Mesopomatian Eye Disease Texts: The Nineveh Treatise. By Markham J. Geller and Strahil V. Panayotov. Die Babylonisch-Assyrische Medizin in Texten und Untersuchungen, vol. 10. Berlin: de Gruyter, 2020. Pp. xii + 454, illus. $181.99.

Until recently, the ocular surface is thought by many to be sterile and devoid of living microbes. It is now becoming clear that this may not be the case. Recent and sophisticated PCR analyses have shown that microbial DNA‐based “signatures” are present within various ethnic, geographic, and contact lens wearing communities. Furthermore, using a mouse model of ocular surface disease, we have shown that the microbe, Corynebacterium mastitidis (C. mast), can stably colonize the ocular mucosa and that a causal (...) relationship exists between ocular C. mast colonization and beneficial local immunity. While this constitutes proof‐of‐concept that a bona fide ocular microbiome that tunes immunity can exist at the ocular surface, there remain numerous unanswered questions to be addressed before microbiome‐modulating therapies may be successfully developed. Here, the authors will briefly outline what is currently known about the local ocular microbiome as well as microbiomes associated with other sites, and how those sites may play a role in ocular surface immunity. Understanding how commensal microbes affect the ocular surface immune homeostasis has the potential revolutionize how we think about treating ocular surface disease. (shrink)

PurposeTo investigate spontaneous brain activity in patients with dry eye and healthy control using the fractional amplitude of low frequency fluctuation technique with the aim of elucidating the relationship between the clinical symptoms of DE and changes in brain function.Material and MethodsA total of 28 patients with DE and 28 matched healthy volunteers were enrolled. Resting-state functional magnetic resonance imaging scans were performed in both groups. Then all subjects were required to complete a comprehensive Hospital Anxiety and Depression Scale. Receiver (...) operating characteristic curve analysis was used to evaluate the differences in fALFF values between the two groups and their diagnostic value. Linear correlations between HADS and fALFF values in different brain regions of DE patients were analyzed using the Pearson correlation coefficient.ResultsPatients with DE had significantly higher fALFF values in the left calcarine sulcus than the HC group, while fALFF values in the bilateral middle frontal gyrus and right MFG/right inferior frontal gyrus were significantly lower in DE patients than in HC group. fALFF values had a high diagnostic value for differentiating patients with DE from the HC group. Right MFG and right MFG/IFG were significantly correlated with HADS values.ConclusionOur study found that DE mainly involved functional disorders in the brain areas of the left CS, bilateral MFG and right MFG/right IFG, which helped us to find possible clinical features of DE disease and reflected the potential pathological mechanism of DE. (shrink)

Eye-tracking technology has become a powerful tool for biomedical-related applications due to its simplicity of operation and low requirements on patient language skills. This study aims to use the machine-learning models and deep-learning networks to identify key features of eye movements in Alzheimer's Disease (AD) under specific visual tasks, thereby facilitating computer-aided diagnosis of AD. Firstly, a three-dimensional (3D) visuospatial memory task is designed to provide participants with visual stimuli while their eye-movement data are recorded and used to build (...) an eye-tracking dataset. Then, we propose a novel deep-learning-based model for identifying patients with Alzheimer's Disease (PwAD) and healthy controls (HCs) based on the collected eye-movement data. The proposed model utilizes a nested autoencoder network to extract the eye-movement features from the generated fixation heatmaps and a weight adaptive network layer for the feature fusion, which can preserve as much useful information as possible for the final binary classification. To fully verify the performance of the proposed model, we also design two types of models based on traditional machine-learning and typical deep-learning for comparison. Furthermore, we have also done ablation experiments to verify the effectiveness of each module of the proposed network. Finally, these models are evaluated by four-fold cross-validation on the built eye-tracking dataset. The proposed model shows 85% average accuracy in AD recognition, outperforming machine-learning methods and other typical deep-learning networks. (shrink)

Review of Searching Eyes: Privacy, the State, and Disease Surveillance in America – By Amy L. Fairchild, Ronald Bayer, and James Colgrove.

During development of the anterior eye segment, cells that originate from the surface epithelium or the neuroepithelium need to interact with mesenchymal cells, which predominantly originate from the neural crest. Failures of proper interaction result in a complex of developmental disorders such Peters' anomaly, Axenfeld–Rieger's syndrome or aniridia. Here we review the role of transcription factors that have been identified to be involved in the coordination of anterior eye development. Among these factors is PAX6, which is active in both epithelial (...) and mesenchymal cells during ocular development, albeit at different doses and times. We propose that PAX6 is a key element that synchronizes the complex interaction of cell types of different origin, which are all needed for proper morphogenesis of the anterior eye. We discuss several molecular mechanisms that might explain the effects of haploinsufficiency of PAX6 and other transcription factors, and the broad variation of the resulting phenotypes. BioEssays 26:374–386, 2004. © 2004 Wiley Periodicals, Inc. (shrink)

Spontaneous eye blink rate has been linked to attention and memory, specifically working memory. sEBR is also related to striatal dopamine activity with schizophrenia and Parkinson’s disease showing increases and decreases, respectively, in sEBR. A weakness of past studies of sEBR and WM is that correlations have been reported using blink rates taken at baseline either before or after performance of the tasks used to assess WM. The goal of the present study was to understand how fluctuations in sEBR (...) during different phases of a visual WM task predict task accuracy. In two experiments, with recordings of sEBR collected inside and outside of a magnetic resonance imaging bore, we observed sEBR to be positively correlated with WM task accuracy during the WM delay period. We also found task-related modulation of sEBR, including higher sEBR during the delay period compared to rest, and lower sEBR during task phases that place demands on visual attention. These results provide further evidence that sEBR could be an important predictor of WM task performance with the changes during the delay period suggesting a role in WM maintenance. The relationship of sEBR to DA activity and WM maintenance is discussed. (shrink)

