In 1950, Kurt Schneider proposed that a considerable number of schizophrenia patients develop first-rank symptoms (FRS). In such cases, patients report made experiences, replaced control of will, thought insertion, broadcast or withdrawal and delusional perception, respectively. Although a number of recent studies tend to explain FRS in terms of neurobiological and neuropsychological processes, the origin of these symptoms still remains unknown. In this paper, we explore the subjective experience of patients with the following two FRS: (1) "made" impulses and (2) “made" volitional acts.The method applied for the study of two FRS consists first in the overview of psychiatric and philosophical literature and second in the further investigation of subjective experience in patients with FRS. Psychopathological and phenomenological aspects of FRS are discussed by means of patient cases.We discovered a profound transformation of intentionality and agency in schizophrenia patients with body-affecting FRS. This concept offers an insight into the interrelatedness between particular FRS.We propose that the subjective experience of schizophrenia patients with body-affecting FRS is rooted in the disturbance of intentionality and diminished sense of agency. This theoretical account of body-affecting FRS will open up new directions in both phenomenological and neurobiological psychiatric research. Hence they illustrate a profound change in self-experience that may be attributed to a disturbed sense of mineness . Patient methods –16. In t methods –26. Desp methods –29.In the last two decades, in order to increase the precision and reliability in diagnosing mental illness, psychiatry has experienced a paradigm shift: It moved away from subject-oriented explanations of mental disorders grounded on the comprehension of the patients’ experiential world towards new nosological constructs on rigid descriptions and operationalized, but inflexible criteria. This seems to be one of the reasons why today’s studies are often lacking homogenous patient groups due to the oversimplified definition of schizophrenia and its related symptoms ,31. Therth century, French psychologist Pierre Janet introduced a disordered mental state which he called “abaissement du niveau mental” [hypophrenia” [In the history of psychiatry, a number of psychiatrists were interested in the philosophical explanation of anomalies of self-experience. Their descriptions were not restricted to what is reported verbally by the patients. Rather, they also tried to analyze the altered basic structures of experience themselves, such as temporality, spatiality or intersubjectivity. However, these authors did not yet make use of the term “intentionality”, but employed terms with similar meaning. In the late 19 mental” ,40. In 1 mental” . Somewhaphrenia” ,43.th century, many psychopathologists analyzed essential phenomena of schizophrenia by means of Husserlian concepts [intentionality. Beringer, a German psychiatrist, was the first to use this term in order to explain formal thought disorders and impaired language in schizophrenia patients. He assumed that these patients suffer from a reduction of the “intentional span” [common sense [After the introduction of phenomenology at the beginning of the 20concepts ,40,42,44al span” ,46. In pal span” . Accordion sense . Accordion sense . More reon sense ) which lon sense ,51. TakeDifferent theoretical approaches mentioned above have been used to explain FRS in schizophrenia and there are many historical and modern models of these symptoms ,18,52–54“Made” impulses (drive). In this case, patients experience a powerful impulse to carry out an action which they feel stems from an external agent [al agent .“Made” volitional acts. These include phenomena such as made actions and replaced control of one’s will. Such actions are executed by the patients’ bodies, but experienced as actions of an external agent [al agent –60.as something, i.e. in a pre-structured and specific way; it is necessarily an experience of a specific type [From a phenomenological point of view, consciousness is not self-enclosed, but open to objects in the world, it has a world-involving character, i.e. it is intentional . For Husfic type ,64: watcfic type . Furtherfic type  which isfic type ,51,65.gestalt formation based on the fact that all directed bodily experiences and movements are constituted as “consciously performed intentional acts“ [gestalt formation in bodily acts is a dynamic constitution of multiple aspects of mind and body unified in a meaningful way. For example, if I want to pick up a cup, the decision and intentional effort to do so is conjoined with the kinaesthetic experience of moving my arm and hand, and with the visual perception of cup, arm and hand. At the same time, the perception, decision and intentional effort guarantee the directed bodily movement to be experienced as a coherent gestalt [Husserl  further al acts“ . These aal acts“ . As Hussal