The Problem of Empathy: Medicine and the Humanities

Health care institutions and medical educators assert that empathy is essential to optimum patient care, yet medical education and the practice of medicine often neglect empathy in favor of biomedical approaches to disease and injury. This essay discusses the development in medical literature of the concept of "clinical empathy"—which attempts to reorient a biomedical, disease-centered approach to treating illness by accounting for an increasing fluency within the interpersonal relations between physician and patient—and examines arguments for supplementing medical training with the study of literature and the practice of reflective writing as a means of developing empathy in physicians. In order to interrogate the problems as well as the possibilities of clinical empathy, I turn to theories of sympathy produced in the eighteenth century, when innovations in medical technology and knowledge had only begun to create separate categories that would ultimately untwine the body from mind and culture. The eighteenth century was also a time when philosophy and literature, rather than being compartmentalized from medicine as distinct disciplines, informed medical understandings before medicine became specialized as a "science." A critical approach to the theory and literature of the eighteenth century can help to formulate a productive critique of clinical empathy in contemporary medicine and to suggest possibilities for a reconfigured and strengthened understanding of empathy within the larger social context of institutions, systems, and access to care

Fake It Until You Make It? Female Leaders’ Emotional Expression Management and Subordinates’ Gender Stereotypes

As part of their organizational role, leaders manage their emotional expressions for the purpose of maintaining influence over followers, a concept that has received far less attention than the impact of other leadership behaviors. Further, there is almost no existing research regarding an employees’ reactions to the female supervisors’ emotional expression management (EEM), or the influence of subordinates’ underlying gender stereotypes on the relationship between leaders’ EEM and subordinate outcomes. To gain a better understanding of how EEM and the followers’ perception of gender roles interactively influence affective and attitudinal outcomes, this study used multi-source data from female leaders and their followers to examine the moderation effect of subordinates’ sex-based stereotypes on the relationship between leaders’ EEM and three dyadic outcomes: trust, satisfaction with communication, and commitment to goals set by the leader. Results from hierarchical multiple regressions found mixed support for the proposed relationships. As predicted, the relationship between genuinely felt emotional expressions and both subordinate trust and goal commitment was more positive for followers with stronger nontraditional views of women than for those with lower levels of nontraditional views. Additionally, genuinely felt expressions had a weaker positive relationship with trust for subordinates who held stronger communal stereotypes than for employees with lower levels of communal stereotypes. Unexpectedly, the associations between faked positive and suppressed negative EEM and the subordinate outcomes examined were not significantly affected by followers’ stereotypes about how women should act in general. The hypotheses for employee satisfaction with communication were also not supported. Given these results, I speculate that that female leaders may be subject to different behavioral norms than their male counterparts and that employee stereotypes may only have an impact on attitudes toward the leader when she deviates from these norms by expressing genuinely felt emotions. Theoretical and practical implications of the findings are discussed

Helping Employees Help the Environment: An Intervention to Increase Environmental Organizational Citizenship Behaviors (OCB-E) Via a Subtle Stimulus

Researchers’ understanding of the relationships between environmentally-oriented organizational citizenship behaviors (i.e., OCB-Es) and other workplace variables have improved since the turn of the century, but both our comprehension of the behaviors and the effectiveness of interventions targeting them require much more investigation. Further, there is very little research that examines the role of positive affect in promoting these behaviors, even though scholars have suggested that it may be the “silver bullet” (Kals & Müller, 2012) to facilitating employees’ voluntary environmental actions. To that end, the aim of the current research is to take an initial step towards understanding how organizations can use a subtle affective stimulus intervention to increase employees’ OCB-Es, as well as how stable personality traits may moderate this relationship. The current experimental field-study was designed to increase OCBEs via repeated exposure to a positively valenced subtle stimulus (i.e., a picture of a person smiling). In addition to examining positive affect as a mediator of this relationship, I also investigated how certain personality traits (i.e., openness to experience and conscientiousness) may both moderate the relationship between positive affect and OCB-Es and directly affect them. Although neither the proposed relationship between the subtle stimulus and positive affect nor the indirect effect of the stimulus on OCB-Es via positive affect for two of the three performance dimensions were supported, results did demonstrate a mediation effect of the III smiling picture on eco-initiative OCB-Es via positive affect. Additionally, the path analytic results found a direct relationship between openness to experience and eco-civic engagement OCB-Es, and a moderation effect of openness on the relationship to positive affect and ecoinitiative OCB-Es. Unfortunately, the direct and moderation effects for conscientiousness and OCB-Es failed to demonstrate significance. Theoretical and practical implications, limitations, and future directions based on these findings are discussed