The limbus is a narrow band of tissue that encircles the cornea, the transparent ‘window’ into the eye. The outermost layer of the cornea is the epithelium, which is necessary for clear vision. The limbus acts as a ‘reservoir’ for limbal stem cells which maintain and regenerate the corneal epithelium. It also functions as a barrier to the conjunctiva and its blood vessels. Limbal stem cell deficiency is a general term for diseases which are characterised by the impairment of the (...) limbus, limbal stem cells and their ability to replenish the corneal epithelium through proliferation and differentiation. Consequently, sufferers experience chronic pain and progressive blindness. This paper will highlight the salient milestones of limbal stem cell biology and potential future treatments for limbal stem cell deficiency. (shrink)

ObjectiveTo explore alterations in white matter network topology in de novo Parkinson's disease patients with rapid eye movement sleep behavior disorder.Materials and MethodsThis study included 171 de novo PD patients and 73 healthy controls recruited from the Parkinson's Progression Markers Initiative database. The patients were divided into two groups, PD with probable RBD and PD without probable RBD, according to the RBD screening questionnaire. Individual structural network of brain was constructed based on deterministic fiber tracking and analyses were performed (...) using graph theory. Differences in global and nodal topological properties were analyzed among the three groups. After that, post hoc analyses were performed to explore further differences. Finally, correlations between significant different properties and RBDSQ scores were analyzed in PD-pRBD group.ResultsAll three groups presented small-world organization. PD-pRBD patients exhibited diminished global efficiency and increased shortest path length compared with PD-npRBD patients and HCs. In nodal property analyses, compared with HCs, the brain regions of the PD-pRBD group with changed nodal efficiency were widely distributed mainly in neocortical and paralimbic regions. While compared with PD-npRBD group, only increased Ne in right insula, left middle frontal gyrus, and decreased Ne in left temporal pole were discovered. In addition, significant correlations between Ne in related brain regions and RDBSQ scores were detected in PD-pRBD patients.ConclusionsPD-pRBD patients showed disrupted topological organization of white matter in the whole brain. The altered Ne of right insula, left temporal pole and left middle frontal gyrus may play a key role in the pathogenesis of PD-RBD. (shrink)

‘The portraits of disease’ explores the link between the symbolic use of diseases and the propagation of ideologies. It traces the origins of the term ‘Sick Man of Asia’ back to British newspapers in the mid-eighteenth century and its development into a metaphor for actual pathogens. The author contends that coloniality and pathogens share similarities, as both are highly transmissible and cannot be seen with the naked eye. The text also examines the influence of German-influenced microbiological research in the (...) Japanese Empire on the expansion of public health methods and institutions in Taiwan, Korea and north-eastern China. This study calls for a broader conversation about the intersections between science, ideology and power in our contemporary global context. (shrink)

The vestibulo-ocular reflex plays an important role in controlling the gaze at a visual target. Although patients with vestibular hypofunction aim to improve their VOR function, some retain dysfunction for a long time. Previous studies have explored the effects of direct current stimulation on vestibular function; however, the effects of random noise stimulation on eye–head coordination have not previously been tested. Therefore, we aimed to clarify the effects of high frequency noisy vestibular stimulation on eye–head coordination related to VOR function. (...) Thirteen healthy young adult participants with no serious disease took part in our study. The current amplitude and density used were 0.4 mA and 0.2 mA/cm2, respectively, with a random noise frequency of 100–640 Hz. The electrodes were located on both mastoid processes. The stimulus duration and fade in/out duration were 600 and 10 s, respectively. Subjects oscillated their head horizontally, gazing at the fixation point, at 1 Hz for 30 repetitions. The coordination of eye–head movements was measured by eye-tracking and a motion capture system. Peak-to-peak angles for eye and head movement and deviation of the visual line from the fixation target revealed no significant differences between HF-nVS and sham. The lag time between the eye and head movement with HF-nVS post-stimulation was significantly shorter than that of the sham. We found that HF-nVS can reduce the lag time between eye and head movement and improve coordination, contributing to a clear retinal image. This technique could be applied as a form of VOR training for patients with vestibular hypofunction. (shrink)

Postural instability in Parkinson’s disease (PD) is characterized by impaired postural responses to transient perturbations, increased postural sway in stance and difficulty transitioning between tasks. In addition, some studies suggest that loss of dopamine in the basal ganglia due to PD results in difficulty using proprioceptive information for motor control. Here, we quantify the ability of subjects with PD and age-matched control subjects to use and re-weight sensory information for postural control during steady-state conditions of continuous rotations of the (...) stance surface or visual surround. We measure the postural sway of subjects in response to a pseudorandom, surface-tilt stimulus with eyes closed, and in response to a pseudorandom, visual-tilt stimulus. We use a feedback control model of the postural control system to interpret our results, focusing on sensory weighting as a function of stimulus amplitude. We find that subjects with PD can re-weight their dependence upon sensory information in response to changes in surface- or visual-stimulus amplitude. Specifically, subjects with PD behaved like age-matched control subjects by decreasing proprioceptive contribution to stance control with increasing surface-tilt amplitude, and decreasing visual contribution with increasing visual-tilt amplitude. However, subjects with PD do not decrease their reliance on proprioception as much as age-matched controls for small increases in surface-stimulus amplitudes. Levodopa medication did not affect sensory re-weighting behaviors for postural control. The impairment in PD subject’s ability to respond differently to small changes in surface rotation amplitudes is consistent with an increased threshold for perceiving proprioceptive signals, which may result from decreased signal-to-noise in the dopaminergic pathways associated with sensory processing and/or sensory integration. (shrink)

In recent years, the genetic testing and selection of IVF embryos, known as preimplantation genetic testing (PGT), has gained much traction in clinical assisted reproduction for preventing transmission of genetic defects. However, a more recent ethically and morally controversial development in PGT is its possible use in selecting IVF embryos for optimal intelligence quotient (IQ) and other non–disease-related socially desirable traits, such as tallness, fair complexion, athletic ability, and eye and hair colour, based on polygenic risk scores (PRS), in (...) what is referred to as PGT-P. Artificial intelligence (AI) and machine learning–based analysis of big data sets collated from genome sequencing of specific human ethnic populations can be used to estimate an individual embryo’s likelihood of developing such multifactorial traits by analysing the combination of specific genetic variants within its genome. Superficially, this technique appears compliant with Islamic principles and ethics. Because there is no modification of the human genome, there is no tampering with Allah’s creation (taghyīr khalq Allah). Nevertheless, a more critical analysis based on the five maxims of Islamic jurisprudence (qawa'id fiqhiyyah) that are often utilized in discourses on Islamic bioethics, namely qaṣd (intention), yaqın̄ (certainty), ḍarar (injury), ḍarūra (necessity), and `urf (custom), would instead reveal some major ethical and moral flaws of this new medical technology in the selection of non–disease-related socially desirable traits, and its non-compliance with the spirit and essence of Islamic law (shariah). Muslim scholars, jurists, doctors, and biomedical scientists should debate this further and issue a fatwa on this new medical technology platform. (shrink)