acts“ . Consequ gestalt .Ideas I onwards, Husserl [noesis or noetic act (sinnbildender Bewusstseinsakt) and noema or noematic sense . Every act consists of noetic moments, which can be described as “directions of the regard of the pure Ego to the objects ‘meant’ by it, owing to sense-bestowal to the object which is ‘inherent in the sense’ for the Ego” [a priori conditions of all object-full experiences and their correlation characterizes consciousness [Furthermore, in his writings from the  Husserl  developethe Ego” . This methe Ego” . Noesis the Ego” . Both poiousness . Moreoveiousness .ipseity. Ipseity or basic self-awareness  is a me’s self” ,68. Ipse’s self” . The seconality” . It enabonality” . The expis the body (Leib), but also has the body (Körper). This double-aspectivity of the body, with the SO being more a feature of the second aspect, has been a central motive in phenomenological anthropology [Based on the medium of ipseity, I experience my own thinking, feeling, perceiving, moving etc. immediately, noninferentially from the first-person perspective or as mine. According to Gallagher , the notropology . SA, on ropology . Gallaghropology .gestalt of the prodromal phase of schizophrenia.The overall aim of this study is to define the fundamental phenomenological pattern of the two body-affecting FRS. Through the lived body, the subject tacitly participates in the field of experience, interacts within the world –72 and ast-person perspective and the form and structure of conscious experience. Moreover, our aim was to grasp the experiential framework of the two body-affecting FRS and to extract the four stages of their development. We used word-by-word descriptions to understand the perspective and experience of patients with FRS. In order to protect the patients’ anonymity, relevant personal information was changed.In this paper, we will present descriptions of schizophrenia patients with body-affecting FRS. Four patients described ,75 in thBesides the four patient vignettes from our own studies, we also searched for case reports describing schizophrenia patients with body-affecting FRS in the historical and modern psychiatric literature. We identified several descriptions illustrating fundamental disturbances of the self (concerning the feeling of mineness and the sense of agency) and body-affecting FRS in schizophrenia. For the purpose of phenomenological analysis, we cite several patients’ statements from modern and historical psychiatric literature.gestalt of schizophrenia spectrum disorders [In general, the phenomenological approach focuses on the investigation of the structure of patients’ subjective experience and the core isorders . Therefoisorders . In ordeIn the sections above, all elements have been described that are needed to analyse the development of body-affecting FRS. There are four stages that should be distinguished in principle :AWeakening of operative intentionalityBHyperreflexivity and objectification of bodily actionsCDissociation of operative and active-explicit intentionalityDAlienation and externalisation of agencyThe first three levels illustrate the phenomenological characteristics that occur in the pre-psychotic phase of schizophrenia and in schizotypal disorders. The last stage describes the transition to full-blown psychosis.In a healthy mental state, the subject is implicitly aware of the body’s movement and the source of directed actions. It is self-present and acts in the first person perspective. Such tacit experience is an essential presupposition for the subject to interact with his environment. Now the prodromal phase of schizophrenia involves subtle, but often progressive alterations of such basic bodily experience, namely a profound disturbance of pre-reflective self-awareness or ipseity. From a phenomenological point of view, subjects in this state experience an existential insecurity and a diminished feeling of being a demarcated self:Ibelonged in another time or another place or something.” [(1) “I just don’t feel that I belong (…) as if I am different in some way (…) I just feel that I feel too much compared to other people (…) as if ething.”  (2) “I constantly have to ask myself “who am I really?” It is hard to explain … most of the time, I have this very strange thing: I watch myself closely, like, how am I doing now and where are the “parts” – in quotation marks. And that occupies me so much, to think about my condition, because it is not just one condition, it is always more conditions, that is exactly what is not functioning.” The first patient is afraid of losing himself and becoming substantially different from the others. The second patient describes a fragmentation of self-presence: On the one hand, he experiences a feeling of not being an embodied subject anymore; on the other, he observes his feelings more carefully than he did before. Despite the insufficiency of the pre-reflective experience of one’s own body , subject(3) “I thought a lot about everything, my