Technomoral Resilience as a Goal of Moral Education

In today’s highly dynamic societies, moral norms and values are subject to change. Moral change is partly driven by technological developments. For instance, the introduction of robots in elderly care practices requires caregivers to share moral responsibility with a robot (see van Wynsberghe 2013). Since we do not know what elements of morality will change and how they will change (see van der Burg 2003), moral education should aim at fostering what has been called “moral resilience” (Swierstra 2013). We seek to fill two gaps in the existing literature: (i) research on moral education has not paid enough attention to the development of moral resilience; (ii) the very limited literature on moral resilience does not conceptualise moral resilience in relation to new technological developments. We argue that philosophical accounts of moral education need to do justice to the importance of moral resilience, and that a specific form of moral resilience should be conceptualised as “technomoral resilience” to underline the added value of cultivating moral resilience in relation to technomoral change. We illustrate the role of technomoral resilience in practice by looking at the context of elderly care. To make the first step towards an account of how technomoral resilience can be fostered in moral education, we propose that moral education shall focus on a triangle of capacities: (1) moral imagination, (2) a capacity for critical reflection, and (3) a capacity for maintaining one’s moral agency in the face of disturbances

Neural correlates of error prediction in a complex motor task

The goal of the study was to quantify error prediction processes via neural correlates in the Electroencephalogram (EEG). Access to such a neural signal will allow to gain insights into functional and temporal aspects of error perception in the course of learning. We focused on the error negativity (Ne) or error-related negativity (ERN) as a candidate index for the prediction processes. We have used a virtual goal-oriented throwing task where participants used a lever to throw a virtual ball displayed on a computer monitor with the goal of hitting a virtual target as often as possible. After one day of practice with 400 trials, participants performed another 400 trials on a second day with EEG measurement. After error trials (i.e., when the ball missed the target), we found a sharp negative deflection in the EEG peaking 250 ms after ball release (mean amplitude: t = -2.5, df = 20, p = 0.02) and another broader negative deflection following the first, reaching from about 300 ms after release until unambiguous visual knowledge of results (KR; hitting or passing by the target; mean amplitude: t = -7.5, df = 20, p < 0.001). According to shape and timing of the two deflections, we assume that the first deflection represents a predictive Ne/ERN (prediction based on efferent commands and proprioceptive feedback) while the second deflection might have arisen from action monitoring

A brief patient-reported outcome instrument for primary care: German translation and validation of the Measure Yourself Medical Outcome Profile (MYMOP)

Background: Measure Yourself Medical Outcome Profile (MYMOP) is a patient-generated outcome instrument capable of measuring effects from a wide range of health care interventions. This paper reports the translation of this instrument into German (MYMOP-D) and the assessment of validity and sensitivity to change for the MYMOP-D. The instrument was piloted in a German primary care context. Methods: The translation process was conducted according to international guidelines. Recruited patients of both general practitioners and non-medical Complementary and Alternative Medicine (CAM) practitioners (“Heilpraktiker”) in the German state of Baden-Wuerttemberg completed a questionnaire comprised of the MYMOP-D and the EQ-5D. Responses were analysed to assess construct validity. For assessing the instrument’s sensitivity to change, patients received the MYMOP-D again after four weeks at which point they were also asked for their subjective views on change of symptoms. Correlation between MYMOP-D and EQ-5D and sensitivity to change as gradient in score change and as standardized response mean (SRM) were calculated. Results: 476 patients from general practices and 91 patients of CAM practitioners were included. Construct validity of the MYMOP-D was given with a correlation of r = .47 with the EQ-5D. Sensitivity to change for subjective change of symptoms could only be analysed for improvement or no change of symptoms, as only 12 patients reported deterioration of symptoms. Results showed the expected smooth gradient with 2.2, 1.3, and 0.5 points of change for large, little improvement and no change, respectively. SRM for MYMOP-D Profile Score was 0.88. Conclusions: The MYMOP-D shows excellent construct validity. It is able to detect changes when symptoms in patients improve or remain unchanged. Deterioration of symptoms could not be evaluated due to too few data. With its brevity and simplicity, it might be an important tool for enhancing patient-centred care in the German health care context

Evaluation of producer cell lines for yellow fever virus production in up to 1 L bioreactor scale

Yellow fever virus (YFV) vaccine is currently produced in embryonated chicken eggs. Following recent outbreaks of flavivirus-related diseases, such as Zika fever, significant efforts are needed towards fast establishment of cell culture-based production processes for attenuated or inactivated virus vaccines. To support the development of such processes, we have screened various cell lines, including adherent and suspension cells, for permissiveness and productivity of YFV. In particular, the parental adherent Vero cell line possesses a reasonable cell-specific productivity of about 13 PFU/cell. However, surface-depended scale-up restricts production processes to roller bottles, microcarrier-based or fixed-bed bioreactors with limited monitoring and excessive efforts for large-scale production. A preferential alternative is the cultivation of single-cells in stirred-tank bioreactors, which can be operated in perfusion mode to achieve higher cell-densities. Towards this process intensification, we have adapted the parental WHO Vero cell line to grow in suspension. However, infection studies of Vero suspension cells with YFV in spinner flasks using chemically defined medium showed a reduced cell-specific titer (2 PFU/cell). Another option might be the use of BHK-21 cells reaching cell-densities above 5 × 106 cells/mL in shake flasks. Infection studies with YFV in small-scale have resulted in a cell-specific productivity of 10 PFU/cell. Thus, infection parameters (time of infection, MOI = ratio of virus to cell) were optimized and subsequently transferred into 1 L bioreactors. Final titer of 5 × 107 PFU/mL could be reached. As a reference, adherent Vero cells were cultivated on Cytodex-1 microcarriers in 1 L scale resulting in a final titer of 2 × 107 PFU/mL. In both cultivations, cell-specific yields were comparable but due to the adjusted MOI of 10-4 in the BHK-21 cultivation, the overall virus production was 50 × higher than for the Vero cultivation on microcarriers. Although BHK-21 cells and their application for human vaccines are controversial with respect to tumorigenicity and oncogenicity, our results show that it may be worth to reconsider this cell line for future production processes

