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Deep brain stimulation (DBS) has been proposed to improve symptoms of obsessive–compulsive disorder (OCD) but is not yet an established therapy.
To identify relevant guidelines and assess their recommendations for the use of DBS in OCD.
Medline, Embase, American Psychiatric Association PsycInfo and Scopus were searched, as were websites of relevant societies and guideline development organisations. The review was based on the PRISMA recommendations, and the search strategy was verified by a medical librarian. The protocol was developed and registered with PROSPERO (CRD42022353715). The guidelines were assessed for quality using the AGREE II instrument.
Nine guidelines were identified. Three guidelines scored >80% on AGREE II. ‘Scope and Purpose’ and ‘Editorial Independence’ were the highest scoring domains, but ‘Applicability’ scores were low. Eight guidelines recommended that DBS is used after all other treatment options have failed to alleviate OCD symptoms. One guideline did not recommend DBS beyond a research setting. Only one guideline performed a cost-effectiveness analysis; the other eight did not provide details on safe or effective DBS protocols.
Despite a very limited evidence base, eight of the nine identified guidelines supported the use of DBS for OCD as a last line of therapy; however, multiple aspects of DBS provision were not addressed.
Deep brain stimulation (DBS), an invasive neurosurgical treatment where electrical stimuli are delivered in target brain areas, is an intervention that has traditionally been used for neurological movement disorders, but that has recently been considered for the management of psychiatric conditions, one of these being obsessive compulsive disorder (OCD). This review aimed to identify and assess clinical practice guidelines on the use of DBS for OCD, and, secondly, whether or not recommendations are tailored to individual patient characteristics, such as age, gender and comorbidities.
A systematic search of MEDLINE, EMBASE, APA Psych Info and Scopus was conducted, along with guideline development organisation websites, using all relevant synonyms of: “Guideline and DBS and OCD”. Studies were assessed by two independent reviewers, and discrepancies managed by a third reviewer. The protocol was registered with PROSPERO, following the PRISMA checklist. Included guidelines were appraised using the AGREE-II instrument.
Nine guidelines were identified in total. Eight recommended DBS as a last-line option in the management of OCD, whilst the National Institute for Health and Care Excellence (NICE) recommended DBS should be used for research purposes only in OCD. Variability in the recommendations was also noted; indeed, only NICE undertook a cost-effectiveness analysis, and only the Congress of Neurological Surgeons (CNS) recommended target areas for electrode placement (i.e. subthalamic nucleus and nucleus accumbens). No guidelines clarified DBS settings, nor peri-operative optimisation measures. Patients’ preferences, age groups differences, ethnicity or comorbidities were not considered by any guideline. The guidelines’ quality ranged from moderate to high (50–92%), as per AGREE-II, with domains ‘scope and purpose’ and ‘editorial independence’ scoring the highest and ‘applicability’ and ‘stakeholder involvement’ the lowest across all guidelines.
Whilst eight guidelines supported the use of DBS for OCD as last-line therapy, a lack of cost-analysis, specific DBS settings, peri-operative procedures, and patients’ circumstances were analysed. Given the lack of randomised controlled trials in this field, more rigorous research is needed prior to wider DBS implementation.
Given the demographic development of today's Western societies, both individuals and societies are facing ethical questions of how to deal with aging people in public as well as in private spheres. The urgency of the subject manifests itself not only in the growth of relevant academic research and self-help literature, but also in an increasing number of literary explorations of what has been a literary subject since antiquity. This chapter explores ethical problems of age and aging in Annette Pehnt's novel Haus der Schildkröten (2006), a text that forms an important contribution to these ongoing investigations. pehnt's novel deals with conflicts that arise in the lives of two middle-aged characters whose parents live in a nursing home, and in the lives of the elderly inhabitants and their professional caregivers. A focus on the relationships between these characters inevitably involves a discussion of ethics. “Ethics” here designates a system of specific mutual demands concerning the behavior of people toward themselves and others.
In our essay we shall ask, first, what conflicts arise in the novel and what the characters think is morally right. In the cases at hand, deciding what is morally right is no easy matter; for instance, there are tensions between self-fulfillment and responsibilities toward relatives. There is also the basic problem of figuring out what is right for the other person's sake, given that, owing to dementia or other age-related illnesses, this person is no longer capable of expressing her wishes. Second, we shall examine other narrative strategies that shape the ethical discourse of the novel.
