An affective approach to moral motivation

Over the last few years, there has been a surge of work in a new field called "moral psychology", which uses experimental methods to test the psychological processes underlying human moral activity. In this paper, I shall follow this line of approach with the aim of working out a model of how people form value judgements and how they are motivated to act morally. I call this model an "affective picture": 'picture' because it remains strictly at the descriptive level and 'affective' because it has an important role for affects and emotions. This affective picture is grounded on a number of plausible and empirically supported hypotheses. The main idea is that we should distinguish between various kinds of value judgements by focusing on the sort of state of mind people find themselves in while uttering a judgement. "Reasoned judgements" are products of rational considerations and are based on preliminary acceptance of norms and values. On the contrary, "basic value judgements" are affective, primitive and non-reflective ways of assessing the world. As we shall see, this analysis has some consequences for the traditional internalism-externalism debate in philosophy; it highlights the fact that motivation is primarily linked to "basic value judgements" and that the judgements we openly defend might not have a particular effect on our actions, unless we are inclined to have an emotional attitude that conforms to them.

Pragmatic approach to nutrition in the ICU: Expert opinion regarding which calorie protein target.

BACKGROUND & AIMS: Since the publications of the ESPEN guidelines on enteral and parenteral nutrition in ICU, numerous studies have added information to assist the nutritional management of critically ill patients regarding the recognition of the right population to feed, the energy-protein targeting, the route and the timing to start. METHODS: We reviewed and discussed the literature related to nutrition in the ICU from 2006 until October 2013. RESULTS: To identify safe, minimal and maximal amounts for the different nutrients and at the different stages of the acute illness is necessary. These amounts might be specific for different phases in the time course of the patient's illness. The best approach is to target the energy goal defined by indirect calorimetry. High protein intake (1.5 g/kg/d) is recommended during the early phase of the ICU stay, regardless of the simultaneous calorie intake. This recommendation can reduce catabolism. Later on, high protein intake remains recommended, likely combined with a sufficient amount of energy to avoid proteolysis. CONCLUSIONS: Pragmatic recommendations are proposed to practically optimize nutritional therapy based on recent publications. However, on some issues, there is insufficient evidence to make expert recommendations.

Syndrome de Sjögren: enfin une nouvelle approche de traitement [Sjögren's syndrome: a new approach to treatment].

Södgren's syndrome treatment has essentially been based on symptomatic approach and has been of limited efficacy. Novel biological therapies targeting B cells, a key player in the pathophysiology of the syndrome, have recently been tested in controlled clinical trials and raise the hope of improving glandular and extraglandular manifestations of Söigren's syndrome.

The likelihood approach to compare populations : a study on DNA evidence and pitfalls of intuitions

The paper follows on from earlier work [Taroni F and Aitken CGG. Probabilistic reasoning in the law, Part 1: assessment of probabilities and explanation of the value of DNA evidence. Science & Justice 1998; 38: 165-177]. Different explanations of the value of DNA evidence were presented to students from two schools of forensic science and to members of fifteen laboratories all around the world. The responses were divided into two groups; those which came from a school or laboratory identified as Bayesian and those which came from a school or laboratory identified as non-Bayesian. The paper analyses these responses using a likelihood approach. This approach is more consistent with a Bayesian analysis than one based on a frequentist approach, as was reported by Taroni F and Aitken CGG. [Probabilistic reasoning in the law, Part 1: assessment of probabilities and explanation of the value of DNA evidence] in Science & Justice 1998.

Parametric estimation of pulse arrival time: a robust approach to pulse wave velocity.

Pulse wave velocity (PWV) is a surrogate of arterial stiffness and represents a non-invasive marker of cardiovascular risk. The non-invasive measurement of PWV requires tracking the arrival time of pressure pulses recorded in vivo, commonly referred to as pulse arrival time (PAT). In the state of the art, PAT is estimated by identifying a characteristic point of the pressure pulse waveform. This paper demonstrates that for ambulatory scenarios, where signal-to-noise ratios are below 10 dB, the performance in terms of repeatability of PAT measurements through characteristic points identification degrades drastically. Hence, we introduce a novel family of PAT estimators based on the parametric modeling of the anacrotic phase of a pressure pulse. In particular, we propose a parametric PAT estimator (TANH) that depicts high correlation with the Complior(R) characteristic point D1 (CC = 0.99), increases noise robustness and reduces by a five-fold factor the number of heartbeats required to obtain reliable PAT measurements.