every movement … like things you usually take for granted, like now I take the toothbrush, now I ... it is just something you do, it is not something you tell your body to do, it is just something the brain automatically does, right, it is as if that function has been blurred so that I kind of had to tell myself to do some of those things or just had to think hard about it, or something, I don’t know, there were many times where I-I think that many of the things I took for granted just became much more difficult, even the simplest thing became incredibly difficult.” (4) “I find it very difficult to do things now, just everyday things like shaving, things you do immediately you get up. Just things I used to do without thinking, like hanging your coat up or taking your tea. I am very easily put off now – by noises or people speaking to me. It’s trying to concentrate on two things. Sometimes I have just to cut everything short and sit down.” From a phenomenological point of view, in both cases (3 and 4) the movements are not embedded in basic self-experience anymore. The patients are slowed down and experience everyday actions as disintegrated and unreal. They have to intensively concentrate on every single movement, because otherwise they would not be able to fulfill their intentions. Thus, they illustrate the weakening of operative intentionality of movement, or the disturbance of the tacit dimension of experience. However, patients at this stage are still able to compensate for the disturbances through intensive self-monitoring. This phenomenon will be described in the next paragraph.decrease on the first-level pre-reflective self-awareness and the compensatory increase of activity on the second-level reflective self-consciousness. If bodily movements are not embedded in basic self-presence, patients begin to ponder intensively about each single action. Four prodromal patients who later developed schizophrenia reported disturbances of their motor functions:The weakening of operative intentionality leads to an increasing gap between the two layers of intentional consciousness described above and to an increased self-monitoring. There is a correlation between the “None of my movements come automatically to me now. I’ve been thinking too much about them, even walking properly, talking properly and smoking – doing anything. Before they would be able to come automatically.” “If I do something like going for a drink of water, I’ve to go over each detail – find cup, walk over, turn tap, fill cup, turn tap off, drink it.” “(...)it was one of those things I did when I was feeling bad ... I had the tendency to study, well, this thing about from the thought and from the brain to send the movement to the arm, I could think – think all the way, it was as if I could not make a movement without having the brain with me, it was not something – I could not do things you take for granted(...)” “There were periods in which I felt extremely badly coordinated, when I just made a movement with the arm and the arm had moved further than I wanted it to move. But I also found myself to be extremely clumsy, somehow, when walking. I therefore constantly observed my walking and my movements … Climbing the stairs was also very extreme, when you need a bit of concentration and a feeling of balance. I really thought each step after the other, as it were, each movement…” In these cases we face a weakness of operative intentionality on the one hand, and an objectification of bodily movements on the other. These patients are unable to realize their bodily intentions in a synchronized way. The bodily actions are not constituted as a whole, but rather pieced together as successions of singular, fragmented movements. They are not proceeding automatically but become slow, angular and rigid; they also inhibit the patients’ intentional efforts. The link between basic self-awareness and the tacit intentionality of movement is disrupted. As a result of this disconnection, the patients are not able to initiate, plan and structure their directed bodily actions coherently anymore.In Sass’ phenomenological view, the hyperreflexivity described by the patients contributes much to the fact that their self-experience is becoming opaque and reified . The nornoetic consciousness [The next stage is reached when the gap between the two layers of intentionality amounts to a disconnection of the first-level pre-reflective bodily self-awareness and the second-level reflective self-consciousness. The patients lose the tacit form of acting and their bodies do not serve as a medium for interacting within the world anymore. In parallel to this development, the pre-reflective SA linked to the implicit experience of bodily actions separates from the higher-order SA linked to the conscious attribution of movement. In fact, patients experience the beginning of a change in the structure of their intentional bodily acts. This progression ends in a state where all automatic performances