A critical perspective on second-order empathy in understanding psychopathology: phenomenology and ethics

The centenary of Karl Jaspers’ General Psychopathology was recognised in 2013 with the publication of a volume of essays dedicated to his work (edited by Stanghellini and Fuchs). Leading phenomenological-psychopathologists and philosophers of psychiatry examined Jaspers notion of empathic understanding and his declaration that certain schizophrenic phenomena are ‘un-understandable’. The consensus reached by the authors was that Jaspers operated with a narrow conception of phenomenology and empathy and that schizophrenic phenomena can be understood through what they variously called second-order and radical empathy. This article offers a critical examination of the second-order empathic stance along phenomenological and ethical lines. It asks: (1) Is second-order empathy (phenomenologically) possible? (2) Is the second-order empathic stance an ethically acceptable attitude towards persons diagnosed with schizophrenia? I argue that second-order empathy is an incoherent method that cannot be realised. Further, the attitude promoted by this method is ethically problematic insofar as the emphasis placed on radical otherness disinvests persons diagnosed with schizophrenia from a fair chance to participate in the public construction of their identity and, hence, to redress traditional symbolic injustices

More things in Heaven and Earth: spirit possession, mental disorder, and intentionality

Spirit possession is a common phenomenon around the world in which a non-corporeal agent is involved with a human host. This manifests in a range of maladies or in displacement of the host's agency and identity. Prompted by engagement with the phenomenon in North Africa, this paper draws connections between spirit possession, and the concepts of personhood and intentionality. It employs these concepts to articulate spirit possession, while also developing the intentional stance as formulated by Daniel Dennett. It argues for an understanding of spirit possession as the spirit stance: an intentional strategy that aims at predicting and explaining behaviour by ascribing to an agent (the spirit) beliefs and desires, but is only deployed once the mental states and activity of the subject (the person) fail specific normative distinctions. Applied to behaviours which are generally taken to signal mental disorder, the spirit stance preserves a peculiar form of intentionality where behaviour would otherwise be explained as a consequence of a malfunctioning physical mechanism. Centuries before the modern disciplines of psychoanalysis and phenomenological-psychopathology endeavoured to restore meaning to 'madness', the social institution of spirit possession had been preserving the intentionality of socially deviant behaviour

Genomic epidemiology of the Escherichia coli O104:H4 outbreaks in Europe, 2011

The degree to which molecular epidemiology reveals information about the sources and transmission patterns of an outbreak depends on the resolution of the technology used and the samples studied. Isolates of Escherichia coli O104:H4 from the outbreak centered in Germany in May–July 2011, and the much smaller outbreak in southwest France in June 2011, were indistinguishable by standard tests. We report a molecular epidemiological analysis using multiplatform whole-genome sequencing and analysis of multiple isolates from the German and French outbreaks. Isolates from the German outbreak showed remarkably little diversity, with only two single nucleotide polymorphisms (SNPs) found in isolates from four individuals. Surprisingly, we found much greater diversity (19 SNPs) in isolates from seven individuals infected in the French outbreak. The German isolates form a clade within the more diverse French outbreak strains. Moreover, five isolates derived from a single infected individual from the French outbreak had extremely limited diversity. The striking difference in diversity between the German and French outbreak samples is consistent with several hypotheses, including a bottleneck that purged diversity in the German isolates, variation in mutation rates in the two E. coli outbreak populations, or uneven distribution of diversity in the seed populations that led to each outbreak

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Polymerization shrinkage of resin-based composites for dental restorations: A digital volume correlation study

Objective: Resin-based composites are widely used in dental restorations; however, their volumetric shrinkage during polymerization leads to several issues that reduce the restoration survival rates. For overcoming this problem, a deep study of shrinkage phenomena is necessary. Methods: In this study, micro-tomography (μ-CT) is combined with digital volume correlation (DVC) to investigate the effect of several factors on the polymerization strain of dental composites in model cavities: the presence/absence of an adhesive, the use of transparent/blackened cavities, and irradiation times between 1 and 40 s. Results: The results indicate that the presence of an adhesive at the interface between the cavity and composite does not reduce the total strain but instead limits it to a preferential direction. In addition, regardless of the conditions, the main strain is generated along the axis parallel to the polymerization irradiation (the vertical axis). Finally, the total strain appears to occur in the first 5 s of irradiation, with no further evolution observed for longer irradiation times. Significance: This work provides new insight into resin-based composite shrinkage and demonstrates the benefit of coupling DVC and μ-CT to better understand the degradation mechanisms of these materials

Comparative genomics of Clostridium bolteae and Clostridium clostridioforme reveals species-specific genomic properties and numerous putative antibiotic resistance determinants.

