Naturalizing Institutions: Evolutionary Principles and Application on the Case of Money

In recent extensions of the Darwinian paradigm into economics, the replicator-interactor duality looms large. I propose a strictly naturalistic approach to this duality in the context of the theory of institutions, which means that its use is seen as being always and necessarily dependent on identifying a physical realization. I introduce a general framework for the analysis of institutions, which synthesizes Searle's and Aoki's theories, especially with regard to the role of public representations (signs) in the coordination of actions, and the function of cognitive processes that underly rule-following as a behavioral disposition. This allows to conceive institutions as causal circuits that connect the population-level dynamics of interactions with cognitive phenomena on the individual level. Those cognitive phenomena ultimately root in neuronal structures. So, I draw on a critical restatement of the concept of the meme by Aunger to propose a new conceptualization of the replicator in the context of institutions, namely, the replicator is a causal conjunction between signs and neuronal structures which undergirds the dispositions that generate rule-following actions. Signs, in turn, are outcomes of population-level interactions. I apply this framework on the case of money, analyzing the emotions that go along with the use of money, and presenting a stylized account of the emergence of money in terms of the naturalized Searle-Aoki model. In this view, money is a neuronally anchored metaphor for emotions relating with social exchange and reciprocity. Money as a meme is physically realized in a replicator which is a causal conjunction of money artefacts and money emotions

Improvement of a Clinical Score for Necrotizing Fasciitis: ‘Pain Out of Proportion’ and High CRP Levels Aid the Diagnosis

<div><p>Necrotizing fasciitis (NF) is a rare mono-/polymicrobial skin infection that spreads to underlying tissues. NF is quickly progressing and leads to life threatening situations. Immediate surgical debridement together with i.v. antibiotic administration is required to avoid fatal outcome. Early diagnosis is often delayed due to underestimation or confusion with cellulitis. We now compared the initial clinical and laboratory presentation of NF and cellulitis in detail to assess if a typical pattern can be identified that aids timely diagnosis of NF and avoidance of fatal outcome. 138 different clinical and laboratory features of 29 NF patients were compared to those of 59 age- and gender matched patients with severe erysipelas requiring a subsequent hospitalization time of ≥10 days. Differences in clinical presentation were not obvious; however, NF patients suffered significantly more often from strong pain. NF patients exhibited dramatically elevated CRP levels (5-fold, p>0.001). The overall laboratory risk indicator for necrotizing fasciitis (LRINEC) score was significantly higher in NF patients as compared to cellulitis. However, a modification of the score (alteration of laboratory parameters, addition of clinical parameters) led to a clear improvement of the score with a higher positive predictive value without losing specificity. In summary, clinical differentiation of NF from cellulitis appears to be hard. ‘Pain out of proportion’ may be an early sign for NF. An improvement of the LRINEC score emphasizing only relevant laboratory and clinical findings as suggested may aid the early diagnosis of NF in the future leading to improvement of disease outcome by enabling rapid adequate therapy.</p></div

Modifications of the laboratory risk indicator for necrotizing fasciitis (LRINEC) strongly improves its clinical value.

<p>A, For a all 29 NF and 59 matched cellulitis patients, the LRINEC score was calculated. Results are shown as box plots. B-F, To improve its clinical relevance, several variations to the LRINEC sore have been introduced. In B, CRP levels were modified to 2 points (≥100 mg/dl) and 4 points (≥150). In C, sodium and glucose were exchanged for erythrocyte count (<4 x10⁶/μl– 1 point) and fibrinogen levels (>750 mg/dl– 2 points). In D, alterations of B+C were combined. In E, clinically, immediately obvious parameters were added as follows: pain (strong– 2 points, intermediate– 1 point, mild/none– 0 points), fever (≥38°C– 2 points, 37.6–37.9°C– 1 point, ≤37.5°C– 0 points), tachycardia (>100 heart beats/minute– 1 point), and signs of renal failure (– 1 point). F, combination of D and E. For all variations, the scores were ranked as ‘no signs of NF’ (white), ‘suspicious’ (stripes), and ‘clear signs of NF’ (pink). At the bottom, sensitivity (sens.), specificity (spec.), positive and negative predictive values (PPV/NPV) of the (modified) scores are shown.</p

Clinical presentation of patients with necrotizing fasciitis (NF) as compared to cellulitis.

<p>All patient charts of 29 NF and 59 age- and gender matched patients with severe cellulitis were analysed retrospectively for various dermatological signs/descriptions of disease presentation, localization of disease, suspected etiology, and body temperature. All information is given in % of cases.</p

Laboratory findings in NF patients revealed significant signs of inflammation, renal failure and anaemia.

<p>Laboratory investigations were performed in most cases of NF and erysipelas. A, All findings were analysed using PASW Statistics 18.0 (IBM SPSS Inc.) and the binary logistic regression test; data are shown as box plots. Normal values/ranges are depicted as dotted lines (for erythrocyte count, and hemoglobuline gender specific ranges are given). Statistical differences between NF and cellulitis patients are indicated (* = <i>p</i>≤0.05). B, Laboratory values for erythrocyte counts, hemoglobulin and CRP were split by age groups as indicated.</p

‘Pain out of proportion’ is indicative for necrotizing fasciitis (NF), but not cellulitis.

<p>Pain description in the patient charts of 29 NF and 59 age- and gender matched patients with severe cellulitis was scored as “mild/none”, “intermediate” or “strong”. A, al information is given in % of cases. B, Patients with NF or cellulitis were divided into the age groups indicated. Pain assessment for NF and cellulitis is depicted separately.</p

Assessment of co-morbidities in NF and cellulitis patients.

<p>A, The number of concomitant diseases was assessed for each case of NF (n = 29) and cellulitis (n = 59). B, For NF and cellulitis patients, the % of cases showing co-morbidities for each of the indicated diseases is shown. Statistical analyses using the binary logistic regression test revealed statistically significant differences for renal failure and chronic venous insufficiency. C, The body mass index was calculated for each patient. A+C, all data is shown as box plot.</p

Clinical presentation of patients with necrotizing fasciitis (NF) as compared to cellulitis.

<p>All patient charts of 29 NF and 59 age- and gender matched patients with severe cellulitis were analysed retrospectively for various dermatological signs/descriptions of disease presentation, localization of disease, suspected etiology, and body temperature. All information is given in % of cases.</p