aim of present study was to investigate the effect of AKT silence on malignant behavior of renal cell carcinoma cells.

METHODS

AKT expression was quantified by immunohistochemistry in tumor tissues and normal tissues. The human RCC cell lines Caki-2 cell were chosen for this study. The optimal silencing siRNA was subsequently selected by RT-qPCR and western blot. The effect of AKT silence on RCC cells was investigated by CCK8 assay, transwell assay, scratch test and flow cytometry. The AKT1 expression in human renal cell carcinoma tissue was detected by immunohistochemical staining.

RESULTS

The AKT in Caki-2 cells was silenced successfully. The results shown AKT silence could inhibit cell proliferation, invasion, and, migration. In addition, AKT silence could promote Caki-2 cell apoptosis with prevention of RCC cells move from G1 phase to S phase. Immunohistochemical staining revealed significant difference of expression of AKT1 in RCC tissues and normal renal tissues. Taken together, AKT family members might involve in malignant growth of RCC, and might be a potential therapeutic target.

CONCLUSION

Our data show that AKT silence inhibited cell proliferation, invasion, and, migration of Caki-2 cell, and promoted Caki-2 cell apoptosis. Moreover, AKT silence prevented RCC cells move from G1 phase to S phase. Therefore, AKT may act as an effective therapeutic target for RCC.

Epidemiology of Connectional Silence in specialist serious illness conversations

CONTEXT

Human connection can reduce suffering and facilitate meaningful decision-making amid the often terrifying experience of hospitalization for advanced cancer. Some conversational pauses indicate human connection, but we know little about their prevalence, distribution or association with outcomes.

PURPOSE

To describe the epidemiology of Connectional Silence during serious illness conversations in advanced cancer.

METHODS

We audio-recorded 226 inpatient palliative care consultations at two academic centers. We identified pauses lasting 2+ seconds and distinguished Connectional Silences from other pauses, sub-categorized as either Invitational (ICS) or Emotional (ECS). We identified treatment decisional status pre-consultation from medical records and post-consultation via clinicians. Patients self-reported quality-of-life before and one day after consultation.

RESULTS

Among all 6769 two-second silences, we observed 328 (4.8%) ECS and 240 (3.5%) ICS. ECS prevalence was associated with decisions favoring fewer disease-focused treatments (OR_adj: 2.12; 95% CI: 1.12, 4.06). Earlier conversational ECS was associated with improved quality-of-life (p = 0.01). ICS prevalence was associated with clinicians' prognosis expectations.

CONCLUSIONS

Connectional Silences during specialist serious illness conversations are associated with decision-making and improved patient quality-of-life. Further work is necessary to evaluate potential causal relationships.

PRACTICE IMPLICATIONS

Pauses offer important opportunities to advance the science of human connection in serious illness decision-making.

Evaluation of Medial Olivocochlear Neural Efferent Pathway in Tinnitus Perception in Normal-hearing Individuals

OBJECTIVE

The objective of this study is to investigate a possible role of the Medial Olivocochlear (MOC) efferent neural pathway and neural connections responsible for tinnitus generation in silence/sensory deprivation.

DESIGN

By placing normal hearing participants in a sound booth for 10 minutes, silence/sensory deprivation was created. This offered assessment of MOC neural pathway in normal hearing participants in silence. Hyperactivity of MOC neural pathway was assessed by its more suppressive effect on Transient Otoacoustic Emissions (TEOAEs) in silence. The required auditory measurements were recorded in the sound booth using recommended diagnostic protocols to ensure the effect of 'only silence' on auditory structures. TEOAE were recorded from the right ear and suppression was measured by placing noise in the left ear. Fifty-eight normal hearing male individuals between age 18-35 years were recruited as participants in this study.

RESULTS

Approximately, forty-one percent of the participants perceived some type of tinnitus during/after 10 minutes of silence. No statistically significant difference was found in the total TEOAE amplitude and TEOAE suppression amplitude before and after ten minutes of silence. Post silence total TEOAE suppression between tinnitus perceiving and non-perceiving tinnitus participants were not statistically significantly different.

