Vulnerable Subjects Research Articles

An observational study of the evaluation of fatty liver in non-alcoholics with metabolic syndrome using fatty liver index and its correlation with USG elastography

Background: NAFLD (Non Alcoholic Fatty Liver Disease) is being considered the hepatic component of metabolic syndrome. It is now the most common cause of chronic liver disease worldwide and needs to be addressed urgently as it is asymptomatic and widely prevalent and can progress to cirrhosis and hepatocellular carcinoma. There is a need for simpler methods to diagnose the condition in modern day practice which will help in identifying vulnerable subjects and in bringing about awareness and lifestyle modifications focused on reversal of the condition. Aim of this study was to check the applicability of the fatty liver index in modern day out patient practice using formula based FLI calculator.Methods: It was a cross sectional study on patients with metabolic syndrome in a tertiary care hospital. 60 patients with metabolic syndrome, both male and female above the age of 30 years and who were non-alcoholics were enrolled in the study. BMI, waist circumference, lipid profile and GGT were obtained and FLI calculated. It was compared with the ultrasound and Elastography reports. Chi square test, Independent t test and ANOVA test were used for comparing parameters. A p value of <0.05 was considered statistically significant.Results: Among 60 patients all had fatty liver which emphasizes that fatty liver is the hepatic component of metabolic syndrome. There is a significant correlation between BMI (Body Mass Index) and waist circumference in predicting fatty liver and to some extent its grade. Patients with higher BMI had a greater grade of fatty liver.Conclusions: The fatty liver index is a reliable predictor of fatty liver in people with metabolic syndrome. The grade of fatty liver increases with increase in waist circumference and increased BMI. Ultrasound and Elastography are reliable non invasive methods of detecting fatty liver. BMI and Waist circumference are strong predictive factors for fatty liver.

Valuing Literature: The Picaresque and the Writing Life in Mexico

This article contends that Mexican writers have drawn on the picaresque to ponder what they regard as the precariousness of intellectual labor in Mexico. It analyzes the role that the afterlives of the picaresque have played in the portrayal of writers as disenfranchised and vulnerable subjects, two of the most relevant features of the archetype ofpícaros. In addition, this project also suggests that picaresque narratives embody a discourse of precarity that goes beyond pícaros and applies to all subjects who engage in the production and circulation of literature, turning the picaresque in a suitable form in which Mexican writers can reflect on the value of literature in Mexican society.

Ethics in the Environment of Media and Technologies

The scientific conference ‘Ethics in the Environment of Media and Technologies’ held at the Lithuanian Academy of Sciences is reviewed in the article. The text represents the course of the conference and the main thoughts of speakers, and some ideas of the participants are discussed in more detail. The topics explored in this scientific event are the following: the meaning of sacrifice, decentered subject in media, the wars of world-views, technical artefacts in the antique philosophy, the problem of nihilism in Heidegger’s philosophy, ethics of representation of vulnerable subjects, paradoxes of media ethics, face in media, evil in communication, ethics of cultural and creative industries, ethics of technology, and various other ethical problems of media, politics and medicine.

Das resiliente Selbst?

Abstract The Resilient Self? A Vulnerability Theoretic Attempt Concerning a Pedagogical ›Real Fiction‹ The article emphasizes current social science discourses in which different vulnerable subject types are invoked. It is based on Alain Ehrenberg’s thesis that the change of subjectivation forms can be demonstrated by the change of dominant disease patterns. Finally, the now prominent ideal type of the resilient self is subjected to critical reflection and put into relation with postfordist modes of production.

The relationship between death obsession and religiosity in Muslim nursing home non-demented residents in Tunisia

The death distress would be one of the most important problems in the older population and would be more pronounced in some vulnerable older subjects, including those living in nursing homes facilities. We aimed to assess death obsession (DO) in elderly without dementia living in nursing homes, and to examine the association between DO and religiosity. We carried out a cross-sectional survey involving 42 old subjects living in Manouba nursing home. The "Mini-Mental State Examination", the "Geriatric Depression Scale", the "Activity of Daily Living", the "Cumulative Illness Rating Scale-Geriatric", the "Death Obsession Scale", the "Brief religious coping scale" and the "Arabic Religiosity Scale" were used to assess cognitive functions, depression, level of dependency, comorbidities, death obsession, religious coping and religiosity, respectively. We found relatively high death obsession scores, with no gender differencies (mean scores = 33.1 ± 18.1). The death obsession was significantly and positively associated with comorbidity scores (p = 0.04). No significant correlation was found between death obsession scores and religiosity and religious coping scores in the bivariate analysis. Similarly, multiple hierarchical regression found that religious variables (global religiosity and religious coping) did not significantly contribute to the variance of the death obsession. Older people living in nursing homes have specific psychosocial and spiritual needs, that health care providors should recognize, assess and care for, early and adequately.