Anatomical Joint Form Variation in Sacroiliac Joint Disease: Current Concepts and New Perspectives

Purpose of Review: The aim of this article is to further the understanding of anatomical variation of the sacroiliac joint (SIJ) within the rheumatological community and point out promising fields of research in the interplay of SIJ anatomy and joint disease. Recent Findings: Mechanical strain has long been implicated in onset and progression of axial spondyloarthritis (axSpA). Recent investigations found changes in the pattern of degenerative lesions of the SIJ in the normal population in patients with atypical joint forms. Furthermore, atypical SIJ forms are more prevalent in patients with axial spondyloarthritis and mechanical SIJ disease. Mechanical stress from anatomical joint form variation may have an impact on development and progression of axSpA. Furthermore, mechanically induced bone marrow edema may act as an axSpA mimic on MRI and needs to be more accurately classified

Imaging of Joints and Bones in Autoinflammation

Autoinflammatory disorders are commonly characterized by seemingly unprovoked systemic inflammation mainly driven by cells and cytokines of the innate immune system. In many disorders on this spectrum, joint and bone involvement may be observed and imaging of these manifestations can provide essential diagnostic information. This review aimed to provide a comprehensive overview of the imaging characteristics for major diseases and disease groups on the autoinflammatory spectrum, including familial Mediterranean fever (FMF), Behcet disease (BD), crystal deposition diseases (including gout), adult-onset Still's disease (AoSD), and syndromatic synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO)/chronic recurrent multifocal osteomyelitis (CRMO). Herein, we discuss common and distinguishing imaging characteristics, phenotypical overlaps with related diseases, and promising fields of future research

Dual-energy CT collagen density mapping of wrist ligaments reveals tissue remodeling in CPPD patients: first results from a clinical cohort

Objectives: To evaluate differences in collagen density as detected by dual-energy computed tomography (DECT) of wrist ligaments between patients with calcium pyrophosphate-dihydrate deposition disease (CPPD) and a control group in order to gain insight into changes of the extracellular matrix in response to crystal deposition. Materials and methods: This retrospective study included 28 patients (18 with CPPD, 10 controls) who underwent DECT of the wrist. Collagen density maps were reconstructed from the DECT datasets and used to measure densities in regions of interest (ROIs) placed in the scapholunate (SL) ligament (dorsal, palmar, proximal), lunotriquetral (LT) ligament, and extensor carpi radialis (ECR) tendon, (n = 260 measurements). The presence of calcifications on standard CT images in these regions was assessed by a blinded reader. Densities were compared with nonparametric tests, and linear regression analysis was performed to investigate the impact of age, sex, and CT- detected calcium deposition on collagen density. Results: Collagen density in the SL ligament was significantly higher in CPPD patients than in controls (overall mean: 265.4 ± 32.1 HU vs. 196.3 ± 33.8 HU; p < 0.001). In the ECR tendon, collagen densities did not differ significantly (p = 0.672): 161.3 ± 20.1 HU in CPPD vs. 163.6 ± 12.0 HU in controls. Regression analysis showed that diagnosis, but not age or calcification, had a significant impact on collagen density. Conclusion: Collagen density of the SL ligament is significantly higher in CPPD patients than in control patients. Further research is needed to understand these changes in the extracellular matrix of ligaments in CPPD

A Resolved Simulation Approach to Investigate the Separation Behavior in Solid Bowl Centrifuges Using Material Functions

The separation of finely dispersed particles from liquids is a basic operation in mechanical process engineering. On an industrial scale, continuously operating decanter centrifuges are often used, whose separation principle is based on the density difference between the solid and the liquid phase due to high g-forces acting on both phases. The design of centrifuges is based on the experience on the individual manufacturer or simplified black box models, which only consider a stationary state. Neither the physical behavior of the separation process nor the sediment formation and its transport is considered. In this work, a computationally-efficient approach is proposed to simulate the separation process in decanter centrifuges. Thereby, the open-source computation software OpenFOAM was used to simulate the multiphase flow within the centrifuge. Sedimentation, consolidation of the sediment, and its transport are described by material functions which are derived from experiments. The interactions between the particles and the fluid are considered by locally defined viscosity functions. This work shows that the simulation method is suitable for describing the solid-liquid separation in a simplified test geometry of a decanter centrifuge. In addition, the influence of the rheological behavior on the flow in the test geometry can be observed for the first time