Toward a More PERMA(nent) Conceptualization of Worker Well-Being? A Cross-Cultural Study of the Workplace PERMA Profiler

We examined the factor structure of the recently developed worker well-being measure the Workplace PERMA Profiler and relationships between PERMA dimensions (i.e., positive emotions, engagement, positive relationships, meaning, accomplishment) and job performance (viz., task performance, organizational citizenship behaviors benefiting individuals and the organization at large). The measure exhibited metric (i.e., weak) invariance across samples of participants from the U.S. (N = 284) and China (N = 420). Additionally, for participants who responded to both the Workplace PERMA Profiler and the performance measures, there was a general pattern of positive PERMA–performance relationships across both samples (NU.S. = 147; NChina = 202). Overall, the Workplace PERMA Profiler may have problematic psychometric properties and item wordings and thus would benefit from further refinement

The Potential and Peculiarities of PERMA: A Meta-Analysis of Two Well-Being Measures With Working Samples

In the first meta-analysis of the PERMA well-being framework (i.e., positive emotions, engagement, positive relationships, meaning, accomplishment), we cumulated 692 effect sizes (k = 33 independent samples, N = 10,050 workers). Average reliability did not meet the conventional ɑ = .70 threshold for engagement measured with the PERMA-Profiler or the Workplace PERMA Profiler or for negative emotions measured with the former. Overall, PERMA dimensions were strongly intercorrelated, and model comparisons suggested multidimensionality. We also summarized PERMA’s relationships with some conceptual antecedents (conscientiousness, loneliness); correlates (happiness, negative emotions); and outcomes (physical health, depressive symptoms, overall job performance). Additionally, we used dominance analysis to examine PERMA dimensions’ incremental validity. Although the framework holds promise for organizational research, PERMA measurement must be refined

Best practices for urban local food entrepreneurs and building regional Extension networks

Interest in local foods production in the urban environment has been steadily increasing in North Dakota and the surrounding region. Food entrepreneurs are seeking safe and reliable ways to grow, create, and market their fresh or freshly preserved products. Urban consumers are demanding local foods and food products that are fresh and safe. As an increasing number of producers and vendors enter farmers markets and other local food sales channels, these growing small businesses need technical assistance for safe food handling and marketing in the changing world of pandemics and supply chain issues. Although some basic practices, such as hand washing, have been encouraged for decades, the pandemic has shown that they are in constant need of reinforcement. Regulations for small-scale food entrepreneurs vary widely from state to state and can be confusing for both entrepreneurs and consumers. This lack of clarity is an ongoing issue, so a best practices document was created and disseminated throughout the North Central Region. The North Central Food Safety Extension Network (NCFSEN) has been building a coalition of Extension food safety professionals in our region since 2016. We have implemented several activities together, including monthly meetings, building relationships with industry professionals, developing educational materials, and creating a program evaluation tool for our region. Our network also has been working steadily to help other regions establish their own Extension coalitions to better serve their constituents as developed around a particular topic, such as food safety in our case. To that end, we have assembled best practices for creating regional Extension networks. The following elements was presented at the conference: 1) background of cottage foods in our region, pre- and post-pandemic; 2) best practices for local food entrepreneurs, including the relevance of “best practices” in view of varying state laws and regulations, health and hygiene policy for employees, volunteers, and family members, market day preparations and contingencies, creating, labeling, and sampling value-added food products; 3) evolving practices for pandemic circumstances in urban markets; 4) building regional Extension coalitions to better serve local constituencies; and 5) best practices for implementing your own regional Extension network, including benefits of regional collaboration, organization, communication, and setting goals

Immediate effect of a spinal mobilisation intervention on muscle stiffness, tone and elasticity in subjects with lower back pain - A randomized cross-over trial

Background Despite the lack of objective evidence, spinal manual therapies have been common practice for many years, particularly for treatment of lower back pain (LBP). This exploratory study measured and analysed the effect of a spinal mobilisation intervention on muscle tissue quality in LBP sufferers. Methods 40 people with LBP participated in a within-subject repeated measures cross-over study with intervention and control conditions. A myometer was used to assess the change in para-spinal muscle tissue quality before and after the intervention. Analysis considered the magnitude of muscle response together with individual covariates as potential contributors. Results A significant post-intervention reduction was observed in muscle stiffness (p = 0.012, η 2 partial = 0.15), tone (p = 0.001, η 2 partial = 0.25) and elasticity (p = 0.001, η 2 partial = 0.24). Significant increases were seen in 2 variables post-control: stiffness (p = 0.004, η 2 partial = 0.19), tone (p = 0.006, η 2 partial = 0.18) and a significant decrease in elasticity (p ˂ 0.000, η 2 partial = 0.3). Significant contributing covariates include baseline stiffness, BMI, waist circumference and sex. Baseline stiffness and tone were significantly correlated to their response levels. Conclusions The significant reduction in all muscle tissue qualities following the intervention provide preliminary data for an evidence-based LBP therapeutic. Baseline stiffness, BMI, waist circumference and sex could act as significant contributors to magnitude of response. The results warrant further investigation into spinal mobilisation therapies to further build the objective evidence base

Quantitative Expression and Co-Localization of Wnt Signalling Related Proteins in Feline Squamous Cell Carcinoma.