In the last few decades, philosophy of science has increasingly focused on multilevel models and causal mechanistic explanations to account for complex biological phenomena. On the one hand, biological and biomedical works make extensive use of mechanistic concepts; on the other hand, philosophers have analyzed an increasing range of examples taken from different domains in the life sciences to test—support or criticize—the adequacy of mechanistic accounts. The article highlights some challenges in the elaboration of mechanistic explanations with a focus on (...) cancer research and neuropsychiatry. It jointly considers fields, which are usually dealt with separately, and keeps a close eye on scientific practice. The article has a twofold aim. First, it shows that identification of the explananda is a key issue when looking at dynamic processes and their implications in medical research and clinical practice. Second, it discusses the relevance of organizational accounts of mechanisms, and questions whether thorough self-sustaining mechanistic explanations can actually be provided when addressing cancer and psychiatric diseases. While acknowledging the merits of the wide ongoing debate on mechanistic models, the article challenges the mechanistic approach to explanation by discussing, in particular, explanatory and conceptual terms in the light of stances from medical cases. (shrink)

Background: Arthritis is very common but is not well understood. Actually, “arthritis” is not a single disease; it is an informal way of referring to joint pain or joint disease. There are more than 100 different types of arthritis and related conditions. People of all ages, sexes and races can and do have arthritis, and it is the leading cause of disability in America. More than 50 million adults and 300,000 children have some type of arthritis. It is (...) most common among women and occurs more frequently as people get older. Common arthritis joint symptoms include swelling, pain, stiffness and decreased range of motion. Symptoms may come and go. They can be mild, moderate or severe. They may stay about the same for years, but may progress or get worse over time. Severe arthritis can result in chronic pain, inability to do daily activities and make it difficult to walk or climb stairs. Arthritis can cause permanent joint changes. These changes may be visible, such as knobby finger joints, but often the damage can only be seen on X-ray. Some types of arthritis also affect the heart, eyes, lungs, kidneys and skin as well as the joints. Objectives: The main goal of this expert system is to get the appropriate diagnosis of disease and the correct treatment and give the appropriate method of treatment through several tips that concern the disease and how to treat it and we will see it through the application on the expert system. Methods: in this paper the design of the proposed Expert System which was produced to help Orthopedist in diagnosing Arthritis disease through its symptoms such as: pain on pressure in a joint , Inflammation indicated by joint swelling, Stiffness especially in the morning , Loss of flexibility of joint, Limited, joint movement, Deformity of the joints , Weight loss and fatigue , Non-specific fever and Crepitus. The proposed expert system presents an overview about Arthritis disease is given, the cause of diseases is outlined and the treatment of disease whenever possible is given out. SL5 Object Expert System language was used for designing and implementing the proposed expert system. Results: The proposed Arthritis disease diagnosis expert system was evaluated by Orthopedics students and they were satisfied with its performance. Conclusions: The Proposed expert system is very useful for Orthopedist, patients with arthritis and newly graduated Orthopedics students. (shrink)

The growth of strawberry will be stressed by biological or abiotic factors, which will cause a great threat to the yield and quality of strawberry, in which various strawberry diseased. However, the traditional identification methods have high misjudgment rate and poor real-time performance. In today's era of increasing demand for strawberry yield and quality, it is obvious that the traditional strawberry disease identification methods mainly rely on personal experience and naked eye observation and cannot meet the needs of people (...) for strawberry disease identification and control. Therefore, it is necessary to find a more effective method to identify strawberry diseases efficiently and provide corresponding disease description and control methods. In this paper, based on the deep convolution neural network technology, the recognition of strawberry common diseases was studied, as well as a new method based on deep convolution neural network strawberry disease recognition algorithm, through the normal training of strawberry image feature representation in different scenes, and then through the application of transfer learning method, the strawberry disease image features are added to the training set, and finally the features are classified and recognized to achieve the goal of disease recognition. Moreover, attention mechanism and central damage function are introduced into the classical convolutional neural network to solve the problem that the information loss of key feature areas in the existing classification methods of convolutional neural network affects the classification effect, and further improves the accuracy of convolutional neural network in image classification. (shrink)

Primary progressive aphasia is a degenerative disease affecting language while leaving other cognitive facilities relatively unscathed. The agrammatic subtype of PPA is characterized by agrammatic language production with impaired comprehension of noncanonical filler-gap syntactic structures, such as object-relatives [e.g., The sandwich that the girl ate was tasty], in which the filler is displaced from the object position within the relative clause to a position preceding both the verb and the agent and is replaced by a gap linked with the (...) filler. One hypothesis suggests that the observed deficits of these structures reflect impaired thematic integration, including impaired prediction of the thematic role of the filler and impaired thematic integration at the gap, but spared structure building. In the current study, we examined the on-line comprehension of object-relative and subject-relative clauses in healthy controls and individuals with agrammatic and logopenic PPA using eye-tracking. Eye-movement patterns in canonical subject-relative clause structures were essentially spared in both PPA groups. In contrast, eye-movement patterns in noncanonical object-relative clauses revealed delayed thematic prediction in both agrammatic and logopenic PPA, on-time structure building in both groups, and abnormal thematic integration in agrammatic, but not logopenic, PPA. We argue that these results are consistent with the hypothesis that agrammatic comprehension deficits reflect impaired thematic integration. (shrink)