become explicitand disintegrated. According to Stanghellini , patientiousness . They of“If the mind is empty it works like a plotter or a photocamera.” “The computer has been deleted and my brain cells have died. I don’t feel any emotions, because the emotions are located in the right hemisphere of my brain and the right computer has been deleted.”In both cases, the tacit, automatically synthesized unity of body and mind is interrupted, leading to a feeling of inanimateness . ConsequFor me it was as if my eyes were cameras, and my brain would still be in my body, but somehow as if my head were enormous, the size of a universe, and I was in the far back and the cameras were at the very front. So extremely far away from the cameras. And I walk, and I look around … and I’m dizzy and all is like a machine. … I just didn’t have much control over myself. …, I have this robot-like feeling in my head, to be looking through cameras, and you observe your whole body, and the steps you take towards the bench.” [“ bench.” Ilive.” [“The body is something that functions, not something that’s mine, that live.” th century. He conceived of the human body as a mechanical apparatus and explained its functions using physical, chemical and materialist vocabulary [Beeinflussungsstimmung” (mood of influence) [From a phenomenological point of view, both patients suffer from a disembodiment ,57,74 ofcabulary ,85,86. Icabulary . At thisfluence) . AccordiAt the last stage, the intentional arc of bodily movement dissolves; patients’ lose their sense of agency which is instead ascribed to some external force. Impulses and motor actions are no longer experienced as self-generated, but as made impulses and experiences. A patient suffering from schizophrenia coined the term “existential permeability” and described this novel experiential state as follows: “Actions, emotions, and thoughts become strange to the individual, so he attributes them to an external agency, a third-party who controls everything he experiences. (…) In fact, all 3 types of disturbances in existential permeability are rooted in a silenced and diminished sense of self-consciousness, a disappearing awareness that is not part and parcel of ones ego anymore.” . In StanThe following quotation of a schizophrenia patient exemplifies this:(1) “When I ate this morning, I felt as if somebody else’s head would also be there and would eat with me. It feels like other people would stick their head into my head. When I am chewing, it seems that another tongue comes and takes the food.” ,89Another patient with schizophrenia who feels like a “mechanical man”  describe(2) “When I do some work, like swabbing, somebody else is working with me. Just like another person stepped in … It is as if they would be able to put their head in yours. When you move they grab; sometimes they are scared that you would fall. They try to help you, but they are clumsy. (…) It is hard to control the tongue; they just drop some words on your tongue. They fight like devils. My tongue is heavy, like if somebody would hold it.” Another patient suffering from full-blown schizophrenia said:(3) “My fingers pick up the pen, but I don’t control them. What they do has nothing to do with me (…) The force moved my lips. I began to speak. The words were made for me” All three patients experience alienation of their own bodily movements. They suffer from a profound change in the phenomenological structure of their experience. It feels like being far away from the lived body. Consequently, they also suffer from a disconnection of normally unified intentional acts such as moving one’s facial muscles in order to eat and the kinaesthetic feedback of these muscles. The synthesis of the initiative to eat, to work or talk to somebody and the corresponding bodily action  is not achieved. The intentional arc which normally connects both components is torn apart, and they seem to exist independently of each other. As a result, the patients experience their bodily actions as initiated by an external agent. As a result, the form of the self-experience affects the change in content (e.g. bizarre delusions). In the case of made impulses, they experience a sudden drive to carry out some action as coming from the outside. Thus, both bodily drives and movements may appear as externalized and manipulated. A new hidden intentionality takes rule over the patients’ disembodied volitions and impulses. However, this other subjectivity is still hidden, beyond recognition. In other cases with flamboyant psychotic symptoms, patients refer to an identifiable source of "made" acts (case 4-6) and "made" impulses (case 7):(4) “When I reach my hand for the comb it is my hand and arm which move, and my fingers pick up the pen, but I don’t control them … I sit there watching them move, and they are quite independent, what they do is nothing to do with me … I’m just a puppet who is manipulated by cosmic strings. When the strings are pulled my body moves and I cannot