Prise en charge d'adolescents souffrant d'anorexie mentale: le rôle des parents, une approche basée sur l'évidence [Adolescents with an eating disorder: an evidence-based approach on the role of parents].

L'adolescence est une période de grands changements et de ce fait potentiellement de grande vulnérabilité. Ainsi, les bouleversements physiques et psychiques induits par les processus pubertaires sont un terrain propice à l'émergence d'un trouble des conduites alimentaires (TCA). La thérapie familiale selon Maudsley, ou family based treatment (FBT), a émergé en parallèle aux avancées neurobiologiques, qui confirment une origine multifactorielle des troubles du comportement alimentaire. Cette thérapie replace les parents au centre de la prise en charge des adolescents souffrant d'un TCA avec comme grand atout, une approche basée sur l'évidence scientifique. Adolescence is a time of great change and therefore, potentially of great vulnerability. Thus, physical and psychological changes induced by pubertal processes are fertile ground for the emergence of an eating disorder (ED). Family therapy according to Maudsley or "family based treatment" (FBT) has emerged in parallel with neurobiological advances confirming a multifactorial origin of eating disorders. This therapy places parents at the centre of care for adolescents with EDs. Its great asset is the evidence-based approach underpinning the therapy.

An individualized approach to abdominoplasty in the presence of bilateral subcostal scars after open gastric bypass.

BACKGROUND: Patients requiring surgical skin excision after massive weight loss are challenging and require an individualized approach. The characteristic abdominal deformity includes a draping apron of panniculus, occasionally associated with previous transverse surgical scars from open gastric bypass surgery in the upper abdomen, which compromise blood supply of the abdominal skin. METHODS: We propose four different surgical techniques for safe abdominal body contouring in the presence of such scars: (1) a limited abdominoplasty of the lower abdomen is performed, and then contouring is completed by a reversed abdominoplasty with scar positioning in the submammary folds; (2) a one-stage procedure characterized by skin resection in the upper and lower abdomen, in which blood supply of the skin island between the submammary and suprapubic incisions is ensured by periumbilical perforators; (3) a perforator-sparing abdominoplasty with selective dissection of periumbilical abdominal wall perforators to secure flap blood supply and allow complete flap undermining up to the xyphoid process; (4) for patients with extensive excess skin, a modified Fleur-de-Lys abdominoplasty performed in such a way that the old transverse scar is transformed into a vertical scar. RESULTS: The treatment of four exemplary patients is described. All techniques yielded good esthetic and functional results through preservation of abdominal blood supply. CONCLUSION: Through an individualized approach, adequate abdominal body contouring can be performed safely, even in the presence of transverse surgical scars in the upper abdomen.

Principal components of functional connectivity: A new approach to study dynamic brain connectivity during rest.

Functional connectivity (FC) as measured by correlation between fMRI BOLD time courses of distinct brain regions has revealed meaningful organization of spontaneous fluctuations in the resting brain. However, an increasing amount of evidence points to non-stationarity of FC; i.e., FC dynamically changes over time reflecting additional and rich information about brain organization, but representing new challenges for analysis and interpretation. Here, we propose a data-driven approach based on principal component analysis (PCA) to reveal hidden patterns of coherent FC dynamics across multiple subjects. We demonstrate the feasibility and relevance of this new approach by examining the differences in dynamic FC between 13 healthy control subjects and 15 minimally disabled relapse-remitting multiple sclerosis patients. We estimated whole-brain dynamic FC of regionally-averaged BOLD activity using sliding time windows. We then used PCA to identify FC patterns, termed "eigenconnectivities", that reflect meaningful patterns in FC fluctuations. We then assessed the contributions of these patterns to the dynamic FC at any given time point and identified a network of connections centered on the default-mode network with altered contribution in patients. Our results complement traditional stationary analyses, and reveal novel insights into brain connectivity dynamics and their modulation in a neurodegenerative disease.