Man controls and dominates the habitat of most animals, both domestic and wild and there is a need for a pragmatic, workable approach to the problem of reconciling animal welfare with economic forces and the needs of man. It is the author's contention that much of the current philosophical discussion of animal welfare is misdirected now that it is possible to measure to some extent what animals think and feel and how much they can appreciate their quality of life. The (...) book deals with farm animals, pets, wild animals and laboratory animals and dicusses their environmental requirements, fear and stress, their response to pain, injury, disease and death, behaviour and aggression, and the implications of biotechnology and genetic engineering. Finally, the book tries to reconcile reverence for life with the inescapability of killing and reviews the prospects of preserving and enhancing quality of life for animals through legislations, education, economic and moral incentives. (shrink)

This chapter presents findings on a study of neuropsychological aspects of visual hallucinations with a focus on hallucinations in Parkinson's disease. The results of the study suggest that VHs in PD are a complex multifactor effect of different risk factors, primarily the dysfunctions of the visual system and the system that regulates rapid eye movement sleep and arousal. The study reported here also investigated whether the same risk factors are implicated in proneness to VHs as they are in VHs (...) in PD. The results suggest that the predisposition to VHs in the healthy young population is a multifactor effect of strikingly similar risk factors to those found in PD. However, in addition to the dysfunctions of the visual and arousal system, proneness to hallucinations in the normal population is also predicted by a specific personality profile. (shrink)

The discovery of RNA interference in 1998 has made a lasting impact on biological research. Identifying the regulatory role of small RNAs changed the modes of molecular biological inquiry as well as biologists' understanding of genetic regulation. This article examines the early years of small RNA biology's success story. I query which factors had to come together so that small RNA research came into life in the blink of an eye. I primarily look at scientific repertoires as facilitators of rapid (...) scientific change. I show that for a short period of time, between the years 1998 and 2002, different model organism communities, investigative strategies, technological innovations, and research interests could be successfully aligned to take small RNA research off the ground. I discuss how the keystone discoveries were situated in specific experimental traditions and what strategies were employed to establish these discoveries as more general phenomena. Providing thus a practice-based approach of rapid scientific change, I ask how to relate the change in propositional bits of scientific knowledge with changes in scientific practice. (shrink)

ObjectiveTo elucidate the clinical, radiologic characteristics of Leber’s hereditary optic neuropathy (LHON) associated with the other diseases.Materials and methodsClinical data were retrospectively collected from hospitalized patients with LHON associated with the other diseases at the Neuro-Ophthalmology Department at the Chinese People’s Liberation Army General Hospital (PLAGH) from December 2014 to October 2018.ResultsA total of 13 patients, 24 eyes (10 men and 3 women; mean age, 30.69 ± 12.76 years) with LHON mitochondrial DNA (mtDNA) mutations, were included in the cohort. 14502(5)11778(4)11778 (...) &11696(1)12811(1)11696(1)3460(1). One patient was positive for aquaporin-4 antibody (AQP4-Ab), and two were positive for myelin oligodendrocyte glycoprotein antibody (MOG-Ab). Three patients were associated with idiopathic optic neuritis (ON). Two patients were with compression optic neuropathy. Three patients were with the central nervous system (CNS) diseases. One patient was with proliferative diabetic retinopathy (PDR) and one with idiopathic orbital inflammatory syndrome (IOIS). At the onset, visual acuity (VA) in eighteen eyes was below 0.1, one eye was 0.5, five eyes were above 0.5, while VA in sixteen eyes was below a 0.1 outcome, three eyes experienced moderate vision loss. MRI images showed T2 lesions and enhancement in nine patients who received corticosteroids treatment; additional immune modulators treatment was performed on two patients. None of the patients had relapse during the follow-up time.ConclusionLeber’s hereditary optic neuropathy can be accompanied with multiple-related diseases, especially different subtypes of ON, which were also exhibited with IOIS and compression optic neuropathy for the first time in this cohort. This condition may be a distinct entity with an unusual clinical and therapeutic profile. (shrink)

Patients requiring deep brain stimulation due to intracerebral metallic foreign substances have not been reported elsewhere in the world. Additionally, the long-term effects of metallic foreign bodies on deep brain stimulation are unknown. A 79-year-old man with a 5-year history of Parkinson's disease reported that, 40 years ago, while playing with a pistol, a metallic bullet was accidentally discharged into the left brain through the edge of the left eye, causing no discomfort other than blurry vision in the left (...) eye. DBS was performed due to the short duration of efficacy for oral medication. Because the bullet was on the left subthalamic nucleus electrode trajectory and the patient's right limb was primarily stiff, the patient received globus pallidus interna -DBS implantation in the left hemisphere and STN-DBS implantation in the right hemisphere. During a 6-month postoperative follow-up, the patient's PD symptoms were effectively managed with no noticeable discomfort. (shrink)

Howard Adelmann’s majestic five volume Marcello Malpighi and the Evolution of Embryology was published nearly 50 years ago. A mix of paraphrase and translation, as well as extended commentary, Adelmann described Malpighi as “one of the cardinal figures in the history of biology. As we look back over the three centuries that separate him from us, he may, for all his towering stature, at first glance seem a distant figure. And yet he and his work are not so remote after (...) all” . Much has changed in the history of biology since Adelmann’s groundbreaking work, and among the many lessons to be taken from Domenico Bertoloni-Meli’s carefully researched, persuasive and, at times, beautifully rendered book is that the life sciences in the early modern period must be studied with an eye to the history of science, medicine and philosophy—i.e., calling Malpighi simply a “biologist” is very liable to mislead. This point, though only implicit in Meli’s choice to study Malpighi “in relati .. (shrink)

Applying Behrendt & Young's (B&Y's) model of thalamocortical synchrony to complex visual hallucinations in neurodegenerative disorders, such as dementia with Lewy bodies and progressive supranuclear palsy, leads us to propose that the primary pathology may be cortical rather than thalamic. Additionally, the extinction of active hallucinations by eye closure challenges their conception of the role of reduced sensory input.

