Psychiatric diagnosis and hermeneutical injustice: the impact of biomedical diagnoses on personal narratives

Users of mental health services are at risk of becoming victims of epistemic injustice, as described by Miranda Fricker. In this thesis, I claim that they can be victims specifically of hermeneutical injustice, which can occur due to the diagnosis they receive. A psychiatric diagnosis is often taken to represent some kind of discrete disease, as if it connotes a natural kind of disease entity. I argue that many physical diseases can be understood as natural kinds in medical science. However, most psychiatric diagnostic categories cannot be so understood. They do not offer any explanation for the patient’s condition. Much of modern psychiatry is based on the biomedical model of diseases. This model seeks the causes of patients’ illnesses in biological abnormalities in the body. Accordingly, the receipt of a psychiatric diagnosis can convey a biomedical narrative about the nature of the patient’s condition, one that tends to locate the cause of the condition in abnormal brain processes of some kind. The effect of this can be understood in terms of the self-narratives that individuals construct for themselves. I discuss several accounts of narrativity which explain how individuals gain meaning in their lives through their self-narratives. These narratives can be changed by the person’s social circumstances and by extraneous events. Receiving a psychiatric diagnosis is one such event in some people’s lives which can change the recipient’s self-narrative about their life and their difficulties. The medicalization implicit in psychiatric diagnoses conveys a biomedical narrative which may conflict with or diminish the recipient’s previous self- narratives at a time when they will be experiencing significant emotional distress and disturbance. As such, the recipient’s own hermeneutical resources for making sense of their experiences can become marginalised. This can result in the recipients of psychiatric diagnoses becoming victims of hermeneutical injustice

Fungicide resistance among Cladobotryum spp. – causal agents of cobweb disease of the edible mushroom Agaricus bisporus

A survey of fungicide resistance among isolates of the mushroom pathogens Cladobotryum mycophilum and C. dendroides Types I and II was undertaken, with respect to the active ingredients thiabendazole, carbendazim (benzimidazoles) and prochloraz manganese following an epidemic in Britain and Ireland in 1994/95. The majority of isolates (41/57) were strongly resistant to thiabendazole (ED50 > 200 ppm) and were exclusively C. dendroides Type II. All C. mycophilum and C. dendroides Type I isolates, and four C. dendroides Type II isolates, were weakly resistant to thiabendazole (ED50 1–10 ppm). Thiabendazole-resistant C. dendroides Type II isolates were only weakly resistant to carbendazim (ED50 2–10 ppm) and isolates which were weakly resistant to thiabendazole were carbendazim-sensitive (ED50 < 1 ppm), demonstrating a lack of complete cross resistance between these two benzimidazole fungicides. The ED50 values for all isolates with respect to prochloraz manganese ranged from 0.14 to 7.8 ppm. Benzimidazole resistance was considered to have been an important factor influencing the severity of the 1994/95 cobweb epidemic but 25% of isolates collected were benzimidazole sensitive

Survival and haematological recovery of children with severe malaria transfused in accordance to WHO guidelines in Kilifi, Kenya