Evolutionary impact assessment: accounting for evolutionary consequences of fishing in an ecosystem approach to fisheries management

Managing fisheries resources to maintain healthy ecosystems is one of the main goals of the ecosystem approach to fisheries (EAF). While a number of international treaties call for the implementation of EAF, there are still gaps in the underlying methodology. One aspect that has received substantial scientific attention recently is fisheries-induced evolution (FIE). Increasing evidence indicates that intensive fishing has the potential to exert strong directional selection on life-history traits, behaviour, physiology, and morphology of exploited fish. Of particular concern is that reversing evolutionary responses to fishing can be much more difficult than reversing demographic or phenotypically plastic responses. Furthermore, like climate change, multiple agents cause FIE, with effects accumulating over time. Consequently, FIE may alter the utility derived from fish stocks, which in turn can modify the monetary value living aquatic resources provide to society. Quantifying and predicting the evolutionary effects of fishing is therefore important for both ecological and economic reasons. An important reason this is not happening is the lack of an appropriate assessment framework. We therefore describe the evolutionary impact assessment (EvoIA) as a structured approach for assessing the evolutionary consequences of fishing and evaluating the predicted evolutionary outcomes of alternative management options. EvoIA can contribute to EAF by clarifying how evolution may alter stock properties and ecological relations, support the precautionary approach to fisheries management by addressing a previously overlooked source of uncertainty and risk, and thus contribute to sustainable fisheries.

Isolating DNA from sexual assault cases: a comparison of standard methods with a nuclease-based approach.

AbstractText BACKGROUND: Profiling sperm DNA present on vaginal swabs taken from rape victims often contributes to identifying and incarcerating rapists. Large amounts of the victim's epithelial cells contaminate the sperm present on swabs, however, and complicate this process. The standard method for obtaining relatively pure sperm DNA from a vaginal swab is to digest the epithelial cells with Proteinase K in order to solubilize the victim's DNA, and to then physically separate the soluble DNA from the intact sperm by pelleting the sperm, removing the victim's fraction, and repeatedly washing the sperm pellet. An alternative approach that does not require washing steps is to digest with Proteinase K, pellet the sperm, remove the victim's fraction, and then digest the residual victim's DNA with a nuclease. METHODS: The nuclease approach has been commercialized in a product, the Erase Sperm Isolation Kit (PTC Labs, Columbia, MO, USA), and five crime laboratories have tested it on semen-spiked female buccal swabs in a direct comparison with their standard methods. Comparisons have also been performed on timed post-coital vaginal swabs and evidence collected from sexual assault cases. RESULTS: For the semen-spiked buccal swabs, Erase outperformed the standard methods in all five laboratories and in most cases was able to provide a clean male profile from buccal swabs spiked with only 1,500 sperm. The vaginal swabs taken after consensual sex and the evidence collected from rape victims showed a similar pattern of Erase providing superior profiles. CONCLUSIONS: In all samples tested, STR profiles of the male DNA fractions obtained with Erase were as good as or better than those obtained using the standard methods.

Data-based approach for developing a physical activity frequency questionnaire.

Measurement of total energy expenditure may be crucial to an understanding of the relation between physical activity and disease and in order to frame public health intervention. To devise a self-administered physical activity frequency questionnaire (PAFQ), the following data-based approach was used. A 24-hour recall was administered to a random sample of 919 adult residents of Geneva, Switzerland. The data obtained were used to establish the list of activities (and their median duration) that contributed to 95% of the energy expended, separately for men and women. Activities that were trivial for the whole sample but that contributed to > or = 10% of an individual's energy expenditure were also selected. The final PAFQ lists 70 activities or group of activities with their typical duration. About 20 minutes are required for respondents to indicate the number of days and the number of hours per day that they performed each activity. The PAFQ method was validated against a heart rate monitor, a more objective method. The total energy estimated by the PAFQ in 41 volunteers correlated well (r = 0.76) with estimates using a heart rate monitor. The authors conclude that the design of their self-administered physical activity frequency questionnaire based on data from 24-hour recall appeared to accurately estimate energy expenditure.