CONCLUSION

These results suggest that the medial olivocochlear efferent pathway or lower brain stem area does not appear to play a role in the emergence of temporary tinnitus in silence however indicate the involvement of higher central auditory nervous system structures in perception of the tinnitus which support the well-accepted notion that tinnitus is the central auditory processing phenomenon.

Effect of COVID-19 lockdown on noise pollution levels in an Indian city: a case study of Kanpur

Noise pollution is an emerging environmental threat, prolonged exposure of which can cause annoyance, sleep disturbance, hypertension, psychiatric disorders, and also hormonal dysfunction. Among all the sources of noise pollution, the noise generated by road vehicle traffic significantly affects the quality of urban environments. Concerning the recent imposition of COVID-19 societal lockdown, this study attempts to investigate the impacts of COVID-19 lockdown on the changes in noise pollution levels before, during, and after lockdown phase in different residential, commercial, industrial, and silence zones of the city of Kanpur, India. Utilizing data collected from portable environmental sensors, the average noise levels before lockdown and during lockdown were found to be in the range of 44.85 dB to 79.57 dB and 38.55 dB to 57.79 dB, respectively, for different zones. Although a significant reduction in the noise levels was observed during lockdown, except for commercial zone, all other monitoring stations had reported sound levels quite higher than the recommended noise limits set by the Central Pollution Control Board (CPCB) of India. Results further indicated that the impact of road traffic noise on risk of high annoyance and sleep disturbance was found to be lower during lockdown as compared to that of pre-lockdown and unlock phase. While the annoyance level in residential (86.23%), industrial (87.44%), and silence (84.47%) was higher in pre-lockdown period, it reduced to 41.25, 50.28, and 43.07% in the lockdown phase. Even the risk of sleep disturbance in the residential zone was found to reduce from 37.96% during pre-lockdown to 14.72% during lockdown phase. Several noise mitigation strategies are also proposed, which may indeed pave the way for devising noise control measures in the local and regional level.

Exploring the role of monocyte chemoattractant protein-1 in fibroblast-like synovial cells in rheumatoid arthritis

Background

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease with persistent synovitis. In the present study, the impact of monocyte chemoattractant protein-1 (MCP-1) was explored to determine methods for the diagnosis and treatment of RA.

Methods

First, fibroblast-like synoviocytes (FLSs) were obtained from a collagen-induced rat RA model. Next, MCP-1-overexpression plasmid and small interfering RNA were transfected into human and rat FLSs. Cell Counting Kit-8 (CCK-8), Transwell migration and flow cytometry assays were used to analyze cell proliferation, migration and apoptosis of FLSs following MCP-1 transfections, respectively. Furthermore, western blotting was used to analyze the expression levels of p-P38, p-PI3K, PI3K, CD31, VEGF, TNF-α and IL-β in FLSs following MCP-1 transfection. In addition, reverse transcription-quantitative PCR and ELISAs were used to analyze the expression levels of C-reactive protein (CRP), estrogen receptor, MCP-1 and pentraxin-3 in patients with clinical RA, followed by correlation analysis of clinical data. Finally, expression validation, diagnostic and protein-protein interaction (PPI) network analysis of MCP-1 were performed.

Results

MCP-1 promoted FLS proliferation and migration, and affected the apoptosis of FLSs. In addition, the expression levels of p-P38, p-PI3K, PI3K, CD31, VEGF, TNF-α and IL-β were also affected by MCP-1. In patients with clinical RA, the expression level of MCP-1 was increased. Moreover, CRP expression level was significantly up-regulated in RA. Clinically, MCP-1 was strongly correlated with tender joint count, swollen joint count, visual analog scale for general health and disease activity score 28 (DAS28)-MCP-1, and was moderately correlated with DAS28 and DAS28-CRP. PPI analysis showed that MCP-1 mainly interacted with other inflammatory cytokines.

Conclusion

In conclusion, MCP-1 may play a significant regulatory role in RA, and could be used as a measurement index of clinical RA activity.