Feline oral squamous cell carcinoma (FOSCC) is an aggressive neoplasm in cats. Little is known about the possible molecular mechanisms that may be involved in the initiation, maintenance and progression of FOSCC. Wnt signalling is critical in development and disease, including many mammalian cancers. In this study, we have investigated the expression of Wnt signalling related proteins using quantitative immunohistochemical techniques on tissue arrays. We constructed tissue arrays with 58 individual replicate tissue samples. We tested for the expression of four key Wnt/ß-catenin transcription targets, namely Cyclin D1 (CCND1 or CD1), FRA1, c-Myc and MMP7. All antibodies showed cross reactivity in feline tissue except MMP7. Quantitative immunohistochemical analysis of single proteins (expressed as area fraction / amount of tissue for normal vs tumor, mean ± SE) showed that the expression of CD1 (3.9 ± 0.5 vs 12.2 ± 0.9), FRA1 (5.5 ± 0.6 vs 16.8 ± 1.1) and c-Myc (5.4 ± 0.5 vs 12.5 ± 0.9) was increased in FOSCC tissue by 2.3 to 3 fold compared to normal controls (p<0.0001). By using a multilabel, quantitative fluorophore technique we further investigated if the co-localization of these proteins (all transcription factors) with each other and in the nucleus (stained with 4',6-diamidino-2-phenylindole, DAPI) was altered in FOSCC compared to normal tissue. The global intersection coefficients, a measure of the proximity of two fluorophore labeled entities, showed that there was a significant change (p < 0.01) in the co-localization for all permutations (e.g. CD1/FRA1 etc), except for the nuclear localization of CD1. Our results show that putative targets of Wnt signalling transcription are up-regulated in FOSCC with alterations in the co-localization of these proteins and could serve as a useful marker for the disease.This research was funded by the Prostate Cancer Research Centre charity (registered UK charity no. 1156027), Grant Number AA1. A small financial contribution was also made through intra-mural funds from the Royal Veterinary College.This is the final version of the article. It first appeared from PLOS via http://dx.doi.org/10.1371/journal.pone.016110

Allele-specific demethylation at an imprinted mammalian promoter

A screen for imprinted genes on mouse Chromosome 7 recently identified Inpp5f_v2, a paternally expressed retrogene lying within an intron of Inpp5f. Here, we identify a novel paternally expressed variant of the Inpp5f gene (Inpp5f_v3) that shows a number of unusual features. Inpp5f_v3 initiates from a CpG-rich repeat region adjoining two B1 elements, despite previous reports that SINEs are generally excluded from imprinted promoters. Accordingly, we find that the Inpp5f_v3 promoter acquires methylation around the time of implantation, when many repeat families undergo de novo epigenetic silencing. Methylation is then lost specifically on the paternally derived allele during the latter stages of embryonic development, resulting in imprinted transcriptional activation on the demethylated allele. Methylation analyses in embryos lacking maternal methylation imprints suggest that the primary imprinting mark resides within an intronic CpG island ∼1 kb downstream of the Inpp5f_v3 transcriptional start site. These data support the hypothesis that SINEs can influence gene expression by attracting de novo methylation during development, a property likely to explain their exclusion from other imprinted promoters

Distinguishing Asthma Phenotypes Using Machine Learning Approaches.

Asthma is not a single disease, but an umbrella term for a number of distinct diseases, each of which are caused by a distinct underlying pathophysiological mechanism. These discrete disease entities are often labelled as asthma endotypes. The discovery of different asthma subtypes has moved from subjective approaches in which putative phenotypes are assigned by experts to data-driven ones which incorporate machine learning. This review focuses on the methodological developments of one such machine learning technique-latent class analysis-and how it has contributed to distinguishing asthma and wheezing subtypes in childhood. It also gives a clinical perspective, presenting the findings of studies from the past 5 years that used this approach. The identification of true asthma endotypes may be a crucial step towards understanding their distinct pathophysiological mechanisms, which could ultimately lead to more precise prevention strategies, identification of novel therapeutic targets and the development of effective personalized therapies