Classification of patients with knee osteoarthritis in clinical phenotypes: data from the osteoarthritis initiative

<div><p>Objectives</p><p>The existence of phenotypes has been hypothesized to explain the large heterogeneity characterizing the knee osteoarthritis. In a previous systematic review of the literature, six main phenotypes were identified: Minimal Joint Disease (MJD), Malaligned Biomechanical (MB), Chronic Pain (CP), Inflammatory (I), Metabolic Syndrome (MS) and Bone and Cartilage Metabolism (BCM). The purpose of this study was to classify a sample of individuals with knee osteoarthritis (KOA) into pre-defined groups characterized by specific variables that can be linked to different disease mechanisms, and compare these phenotypes for demographic and health outcomes.</p><p>Methods</p><p>599 patients were selected from the OAI database FNIH at 24 months’ time to conduct the study. For each phenotype, cut offs of key variables were identified matching the results from previous studies in the field and the data available for the sample. The selection process consisted of 3 steps. At the end of each step, the subjects classified were excluded from the further classification stages. Patients meeting the criteria for more than one phenotype were classified separately into a ‘complex KOA’ group.</p><p>Results</p><p>Phenotype allocation (including complex KOA) was successful for 84% of cases with an overlap of 20%. Disease duration was shorter in the MJD while the CP phenotype included a larger number of Women (81%). A significant effect of phenotypes on WOMAC pain (F = 16.736 p <0.001) and WOMAC physical function (F = 14.676, p < 0.001) was identified after controlling for disease duration.</p><p>Conclusion</p><p>This study signifies the feasibility of a classification of KOA subjects in distinct phenotypes based on subgroup-specific characteristics.</p></div

What is conscience and why is respect for it so important?

The literature on conscience in medicine has paid little attention to what is meant by the word 'conscience.' This article distinguishes between retrospective and prospective conscience, distinguishes synderesis from conscience, and argues against intuitionist views of conscience. Conscience is defined as having two interrelated parts: (1) a commitment to morality itself; to acting and choosing morally according to the best of one's ability, and (2) the activity of judging that an act one has done or about which one is deliberating would violate that commitment. Tolerance is defined as mutual respect for conscience. A set of boundary conditions for justifiable respect for conscientious objection in medicine is proposed

Are Lovers Ever One? Reconstructing the Union Theory of Love

Finanziert aus dem Open-Access-Publikationsfonds der Universität Siegen für ZeitschriftenartikelCurrent analytical philosophies of romantic love tend to identify the essence of such love with one specific element, such as concern for the beloved person, valuing the beloved person or the union between the lovers. This paper will deal with different forms of the union theory of love which takes love to be the physical, psychic or ontological union of two persons. Prima facie, this theory might appear to be implausible because it has several contra-intuitive implications, and yet, I submit, it is more coherent and attractive than it seems to be. I shall distinguish three specific models and thereby offer a differentiated account of the union theory which has not previously been provided in the literature (1). I will claim that two of these models (the strong ontological model and the striving model) should be rejected (2). I shall then defend the third model (the moderate ontological model) against certain possible objections (3); but nevertheless, I shall conclude by showing how this model, too, faces further significant objections which ultimately expose the limits of the union theory of love (4). In conclusion, I will sketch the outlines of a non-reductive cluster theory of love