Are male nurses sexually harassed? A cross-sectional study in the Greek Health System

BACKGROUND

The #MeToo and #Times Up movements have put a global spotlight on the phenomenon of sexual harassment in healthcare. Yet, most studies have explored sexual harassment among female professionals. This study departs from current research practices and investigates the frequency of sexual harassment in male nurses working in the Greek NHS and the reasons for not reporting their experiences.

METHODS

A cross-sectional study was conducted using the Sexual Experiences Questionnaire (SEQ) to collect data from 507 male nurses working in Greece's various settings during October and February 2021. The electronic survey was sent to male nurses (n=3,091 registered with the Hellenic Association of Nurses. Survey items were consent form, demographics, three-dimensions of sexual harassment, silencing and negative consequences. Questions were measured using five-point Likert scales, binary scale and multiple-choice questions. ANOVA and T-tests were used to investigate whether specific groups more frequently dealt with sexual harassment. Multiple regression analyses were conducted to investigate the association between independent variables (sexually harassing behaviours) and the dependent variable (participants' negative physical, mental, and job-related outcomes).

RESULTS

40% of male nurses have experienced sexual harassment at least once in their working lives, and the most common form of sexual harassment faced was gender harassment, followed by unwanted sexual attention. Male doctors and male nurses were the most common perpetrators. Private and younger male nurses with up to 5 years of experience experienced more frequent sexual harassment. 30% did not report sexual harassment due to the fear that no one would believe them, and because of beliefs, no action would be taken against the wrongdoer. Multiple regression analyses showed that unwanted sexual attention and sexual coercion were associated with physical and job-related outcomes. Cronbach Alpha was 0.91.

CONCLUSION

A high proportion of male nurses have experienced sexual harassment during their careers. Being younger with limited working experience and working in the private sector were positively associated with sexual harassment. Policymakers and health managers should focus on sexual harassment prevention strategies and report-enabling policies.

SILENCE: Capturing the Feeling of Inner Quietude

Silent experiences are integral parts of human life, and despite such moments of silence-phenomena may falsely be perceived as moments of "nothings", they are in fact an essential part of human apperception and meaning-making. The significance of moments of silence (an internal, timeless state of being often perceived as solitary, spiritual-mystical, and unconscious, involuntary experiences) and silences (contextual states of temporally oriented and social experiences) is supported by the principles behind the concepts of Gestalten and zero signifiers, in that such absence can lead to greater understanding of meaning than any explicit and direct element ever could. The human experience of life is inseparably linked with the function of apperception as experiencing the presence in a combination with reconstruction of the past and imagination of the future. And as this dynamic across irreversibility of time is in any human experience it is as well present within experiences of silence. Furthermore, is the phenomenon of Einfühlung (the process of feeling in and through others, objects, and oneself) a crucial part of silence-phenomena, as it is uncovered to be connected with both silence as a facilitator of emergence of silence as well as silences affect the act of Einfühlung. Aesthetic experiences can in the form of poetic instants lead to moments of silence, through the human function of Einfühlung. Finally, an analysis of a passage from Lev Vygotsky's personal notebooks will support the line of reasoning the centrality of the existence of silence.

"I feel I have no voice": hospital doctors' workplace silence in Ireland

Purpose

Workplace silence impedes productivity, job satisfaction and retention, key issues for the hospital workforce worldwide. It can have a negative effect on patient outcomes and safety and human resources in healthcare organisations. This study aims to examine factors that influence workplace silence among hospital doctors in Ireland.

Design/methodology/approach

A national, cross-sectional, online survey of hospital doctors in Ireland was conducted in October–November 2019; 1,070 hospital doctors responded. This paper focuses on responses to the question “If you had concerns about your working conditions, would you raise them?”. In total, 227 hospital doctor respondents (25%) stated that they would not raise concerns about their working conditions. Qualitative thematic analysis was carried out on free-text responses to explore why these doctors choose to opt for silence regarding their working conditions.

Findings

Reputational risk, lack of energy and time, a perceived inability to effect change and cultural norms all discourage doctors from raising concerns about working conditions. Apathy arose as change to working conditions was perceived as highly unlikely. In turn, this had scope to lead to neglect and exit. Voice was seen as risky for some respondents, who feared that complaining could damage their career prospects and workplace relationships.

