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Debates concerning the reliability and validity of operationalized criteria and diagnostic tools have surrounded the issue of schizophrenia diagnosis and clinical decision-making related to the disorder. The notion of the praecox feeling (PF) has played a prominent role in the discussions as an example of the possibility of a rapid and potentially valid diagnosis based solely on “intuition” or a peculiar emotional experience or impression arising in a physician during an interaction with a patient with schizophrenia. In this paper, we argue that PF is enabled by the (phenomenologically understood) intercorporeal dimension of the clinical encounter. Intercorporeality in this sense denotes intertwinement between embodied expressions that may lead to feelings of connection but also, as in the case of PF, of disconnection and strangeness—the experience of alienness. Following Waldenfels, alienness ranges from the average social encounter to more extreme and peculiar forms—such as PF. To prove our point, we analyze the metaphors used by physicians in various cultural contexts (the United States, the United Kingdom, and Poland) to express the apparently ineffable experience of the PF. We focus on two dominant metaphors of distance: the first expressing spatial distance by referring to an “object in-between” the physician and the patient and the second expressing mental distance by referring to the “other-worldliness” of the patient. We interpret the object in-between metaphors as reflecting the sense of separateness and the other-worldliness metaphors as reflecting the sense of strangeness, with both meanings unified in the notion of “close remoteness.” Such unsettling but speculation-provoking feeling of close remoteness may be rendered by the concept of “the eerie” (Mark Fisher). We conclude that metaphor and phenomenological analysis facilitate an understanding of the experiential profile of PF in the clinical encounter, outlining relevant clinical implications.

Objectives: The objective is to evaluate the efficacy of the continuous wound infusion (CWI) with Ropivacaine (naropeine 2 mg/ml) on postoperative pain, analgesics consumption, and bowel function in renal transplantation patients. Materials and Methods: A retrospective study trial including 79 patients who underwent renal transplantation. Patients were separated into two groups (catheter or without catheter). We identified 52 (65.8%) patients who received catheter wound infusion during the first 48 h postoperatively. On the other hand, 27 (34.1%) patients received standard without catheter anesthetic technique. Catheter wound infusion was achieved through a 12 cm catheter, inserted subcutaneously after abdominal closure. The catheter was placed above the external oblique aponeurosis. All postoperative data were examined to evaluate the first postoperative 48 h. This study aims to assess three variables: postoperative pain analysis through a visual analog scale, analgesics consumption, and bowel function. Results: The overall score of the three variables was studied. Regarding pain assessment, we have determined that the group of patients with catheter scored better than patients without catheter with borderline significance (66.3 vs. 61.2 consecutively; P = 0.0843). An early bowel function was noted in patients with catheters on the 2nd postoperative day (P = 0.0209). Moreover, patients without catheter consumed more painkillers with nonsignificant difference (P = 0.2499). Conclusion: Patients with catheter showed earlier bowel function than the noncatheter group on the 2nd postoperative day. The catheter group had better pain evaluation.

IntroductionBasic self-disorders on the one hand and motor symptoms on the other hand are discussed as endophenotypes of schizophrenia psychopathology. However, the systematic interaction between motor symptoms and the self-experience of patients is rarely studied.MethodsIn a previous study we defined motor markers of schizophrenia via a data-driven analysis of patients' gait patterns. In this study, we related the movement markers to measures of basic self-disorder obtained with EASE interviews. We substantiated the correlations with a qualitative content analysis of the interviews of a subset of four patients. We related qualitative and quantitative data on an intra- and interpersonal level.ResultsOur results suggest an association between the previously defined, theory-independent movement markers and basic self-disorders, specifically in the domain of cognition, self-experience and bodily experiences. While movement marker manifestation was not precisely reflected in the individuals' descriptions of anomalous self- and body experience, we found clear trends of more and more intense descriptions with increasing movement marker scores, when looking at specific experiences, such as hyper reflexivity.DiscussionThese results foster an integrated view of the patient and could stimulate therapeutic approaches aiming at an improvement of self- and body-experience of patients with schizophrenia.

Using an optical brain computer interface in mice, here the authors demonstrate that new skill acquisition is not inherently disruptive to existing function. These findings suggest neural networks are robust to perturbations associated with integrating new information.