Advocate cultivation of academic ethics: why is it necessary?

We teach and practice ethical behavior with all clinical and research activities. Notably, we are well educated to treat the subjects participating in research studies with high ethical standards. However, the ethics of interacting with colleagues, or with junior faculty members, are neither well defined nor taught. Dealing with junior faculty has parallels to dealing with vulnerable research subjects such as children, mentally or physically challenged groups, prison inmates or army recruits. Like any other vulnerable population, lower-ranking faculty members are often at the mercy of department chairs or other higher-ranked faculty members. Herein we present some potentially unethical or unfair examples related to academic research. Our goal is to educate the academic community of conceptual paths and to prevent similar untoward occurrences from happening in the future. Unethical behaviors related to sexual misconduct have already been described elsewhere and are not included in this manuscript.

How to Maximize Children's Involvement in Non-therapeutic Research-Lessons Learnt From EFFECTOR.

Background: Children are vulnerable study subjects, especially in non-therapeutic research. Nowadays more attention is paid to the children's voice in both decision-making on participation and their experience of clinical research procedures.Methods: We share our experiences from a long-term, cross-sectional, non-therapeutic follow-up study in the offspring of mothers who participated in scientific research during their pregnancy.Results: During the data collection process, different strategies were developed to achieve a satisfactory participation rate with a focus on the involvement of the children. All study documents and measurements were assembled into a superhero framework. This theme is flexible and attracts children of a wide age-span. In order to inform the children before the study visit, a visually attractive assent was created as well as a superhero video. During the study visit, a sticker diploma was used with similar visuals from the assent. The toddlers received a superhero-cape. The children were involved in the decision-making process during the whole process.Discussion and conclusion: From our experience during the EFFECTOR data collection process, parents and their children can be motivated to participate in a long-term, non-therapeutic, follow-up study when child friendly and adequate communication is used. Framing in a superhero theme is simple and suitable for children of a wide age-span.

Validation of the French version of the Vulnerable Elders Survey-13 (VES-13)

BackgroundIdentifying and assessing degree and type of frailty among older persons is a major challenge when targeting high risk populations to identify preventive interventions. The Vulnerable Elders Survey-(VES-13) is a simple instrument to identify frailty defined as risk for death, functional decline or institutionalization.ObjectiveTranslate VES-13 into French and validate it.MethodsThe French version of VES-13 was developed by forward-backward translation of the VES-13 survey instrument. The authors assessed its feasibility, construct validity, and ability to predict the combined outcomes of admission to institution or death at 18 months, in 135 persons over 70 years of age living in the community. Subjects were recruited from three settings: Group 1 – a health prevention center (n = 45); Group 2 – an ambulatory care geriatric clinic (n = 40); and Group 3 – an intermediate care hospital unit (n = 50). The combined outcomes data were recorded by telephone interview with participants or a proxy.ResultsFeasibility of the French version, named Echelle de Vulnérabilité des Ainés-13 or EVA-13, was excellent. The scale classified 5 (11%) persons as vulnerable (score of 3 or more) in Group 1, 23 (58%) in Group 2 and 45 (90%) in Group 3 (p < 0.001) with scores of 0.91 +/− 1.16, 4.27 +/− 3.17 and 6.90 +/− 3.17, respectively (p < 0.001). At follow-up, among the 60 non-vulnerable subjects, 58 (96%) were alive and living at home, whereas 46 (65%) of the 70 vulnerable subjects were alive and living at home (p < 0.001).ConclusionsEVA-13 was determined to be valid and reliable.

Prepulse Inhibition of the Startle Reflex as a Predictor of Vulnerability to Develop Locomotor Sensitization to Cocaine.