Originality/value

This study highlights the systemic, cultural and practical issues that pressure hospital doctors in Ireland to opt for silence around working conditions. It adds to the literature on workplace silence and voice within the medical profession and provides a framework for comparative analysis of doctors' silence and voice in other settings.

Absence or presence: Silent discourse in the operating room and impact on surgical team action

BACKGROUND

Our objective was to examine the influence of silence on team action in the operating room.

METHODS

We conducted a constructed grounded theory study with semi-structured interviews with 25 interprofessional surgical team members. Using a framework of silence as communication and performance, transcripts were iteratively team-coded to develop themes and a conceptual model.

RESULTS

OR silence is expressed verbally and nonverbally. Two contexts of silence were identified: homogenous as collective action, and disparate, as disengagement. Complex and dynamic, two primary themes emerged, Power that often shuts down communication, and Focus during critical moments. Five additional sub-themes included critical moments, respect, self-reflection, personal preference, and, bad mood.

CONCLUSION

OR silence is not an absence of communication and requires a response. Whether homogenous through cohesiveness, or desperate as a solitary act, OR silence is a call to action. Examining silence as a part discourse has important implications on surgical team function.

[Phone sessions in Covid-19 environment: The frame and his limits]

Cet article introduit son propos en relatant l’épidémie de peste dans la Grèce antique pour montrer l’impact de l’environnement sur l’humain et ses incidences fantasmatiques collectives. Face à la pandémie du Covid-19, les mesures de protection sanitaire imposent des modifications de nos pratiques cliniques. Face au caractère inédit de cette situation, le psychothérapeute en libéral est amené à repenser certains aspects du cadre de sa pratique afin de préserver le fil de la relation transférentielle. Les auteurs développent une réflexion clinique sur le cadre clinique en période de pandémie en explorant notamment la dynamique des séances par téléphone. Pour des entretiens au téléphone, la question de l’enveloppe sonore est centrale, notamment quant à la fonction psychique du silence. Davantage qu’en nous appuyant sur des cas cliniques au déroulement long, nous choisissons d’illustrer notre propos avec de courtes vignettes, plus à même de représenter la variété des nouvelles situations cliniques rencontrées et des interrogations qui les accompagnent.

The effect of different genres of music and silence on relaxation and anxiety: A randomized controlled trial

High stress and anxiety in healthy individuals may lead to use different pharmacological and non-pharmacological therapies. The study aimed to investigate the effect of different genres of music on anxiety and relaxation in healthy participants. This study was a randomized controlled trial with a cross-over design. Forty-six healthy undergraduates participated in the study and randomly received different genres of music (Pop, Rock, Western Classical, and Persian Traditional) and silence for five consecutive days between February and June 2018. Each participant was her/his own control. Relaxation and the State Anxiety were checked with Smith Relaxation States Inventory 3 and The State Anxiety Inventory before and after listening to 15 min of music or laying down in silence. None of the five procedures were preferred for a more relaxing effect (P > 0.05). Also, none of the interventions were preferred for reduction of the state anxiety (P > 0.05). Although different genres of music, i.e., Pop, Rock, Western Classical, Persian Traditional, could reduce state anxiety and improve relaxation, they had no extra effect compared to Silence.

'An uneasy compromise': strategies and dilemmas in realizing a permissive abortion law in Ethiopia

Introduction

At the turn of the century, when the Millennium Development Goals placed maternal mortality reduction high on the global agenda, Ethiopia relaxed its restrictive abortion law to expand grounds on which a woman could legally obtain an abortion. This radical policy shift took place within a context of predominant anti-abortion public opinion shaped by strong religious convictions. Drawing upon Walt and Gilson’s policy analysis framework, this paper explores the tension between public policy and religious dogma for the strategies chosen by the Ethiopian Ministry of Health and its partners implementing the new policy, and for access to safe abortion services.

Methods

The study employed a qualitative research methodology. It targeted organizations that are key stakeholders in the field of reproductive health. These included policy makers and policy implementers like ministries, UN agencies and international and national NGOs as well as religious organizations as key opinion leaders. The data collection took place in Addis Ababa between 2016 and 2018. A total of 26 interviews were conducted, transcribed, and analyzed using the principles of qualitative content analysis.

