Skin and the Non‐Human Human: Transformation and Reversal in Titian's The Flaying of Marsyas

The article puts forward an aesthetic and psychoanalytic analysis of Titian's painting, The Flaying of Marsyas, arguing that the painting is a reflection on the human subject as a being constituted by skin and by a core of non‐humanity. The analysis is partly an answer to Melanie Hart's (2007) article ‘Visualizing the mind: Looking at Titian's Flaying of Marsyas', addressing features of the painting not commented on by Hart, and supplementing Hart's (Kleinian) theoretical frame by involving Didier Anzieu's ‘skin ego’, Slavoj Zizek's concept of the ‘non‐human’, Giorgio Agamben's term of the ‘Muselmann’, and Anton Ehrenzweig's psychoanalytic theory of artistic creation. Whereas Hart is focusing on form and colour, I also turn my attention towards the texture of the painting.     

Assessing and combining repeated prognosis of physicians and temporal models in the intensive care

ObjectiveRecently, we devised a method to develop prognostic models incorporating patterns of sequential organ failure to predict the eventual hospital mortality at each day of intensive care unit (ICU) stay. In this study, we investigate using a real world setting how these models perform compared to physicians, who are exposed to additional information than the models.MethodsWe developed prognostic models for days 2–7 of ICU stay by data-driven discovery of patterns of sequential qualitative organ failure (SOFA) scores and embedding the patterns as binary variables in three types of logistic regression models. Type A models include the severity of illness score at admission (SAPS-II) and the SOFA patterns. Type B models add to these covariates the mean, max and delta (increments) of SOFA scores. Type C models include, in addition, the mean, max and delta in expert opinion (i.e. the physicians’ prediction of mortality).ResultsPhysicians had a statistically significantly better discriminative ability compared to the models without subjective information (AUC range over days: 0.78–0.79 vs. 0.71–0.74) and comparable accuracy (Brier score range: 0.15–0.18 vs. 0.16–0.18). However when we combined both sources of predictions, in Type C models, we arrived at a significantly superior discrimination as well as accuracy than the objective and subjective models alone (AUC range: 0.80–0.83; Brier score range: 0.13–0.16).ConclusionThe models and the physicians draw on complementary information that can be best harnessed by combining both prediction sources. Extensive external validation and impact studies are imperative to further investigate the ability of the combined model.     

Influence of visual feedback sampling on obstacle crossing behavior in people with Parkinson's disease

The purpose of the current study was to investigate the role of visual information on gait control in people with Parkinson's disease as they crossed over obstacles. Twelve healthy individuals, and 12 patients with mild to moderate Parkinson's disease, walked at their preferred speeds along a walkway and stepped over obstacles of varying heights (ankle height or half-knee height), under three visual sampling conditions: dynamic (normal lighting), static (static visual samples, similar to stroboscopic lighting), and voluntary visual sampling. Subjects wore liquid crystal glasses for visual manipulation. In the static visual sampling condition only, the patients with Parkinson's disease made contact with the obstacle more often than did the control subjects. In the successful trials, the patients increased their crossing step width in the static visual sampling condition as compared to the dynamic and voluntary visual sampling conditions; the control group maintained the same step width for all visual sampling conditions. The patients showed lower horizontal mean velocity values during obstacle crossing than did the controls. The patients with Parkinson's disease were more dependent on optic flow information for successful task and postural stability than were the control subjects. Bradykinesia influenced obstacle crossing in the patients with Parkinson's disease.     

Factors affecting prophylactic immunization compliance in elderly veterans: A study of pneumococcal immunization in the aged

Immunization among the high risk groups, including the elderly, remains unacceptably low for pneumococcal and influenza vaccines. This study determined the factors which influence pneumococcal vaccine compliance in the aged. A questionnaire developed for this study was mailed to all 300 veterans in west central Florida who were 85 years or older and were eligible for ambulant medical care at the James A. Haley Veterans Hospital, Tampa, Florida. They were asked regarding circumstances which influenced their decision for or against accepting pneumococcal vaccine. Ninety-two persons responded in self-addressed stamped envelopes and data were analyzed six months following mailing date. The single most important factor for not accepting vaccination was lack of information and unawareness that the immunization was necessary (81%). Fear of “shots” and side effects was the next most important reason for not taking the vaccine (15%). Lack of transportation to the doctor’s office prevented 12% of the subjects. Some subjects also did not have an interest in prophylactic immunization (8%). These data suggest that the lack of awareness, knowledge and information about pneumococcal immunization plays major roles in its poor acceptance among the elderly. Health education measures should improve vaccine compliance in this population who suffer from higher death rates and complications from pneumonia.     

Comparison of the acute response to meals enriched with cis- or trans-fatty acids on glucose and lipids in overweight individuals with differing FABP2 genotypes

Trans-fatty acids have been implicated as a risk factor for cardiovascular disease and diabetes. In addition, a polymorphism at codon 54 (Ala54Thr) in the fatty acid-binding protein 2 (FABP2) gene has been suggested to modify an interaction between dietary fat and insulin sensitivity. We examined the postprandial metabolic profiles after meals enriched with C18:1trans- relative to a similar meal with C18:1cis-fatty acid in individuals who were either FABP2 Ala54 homozygotes or Thr54 carriers. Moderately overweight men and women ate 2 breakfast test meals, separated by 1 week, each providing 40% of their daily energy requirement and containing 50% of energy as fat. In one meal, 10% of energy was from C18:1trans, and in the other meal, the C18:1trans was replaced with C18:1cis. Metabolic parameters were assessed during an 8-hour period. Insulin and C-peptide levels increased more after the C18:1trans meal, and this was associated with a greater fall in free fatty acids. Postprandial glucose levels and oxidation of fatty acids and carbohydrate were not different between the 2 test meals. The Thr54 allele for FABP2 increased the rise in postprandial glucose but not triacylglycerols. Fractional triacylglycerol synthetic rates were higher after consumption of the C18:1trans meal relative to the C18:1cis meal only in Thr54 carriers. These data show that a single meal enriched with C18:1trans-fatty acids can significantly increase insulin resistance, and that in the presence of the FABP2 Thr54 allele, may contribute to increased partitioning of glucose to triacylglycerols and insulin resistance.     

High normal serum levels of C3 and C1 inhibitor,two acute-phase proteins belonging to the complement system,occur more frequently in patients with Crohn's disease than ulcerative colitis

Few data are available on measurements of serum concentrations of complement proteins in inflammatory bowel disease (IBD). Therefore we measured serum levels of C3, C4, and C1-esterase inhibitor (C1-INH) as well as C-reactive protein (CRP) in 167 patients with Crohn's disease (CD) and 111 patients with ulcerative colitis (UC). Median serum concentrations of C3 and C1-INH were significantly higher in CD than in UC. According to multiple logistic regression analysis adjusted to age, sex, activity of disease, and presence of extraintestinal manifestations, IBD patients with high-normal (128%, 75th percentile ) C1-INH concentrations had significantly (0.0275) higher odds ratio to have a diagnosis of CD than UC. Patients with high-normal C3 (1.40 g/liter) and high (20 mg/liter) CRP concentrations had an even higher odds ratio of a CD diagnosis (P = 0.0132). Our findings indicate that measurement of C3, C1-INH, and CRP can be used as an additional marker to pANCA/ASCA for distinguishing patients with CD and UC.