Prepulse inhibition (PPI) of the startle reflex is a measure of sensory-motor synchronization. A deficit in PPI has been observed in psychiatric patients, especially those with schizophrenia and vulnerable subjects, since the neural bases of this disorder are also involved in the regulation of PPI. Recently, we have reported that baseline PPI levels in mice can predict their sensitivity to the conditioned reinforcing effects of cocaine in the conditioned place preference (CPP) paradigm. Mice with a low PPI presented a lower sensitivity to the conditioned rewarding effects of cocaine; however, once they acquired conditioned preference with a higher dose of the drug, a more persistent associative effect of cocaine with respect to environmental cues was evident in these animals when compared with High-PPI mice. Therefore, we proposed that the PPI paradigm can determine subjects with a higher vulnerability to the effects of cocaine. Developing locomotor sensitization after pre-exposure to cocaine is considered an indicator of transitioning from recreational use to a compulsive consumption of the drug. Thus, the aim of the present study was to evaluate whether subjects with a low PPI display a higher locomotor sensitization induced by cocaine. First, male and female OF1 mice were classified as High- or Low-PPI according to their baseline PPI levels. Subsequently, the motor effects induced by an acute dose of cocaine (Experiments 1 and 2) and the development of locomotor sensitization induced by pre-exposure to this drug (Experiments 3 and 4) were recorded using two apparatuses (Ethovision and actimeter). Low-PPI mice presented low sensitivity to the motor effects of an acute dose of cocaine, but a high increase of activity after repeated administration of the drug, thus suggesting a great developed behavioral sensitization. Differences after pretreatment with cocaine vs. saline were more pronounced among Low-PPI subjects than among High-PPI animals. These results endorse our hypothesis that the PPI paradigm can detect subjects who are more likely to display behaviors induced by cocaine and which can increase the risk of developing a cocaine use disorder. Herein, we further discuss whether a PPI deficit can be considered an endophenotype for cocaine use disorder.

Disability and vulnerability: a human rights reading of the responsive state

ABSTRACT Universal human rights of all are complemented with particular, targeted protection of some, especially those that traditionally have been left behind. By juxtaposing the ideas of universality and particularity, the article studies vulnerability as a particularising tool within human rights with a comparative approach to the influential vulnerability theory by Martha Fineman. By outlining the similarities and the differences between the two approaches of vulnerability theory and human rights project, the article sheds light on how the particular protection needs of persons with disabilities play out in the universalistic logic of vulnerability. The article argues that both universal and particular obligations of responsive states – and responsive humans – are needed as a way of materialising substantive equality for persons with disabilities as vulnerable legal subjects. Such obligations cannot be codified in full detail, but the intrinsic essence of rights requires each right to be interpreted in context and with regard to the particular individual vulnerabilities and resilience of each person. In operationalising the obligations arising from such rights, the human rights project and the vulnerability theory complement and reinforce each other in terms of specifying the rationale and the detailed benchmarks for state action.

The Gendered Representation of Refugees Using Visual Frames in the Main Western European Media

In this paper we content analysed the way female refugees are depicted in 500 journalistic photographs published between 2013 and 2017 on ten of the news digital media with the greatest public impact from five of the Western European countries most affected by the wave of migration during the refugee crisis (France, Germany, Italy, Spain and United Kingdom). The most representative media of western culture and with an international projection were selected. We tested from the visual framing theory if women were underrepresented in these main European media, if they were associated to religious symbols more frequently than male refugees, and if they were depicted connotatively in a different way than male refugees. We found that, indeed, there was an underrepresentation of female refugees in the photographs of the analysed European media, and female refugees were more frequently associated with religious symbols than male. Moreover, female refugees were more frequently depicted as victims compared to male, while male refugees were more frequently depicted in burden or threat frames compared to female, so that in a more negative but also more active way. This means that, both through the under-representation and through the way in which they are represented in the European media photographs, female refugees are being associated with a passive and secondary role. European media are contributing to reinforce the so-called “symbolic annihilation” of women by condescendingly showing female refugee as an inoffensive, vulnerable, and submissive subject.

Effects of Kappa opioid receptor blockade by LY2444296 HCl, a selective short-acting antagonist, during chronic extended access cocaine self-administration and re-exposure in rat.