This is an impressive and important book about perception in Plato’s Timaeus, but most of its readers will probably be researchers who are interested in much broader questions about the dialogue. There is nothing deficient or lacking about this treatment of perception, but this book should be put alongside Thomas Johansen’s Plato’s Natural Philosophy and Sarah Broadie’s Nature and Divinity in the sense that this is, for all intents and purposes, a monograph about the whole Timaeus, even though it is (...) pitched as being focused on perception. There are only a few topics missing, such as the nature of the cosmic receptacle and psychic diseases. Virtually everything else, including the status of Timaeus’ so-called likely story, the generation of the lower gods, and the nature of bone, is discussed at length. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Self-Culture in Emerson’s Schellingian Solution to FateNicholas L. Guardiano (bio)Professor of English literature, President of Yale University, and Commissioner of Major League Baseball, Angelo Bartlett Giamatti (1938–1989), delighted in saying that Emerson “is as sweet as barbed wire.”1 Giamatti understood the full range of Emerson’s thought, which spans the highs and lows of the human condition. Writings such as “Experience,” “Illusions,” “The Tragic,” and “Fate” demonstrate the transcending of (...) Emerson’s transcendentalism beyond any soft Romanticism or naïve idealism. They consistently assert the reality of antagonistic forces pervading human experience and nature. “The Tragic” opens with the lines: “He has seen but half the universe who never has been shown the House of Pain. As the salt sea covers more than two thirds of the surface of the globe, so sorrow encroaches in man on felicity” (CW 10:334).2 “Fate” similarly insists: “We cannot trifle with this reality [of fate], this cropping-out in our planted gardens of the core of the world. No picture of life can have any veracity that does not admit the odious facts” (CW 6:11; my emphasis). Emerson was made intimately aware of the House of Pain by his own personal hardships. To name only a few, there was the death of his first wife Ellen at age 19 from tuberculosis, a rheumatic eye disease that left Emerson nearly blind for months, the terrible loss of his five-year old son Waldo to scarlet fever, the untimely deaths of his two brothers Charles and Edward in their 20s, a fire that partially destroyed the Emerson family home, and the inexorable mental decline into aphasia afflicting Emerson in his final years. Emerson further bore sympathetic witness to the hardships of his friends, family, and community. In addition, he lived through the national crisis of the American Civil War, and was a committed abolitionist willing to face head on the real evils of slavery. These experiences and others were a discipline in the tragic [End Page 28] constitution of the world. Furthermore, they provided hints on how to make one’s way through it.3In this essay, I aim to do some justice to Emerson’s mature transcendentalism by examining his metaphysical-ethical co-principles of fate and freedom, or necessity and power. These co-principles are the central topic of the essay “Fate,” which appeared as the opening chapter of the book The Conduct of Life (1860). There, Emerson somewhat paradoxically admits both principles as opposing forces, and attempts to show their compatibility using a Schellingian dialectic. After presenting Emerson’s understanding of fate and an interpretation of his metaphysical solution to it, I follow up on the primary ethical concern that opens the essay and book, namely “How shall I live?” (CW 6:1). To that end, I attempt to flesh out the ethical character of a life that embraces fate in terms of an Emersonian project of self-culture. My methodological approach throughout evolves progressively from the interpretation to the expansion of Emerson’s ideas. Its first section examines his philosophy as an offshoot of the world-historical line of thought extending from Plato to the Neoplatonists, Eriugena, Spinoza, Goethe, and Schelling, among others. Later philosophers, scientists, and artists who took inspiration from Emerson’s transcendentalism, including Charles Peirce, the Hudson River School painters, Wallace Stevens, and Loren Eiseley, follow the same intellectual trajectory.4 Further taking up the torch, my second section creatively amplifies Emerson’s insights for an ethics of self-culture, and in this way argues for the truth of his Schellingian form of freedom.I. The Problem and Its SolutionFor Emerson, fate is real. It consists in the “immovable limitations” and necessary “laws of the world” (CW 6:2). These limits or laws occur in the conduct of life not so much as theoretical abstractions or remote chains of efficient [End Page 29] causality but as impositions on our will, both from within and without. On the one hand, we are confronted by the rough and tumble of nature, the outside environment in which we live. Serious in Emerson’s nineteenth century and remaining so today are... (shrink)

The physiological blind spot corresponds to the optic disc where the retina contains no light-detecting photoreceptor cells. Our perception seemingly fills in this gap in input. Here we suggest that rather than an active process, such perceptual filling-in could instead be a consequence of the integration of visual inputs at higher stages of processing discounting the local absence of retinal input. Using functional brain imaging, we resolved the retinotopic representation of the physiological blind spot in early human visual cortex and (...) measured responses while participants perceived filling-in. Responses in early visual areas simply reflected the absence of visual input. In contrast, higher extrastriate regions responded more to stimuli in the eye containing the blind spot than the fellow eye. However, this signature was independent of filling-in. We argue that these findings agree with philosophical accounts that posit that the concept of filling-in of absent retinal input is unnecessary. (shrink)

In this unique and exhilarating autobiography, Allan Jones – Canada’s first blind diplomat – vividly describes how an untreatable eye disease slowly decimated his visual world, most challengingly during his postings in Tokyo and New Delhi, and how he discovered and took to heart the revelatory Indian philosophy that changed his life. Advaita Vedanta, the most iconoclastic and liberating of the classical Indian philosophies, profoundly altered the author’s experience of self and world. He found that the true self, as (...) distinct from the individual ego, far exceeds the boundaries of individuality. It lies beneath sightedness or blindness and is absolutely unaffected by the latter. This welcome shift of perspective was reinforced by startling discoveries in contemporary physics, evolutionary biology, and developmental psychology that are fully consistent with Advaitic metaphysics. As for the practical applications of metaphysics, this book demonstrates step by step how Advaitic insight and practice significantly reduce physical and psychological tension. The most telling examples have to do with adjustments compelled by extreme circumstances. Thus Jones describes how he drew upon Advaitic mindfulness techniques to maintain his white cane mobility skills in the teeth of permanent spinal, nerve, and muscle pain. The arc of Beyond Vision moves from the claustrophobically personal to the openness of the transpersonal. It begins in a dysfunctional family background, breaking out into a full life encompassing an adventurous foreign service career, spiritual exploration, and an unconventional kind of marital love. (shrink)

Collerton et al. propose that one and the same mechanism (PAD) underlies recurrent complex visual hallucinations (RCVH) in various disorders, including schizophrenia, dementia, and eye disease. The present commentary offers an alternative account of RCVH and other recurrent complex hallucinations specific to schizophrenia and related disorders only. The proposed account is consistent with the bias of schizophrenic RCVH contents toward animate, socially active entities.