prevent it.” (5) “Airport security staff had implanted a microchip and a microphone into my neck to control and observe my behaviour and actions. They used these devices to listen to my thoughts and to control me because of my previous suicidal attempts.” (own patient case )(6) “They inserted a computer in my brain. It makes me turn to left or right.” (7) “A 26 year old engineer emptied the contents of a urine bottle over the ward dinner trolley. He said: The sudden impulse came over me that I must do it. It was not my feeling, it came to me from the X-ray department, that was why I was sent there for implants yesterday. It has nothing to do with me, they wanted it done. So I picked up the bottle and poured it in. It seemed all I could do.” In the first three cases (case 4-6), due to alienation and externalisation of agency, a second, overwhelming intentionality takes over and causes the patients’ bodily actions. Not until this particular stage of the illness, the phenomenological and clinical distinction between made impulses and made volitional acts is possible: According to Gallagher , the firTaken together, however, all four patients are unable to actively intend their bodily actions; rather, they are passively moved and pushed to realize motor activities by an external force. Instead of acting, they feel acted upon. The manipulating agent is not hidden anymore, but gains a concrete, though technical form such as a computer, cosmic strings or an X-ray department. In some cases, there is even a personalized agent . At thisIn summary, from a phenomenological point of view, the transition to frank psychosis occurs in the course of alienation and externalisation of both the level of active-explicit intentionality and the sense of agency after the loss of the anchoring centre of ipseity : At the This paper aimed at investigating the self-experience of schizophrenia patients with body-affecting Schneiderian FRS. We have also been looking for the fundamental pattern that characterizes the subjectivity of schizophrenia patients with particular FRS. Two main findings emerged: (1) The subjective experience of made volitional acts and made impulses in schizophrenia is based on a fundamental transformation of both levels of intentionality and sense of agency(2). The above mentioned two FRS are, although clinically very different, of a similar phenomenological structure.Since the past decade, there is growing empirical evidence that disorders of basic self-awareness are a core feature of schizophrenia spectrum disorders ,92–94. WOn the basis of the present study and other papers investigating FRS in schizophrenia spectrum disorders, assessing psychotic symptoms such as FRS by means of phenomenological psychopathology in daily clinical routine might have some relevant implications: Patients’ statements about their mental state are highly polysemic and their interpretation remains a challenge. In general, a phenomenological approach and careful interviewing might help to extract the salient profile of the psychic disorder behind the patients’ statements (e.g. FRS) . Second,We acknowledge potential limitations of the phenomenological method in general and our qualitative study of FRS in particular(1). The patients’ quotations in this paper are of different quality(2). It is important to bear in mind that the investigation of patients’ subjective life depends on their ability to introspect, describe and communicate the symptoms which they are suffering from. In addition, patients might be suspicious, indifferent and not willing to speak about their private and often embarrassing experiences(3). The clinical presentation and the statements which the interviewer is confronted with might be interpreted in different ways (4). A precise phenomenological exploration requires clinical expertise, time, effort and skill to empathize with the interviewee(5). Last but not least, patients suffering from disorders of pre-reflective self-awareness might have difficulties to articulate their experiences ,99. Herest-person experience and the developmental trajectory of psychotic symptoms might have far-reaching consequences regarding the treatment. Therefore, because of its clinical impact, further phenomenological studies on intentionality and sense of agency in patients with manic disorders are needed.In this paper we showed that Husserl’s phenomenology is useful to provide a descriptive account and theoretical framework for further psychopathological research on FRS. It is a well-known fact that the clinical distinction between acute psychotic experience in schizophrenia and bipolar or manic disorders in which patients might exhibit risky behavior is very difficult. In daily clinical practice, the differentiation between these two disorders might even be impossible. Furthermore, psychiatric exploration alone cannot pinpoint the underlying theoretical basis of these entities. However, the information about the 1We also suggest that our model