Cocaine addiction is a chronic brain disease characterized by compulsive drug intake and dysregulation of brain reward systems. Few preclinical studies have modeled the natural longitudinal course of cocaine addiction. Extended access self-administration protocols are powerful tools for modeling the advanced stages of addiction; however, few studies have duration of drug access longer than 12h/session, potentially limiting their construct validity. Identification of changes in cocaine intake patterns during the development of addictive-like states may allow better treatments for vulnerable subjects. The kappa opioid receptor (KOPr) system has been implicated in the neurobiological regulation of addictive states as well as mood and stress disorders, with selective KOPr antagonists proposed as possible pharmacotherapeutic agents. Chronic cocaine exposure increases the expression of KOPr and its endogenous agonists, the dynorphins, in several brain areas in rodents. To examine the behavioral pattern of intake during chronic (14days) 18 h intravenous cocaine self-administration (0.5mg/kg/infusion) and the effect of a novel short-acting KOPr antagonist LY2444296 HCl (3mg/kg) administered during sessions 8 to 14 of chronic 18h/day cocaine self-administration and prior to a single re-exposure session after 2 cocaine-free withdrawal days. Both daily and hourly cocaine intake patterns changed over 14days of 18h self-administration. LY pretreatment affected the pattern of self-administration across the second week of extended access cocaine self-administration and prevented the increase in cocaine intake during re-exposure. Overall, the KOPr antagonist attenuated escalated cocaine consumption in a rat model of extended access cocaine self-administration.

Risk narrations and perceptions in the COVID-19 time. A discourse analysis through the Italian press

This paper explores how the risk related to the pandemic of COVID-19 was managed, narrated and perceived in Italy during the lockdown phase, from February until June 2020. To reach this aim, the study provides a discourse analysis of three main level: the official institutional discourses declaimed by the government and the health authority; the risk narration spread through the diaphragm of the Italian press, and specifically through two of the most-read newspapers in Italy (<i>Repubblica</i> and <i>Corriere della Sera</i>) and their related weeklies (<i>Venerdì di Repubblica</i> and <i>Sette</i>); finally, the diverse reactions and perceptions to the risk coming from the most affected and most vulnerable subjects, communities and territories. In order to record this narrative frame, our study started by looking for the more recurrent keywords through which the public discourse about COVID-19 emergency was spread in Italy. The examined words, together with a literary review about risk, disaster, and sustainability, give back, and allow to understand, the mirror of the risk management, perception, and narration in the pandemic society. According to the Foucaultos thought, a constant theoretical reference has been the power control exerted in the plague city. In this article we show in a nutshell some of the main elements emerged through this discourse analysis. Firstly, it comes to light how the world has been caught totally unprepared to manage collectively a pandemic of this magnitude. Secondly, two main emergency consequences emerged. Indeed, if on one hand the risk management created privileges and inequalities, on the other hand the risk perception led to communitieso practices of solidarity and resilience. Finally, our research demonstrates what is depicted in the reported literary review: disasters are unevenly and differential phenomena.

COVID-19 disease emergency operational instructions for Mental Health Departments issued by the Italian Society of Epidemiological Psychiatry.

During the current COVID-19 disease emergency, it is not only an ethical imperative but also a public health responsibility to keep the network of community psychiatry services operational, particularly for the most vulnerable subjects (those with mental illness, disability, and chronic conditions). At the same time, it is necessary to reduce the spread of the COVID-19 disease within the outpatient and inpatient services affiliated with Mental Health Departments. These instructions, first published online on 16 March 2020 in their original Italian version, provide a detailed description of actions, proposed by the Italian Society of Epidemiological Psychiatry, addressed to Italian Mental Health Departments during the current COVID-19 pandemic. The overall goal of the operational instructions is to guarantee, during the current health emergency, the provision of the best health care possible, taking into account both public health necessities and the safety of procedures. These instructions could represent a useful resource to mental health providers, and stakeholders to face the current pandemic for which most of Mental Health Departments worldwide are not prepared to. These instructions could provide guidance and offer practical tools which can enable professionals and decision makers to foresee challenges, like those already experienced in Italy, which in part can be avoided or minimised if timely planned. These strategies can be shared and adopted, with the appropriate adjustments, by Mental Health Departments in other countries.

Vulnerability in Research: Basic Ethical Concepts and General Approach to Review.