“Memory contests” are a defining feature of contemporary German cultural and political life. As Anne Fuchs and Mary Cosgrove explain, the term denotes “highly dynamic public engagements with the past,” which in the German context constitutes “hotly contested territory.” While the now well-established notion was developed in response to framings of the national socialist past, it can also be applied to ongoing attempts to articulate and account for the east German experience. This chapter engages in such an application, with the complementary aim of bringing to light the ethical implications of these memory contests. “ethics,” here, connotes a relationship of obligation to “the other.” The chapter asks: what is at stake, ethically, in writings of the GDR past? How do such writings fit into, or indeed challenge, the “continuing struggle to imagine Germany as a unified, democratic, and capitalist country”? And what do they tell us more broadly about the relationship between ethics and memory?
This project involves an examination of four recent German novels in which the memory of life in the GDR plays an important role: Julia Schoch's Mit der Geschwindigkeit des Sommers (2009), Stefan Moster's Die Unmöglichkeit des vierhändigen Spiels (2009), Antje Rávic Strubel's Sturz der Tage in die Nacht (2011), and Judith Schalanksy's Der Hals der Giraffe (2011). In all of these works, the memory of the GDR is mediated and explored through the depiction of difficult, even taboo, familial or quasi-familial relationships. In all the texts, shame—“an intense and painful sensation that is bound up with how the self feels about itself”— features significantly.
At the beginning of the twenty-first century, there is a pressing need to engage critically with the way human beings belong to the material world. Under the impact of globalization and digital technologies, ethical dilemmas posed by materiality are changing and evolving rapidly. In ecological terms, for example, the need for sustain-ability, which requires the reduction of consumption by a wealthy minority and the simultaneous decoupling of development from resource use, presents challenges of unprecedented scale and urgency. On a social level, meanwhile, the disconnect between the global impact of consumption and local, lived practice is felt particularly keenly in our daily interactions with things. While in the developing world many do not have the material resources to sustain life itself, affluent consumers in wealthy economies are frustrated by choice and by the need to navigate competing discourses of sustainability in order to make their purchases in an ethical way. At the same time, the rapid development of information technologies has profoundly unsettled our psychological and physiological relationships with materiality, prompting anxious questions about embodiment and disembodiment, such as “how can we be present yet also absent?” and “what is a self if it is not in a body?” One example of the way in which such concerns coalesce is the current media and scientific interest in the phenomenon of hoarding, which appears to “speak to and about our moment.”
Since the 2010 publication of Thilo Sarrazin's controversial bestseller Deutschland schafft sich ab, there has been renewed debate in Germany over the country's cultural identity and the success of policies that promote multiculturalism. Central to these debates has been the question of the integration and assimilation of Germany's large and growing Muslim population. The role and place of Islam in contemporary German society has increasingly been both a source of controversy and an impetus for dialogue about religious freedom and tolerance. The issue of whether or not Islam is compatible with european values is explored in greater depth in recent works by two of Germany's leading Muslim writers and intellectuals, Zafer Šenocak's Deutschland: Eine Aufklärungsschrift (2011) and Navid Kermani's Wer ist wir? Deutschland und seine Muslime (2010). While Şenocak was born in 1961 in Turkey and moved to Germany as a child, Kermani was born in 1967 in Germany to Iranian parents. Both are self-identified Muslims who write about their experiences as German Muslims and position themselves as writer-intellectuals who embrace multiple identities and thus straddle both the eastern and Western worlds. An analysis of their works and their relationship to European culture, including the enlightenment, is fruitful in helping bridge the growing gap between eastern and Western cultural traditions and values and in addressing the question of the possibility of multicultural societies in Western Europe.