Results

Our analysis showed that the implementing organizations adopted a strategy of silence not to provoke anti-abortion sentiments and politicization of the abortion issue which was seen as a threat to the revised law and policy. This strategy has facilitated a rollout of services and has improved access to safe abortion care. Nevertheless informants were concerned that the silence strategy has prevented dissemination of knowledge about the revised law to the general public, to health workers and to the police. In turn this has caused confusion about eligibility to legal and safe abortion procedures.

Conclusions

While silence as a strategy works to protect the law enhancing the health and survival of young women, it may at the same time prevent the law from being fully effective. As a long term strategy, silence fails to expand awareness and access to safe abortion services, and may not sufficiently serve to fulfill the potential of the law to prevent abortion related maternal deaths.

"I Just Kept It to Myself": The Shaping of Latina Suicidality Through Gendered Oppression, Silence, and Violence

Suicide is a critical issue among Latina youth. In this study, we use family case analysis to explore how gendered oppression, silencing, and violence shape suicidal behaviors among a sample of Latina daughters (n = 10), and their parents. For comparison, we include family narratives from Latina adolescents with no histories of suicide attempts (n = 10). Results suggest how secrets and silence, as indicative of gendered oppression, may catalyze a suicide attempt. The risks are particularly salient when daughter and mother both have experienced violence that conflicts with gendered cultural scripts. Findings highlight the importance of parental engagement and exploration of histories of violence in the treatment of Latina suicide attempters. Future research should incorporate the risk factors of gendered oppression and violence to better understand the development of suicidality among Latina women.

Why Patients with Chronic Disease Keep Silent? Analysis of Item Nonresponse in Rural China

BACKGROUND

This study aimed to identify the characteristics of item nonresponse and examine the factors affecting the refusal or failure to respond of patients with chronic disease in rural China.

METHODS

A cross-sectional survey data from patients with chronic disease from rural China were analyzed. A total of 1,099 patients were enrolled. Chi-square test and cumulative logistic regression determined the predictors of having item nonresponse.

RESULTS

The respondents in central provinces (OR = 2.311, 95%CI = 0.532∼1.144, P < 0.001) with over eight household members (OR = 0.067, 95%CI = -1.632∼-0.349, P = 0.002), multiple chronic diseases (OR = 0.301, 95%CI = -1.673∼-0.727, P < 0.001), and low health knowledge level (OR = 2.112, 95%CI = 0.405∼1.090, P < 0.001) had more item nonresponse numbers. Compared with the participants with high school education level and above, the item nonresponse number seemed to increase when the participants were illiterate (OR = 2.159, 95%CI = 0.254∼1.285, P = 0.003), had primary school education (OR = 2.161, 95%CI = 0.249∼1.294, P = 0.004) and junior school education (OR = 2.070, 95%CI = 0.160∼1.296, P = 0.012).

CONCLUSION

This study indicates the influencing factors of the item nonresponse in survey of patients with chronic disease in rural China. This study contributes to investigation practice and highlights that health institutions should improve the quality of follow-up services. Moreover, the government should pay more attention to the care of vulnerable groups, especially patients with chronic disease in rural areas.

When abortion is not within reach: Ethiopian university students struggling with unintended pregnancies

Background

In spite of increasing international commitment to young people’s sexual and reproductive health, unintended pregnancies remain a major problem for young women worldwide. This article explores the issue of unintended pregnancies among Ethiopian university students and investigates narratives of students who carried their pregnancy to term. Ethiopia’s relatively permissive abortion law forms part of the backdrop for the exploration. We also consider how socio-cultural and religious norms surrounding female premarital sex/pregnancy, and gendered and urban-rural inequities, play a role in how students handle the challenge.

Methods

The article is based on research conducted among students at Addis Ababa, Jimma and Mekelle Universities in Ethiopia between September 2016 and June 2017. Drawing on an interpretative, phenomenological approach to science and employing a qualitative methodology, the authors conducted in-depth interviews with 53 students and 24 selected staff at the three universities, and held two focus group discussions with students at Addis Ababa University.