Background: Severe anaemia requiring emergency blood transfusion is a common complication of malaria in children. To ensure access for urgent blood transfusion, the World Health Organization has developed clear guidelines with haemoglobin thresholds prevent unwarranted transfusion,. Few studies have reported outcome and haematological recovery of children with severe malaria where transfusion practice complies with WHO recommendations. Methods: A prospective observational study of survivors of severe and complicated malaria transfused in accordance with WHO guidelines. Children were invited for review at one month post-discharge. Non-attendees were traced in the community to ascertain survival. Results: Outcome was assessed in 213 survivors. Those transfused were younger, had a higher base deficit, mean lactate levels and a higher prevalence of respiratory distress. As expected mean admission haemoglobin (Hb) was significantly lower amongst transfused [5.0 g/dL SD: 1.9] compared to non-transfused children [8.3 g/dL SD: 1.7] (p < 0.001). At discharge mean Hb was similar 6.4 g/dL [SD: 1.5] and 6.8 g/dL [SD: 1.6] respectively (p = 0.08), most children remained moderately to severely anaemic. At one month follow up 166 children (78%) returned, in whom we found no differences in mean Hb between the transfused (10.2 g/dL [SD: 1.7]) and non-transfused (10.0 g/dL [SD: 1.3]) survivors ( p = 0.25). The major factors affecting haematological recovery were young age (< 24 months) and concomitant malaria parasitaemia; Hb being 8.8 g/dL [SD: 1.5] in parasitaemic individuals compared with 10.5 g/dL [SD: 1.3] in those without (p < 0.001). Conclusion: This data supports the policy of rational use of blood transfusion, as proposed in the WHO guidelines, for children with anaemia in areas where access to emergency transfusion is not guaranteed. We have provided empirical data indicating that transfusion does not influence superior recovery in haemoglobin concentrations and therefore cannot be justified on this basis alone. This may help resolve the disparity between international policy and current clinical practice. Effective anti- malarial treatment at discharge may prevent reoccurrence of anaemia

Overexpression of an endogenous type 2 diacylglycerol acyltransferase in the marine diatom Phaeodactylum tricornutum enhances lipid production and omega-3 long-chain polyunsaturated fatty acid content

Background: Oleaginous microalgae represent a valuable resource for the production of high-value molecules. Considering the importance of omega-3 long-chain polyunsaturated fatty acids (LC-PUFAs) for human health and nutrition the yields of high-value eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) require significant improvement to meet demand; however, the current cost of production remains high. A promising approach is to metabolically engineer strains with enhanced levels of triacylglycerols (TAGs) enriched in EPA and DHA. Results: Recently, we have engineered the marine diatom Phaeodactylum tricornutum to accumulate enhanced levels of DHA in TAG. To further improve the incorporation of omega-3 LC-PUFAs in TAG, we focused our effort on the identification of a type 2 acyl-CoA:diacylglycerol acyltransferase (DGAT) capable of improving lipid production and the incorporation of DHA in TAG. DGAT is a key enzyme in lipid synthesis. Following a diatom based in vivo screen of candidate DGATs, a native P. tricornutum DGAT2B was taken forward for detailed characterisation. Overexpression of the endogenous P. tricornutum DGAT2B was confirmed by qRT-PCR and the transgenic strain grew successfully in comparison to wildtype. PtDGAT2B has broad substrate specificity with preferences for C16 and LC-PUFAs acyl groups. Moreover, the overexpression of an endogenous DGAT2B resulted in higher lipid yields and enhanced levels of DHA in TAG. Furthermore, a combined overexpression of the endogenous DGAT2B and ectopic expression of a Δ5-elongase showed how iterative metabolic engineering can be used to increase DHA and TAG content, irrespective of nitrogen treatment. Conclusion: This study provides further insight into lipid metabolism in P. tricornutum and suggests a metabolic engineering approach for the efficient production of EPA and DHA in microalgae

Using mechanistic models to highlight research priorities for tick-borne zoonotic diseases: improving our understanding of the ecology and maintenance of Kyasanur forest disease in India