This paper presents and discusses a manuscript by one of the core founders of phenomenological psychopathology, Erwin W. Straus, concerning psychotic disorders of space and time (see attached Supplementary material). Written in June 1946, the manuscript is published for the first time as supplementary material to this paper. It is a clinical case-study of a patient with psychotic depression from Henry Phipps Clinic. It contains themes known from both Straus’ earlier and later work on lived time and mental illness, in particular a critique of physicalism in psychology, a vindication of primary sensing, a description of the spatiotemporal unity of lived experience, and the notion of temporal becoming. However, it is the only work by Straus that explores in such detail a patient’s case and shows how the lived experience is spatiotemporally structured and intrinsically related to affectivity, embodiment, and action. The manuscript is yet another piece of evidence of Straus’ significance in developing the field of phenomenological psychiatry in both Germany and the United States.

Using phenomenological and ecological psychology as a base, the author develops the concept of lived space as the totality of an individual's spatial and social relationships, including his ”horizon of possibilities”. The lived space may also be regarded as the individual's ecological niche, which is continuously shaped by his exchange with the environment. Mental illness may then be conceived as a limitation or deformation of the patient's lived space, inhibiting his responsivity and exchange with the environment. Unconscious dysfunctional patterns of feeling and behaving act as "blind spots" or "curvatures" in lived space and lead to typical distortions, thereby further restricting the patient's potentialities and development. Accordingly, the task of psychotherapy is to explore and understand the patient's lived space in order to reopen his horizon of possibilities. The main agent for this purpose is the interactive field of psychotherapy, which may be regarded as a "fusion of horizons" of the patient's and the therapist's worlds.

Abstract Background Long-bone non-unions after intramedullary nailing can be treated by nail dynamization or focused high-energy extracorporal shock wave therapy (fESWT). The objective of this study was to assess the effect of the combination therapy of nail dynamization and fESWT on long-bone non-unions. Materials and methods 49 patients with long-bone non-unions (femur and tibia) after nailing were treated with nail dynamization (group D, n = 15), fESWT (group S, n = 17) or nail dynamization in addition to fESWT (group DS, n = 17). Patients were followed up for 6 months retrospectively. Furthermore, age, sex, Non-Union Scoring System (NUSS) score, time intervals from primary and last surgery until intervention and smoking status were analysed for their correlations to bone union. Results Union rates were 60% for group D, 64.7% for group S and 88.2% for group DS, with a significant difference between group D and DS (p = 0.024). Successful treatment was correlated with high age (OR 1.131; 95% CI 1.009–1.268; p = 0.034), female gender (OR 0.009; 95% CI 0.000–0.89; p = 0.039), low NUSS score (OR 0.839; 95% CI 0.717–0.081; p = 0.028) and negative smoking status (OR 86.018; 95% CI 3.051–2425.038; p = 0.009). Conclusions Data from the present study indicate that the combination therapy of nail dynamization and fESWT leads to a higher union rate than dynamization or fESWT alone. Level of evidence Level 3.

Transient dark exposure, typically 7–10 days in duration, followed by light reintroduction is an emerging treatment for improving the restoration of vision in amblyopic subjects whose occlusion is removed in adulthood. Dark exposure initiates homeostatic mechanisms that together with light-induced changes in cellular signaling pathways result in the re-engagement of juvenile-like plasticity in the adult such that previously deprived inputs can gain cortical territory. It is possible that dark exposure itself degrades visual responses, and this could place constraints on the optimal duration of dark exposure treatment. To determine whether eight days of dark exposure has a lasting negative impact on responses to classic grating stimuli, neural activity was recorded before and after dark exposure in awake head-fixed mice using two-photon calcium imaging. Neural discriminability, assessed using classifiers, was transiently reduced following dark exposure; a decrease in response reliability across a broad range of spatial frequencies likely contributed to the disruption. Both discriminability and reliability recovered. Fixed classifiers were used to demonstrate that stimulus representation rebounded to the original, pre-deprivation state, thus dark exposure did not appear to have a lasting negative impact on visual processing. Unexpectedly, we found that dark exposure significantly stabilized orientation preference and signal correlation. Our results reveal that natural vision exerts a disrupting influence on the stability of stimulus preference for classic grating stimuli and, at the same time, improves neural discriminability for both low and high-spatial frequency stimuli.