Multi-dimensional approach to bullying

RÉSUMÉ : Le bullying est un type de comportement agressif qu'un élève (ou plusieurs) fait subir à un autre et qui se manifeste par des agressions verbales, physiques et/ou psychologiques. Les caractéristiques du bullying sont la répétitivité d'actions négatives sur le long terme et une relation de pouvoir asymétrique. Pour la victime, ce type de comportement peut avoir des conséquences graves telles qu'échec scolaire, dépression, troubles alimentaires, ou idées suicidaires. De plus, les auteurs de bullying commettent plus de comportements déviants au sein de l'école ou à l'extérieur de cette dernière. La mise en place d'actions ciblées auprès des auteurs de bullying pourrait donc non seulement prévenir une victimisation, mais aussi réduire les actes de délinquance en général. Hormis quelques études locales ou cantonales, aucune recherche nationale auprès d'adolescents n'existait dans le domaine. Ce travail propose de combler cette lacune afin d'obtenir une compréhension suffisante du phénomène qui permet de donner des pistes pour définir des mesures de prévention appropriées. Afin d'appréhender la problématique du bullying dans les écoles secondaires suisses, deux sondages de délinquance juvénile autoreportée ont été effectués. Le premier a eu lieu entre 2003 et 2005 dans le canton de Vaud auprès de plus de 4500 écoliers. Le second a été administré en 2006 dans toute la Suisse et environ 3600 jeunes y ont participé. Les jeunes ont répondu au sondage soit en classe (questionnaire papier) soit en salle d'informatique (questionnaire en ligne). Les jeunes ayant répondu avoir sérieusement harcelé un autre élève est d'environ 7% dans le canton de Vaud et de 4% dans l'échantillon national. Les analyses statistiques ont permis tout d'abord de sélectionner les variables les plus fortement liées au bullying. Les résultats montrent que les jeunes avec un bas niveau d'autocontrôle et ayant une attitude positive envers la violence sont plus susceptibles de commettre des actes de bullying. L'importance des variables environnementales a aussi été démontrée: plus le jeune est supervisé et encadré par des adultes, plus les autorités (école, voisinage) jouent leur rôle de contrôle social en faisant respecter les règles et en intervenant de manière impartiale, moins le jeune risque de commettre des actes de bullying. De plus, l'utilisation d'analyses multiniveaux a permis de montrer l'existence d'effets de l'école sur le bullying. En particulier, le taux de bullying dans une école donnée augmente lorsque les avis des jeunes divergent par rapport à leur perception du climat scolaire. Un autre constat que l'on peut mettre en évidence est que la réaction des enseignants lors de bagarres a une influence différente sur le taux de bullying en fonction de l'établissement scolaire. ABSTRACT : Bullying is the intentional, repetitive or persistent hurting of one pupil by another (or several), where the relationship involves an imbalance of power. Bullying is a type of aggressive behaviour and the act can be verbal, physical and/or psychological. The consequences on the victims are serious: school failure, depressive symptomatology, eating disorders, or suicidal ideation. Moreover, the authors of bullying display more delinquent behaviour within or outside the school. Thus, preventive programmes targeting bullying could not only prevent victimisation, but also reduce delinquency in general. Very little data concerning bullying had been collected in Switzerland and, except some local or cantonal studies, no national research among teenagers existed in the field. This work intends to fill the gap in order to provide sufficient understanding of the phenomenon and to suggest some tracks for defining appropriate measures of prevention. In order to understand the problems of bullying in Swiss secondary schools better, two surveys of self-reported juvenile delinquency were carried out. The first one took place between 2003 and 2005 in the canton Vaud among more than 4500 pupils, the second in 2006 across Switzerland with about 3600 youths taking part. The pupils answered to the survey either in the classroom (paper questionnaire) or in the computer room (online questionnaire). The youths that answered having seriously bullied another pupil are about 7% in canton Vaud and 4% in the national sample. Statistical analyses have selected the variables most strongly related to bullying. The results show that the youths with a low level of self-control and adopting a positive attitude towards violence are more likely to bully others. The importance of the environmental variables was also shown: the more that youth is supervised and monitored by adults, and the more the authorities (school, neighbourhood) play their role of social control by making the rules be respected through intervening in an impartial way, the less the youth bully. Moreover, the use of multilevel analyses permitted to show the existence of effects of the school on bullying. In particular, the rate of bullying in a given school increases when there is a wide variation among students of the same school in their perception of their school climate. Another important aspect concerns teachers' reactions when pupils fight: this variable does not influence the bullying rate to the same extent, and depends on the school.