Background: The concept of vulnerability is a cornerstone of the theoretical basis and practical application of ethics in human subjects research. Risks to humans participating in research must be minimized; that is, subjects must be offered protection from risks. Vulnerable subjects require additional protections.Methods: This paper reviews the ethical and conceptual basis of vulnerability within the context of human subjects research and suggests a basic approach that institutional review boards (IRBs) can use when considering if the research includes adequate safeguards to protect the rights and welfare of subjects who are likely to be vulnerable.Results: Two distinct approaches to describing the features that make a person vulnerable are the categorical approach and the contextual approach. The categorical approach considers certain groups or populations as vulnerable. This approach is not optimal because it does not address persons with multiple vulnerabilities, does not account for variation in the degree of vulnerability within the group based on individual characteristics, and classifies certain persons as vulnerable rather than identifying situations in which individuals might be considered vulnerable. The alternate contextual approach allows for a more nuanced understanding of the nature of the vulnerability than the categorical approach and therefore a more focused approach to safeguards. The IRB is charged with ensuring that additional safeguards to protect the rights and welfare of subjects who are likely to be vulnerable are included in the study under review. To make this determination, the IRB might be advised to consider two questions: (1) is inclusion necessary? and (2) if so, are safeguards adequate?Conclusion: Although vulnerability is often presented as a yes/no consequence related to some characteristic of a group, a more accurate approach is to consider vulnerability as occurring along a spectrum of seriousness and as a consequence of situations and context. With this idea in mind, investigators and IRBs are advised to take a stepwise approach to determining if the study meets the regulatory and ethical admonition to ensure that safeguards protect the rights and welfare of vulnerable subjects.

The Wounded Self: Writing Illness in Twenty-First-Century German Literature by Nina Schmidt

Reviewed by: The Wounded Self: Writing Illness in Twenty-First-Century German Literature by Nina Schmidt Franziska Gygax (bio) The Wounded Self: Writing Illness in Twenty-First-Century German Literature Nina Schmidt Camden House, 2018, xii + 235 pages. ISBN 9781640140165, $75.00 hardback. At the beginning of her comprehensive and excellently argued study of autobiographical representations of illness in contemporary German literature, Nina Schmidt refers to Virginia Woolf's On Being Ill and her canonical statement that illness has not acquired the crucial status of a serious literary topic that it deserves. To serve as a striking example of this inadequate judgment and of the necessary theorization of and explanation for the contrary, Schmidt takes as one of her primary texts Christoph Schlingensief's cancer diary So schön wie hier kanns im Himmel gar nicht sein! Tagebuch einer Krebserkrankung (It can't possibly be as beautiful in heaven as it is here! A diary of cancer, 2009), and the ensuing attack in the feuilleton that illness narratives are not real literature. Furthermore, the fact that numerous illness narratives have been published in the past twenty years (not only in the German-speaking world) and that they have received both public and scholarly attention demonstrates the need for further recognition and serious literary criticism, which has actually already been the case in the Anglophone world for quite some time. Besides Schlingensief's cancer diary, Schmidt focuses on Charlotte Roche's 2011 Schossgebete (published in English as Wrecked, 2013), Kathrin Schmidt's Du stirbst nicht (You aren't dying, 2009), Verena Stefan's Fremdschläfer (Alien sleeper, 2007), and Wolfgang Herrndorf's Arbeit und Struktur (Work and structure, 2010–2013), and she convincingly explains her selection by the different range of genres and narrative forms of these texts. These specific narrative forms and aesthetic strategies are the main objectives of her study, and they bring to light the crucial themes of illness, disability, and dying as they appear as lived experiences. In her introduction, Schmidt points out the difficulty of differentiating between illness and disability. She relies on insights from the field of disability [End Page 508] studies, and elucidates how readers often adopt a discriminatory attitude toward narrative on disability (and illness), considering it as deviating from the norm, which seems to be "ablebodiedness." Thus, Schmidt's approach is very much grounded in challenging normative values inadequately based on binary thinking, such as healthy vs. ill and disabled, external vs. internal, or heterosexual vs. homosexual/lesbian in Stefan's Fremdschläfer, and "Selbstbild" (self-image) vs. "Fremdbild" (externally determined image) in Kathrin Schmidt's Du stirbst nicht (71). Additionally, she emphasizes her goal of highlighting the intricate relationship between the autobiographical and the (auto)fictional, a highly contested, but necessary contemporary debate, to which she contributes with a meticulous discussion of her exemplary texts. Her decision not to proceed chronologically in her analysis of the four texts is clear because of her focus on exploring and theorizing "the relation of the portrayal of illness to the author's own life experience" (33). Thus, her first chapter addresses the boundaries between fact and fiction in Roche's trauma narrative Schossgebete, and she speaks convincingly of an "aesthetics of disgust" (vividly represented in bodily descriptions) that Roche employs to deal with the protagonist's traumatic experiences (34). Schmidt's careful close reading and insightful references to Roche's own life experiences make evident the thin line between the protagonist's and the author's personal experiences. According to Schmidt, this autofictional form lends itself best to the retelling of traumatic experience by the vulnerable subject (author/protagonist). Here one could critically add that clearly identifiable autobiographies enable and empower their authors to narrate their traumata. Analyzing the "autobiographical novel" Du stirbst nicht (66), Nina Schmidt returns to the concept of the stare from disability studies to develop her argument of the successful restoration of the protagonist's self-image (after a brain hemorrhage): because of her illness experience she has become a "staree" (72), but at the same time she begins to stare (back) and recognizes the illusory notion of normality and ablebodiedness. Nina Schmidt establishes an intriguing connection between the protagonist...