Abstract Background Muscle relaxants are routinely used during anesthesia to facilitate endotracheal intubation and to optimize surgical conditions. However, controversy remains about the required depth of neuromuscular block (NMB) needed for optimal surgical working conditions and how this relates to other outcomes. For instance, a deep neuromuscular block yields superior surgical working conditions compared to a standard NMB in laparoscopic surgery, however, a robust association to other (safety) outcomes has not yet been established. Methods Trial design: an international multicenter randomized controlled double-blind strategy trial. Trial population: 922 patients planned for elective, laparoscopic or robotic, abdominal surgery. Intervention: Patients will be randomized to a deep NMB (post-tetanic count 1–2 twitches) or standard care (single-dose muscle relaxant administration at induction and repeated only if warranted by surgical team). Main trial endpoints: Primary endpoint is the difference in incidence of intraoperative adverse events during laparoscopic surgery graded according to ClassIntra® classification (i.e., ClassIntra® grade ≥ 2) between both groups. Secondary endpoints include the surgical working conditions, 30-day postoperative complications, and patients’ quality of recovery. Discussion This trial was designed to analyze the effect of deep neuromuscular block compared to standard neuromuscular block on intra- and postoperative adverse events in patients undergoing laparoscopic surgery. Trial registration ClinicalTrials.gov NCT04124757 (EURO-RELAX); registration URL: https://clinicaltrials.gov/ct2/show/NCT04124757 , registered on October 11th, 2019.

Abstract Background An increasing number of patients older than 80 years are undergoing anesthesia, but little information is available regarding pharmacodynamic effects of myorelaxants in this population. This study aims to compare the time course of rocuronium neuromuscular block in patients ≥ 80 years with those of younger adults. Methods Under total intravenous anesthesia with propofol and sufentanil, time course of a bolus of rocuronium 0.6 mg/kg neuromuscular block was assessed with acceleromyography in patients ≥ 80 and in patients 20–50 years old. Onset time, clinical duration, duration until 90% and 100% recovery of baseline were determined. Results Data from 32 patients were analyzed, 16 were ≥ 80 years and 16 were 20–50 years old. Demographic data are shown in Table 1. In the group ≥ 80, onset time was 190 s ± 46 s compared to 123 s ± 40 s in the group 20–50, P

Die Fortschritte der Künstlichen Intelligenz und der Robotik stellen die Unterscheidung zwischen Simulation und Realität der menschlichen Person zunehmend in Frage. Sie suggerieren einerseits ein computeromorphes Verständnis menschlicher Intelligenz, andererseits eine Anthropomorphisierung der KI-Systeme. Mit anderen Worten: Wir betrachten uns selbst immer mehr wie unsere Maschinen, und umgekehrt unsere Maschinen wie uns selbst. Was also unterscheidet menschliche und künstliche Intelligenz? Der Aufsatz stellt dafür eine Reihe von Kriterien auf.

BackgroundWhile repeated shutdown and lockdown measures helped contain the spread of SARS-CoV-2 during the COVID-19 pandemic, social distancing and self-isolation negatively impacted global mental health in 2020 and 2021. Although suicide rates did reportedly not increase during the first months of the pandemic, long-term data, and data on the quality of serious violent suicide attempts (SVSAs) are not available to date.Materials and methodsOrthopaedic trauma patient visits to the emergency department (ED), ED trauma team activations, and SVSAs were retrospectively evaluated from January 2019 until May 2021 in four Level-I Trauma Centers in Berlin, Germany. SVSAs were assessed for suicide method, injury pattern and severity, type of treatment, and length of hospital stay.ResultsSignificantly fewer orthopaedic trauma patients presented to EDs during the pandemic (n = 70,271) compared to the control (n = 84,864) period (p = 0.0017). ED trauma team activation numbers remained unchanged. SVSAs (corrected for seasonality) also remained unchanged during control (n = 138) and pandemic (n = 129) periods, and no differences were observed for suicide methods, injury patterns, or length of hospital stay.ConclusionOur data emphasize that a previously reported rise in psychological stress during the COVID-19 pandemic does not coincide with increased SVSA rates or changes in quality of SVSAs.