As Thomas Elsaesser has argued recently, European cinema since the end of the Cold War foregrounds ethical, rather than directly political, concerns. For Elsaesser, who refers to a body of work that ranges from Fatih Akin to Michael Winterbottom, from Dogville to the Dardennes Brothers, this is a cinema that largely foregoes offering political solutions to the tensions its central characters experience. Even on the occasions when its focus expands beyond the personal narratives of the protagonists, when its stories address “spaces to be redistributed, and power-relations to be re-negotiated,” it remains, for Elsaesser, primarily an ethical rather than a political cinema. Elsaesser argues that many recent films address a radical encounter with the other, an event that brings with it the risks of violence and of a process of destabilization, yet also opens up the possibility of a genuinely new social awareness.
Elsaesser's account of contemporary cinema rests on categories proposed by the French philosopher Jacques Rancière. Rancière's work has been taken up recently across a number of disciplines, from political philosophy to literary and film studies. Rancière's work is of particular significance for an analysis of the contested areas of contemporary thought where questions of politics, ethics, and aesthetics merge.
The chapter “Grosse Wandelungen” in nineteenth-century Arab German writer Emily Ruete's Memoiren einer arabischen Prinzessin (1886) devotes three skeletal paragraphs to a narration of the author's relationship with a Hamburg trader and her departure for Germany, staged as a direct antidote to the “unrichtige[n] Darstellungen” at that time circulating in the German public realm that depicted these events as a grand narrative with a plot seemingly inspired by Mozart's Entführung aus dem Serail. Centering on the notion of contested representation raised by Ruete in the chapter in question, my essay will go on to explore, under the same terms, three contemporary engagements with this episode that use Ruete's narrative as source material— Tink Diaz's documentary film Die Prinzessin von Sansibar (2007), Hans Christoph Buch's novel Sansibar Blues (2008), and Nicole C. Vosseler's historical romance Sterne über Sansibar (2010). Employing a Deleuzian reading of ethics and representation, which broadly understands an ethical encounter as experiencing rather than interpreting the other's narrative, I will show how all three, precisely in their filling in the skeletal frame, work to thwart the opportunities for the ethical reading that Ruete's narrative itself presents, instead reframing her account in terms of existing narratives by and about young Muslim women.
Emily Ruete (1844–1924), born Sayyida Salme, daughter of the Sultan of Oman and Zanzibar, published her memoirs—considered the earliest surviving autobiography by an Arab woman—in Berlin in 1886. Ruete spent her childhood and young adulthood in several residences around the island of Zanzibar, and included a detailed account of this period of her life in her memoirs. In her early twenties she bought a house in Zanzibar Town, and it was there that she later became acquainted with her neighbor, a German trader named Heinrich Ruete, and the couple fell in love. In 1866 she left Zanzibar for Aden after becoming pregnant with Heinrich Ruete’s child, and he rejoined her the following year, having remained on the island to wind up his business affairs.
Ethics, or moral philosophy, involves the study of morality, and morality concerns beliefs about right and wrong behaviors and good and bad persons or character. As a branch of thought, ethics may seek to prescribe, describe, apply, or theorize moral actions and approaches. Ethical reflections appear not only in explicitly philosophical texts, but also in literary narrative and in films, among other kinds of discourse, and there are longstanding discussions about the nature and value of such nonphilosophical investigations and representations. This volume, the seventh Edinburgh German Yearbook, offers a contribution to such discussions. It brings together explorations of the ethical approaches apparent in a wide range of literary and filmic texts that have emerged in the contemporary German-language context. The essays that feature here vary in their methods and theoretical underpinnings, but there are a number of concerns that run through the collection: the relationship between self and other; the connection between particular and general; the personal and political consequences of individuals' actions; and the potential, and danger, of representation itself. The volume thus reflects on and contributes to debates about a highly topical, widely experienced contemporary crisis of values. Christopher Bennett argues, “There is […] reason to think that we have a particular need for ethics because of the kind of society we live in. […] [Our] society seems […] to be characterised by moral disagreement, and by our being able to choose between a variety of ways of life, and a variety of belief systems”; thus, “we exist in a state of moral uncertainty.” Dissent and relativism are indeed arguably hallmarks of our age.