As many as two million people in the United Kingdom repeatedly see people, animals, and objects that have no objective reality. Hallucinations on the border of sleep, dementing illnesses, delirium, eye disease, and schizophrenia account for 90% of these. The remainder have rarer disorders. We review existing models of recurrent complex visual hallucinations (RCVH) in the awake person, including cortical irritation, cortical hyperexcitability and cortical release, top-down activation, misperception, dream intrusion, and interactive models. We provide evidence that these can (...) neither fully account for the phenomenology of RCVH, nor for variations in the frequency of RCVH in different disorders. We propose a novel Perception and Attention Deficit (PAD) model for RCVH. A combination of impaired attentional binding and poor sensory activation of a correct proto-object, in conjunction with a relatively intact scene representation, bias perception to allow the intrusion of a hallucinatory proto-object into a scene perception. Incorporation of this image into a context-specific hallucinatory scene representation accounts for repetitive hallucinations. We suggest that these impairments are underpinned by disturbances in a lateral frontal cortex–ventral visual stream system. We show how the frequency of RCVH in different diseases is related to the coexistence of attentional and visual perceptual impairments; how attentional and perceptual processes can account for their phenomenology; and that diseases and other states with high rates of RCVH have cholinergic dysfunction in both frontal cortex and the ventral visual stream. Several tests of the model are indicated, together with a number of treatment options that it generates. Key Words: Blindness; Charles Bonnet; cholinergic; cortical release; delirium; dementia; dream intrusion; hallucination; Perception and Attention Deficit (PAD) model; schizophrenia. (shrink)

Anosognosia for visual deficits—cases where significant visual deficits go unnoticed—challenges the view that our own conscious experiences are what we know best. We review these widespread and striking failures of awareness. Anosognosia can occur with total blindness, visual abnormalities induced by brain lesions, and eye diseases. We show that anosognosia for visual deficits is surprisingly widespread. Building on previous accounts, we introduce a framework showing how apparently disparate forms of anosognosia fit together. The central idea is that, to notice a (...) deficit, individuals need to form expectations about normal vision, compare expectations and visual input, and judge any mismatch at the metacognitive level. A failure in any of these three steps may lead to unawareness of visual deficits. (shrink)

The Journal of Medical Ethics can sometimes read part Men Like Gods and part A Brave New World. At times, we learn how all controversies can resolved with reference to four principles. At other times, we learn how “every discovery in pure science is potentially subversive”.1 This issue is no exception. Here, we can read about the utopia of gene editing, manufactured organs, and machine learnt algorithmic decision-making. We can also read about the dystopia of inherited disorders from edited germlines, (...) the testing of xenotransplants on braindead patients, and misdiagnosis by artificial intelligence. What we see in the three papers that I will foreground here is the application of medical ethics to avoid the dystopia while preserving the promises of medical science. But as I seek to explain here, our ability to address the controversies that we anticipate in medical science depend on our ability to refine our understanding of what medical ethics requires of us now. From the diagnosis of eye diseases from fungus images to predicting the risk of imminent risk of suicide attempts, machine learnt medical decision making has, in some high profile instances, outperformed clinicians in medical diagnosis and treatment recommendations. While clinician and machine learnt diagnoses will both involve degrees of uncertainty and fallibility, Thomas Grote2 asks us to consider is how much weight a clinician ought to give an algorithmic diagnosis which she disagreements with. Since a clinician is held to account for …. (shrink)

PurposeThe primary angle-closure glaucoma is an irreversible blinding eye disease in the world. Previous neuroimaging studies demonstrated that PACG patients were associated with cerebral changes. However, the effect of optic atrophy on local and remote brain functional connectivity in PACG patients remains unknown.Materials and MethodsIn total, 23 patients with PACG and 23 well-matched Health Controls were enrolled in our study and underwent resting-state functional magnetic resonance imaging scanning. The regional homogeneity method and functional connectivity method were used to evaluate (...) the local and remote brain functional connectivity. Moreover, support vector machine method was applied to constructing PACG classification model.ResultsCompared with the HC, PACG patients showed increased ReHo values in right cerebellum _8, left CER_4-5, and right CER_8. In contrast, PACG patients showed decreased ReHo values in the bilateral lingual gyrus /calcarine /superior occipital gyrus and right postcentral gyrus. The ReHo value exhibited an accuracy of 91.30% and area under curve of 0.95 for distinguishing the PACG patients from HC.ConclusionOur study demonstrated that the PACG patients showed abnormal ReHo value in the cerebellum, visual cortex, and supplementary motor area, which might be reflect the neurological mechanisms underlying vision loss and eye pain in PACG patients. Moreover, the ReHo values can be used as a useful biomarker for distinguishing the PACG patients from HCs. (shrink)

The ultimate aim of artistic exploration is to explore the claim that objects are different from experience and beauty is just a by-product of the exploration. In other words, the truth in the eyes of each person may quite literarly not be the same. A typical example is that some art archaeologists attribute the artistic achievements of Vincent van Gogh and Paul Cezanne to their eye diseases.1 Saying this, however, is somewhat unreliable—just like we could not arbitrarily say that the (...) world in the eyes of animals, who have a completely different physciological and optic nerve structure, is quite diferent from that of humans. This indicates that differences in the visual apparatus influence the viewing body’s .. (shrink)