•Abstract: The risk of spillover of zoonotic diseases to humans is changing in response to multiple environmental and societal drivers, particularly in tropical regions where the burden of neglected zoonotic diseases is highest and land use change and forest conversion is occurring most rapidly. Neglected zoonotic diseases can have significant impacts on poor and marginalised populations in low-resource settings but ultimately receive less attention and funding for research and interventions. As such, effective control measures and interventions are often hindered by a limited ecological evidence base, which results in a limited understanding of epidemiologically relevant hosts or vectors and the processes that contribute to the maintenance of pathogens and spillover to humans. Here, we develop a generalisable next generation matrix modelling framework to better understand the transmission processes and hosts that have the greatest contribution to the maintenance of tick-borne diseases with the aim of improving the ecological evidence base and framing future research priorities for tick-borne diseases. Using this model we explore the relative contribution of different host groups and transmission routes to the maintenance of a neglected zoonotic tick-borne disease, Kyasanur Forest Disease Virus (KFD), in multiple habitat types. The results highlight the potential importance of transovarial transmission and small mammals and birds in maintaining this disease. This contradicts previous hypotheses that primates play an important role influencing the distribution of infected ticks. There is also a suggestion that risk could vary across different habitat types but currently more research is needed to evaluate this relationship. In light of these results, we outline the key knowledge gaps for this system and future research priorities that could inform effective interventions and control measures. •Author summary: The risk of humans contracting zoonotic diseases (diseases passed from animals to humans) is being altered by changes in the environment. These changes are occurring rapidly in tropical areas, which are burdened with neglected diseases that often disproportionately affect poorer communities. These diseases generally receive little attention and are less well studied. This means we often have a limited understanding of the ecological processes that influence the risk of people catching zoonotic diseases, which can be crucial in designing effective interventions. In this study, we developed mathematical models to highlight the ecological processes that influence the maintenance of Kyasanur Forest Disease, a neglected zoonotic disease affecting people in India. Using this approach, we were able to determine the hosts and forms of transmission that are most likely to play important roles in maintaining this pathogen and understand how risk to humans might vary in different habitats. We were also able to highlight key knowledge gaps and future research priorities that would help to inform interventions. An additional benefit of this approach is that it can also be used for other tick-borne diseases to help understand how pathogens are maintained and to prioritise the research questions that need to be addressed in other disease systems

HST/FOS Eclipse Observations of the Nova-like Cataclysmic Variable UX Ursae Majoris

[abridged abstract] We present and analyze Hubble Space Telescope observations of the eclipsing nova-like cataclysmic variable UX UMa obtained with the Faint Object Spectrograph. Two eclipses each were observed with the G160L grating (covering the ultraviolet waveband) in August of 1994 and with the PRISM (covering the near-ultraviolet to near-infrared) in November of the same year. The system was 50% brighter in November than in August, which, if due to a change in the accretion rate, indicates a fairly substantial increase in Mdot_acc by >~ 50%. Model disk spectra constructed as ensembles of stellar atmospheres provide poor descriptions of the observed post-eclipse spectra, despite the fact that UX UMa's light should be dominated by the disk at this time. Suitably scaled single temperature model stellar atmospheres with T_eff = 12,500-14,500 K actually provide a better match to both the ultraviolet and optical post-eclipse spectra. Evidently, great care must be taken in attempts to derive accretion rates from comparisons of disk models to observations. One way to reconcile disk models with the observed post-eclipse spectra is to postulate the presence of a significant amount of optically thin material in the system. Such an optically thin component might be associated with the transition region (``chromosphere'') between the disk photosphere and the fast wind from the system, whose presence has been suggested by Knigge & Drew (1997).Comment: 35 pages, including 12 figures; to appear in the ApJ (Vol. 499

Pathological demand avoidance: my thoughts on looping effects and commodification of autism

Hacking suggests autism is a human kind, and has used autism to discuss their evolution over time. Looping effects caused the autism human kind to evolve since 1995, with people identifying with the autism human kind, and the commodification of the autism human kind by the autism industry. Pathological demand avoidance (PDA) was created from the looping effects controlled by the autism industry. This has undermined autism self-advocacy by supporting the medical paradigm of the autism human kind. By refusing to engage with PDA, people of the autism human kind limit the commodification of autism; creating greater emancipation

Producing context specific land cover and land use maps of human-modified tropical forest landscapes for infectious disease applications