International audienceClostridium bolteae and Clostridium clostridioforme, previously included in the complex C. clostridioforme in the group Clostridium XIVa, remain difficult to distinguish by phenotypic methods. These bacteria, prevailing in the human intestinal microbiota, are opportunistic pathogens with various drug susceptibility patterns. In order to better characterize the two species and to obtain information on their antibiotic resistance genes, we analyzed the genomes of six strains of C. bolteae and six strains of C. clostridioforme, isolated from human infection.The genome length of C. bolteae varied from 6159 to 6398 kb, and 5719 to 6059 CDSs were detected. The genomes of C. clostridioforme were smaller, between 5467 and 5927 kb, and contained 5231 to 5916 CDSs. The two species display different metabolic pathways. The genomes of C. bolteae contained lactose operons involving PTS system and complex regulation, which contribute to phenotypic differentiation from C. clostridioforme. The Acetyl-CoA pathway, similar to that of Faecalibacterium prausnitzii, a major butyrate producer in the human gut, was only found in C. clostridioforme. The two species have also developed diverse flagella mobility systems contributing to gut colonization. Their genomes harboured many CDSs involved in resistance to beta-lactams, glycopeptides, macrolides, chloramphenicol, lincosamides, rifampin, linezolid, bacitracin, aminoglycosides and tetracyclines. Overall antimicrobial resistance genes were similar within a species, but strain-specific resistance genes were found. We discovered a new group of genes coding for rifampin resistance in C. bolteae. C. bolteae 90B3 was resistant to phenicols and linezolide in producing a 23S rRNA methyltransferase. C. clostridioforme 90A8 contained the VanB-type Tn1549 operon conferring vancomycin resistance. We also detected numerous genes encoding proteins related to efflux pump systems.Genomic comparison of C. bolteae and C. clostridiofrome revealed functional differences in butyrate pathways and in flagellar systems, which play a critical role within human microbiota. Most of the resistance genes detected in both species were previously characterized in other bacterial species. A few of them were related to antibiotics inactive against Clostridium spp. Some were part of mobile genetic elements suggesting that these commensals of the human microbiota act as reservoir of antimicrobial resistances

Sarcopenia Independently and Accurately Predicts Survival in Patients Undergoing Spine Surgery for Metastatic Tumors: A Multicenter Retrospective Cohort Study

BACKGROUND CONTEXT: Predicting survival and surgical morbidity in patients with spinal metastases would help guide clinical decision making and stratify treatments between surgical intervention and palliative care. PURPOSE: To evaluate whether the frailty/sarcopenia paradigm, as measured by psoas size, is strong predictor of survival in patients undergoing surgery for spinal metastasis. To directly compare psoas size with current standards of predicting survival for surgery for spinal metastasis, including Tokuhashi score, Tomita score, and Karnofsky Performance Status (KPS). STUDY DESIGN/SETTING: Multi-center retrospective cohort. PATIENT SAMPLE: Patients from four academic tertiary care centers who had undergone surgery for spinal metastasis. OUTCOME MEASURES: Overall mortality. METHODS: Morphometric measurements were taken of the psoas muscle at the L4 vertebral level \u3c200 days from surgery. Mortality hazard ratios were calculated using multivariate analysis, with variables included from past medical history, type and extent of tumor spread, type and intensity of surgery, and postoperative chemotherapy or radiation. RESULTS: A total of 271 patients from four institutes were identified. Psoas size was predictive of overall mortality; patients in the smallest psoas tertile had shorter overall survival compared to the middle (OR 0.52, p\u3c0.001) and largest tertile (OR 0.45, p\u3c0.001). Psoas size predicted overall mortality more strongly than Tokuhashi score (OR 0.91, p=0.010), Tomita score (OR 1.07, p=0.04), and KPS (OR 0.99, p=0.58). Psoas size was also predictive of 90-day survival; patients in the smallest psoas tertile had shorter 90-day survival compared to the middle (OR 0.24, p=0.003) and largest tertile (OR 0.16, p=0.001). Psoas size predicted 90-day mortality more strongly than Tokuhashi score (OR 0.73, p=0.002), Tomita score (OR 1.00, p=0.92), and KPS (OR 0.98, p=0.39). CONCLUSIONS: In patients undergoing surgery for spine metastases, psoas size as a surrogate for frailty/sarcopenia predicts 90-day and overall mortality, independent of demographical, functional, oncological and surgical characteristics. The sarcopenia/frailty paradigm is a stronger predictor of survival at these time points than the Tokuhashi score, Tomita score and KPS. Psoas size can be used in clinical decision-making to select which patients with metastatic spine tumors are appropriate surgical candidates. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs

Sarcopenia Independently and Accurately Predicts Survival in Patients Undergoing Spine Surgery for Metastatic Tumors: A Multicenter Retrospective Cohort Study

BACKGROUND CONTEXT: Predicting survival and surgical morbidity in patients with spinal metastases would help guide clinical decision making and stratify treatments between surgical intervention and palliative care. PURPOSE: To evaluate whether the frailty/sarcopenia paradigm, as measured by psoas size, is strong predictor of survival in patients undergoing surgery for spinal metastasis. To directly compare psoas size with current standards of predicting survival for surgery for spinal metastasis, including Tokuhashi score, Tomita score, and Karnofsky Performance Status (KPS). STUDY DESIGN/SETTING: Multi-center retrospective cohort. PATIENT SAMPLE: Patients from four academic tertiary care centers who had undergone surgery for spinal metastasis. OUTCOME MEASURES: Overall mortality. METHODS: Morphometric measurements were taken of the psoas muscle at the L4 vertebral level \u3c200 days from surgery. Mortality hazard ratios were calculated using multivariate analysis, with variables included from past medical history, type and extent of tumor spread, type and intensity of surgery, and postoperative chemotherapy or radiation. RESULTS: A total of 271 patients from four institutes were identified. Psoas size was predictive of overall mortality; patients in the smallest psoas tertile had shorter overall survival compared to the middle (OR 0.52, p\u3c0.001) and largest tertile (OR 0.45, p\u3c0.001). Psoas size predicted overall mortality more strongly than Tokuhashi score (OR 0.91, p=0.010), Tomita score (OR 1.07, p=0.04), and KPS (OR 0.99, p=0.58). Psoas size was also predictive of 90-day survival; patients in the smallest psoas tertile had shorter 90-day survival compared to the middle (OR 0.24, p=0.003) and largest tertile (OR 0.16, p=0.001). Psoas size predicted 90-day mortality more strongly than Tokuhashi score (OR 0.73, p=0.002), Tomita score (OR 1.00, p=0.92), and KPS (OR 0.98, p=0.39). CONCLUSIONS: In patients undergoing surgery for spine metastases, psoas size as a surrogate for frailty/sarcopenia predicts 90-day and overall mortality, independent of demographical, functional, oncological and surgical characteristics. The sarcopenia/frailty paradigm is a stronger predictor of survival at these time points than the Tokuhashi score, Tomita score and KPS. Psoas size can be used in clinical decision-making to select which patients with metastatic spine tumors are appropriate surgical candidates. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs

Sarcopenia Predicts Overall Survival in Patients with Lung, Breast, Prostate, or Myeloma Spine Metastases Undergoing Stereotactic Body Radiation Therapy (SBRT), Independent of Histology

BACKGROUND: Predicting survival of patients with spinal metastases would help stratify treatments from aggressive to palliation. OBJECTIVE: To evaluate whether sarcopenia predicts survival in patients with lung, breast, prostate, or multiple myeloma spinal metastases. METHODS: Psoas muscle measurements in patients with spinal metastasis were taken from computed tomography scans at 2 time points: at first episode of stereotactic body radiation therapy (SBRT) and from the most recent scan available. Overall survival and hazard ratios were calculated with multivariate cox proportional hazards regression analyses. RESULTS: In 417 patients with spinal metastases, 40% had lung cancer, 27% breast, 21% prostate, and 11% myeloma. Overall survival was not associated with age, sex, ethnicity, levels treated, or SBRT volume. Multivariate analysis showed patients in the lowest psoas tertile had shorter survival (222 d, 95% CI = 185-323 d) as compared to the largest tertile (579 d, 95% CI = 405-815 d), (HR1.54, P = .005). Median psoas size as a cutoff value was also strongly predictive for survival (HR1.48, P = .002). Survival was independent of tumor histology. The psoas/vertebral body ratio was also successful in predicting overall survival independent of tumor histology and gender (HR1.52, P \u3c .01). Kaplan-Meier survival curves visually represent survival (P = .0005). CONCLUSION: In patients with spine metastases, psoas muscle size as a hallmark of frailty/sarcopenia is an objective, simple, and effective way to identify patients who are at risk for shorter survival, regardless of tumor histology. This information can be used to help with surgical decision making in patients with advanced cancer, as patients with small psoas sizes are at higher risk of death