Airborne transmission via aerosol particles without close human contact is a possible source of infection with airborne viruses such as SARS-CoV-2 or influenza. Reducing this indirect infection risk, which is mostly present indoors, requires wearing adequate respiratory masks, the inactivation of the viruses with radiation or electric charges, filtering of the room air, or supplying ambient air by means of ventilation systems or open windows. For rooms without heating, ventilation, and air conditioning (HVAC) systems, mobile air cleaners are a possibility for filtering out aerosol particles and therefore lowering the probability of indirect infections. The main questions are as follows: (1) How effectively do mobile air cleaners filter the air in a room? (2) What are the parameters that influence this efficiency? (3) Are there room situations that completely prevent the air cleaner from filtering the air? (4) Does the air cleaner flow make the stay in the room uncomfortable? To answer these questions, particle imaging methods were employed. Particle image velocimetry (PIV) was used to determine the flow field in the proximity of the air cleaner inlet and outlet to assess regions of unpleasant air movements. The filtering efficiency was quantified by means of particle image counting as a measure for the particle concentration at multiple locations in the room simultaneously. Moreover, different room occupancies and room geometries were investigated. Our results confirm that mobile air cleaners are suitable devices for reducing the viral load indoors. Elongated room geometries, e.g., hallways, lead to a reduced filtering efficiency, which needs to be compensated by increasing the volume flow rate of the device or by deploying multiple smaller devices. As compared to an empty room, a room occupied with desks, desk separation walls, and people does not change the filtering efficiency significantly, i.e., the change was less than 10%. Finally, the flow induced by the investigated mobile air cleaner does not reach uncomfortable levels, as by defined room comfort standards under these conditions, while at the same time reaching air exchange rates above 6, a value which is recommended for potentially infectious environments.

Background: Individuals on the autism spectrum are often described as having atypical social interactions. Ideally, interactional synchrony helps any interaction flow smoothly with each individual responding verbally, non-verbally, and/or emotionally within a short timeframe. Differences in interactional synchrony may impact how individuals on the autism spectrum experience social encounters.Method: This mixed methods pilot study examined interactional synchrony in five cases of adolescents and adults on the autism spectrum through secondary analysis of video of the participants in movement-based mirroring tasks during dance/movement therapy. Raters described the movement and interactions of the participants while they were leading and following mirroring and engaged in open-ended free dances with a partner. Videos were also scored on measures of affective engagement, flow of the interaction, and synchrony.Results: One of the most striking findings of this study was the difference between engagement in the instructions of the task and engagement with the partner: participants often followed the instructions for the mirroring tasks with little further social engagement with their partner. When participants did engage in moments of social initiation, attunement to the partner, and interactive behaviors, these did not develop into longer interactions. A paired t-test of the correlation coefficients for each participant showed that scores on synchrony and affective engagement were more strongly positively correlated in the less structured open-ended dance and in video clips of interactive behaviors, than in the videos of simply leading or following mirroring. Synchrony was also significantly more strongly positively correlated with the observed flow of the interaction than with observed affective engagement. With the small sample size, however, most of the correlation coefficients were not significant and should be tested on a larger sample.Discussion: Interpersonal synchrony may not be sufficient to effectively support social engagement when individuals on the autism spectrum simply follow instructions to synchronize their movements. Synchrony-based interventions may therefore need to include more complex open-ended social scenarios as interactional synchrony may then be more correlated with perceived interaction quality. Therapists may also need to partner with participants to model using non-verbal social behaviors to develop interactions within mirroring tasks.