Our eyes move in response to stimulus statistics, reacting to surprising events, and adapting to predictable ones. Cortical and subcortical pathways contribute to generating context-specific eye-movement dynamics, and oculomotor dysfunction is recognized as one the early clinical markers of Parkinson's disease. We asked if covert computations of environmental statistics generating temporal expectations for a potential target are registered by eye movements, and if so, assuming that temporal expectations rely on motor system efficiency, whether they are impaired in PD. We (...) used a repeating tone sequence, which generates a hazard rate distribution of target probability, and analyzed the distribution of blinks when participants were waiting for the target, but the target did not appear. Results show that, although PD participants tend to produce fewer and less temporally organized blink events relative to healthy controls, in both groups blinks became more suppressed with increasing target probability, leading to a hazard rate of oculomotor inhibition effects. The covert generation of temporal predictions may reflect a key feature of cognitive resilience in Parkinson's Disease. (shrink)

The sclera, the eye’s tough outer layer, is, among primates, white only in humans, providing the ground necessary for the display of colors that vary in health and disease. The current study evaluates scleral color as a cue of socially significant information about health, attractiveness, and age by contrasting the perception of eyes with normal whites with copies of those eyes whose whites were reddened, yellowed, or further whitened by digital editing. Individuals with red and yellow sclera were rated (...) to be less healthy, less attractive, and older than individuals with untinted control sclera. Individuals with whitened, “super-white” sclera were rated as younger, although not more healthy or attractive, than controls. In humans, clear, white sclera may join such traits as smooth skin and long, lustrous hair as signs of health, beauty, and reproductive fitness. The evolution of a white sclera may have contributed to the emergence of humans as a social species. (shrink)

Surveillance serves as the eyes of public health. It has provided the foundation for planning, intervention, and disease prevention and has been critical for epidemiology research into patterns of morbidity and mortality for a wide variety of disease and conditions. Registries have been essential for tracking individuals and their conditions over time. Surveillance has also served to trigger the imposition of public health control measures, such as contact tracing, mandatory treatment, and quarantine. The threat of such intervention and (...) long-term monitoring has provoked alarm and rendered surveillance suspect for those concerned about the unwarranted exercise of state authority in the name of public health. Thus the history of surveillance has been bounded by promise of disease control and a specter of intrusion. In this article we address the tension between the public's need for knowledge as a foundation for rational policy-making and the centrality of norms of privacy for democratic societies. (shrink)

The arrival of coronavirus disease 2019 in South Africa was responded to by a lockdown, which barred people from moving out of their homes unless for serious and stipulated reasons by government. Amongst other things, one of the most remarkable repercussions of the lockdown was the closing of the educational system. The call to reopen the public schools by the Minister of Basic Education after almost 2 months brought contestations from different sects of life, for instance, labour unions, parents (...) and School Governing Body representatives. Mistrust and suspicions developed amongst parents, SGB's unions and the Department of Basic Education as a result. This has seen certain political parties and unions lodging court cases against the reopening decision. This was likely to be a protracted battle as the issue is between life and education. The aim of this research is to discover if these contestations are for the good of the school children or if there is another underlying issue.CONTRIBUTION: This article unveils the different contestations which are important for the South Africans regarding the shaping of the future through educational weapon. The contestations help open our eyes and make awareness as to where our democracy has done well and where it is still lacking. (shrink)