Current developments in the radiotherapy approach to elderly and frail patients with glioblastoma multiforme.

The benefit of postoperative radiotherapy (RT) has been demonstrated in elderly patients aged 65 years or older with glioblastoma multiforme. Hypofractionated RT schedules can reduce the time and morbidity of treatment while maintaining comparable survival outcomes to lengthy conventional RT. Current international randomized clinical trials are studying the optimized hypofractionated RT regimens, hypofractionated RT in comparison with temozolomide chemotherapy and hypofractionated RT in comparison with the same RT plus temozolomide. Given the guarded prognosis of the elderly and frail patients, quality of life and side effects of treatment should be closely examined. As more than half of cancers in the world occur in developing countries, hypofractionated RT could be better utilized as a cost-effective treatment for this group of patients.

Diffusion-weighted spectroscopy: a novel approach to determine macromolecule resonances in short-echo time 1H-MRS.

Quantification of short-echo time proton magnetic resonance spectroscopy results in >18 metabolite concentrations (neurochemical profile). Their quantification accuracy depends on the assessment of the contribution of macromolecule (MM) resonances, previously experimentally achieved by exploiting the several fold difference in T(1). To minimize effects of heterogeneities in metabolites T(1), the aim of the study was to assess MM signal contributions by combining inversion recovery (IR) and diffusion-weighted proton spectroscopy at high-magnetic field (14.1 T) and short echo time (= 8 msec) in the rat brain. IR combined with diffusion weighting experiments (with δ/Δ = 1.5/200 msec and b-value = 11.8 msec/μm(2)) showed that the metabolite nulled spectrum (inversion time = 740 msec) was affected by residuals attributed to creatine, inositol, taurine, choline, N-acetylaspartate as well as glutamine and glutamate. While the metabolite residuals were significantly attenuated by 50%, the MM signals were almost not affected (< 8%). The combination of metabolite-nulled IR spectra with diffusion weighting allows a specific characterization of MM resonances with minimal metabolite signal contributions and is expected to lead to a more precise quantification of the neurochemical profile.

TCRep 3D: an automated in silico approach to study the structural properties of TCR repertoires.

TCRep 3D is an automated systematic approach for TCR-peptide-MHC class I structure prediction, based on homology and ab initio modeling. It has been considerably generalized from former studies to be applicable to large repertoires of TCR. First, the location of the complementary determining regions of the target sequences are automatically identified by a sequence alignment strategy against a database of TCR Vα and Vβ chains. A structure-based alignment ensures automated identification of CDR3 loops. The CDR are then modeled in the environment of the complex, in an ab initio approach based on a simulated annealing protocol. During this step, dihedral restraints are applied to drive the CDR1 and CDR2 loops towards their canonical conformations, described by Al-Lazikani et. al. We developed a new automated algorithm that determines additional restraints to iteratively converge towards TCR conformations making frequent hydrogen bonds with the pMHC. We demonstrated that our approach outperforms popular scoring methods (Anolea, Dope and Modeller) in predicting relevant CDR conformations. Finally, this modeling approach has been successfully applied to experimentally determined sequences of TCR that recognize the NY-ESO-1 cancer testis antigen. This analysis revealed a mechanism of selection of TCR through the presence of a single conserved amino acid in all CDR3β sequences. The important structural modifications predicted in silico and the associated dramatic loss of experimental binding affinity upon mutation of this amino acid show the good correspondence between the predicted structures and their biological activities. To our knowledge, this is the first systematic approach that was developed for large TCR repertoire structural modeling.