Satellite-based land cover mapping plays an important role in understanding changes in ecosystems and biodiversity. There are global land cover products available, however for region specific studies of drivers of infectious disease patterns, these can lack the spatial and thematic detail or accuracy required to capture key ecological processes. To overcome this, we produced our own Landsat derived 30 m maps for three districts in India's Western Ghats (Wayanad, Shivamogga and Sindhudurg). The maps locate natural vegetation types, plantation types, agricultural areas, water bodies and settlements in the landscape, all relevant to functional resource use of species involved in infectious disease dynamics. The maps represent the mode of 50 classification iterations and include a spatial measure of class stability derived from these iterations. Overall accuracies for Wayanad, Shivamogga and Sindhudurg are 94.7 % (SE 1.2 %), 88.9 % (SE 1.2 %) and 88.8 % (SE 2 %) respectively. Class classification stability was high across all three districts and the individual classes that matter for defining key interfaces between human habitation, forests, crop, and plantation cultivation, were generally well separated. A comparison with the 300 m global ESA CCI land cover map highlights lower ESA CCI class accuracies and the importance of increased spatial resolution when dealing with complex landscape mosaics. A comparison with the 30 m Global Forest Change product reveals an accurate mapping of forest loss and different dynamics between districts (i.e., Forests lost to Built-up versus Forests lost to Plantations), demonstrating an interesting complementarity between our maps and the % tree cover Global Forest Change product. When studying infectious disease responses to land use change in tropical forest ecosystems, we recommend using bespoke land cover/use classifications reflecting functional resource use by relevant vectors, reservoirs, and people. Alternatively, global products should be carefully validated with ground reference points representing locally relevant habitats. [Abstract copyright: Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.

The role of invasive alien species in the emergence and spread of zoonoses

The role of invasive alien species in the transmission dynamics of zoonotic pathogens is often overlooked, despite the rapid escalation in biological invasions globally. Here we synthesise available information on the influence of invasive alien species on zoonotic pathogen dynamics in invaded ranges, focussing on Europe, and identify key associated knowledge gaps. We identified 272 documented interactions between alien species and zoonotic pathogens within invaded ranges. The majority of these involved invasive alien mammals followed by birds with only a few occurrences of other taxa documented. A wide range of potential interactions between invasive alien species and zoonotic pathogens were identified but few studies considered transmission to humans and so there was limited evidence of actual impacts on human health. However, there is an urgent need to raise awareness of the potential risks posed to human health by the transmission of zoonotic diseases by invasive alien species; the role of invasive alien species in zoonotic disease transmission may exceed that of native wildlife and occur in a relatively short period following the arrival of an invasive alien species within a new region. Ecological and social mechanisms govern the dynamics of zoonotic disease transmission but wildlife diseases are not consistently included within animal, plant and human policies. Rapid advances in the development of systems frameworks that integrate the ecological, economic and social processes promoting spillover in rapidly changing environments will increase understanding to inform decision-making

Human settlement of East Polynesia earlier, incremental, and coincident with prolonged South Pacific drought

The timing of human colonization of East Polynesia, a vast area lying between Hawai‘i, Rapa Nui, and New Zealand, is much debated and the underlying causes of this great migration have been enigmatic. Our study generates evidence for human dispersal into eastern Polynesia from islands to the west from around AD 900 and contemporaneous paleoclimate data from the likely source region. Lake cores from Atiu, Southern Cook Islands (SCIs) register evidence of pig and/or human occupation on a virgin landscape at this time, followed by changes in lake carbon around AD 1000 and significant anthropogenic disturbance from c. AD 1100. The broader paleoclimate context of these early voyages of exploration are derived from the Atiu lake core and complemented by additional lake cores from Samoa (directly west) and Vanuatu (southwest) and published hydroclimate proxies from the Society Islands (northeast) and Kiribati (north). Algal lipid and leaf wax biomarkers allow for comparisons of changing hydroclimate conditions across the region before, during, and after human arrival in the SCIs. The evidence indicates a prolonged drought in the likely western source region for these colonists, lasting c. 200 to 400 y, contemporaneous with the phasing of human dispersal into the Pacific. We propose that drying climate, coupled with documented social pressures and societal developments, instigated initial eastward exploration, resulting in SCI landfall(s) and return voyaging, with colonization a century or two later. This incremental settlement process likely involved the accumulation of critical maritime knowledge over several generations