At least as important as a particular item of medical knowledge itself is to know something about the relationships of that knowledge to the experiential world it is talking about. The reason is that the patients the physician is concerned with are parts of that experiential world. So, when using any knowledge in her practice, e.g., some knowledge on infectious diseases, a morally conscientious doctor will be interested in whether, and in what way, this knowledge relates to the ‘world out (...) there’. Does the medical knowledge she employs bear any relevance to the bodies and souls of her patients? Does it enable her to understand the patient’s suffering, illness experience, and illness narrative? Will it help her find useful diagnoses and treatments? Are there in fact any indicators of such qualities of medical knowledge? Why not use astrology, Ayurveda, or exorcism instead of the theory of infectious diseases? A prerequisite for dealing with such questions is the awareness of the relationships between medical knowledge and its referent, i.e., of the semantics of medical knowledge, on the one hand; and of the pragmatic factors beyond this semantics, which influence the role medical knowledge plays in health care, on the other, e.g., social and economic processes. In the present chapter, we shall look at these issues with an eye toward understanding why some particular information is allowed to enter the medical world as knowledge, whereas other information is considered unacceptable or quackery. Is there a clear line of demarcation between medical knowledge and self-deception? To begin with, we will discuss the issues of truth and justification because, as pointed out in Section 10.1 on page 402, knowledge is traditionally defined as justified true belief . These two defining features of knowledge, truth and justifiedness, are due to the classical conception of knowledge as the representation of some ‘reality’. This ancient, representational postulate brings with it that the predominant view on the semantics of medical knowledge is realism, i.e., the view that medical knowledge is concerned with and represents ‘the real world out there’. We shall therefore need to inquire into the philosophy and medical relevance of this doctrine before we proceed to alternative views. Our discussion thus divides into the following five parts: 12.1 Justified True Belief; 12.2 Realism; 12.3 Anti-Realism; 12.4 Beyond Realism and Anti-Realism in Medicine; 12.5 Social Epistemology. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:You Can't Say "No" to That!(A "Difficult Patient" Story)Ingrid BergAs a sequela of COVID-19, my rural Wisconsin hospital has been jam-packed for months with patients for whom we routinely provide care and many for whom we do not. An exodus of health care workers and other constraints have made the transfer of critically ill patients very difficult. In this disquieting "new-normal" of our work life, we routinely must call (...) bigger cities throughout our state to find beds for complex patients.So, it was not surprising when a young patient, an IV drug user in sepsis from a heart infection, was admitted to me in the middle of the night. In less disheartening times, before the pandemic, this patient would have been transferred promptly to the big-city hospital. Now, though, the possibility of finding an open bed is next to impossible. Resigned, I placed admission orders, continued antibiotics and fluids, and crossed my fingers. Then the unexpected happened: a bed opened up, and we could send her at once!The patient had a harsh heart murmur. It was likely that a "vegetation" was clinging to the valve, between the right upper and lower chambers of her heart. A vegetation is a clump of debris, such as platelets, clotting proteins, and bacteria that is a menace to the body. Her chest imaging looked like her infection had already spread to her lungs.A definitive diagnosis for endocarditis requires a special ultrasound with a probe that goes down through the esophagus, a procedure performed by cardiologists. It's a serious infection, one that requires weeks of IV antibiotics and is best monitored by infectious disease specialists. Sometimes, cardiothoracic surgeons are called upon to strip away the infection at the site, depending on how badly the valve has been slayed or the size of the vegetation. My only recommendation for a young, otherwise healthy patient in this scenario, is transfer.All of these reasons for transfer were lolling around in my tired head when the night-time [End Page 14] nursing supervisor approached me and said, "We have a problem." When the patient was updated about the transfer, she balked: "She says she is tired and refusing to go," the supervisor began. "She doesn't feel like getting into an ambulance in the middle of the night and she doesn't care if her condition is life-threatening. She knows we can't force her to go and she will only talk about it again in the morning."The cartoon version of myself at that moment had bugged-out eyes, a dropped jaw, fists tight and clenched at my sides, and steam coming out of my head. I can look past a patient's self-neglect, poor medication adherence, abysmal communication, alcohol and drug addiction, and other crimes. But saying no to a bed at a tertiary care facility? Unacceptable!I marched down the quiet hallway and into her room. She was lying on her side, facing the door, one IV in a thin arm. I was confident I could reason with her once I explained the scarcity of beds and the medical necessity of transfer. But she was having none of it. I was calm until I could no longer maintain my cool: "You can't give up this bed!""Maybe in the morning," she insisted, yawning. "But not now. I am tired and want to rest!""But there might not be a bed in the morning," I countered. "And your infection can be life-threatening." (This is true, but we both knew she wasn't dying at this very moment.)"I am not going anywhere!" She raised her voice and then closed her eyes.And she was right. I had no choice but to keep her. I could not kick her out of the hospital because she was making a poor choice, and I was frustrated for having to manage the fallout of that decision. Giving her antibiotics and fluid boluses to bolster her blood pressure was certainly within my scope of practice. And fretting. Fretting is always within my scope of practice; not that my scope of practice matters when all the big... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Positive Change in Perception and Care for a Difficult PatientMelissa CavanaughIf you asked any healthcare professional if they had ever cared for a difficult patient, I am certain the answer would be a resounding "Yes!" I have encountered many over my forty-two years as an RN. The story of Ms. E. is one of exceptional challenge and, I hope, success.I met Ms. E. in 2012 when I took a (...) nursing position in an outpatient primary care Geriatric Clinic. The clinic was located within an inner city, Level 1 Trauma health system whose mission is to care for the underserved. This organization had cared for the most vulnerable in the area for decades. The clinic model is unique in that it provides a "one-stop shop" for the common medical needs of the older adult. Other specialties, including podiatry, rheumatology, dementia care, and stroke, held appointments in this clinic area. The supporting staff team members assisted in each of these clinics, leading them to interact with the same patients frequently.Most of my previous experiences had been in inpatient units with a quick turnover of patients. There was no time or need to develop a long-term relationship with the patients in these settings. However, the comprehensive services found in this clinic coupled with the low staff turnover, led to a stable group of seniors receiving care in this office. Many of these individuals had been attending this clinic for over twenty years.I heard about Ms. E. before I ever met her. She was well known to the clinic team as a "problem" patient. The general response when she was on the schedule was eye rolling and audible moans. I soon learned that in addition to her scheduled visits, she would randomly appear outside the full glass interior doors. She would hover in the area, tapping on the glass to get the attention of a staff member. She did not hesitate to interrupt staff and other patients to make her needs known when she was in the exam room hallway. Often team members would scatter and hide to avoid dealing with her. If she was not in the building, she was on the triage line with a question or physical complaint. To complicate matters even further, her husband was our patient as well, and they always attended appointments together.Ms. E. suffered from common geriatric chronic diseases such as hypertension, diabetes, and osteoarthritis. Her morbid obesity complicated her diagnoses. Though she was able to safely ambulate with an assistive device such as a cane or walker, she routinely used a motorized chair. She and her husband admitted visiting fast food restaurants often even though they had met with a dietician for counseling on several occasions. They often requested help obtaining medications, yet related stories about visiting the local casino. Ms. E. spoke with a small, weak voice that added to the countenance of helplessness and pity. Unfortunately, these behaviors of noncompliance, attention seeking, and dependency on others extended to her immediate community, and she is estranged from family and friends who may have been a source of support to her. [End Page E1]Ms. E.'s appointments were scheduled at the end of the day due to the expectation and pattern of the extended time they would take. No matter her expressed concerns or needs, our recommendations and interventions were never enough. She continually questioned the assessment information and did not want to accept the education and orders given as the correct response to her problems. As one can see, her appointments could be exhausting!Ms. E. certainly deserved the best and most comprehensive care available from our team. Developing a more therapeutic relationship for her within the clinic became a priority for me. However, it was a daunting task to provide this level of care and to convince her that she deserved and was receiving such care. She presented a laundry list of characteristics that could lead to biases from the staff. Overcoming such individual biases toward her may be a barrier as well. These included her obesity, her lack of initiative, her self-centered behaviors, and her constant need for attention.As healthcare professionals... (shrink)

Early in my career as a neonatologist, I was called into the hospital for a newborn who would not stop crying. Screaming, really. When I entered the unit, I was greeted by a loud, shrill, distinctive cry. After hearing the history and examining the baby, I just stood there for a while, watching and listening. It took some time, but eventually, I noticed a subtle regularity, a rhythmicity. I took off my watch, placed it on the bed next to the (...) child, and found that the crying briefly grew louder about every six or seven seconds. This baby was having an atypical seizure. This preliminary diagnosis was followed by a conversation with the parents and a neurologist, transfer to the nearby academic center for an extensive evaluation, and the eventual demise of the child from a poorly understood disease. About a year later, I walked into the same unit and heard a cry I had heard only once before. I looked over to see the same mother at a newborn's bedside, with tears in her eyes, looking back at me. She knew what the coming days held for her and for her second child. That was over twenty years ago, but two images, or moments, remain with me. One is the watch on the bed next to the first baby; the other is the mother's expression of sadness the morning the second child was born. The image of the timepiece is perhaps instructive. (shrink)