There has been an "ethical turn" in the literature, culture, and theory of recent years. Questions of morality are urgent at a time of increasing global insecurities. Yet it is becoming ever more difficult to make ethical judgments in multicultural, relativist societies. The European economic meltdown has raised further ethical difficulties, widening the gap between rich and poor. Such divisions and difficulties heighten the widespread fear of "the other"in its various manifestations. And in the German context especially, the past and its representation offer ongoing moral challenges. These ethical concerns have found their way into recent German-language literature and culture in texts that deal with history and memory (Timm, Petzold, Schoch, Strubel); materiality (Krau, Overath); gender (Berg, Schneider); age and generation (Moster, Pehnt, Schalansky); religion, especially Islam (Senocak, Kermani, Ruete); and nomadism (Tawada). The relationship between self and other; the connection between particular and general; the personal and political consequences of individuals' actions; and the potential, and danger, of representation itself are issues that are vital to the shaping of our future ethical landscapes, as this volume demonstrates. Contributors: Monika Albrecht, Angelika Baier, David N. Coury, Anna Ertel & Tilmann Köppe, Emily Jeremiah, Alasdair King, Frauke Matthes, Aine McMurtry, Gillian Pye, Kate Roy. Emily Jeremiah is Senior Lecturer in German at Royal Holloway, University of London. Frauke Matthes is Lecturer in German at the University of Edinburgh.
Postmodernism has often been associated with the demise of the ethical. Conversely, the so-called “ethical turn” in contemporary literature means that literary texts are more inclined than ever to engage in ethical dialogue concerning questions of how we act toward one another. Given that encounters between human beings are contingent upon particular social and historical contexts, literature, which typically involves fictional characters interacting with each other in concrete settings, and so depicts specific actions and situations, is arguably well placed to chart a new, emerging form of postmodern ethics, one that rejects universalism and posits specificity as key to ethical behavior.
in this essay, I explore how two contemporary German-language novels negotiate particular encounters between characters: Robert Schneider's Die Luftgängerin (1998) and Sybille Berg's Vielen Dank für das Leben (2012). In spite of the fact that the novels were published fourteen years apart, the narratives' protagonists, maudi and toto respectively, have much in common. Both are intersexed; that is, their bodies exhibit what are socially read as female and male sexual characteristics. Medically speaking Toto is born with ambiguous genitalia (DL 15), whereas maudi's outwardly female appearance hides her non-descended testicles and XY chromosomes (LG 157). Yet in stark contrast to other contemporary literary texts that tell the life stories of intersexed characters and mainly focus on the protagonists'; desperate search for a gendered identity, these diagnoses are of no importance for Maudi and Toto.
We investigated an increase in Trichosporon asahii isolates among inpatients. We identified 63 cases; 4 involved disseminated disease. Trichosporon species was recovered from equipment cleaning rooms, washbasins, and fomites, which suggests transmission through washbasins. Patient washbasins should be single-patient use only; adherence to appropriate hospital disinfection guidelines was recommended.
To attract insects for sexual reproduction, some fungi can induce the formation of pseudoflowers on their hosts. Pseudoflowers are
rosettes of yellow host leaves upon which the fungus presents gametes in sweet nectar. Eleven species of the fungus complex
Uromyces pisi can induce pseudoflowers on the host Euphorbia cyparissias. The taxonomy of these species is based on the choice of
the alternate host, a species of Fabaceae, as well as on teliospore morphology on the Fabaceae hosts. Morphological identification of
the fungi on E. cyparissias is impossible. To identify the fungal species on infected E. cyparissias, we compared sequences from the
ITS region of the rDNA to the DNA from five identified fungal species on Fabaceae. From 43 specimens on E. cyparissias, collected
in 1997–99 in Switzerland, 24 specimens could be identified as U. pisi s. str. and 16 specimens as U. striatus. Two specimens were
identified as U. laburni and U. loti, respectively, and one specimen could not be identified. We therefore conclude that fungal
pseudoflowers are typically induced by U. pisi s. str. on U. striatus in Switzerland, although other species do sometimes occur. The
ITS sequences were then used to reconstruct the phylogenetic relationship among species in the U. pisi complex and two closely
related microcyclic rust species of the complex Uromyces scutellatus. Phylogenetic analyses indicated that the microcyclic species may
be descendants from macrocyclic U. pisi s.l. ancestors. The ITS region sequenced in this study was found to be appropriate for
answering phylogenetic, as well as ecological questions, and provided valuable markers for future studies.
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