Those Who Gather in the Streets

This article examines the notion of vulnerable political subjectivity in Judith Butler’s theory of vulnerability. The paper aims to contribute to critical discussions of Butler’s political theory by offering an account of how the ontological, ethical, and political aspects of vulnerability shape political subjectivity in her work. The first part of the paper analyzes the features of vulnerable political subjects. The second part critically assesses to what extent Butler offers an alternative to the association of vulnerability with a damaged capability to act politically. The third part argues that Butler offers only a partial account of vulnerability as a transformative desire, which is crucial to explaining how and under what conditions vulnerability inspires subjects to engage politically with the conditions that shape their precarity or the precarity of others.

Collaborative audio-visual rhetoric: A self-reflexive review of collaboration in anthropological film projects

Through a self-reflexive review of collaboration in two anthropological film projects conducted during the period from 2013 to 2018, we address the dilemmas that are at stake when producing and distributing audio-visual images of vulnerable subjects (for example, refugees), and the consumption of so-called "subject-generated" imagery. The poetical and political strategies of audio-visual forms of anthropological (re)presentation as well as the existing shortcomings related to those topics, such as the 'refugee crisis', which is caught in the current context of our media-saturated society is explored. We suggest the notion of "shared anthropology" as a framework for exploring the critical potential of collaborative audio-visual rhetoric. From this perspective, we discuss the films Unless the water is safer than the land, in which performers re-enact the narratives of refugees; and Passager, a collaborative film project between an audio-visual anthropologist and a young Afghan refugee who left his country in search of safer living conditions. We explore how these films can be conceptualised as distinctive forms of "collaborative audio-visual rhetoric".

Embodying the breach: (In)securitization and ethnographic engagement in the US

AbstractIn this commentary, the author offers three related perspectives regarding (in)securitization: first, an overview of ongoing discussions taking place among US‐based ethnographers of colour about the effects of surveillance on ethnography; second, an example of the impact that (in)securitization may have on the researcher/researched relationship in contemporary ethnographic research; and third, an extension of Garfinkel’s notion of the “breach” within the current sociopolitical context. Throughout this essay, the author calls for a greater sense of connection to and solidarity with those “vulnerable subjects” that we engage with ethnographically.

Grotius and the Marginalization of Cosmopolitan Duties

This article expounds the role played by Hugo Grotius in marginalizing positive duties for the protection of vulnerable people beyond the sovereign state. In the sixteenth century, theorists writing within a range of traditions had posited solemn and demanding duties to assist and rescue vulnerable subjects of other rulers from tyranny and persecution. In the early seventeenth century, Grotius explicitly subordinated such duties to the duty to seek the preservation and advantage of one’s own state. He claimed that, while the care of the vulnerable subjects of others was praiseworthy, it was not obligatory. No state was bound to accept trouble or inconvenience for the sake of vulnerable outsiders. Grotius turns out to be less of an exemplar for present day notions of the Responsibility to Protect and other international duties of human protection than he is often said to be.