Results

The study findings show three possible scenarios for how students can deal with an unwanted pregnancy. The first is to have the pregnancy terminated secretly, and thereby avoid the stigma linked to premarital pregnancy. The second is to make a deliberate decision to keep the pregnancy and face the consequences to come. The third scenario is found in cases where the student seems paralyzed by feelings of shame, and where she ends up keeping the pregnancy due to her inability to act.

Students who end up carrying their pregnancy to term face many problems. Few support structures at the university are in place to cater for their needs. Moreover, family support is endangered by pregnancy, as it puts the student at risk of being ostracized from her family due to the shame she has imposed on them. Shame and silence are thus important social forces in these students’ lives, underpinned by gendered inequities and patriarchal norms.

Conclusions

Along with rural-urban and gendered inequities, the article demonstrates how a shame-silence nexus forcefully operates in the lives of female students struggling with reproductive challenges, and the serious consequences a pregnancy may have for those who carry it to term.

Suffering of silenced people in northern Rwanda

To contribute to understanding the association between silence and suffering in the context of war and political repression, this study sheds light on the meaning-making process and explores the underlying mechanisms by which silence leads to suffering and how this suffering could be alleviated. The ethnographic research was conducted in 2015-2016, with 43 participants from northern Rwanda, who survived massacres after the 1994 genocide but were prevented from speaking about the experience by political constraints. The findings first describe their suffering, through grief, social isolation and loss of meaning in life and death (expressed as existential questions). Their suffering was worsened by 'unspeakability'; that is, the political context that prevents victims from speaking freely about their war experience, including discussion of those who killed and those who were killed. Unspeakability exacerbated suffering since participants were obstructed from applying ready narratives (e.g. funerary rituals, traditional reconciliation systems) or constructing their own narratives which could ordinarily help them to process mourning and reconciliation and to make sense of the loss. They selectively employed silence for coping and protection, avoiding speaking about the past to maintain everyday life. However, at the same time, unprocessed mourning remained a serious problem, resulting in mental health problems such as hallucinations of the spirits of the dead; participants expressed a strong need for mourning rituals. Overall, this paper highlights the ways in which the suffering of the silenced population worsens when meaning-making processes are obstructed. To alleviate the suffering, it is essential to secure mourning rituals for all survivors, particularly those who, as part of the defeated group of war, are silenced and marginalized in history.

Evidence for a neural signature of musical preference during silence

One of the most basic and person-specific affective responses to music is liking. The present investigation sought to determine whether liking was preserved during spontaneous auditory imagery. To this purpose, we inserted two-second silent intervals into liked and disliked songs, a method known to automatically recreate a mental image of these songs. Neural correlates of musical preference were measured by high-density electroencephalography in twenty subjects who had to listen to a set of five pre-selected unknown songs the same number of times for two weeks. Time frequency analysis of the two most liked and the two most disliked songs confirmed the presence of neural responses related to liking. At the beginning of silent intervals (400-900 ms and 1000-1300 ms), significant differences in theta activity were originating from the inferior frontal and superior temporal gyrus. These two brain structures are known to work together to process various aspects of music and are also activated when measuring liking while listening to music. At the end of silent intervals (1400-1900 ms), significant alpha activity differences originating from the insula were observed, whose exact role remains to be explored. Although exposure was controlled for liked and disliked songs, liked songs were rated as more familiar, underlying the strong relationship that exists between liking, exposure, and familiarity.

Culture, silence and voice: The implications for patient safety in the operating theatre

Team culture is an important antecedent to safety behaviours such as speaking up. A positive safety culture in the operating theatre has been linked to fewer adverse events. Psychological safety, a component of safety culture, is the belief that the team is safe to take risks such as raising concerns. Power dynamics can influence active speaking up behaviour or 'voice'. When theatre team members chose to remain silent rather than voice concerns this can be a protective or defensive strategy rather than passive inactivity.