With the widespread use of masks in the COVID-19 pandemic, it is crucial to understand how emotion recognition is affected by partial face covering. Since individuals with autism spectrum condition often tend to look at the lower half of the face, they are likely to be particularly restricted in emotion recognition by people wearing masks, since they are now forced to look at the upper half of the face. This study compared the recognition of basic and complex emotions in individuals with and without autism spectrum condition, when faces were presented uncovered, with face masks, or with sunglasses. We also used eye tracking to examine group differences in gaze patterns during emotion recognition. Individuals with autism spectrum condition were less accurate at recognizing emotions in all three conditions. Averaged across the three stimulus types, individuals with autism spectrum condition had greater difficulty recognizing anger, fear, pride, and embarrassment than control group. There was no group difference in emotion recognition between the three conditions. However, compared to individuals without autism spectrum condition, there was no evidence of either gaze avoidance or preference for the mouth region. Our results suggest that emotion recognition is reduced in individuals with autism spectrum condition, but this is not due to differences in gaze patterns.

From an embodied and enactive point of view, the mind–body problem has been reformulated as the relation between the lived or subject body on the one hand and the physiological or object body on the other (“body–body problem”). The aim of the paper is to explore the concept of circularity as a means of explaining the relation between the phenomenology of lived experience and the dynamics of organism–environment interactions. This concept of circularity also seems suitable for connecting enactive accounts with ecological psychology. It will be developed in a threefold way:(1) As the circular structure of embodiment, which manifests itself (a) in the homeostatic cycles between the brain and body and (b) in the sensorimotor cycles between the brain, body, and environment. This includes the interdependence of an organism’s dispositions of sense-making and the affordances of the environment.(2) As the circular causality, which characterizes the relation between parts and whole within the living organism as well as within the organism–environment system.(3) As the circularity of process and structure in development and learning. Here, it will be argued that subjective experience constitutes a process of sense-making that implies (neuro-)physiological processes so as to form modified neuronal structures, which in turn enable altered future interactions.On this basis, embodied experience may ultimately be conceived as the integration of brain–body and body–environment interactions, which has a top-down, formative, or ordering effect on physiological processes. This will serve as an approach to a solution of the body–body problem.

BACKGROUND:Deep neuromuscular blockade may facilitate the use of reduced insufflation pressure without compromising the surgical field of vision. The current evidence, which suggests improved surgical conditions compared with other levels of block during laparoscopic surgery, features significant heterogeneity. We examined surgical patient- and healthcare resource use-related outcomes of deep neuromuscular blockade compared with moderate neuromuscular blockade in adults undergoing laparoscopic surgery. METHODS:We conducted a systematic literature review according to the quality standards recommended by the Cochrane Handbook for Systematic Reviews. Randomized controlled trials comparing outcomes of deep neuromuscular blockade and moderate neuromuscular blockade among adults undergoing laparoscopic surgeries were included. A random-effects model was used to conduct pair-wise meta-analyses. RESULTS:The systematic literature review included 15 studies-only 13 were analyzable in the meta-analysis and none were judged to be at high risk of bias. Compared with moderate neuromuscular blockade, deep neuromuscular blockade was associated with improved surgical field of vision and higher vision quality scores. Also, deep neuromuscular blockade was associated with a reduction in the post-operative pain scores in the post-anesthesia care unit compared with moderate neuromuscular blockade, and there was no need for an increase in intra-abdominal pressure during the surgical procedures. There were minor savings on resource utilization, but no differences were seen in recovery in the post-anesthesia care unit or overall length of hospital stay with deep neuromuscular blockade. CONCLUSIONS:Deep neuromuscular blockade may aid the patient and physician surgical experience by improving certain patient outcomes, such as post-operative pain and improved surgical ratings, compared with moderate neuromuscular blockade. Heterogeneity in the pooled estimates suggests the need for better designed randomized controlled trials.

This paper develops a phenomenological analysis of the disturbances of self-experience in dementia. After considering the lack of conceptual clarity regarding the notions of self and person in current research on dementia, we develop a phenomenological theory of the structure of self-experience in the first section. Within this complex structure, we distinguish between the basic level of pre-reflective self-awareness, the episodic sense of self, and the narrative constitution of the self. In the second section, we focus on dementia and argue that, despite the impairment of narrative self-understanding, more basic moments of self-experience are preserved. In accordance with the theory developed in the first part, we argue that, at least until the final stages of the illness, these self-experience in dementia goes beyond the pure minimal self, and rather entail forms of self-reference and an episodic sense of self.