Silence and Memories of War: An Autoethnographic Exploration of Family Secrecy

A personal journey and a scientific challenge, this is an autoethnographic study about my own family's secrecy. I knew my grandfather had been a German prisoner of war during World War II. We all knew. But nobody talked about it. Then one day I decided I wanted to do systematic research on the issue of family secrecy around my grandfather's war experiences. Researching one's own family can be called autoethnography. It could be said that autoethnography is an approach to research that aims to describe and systemically analyze (graphy) personal experience (auto) to understand social and cultural phenomena (ethno). This scientific approach is quite new in the field of family therapy. This study has been an important personal quest, but it also led to important reflections on silences in families, on my own professional development, and on methodological issues concerning autoethnographical research. For one thing, it highlights some of the positive aspects of family secrecy and silences, and invites us-when confronted with family secrecy in clinical practice-to carefully consider the potential destructive and life-giving aspects of the silence.

The Social Life of Abortion Law: on Personal and Political Pedagogy

The current contribution seeks to start a conversation around our pedagogical practice in respect of abortion law. Centralising the traditional portrayal of abortion law within the medical law curriculum, this essay highlights the privileging of a very particular storyline about abortion. Exploring the terrain in evaluating medical law methodologies, this essay highlights the illusion of 'balance', 'objectivity', and 'neutrality' that emerges from current pedagogy in light of how abortion law is framed and in particular what is excluded: women's own voices. Focusing on a number of 'exclusions' and 'silences' and noting how closely these mirror dominant discourse in the public sphere, this essay highlights the irony of a curriculum that reflects, rather than challenges, these discursive gaps. Arguing that the setting of a curriculum is inevitably political, ambitions for delivering a programme around abortion that is 'neutral', 'objective', or 'balanced' are dismissed. Instead, highlighting the problems of what is currently excluded, how materials are ordered, and the tacit hierarchies that lend legitimacy and authority to a particular way of 'knowing' abortion, this essay argues for a new curriculum and a new storyline-one which is supported by prior learning in feminist legal scholarship and a medical law curriculum in which the social, historical, geographical, and above all, personal is ever-present and central.

Eloquent silences: A musical and lexical analysis of conversation between oncologists and their patients

OBJECTIVE

Silences in doctor-patient communication can be "connectional" and communicative, in contrast to silences that indicate awkwardness or distraction. Musical and lexical analyses can identify and characterize connectional silences in consultations between oncologists and patients.

METHODS

Two medical students and a professor of voice screened all 1211 silences over 2s in length from 124 oncology office visits. We developed a "strength of connection" taxonomy and examined ten connectional silences for lexical and musical features including pitch, volume, and speaker turn-taking rhythm.

RESULTS

We identified connectional silences with good reliability. Typical dialog rhythms surrounding connectional silences are characterized by relatively equal turn lengths and frequent short vocalizations. We found no pattern of volume and pitch variability around these silences. Connectional silences occurred in a wide variety of lexical contexts.

CONCLUSION

Particular patterns of dialog rhythm mark connectional silences. Exploring structures of connectional silence extends our understanding of the audio-linguistic conditions that mark patient-clinician connection.

PRACTICE IMPLICATIONS

Communicating with an awareness of pitch, rhythm, and silence - in addition to lexical content - can facilitate shared understanding and emotional connection.

Something Blossoms in Between: Silence-Phenomena as a Bordering Notions in Psychology

Mysterious yet unavoidable, silence-phenomena appear to us in inherent ambiguity. In its plurality of meanings, phenomena related to silence are often perceived as overwhelming because they transcend the communicative capacity of language making it a challenge for cultural psychology to understand its involvement in our processes of making sense of experience and existence. Human growth and development involve processes where presence, void and content, voice, sound and noise, motion, transition and stillness, have dialectic interactions. In this article I discuss silence-phenomena as a bordering notion in terms of its discursive quality, the silent quality of speech, and the awareness of the ineffable. In addition, I highlight the possible implications of such notion in the understanding of affect from the perspective of Semiotic Cultural Psychology. I also emphasize the importance of considering psychological borders as multi-dimensional, taking the phenomenological experience of temporality as an illustration, which is also related to high emotional involvement of attention.