contributes to the interdisciplinary investigation of schizophrenic disorders. In order to develop an empirical pluralistic model of psychiatric illnesses and to overcome the above-mentioned limitations, future studies should combine the subject-oriented first-person approach with objectifying third-person approaches such as magnetic resonance imaging (MRI) or genetic analysis. For example, MRI studies might be helpful to investigate strictly categorized subgroups of schizophrenia patients with particular FRS and to demonstrate that impairments of intentionality of bodily movement on a particular level also have neurobiological correlates. Interestingly, recent neuroimaging studies were able to link both specific psychopathological symptoms –105 as wIn conclusion, we propose that the subjective experience of schizophrenia patients with body-affecting FRS is rooted in the disturbance of intentionality and diminished sense of agency. Furthermore, both FRS are, although clinically very different, of a similar phenomenological structure. Although our phenomenological model does not provide a final explanation of FRS, it can stimulate questions that might initiate further theoretical and empirical research in this field.


Findings highlighted several interesting points concerning the relationships that occur among attachment to preschool teachers and attention. Children with secure attachments presented higher reaction time and better auditory, visual, and visual spatial selectivity and maintenance.Attention underlies and energizes all cognitive and behavioral activities. Many studies showed that the quality of child attachment  influences cognitive functions and attention. This study aimed to investigate the relationships among attachment to preschool teachers and attention in a sample of preschoolers. In particular, the study analyzed whether child attachment security to preschool teachers influences the different aspects of their attention skills. In addition, gender- and age-related differences in attention and teacher attachment were explored. Research was conducted using two standardized instruments: the Attention and Concentration Battery, and the Attachment Q Sort. Participants were 279 children  who attended two preschools in a town in Southern Italy. Descriptive analyses,  Cognition is the information-handling aspect of behaviour. It comprises four classes of processes, “receptive functions”, “learning and memory”, “thinking” and “expressive functions” that are the common background of all complex performances Lezak . To thesAttention comprises several different aspects, such as “reaction time”, “selectivity”, “maintenance”, “voluntary shifting”, and “divided attention”. These aspects are involved in learning, memory, and programming of both motor and behavioural responses. Attention permits to detect the appearance of the environmental stimuli, and influences the capacity to highlight a stimulus while suppressing awareness of competing distractions . The child uses the attachment figure as a secure base from which to explore the environment and a safe haven in times of distress. The formation of attachment to caregivers is a normative event; all children form attachments to their caregivers even if they do not receive adequate care, and thus attachments vary in quality.Different attachment patterns  have been identified  influences cognitive functions and attention. On the basis of these considerations, the overall goal of this study was to investigate the relationships among attachment to preschool teachers and attention functioning in a sample of preschoolers. In particular, this study seeks to provide a better understanding of the role of attachment security in the different aspect of the attentional performances. In addition, gender and age-related differences in attention and teacher attachment in preschoolers were explored.Research was conducted using a sample of 279 children  who attended two preschools in a town in Southern Italy. Unlike the USA in which kindergarten and preschool are separate , Italian children attend the same childcare setting  from 3 to 5 years, and begin primary school at 6 year of age. Preschool teaches children the prerequisite skills of reading and writing but not the ability to read and write.SD = .52). Participants spent at least 25 hours per week at the preschool from Monday to Friday. The teachers  who cared for the children had a specific education certificate (high school certificate) and the post-certificate qualification required by Italian law. The ratio of teachers to children was one to 15. All of the teachers were female.All participants were between 4–5 years old, come from two-parent, intact families, and attended the preschool where the research was conducted for at least one year. 140 children were four years old, and 139 children were five years old . After a training section the child is presented a stimulus. He is instructed to push, used the favoured hand, a specific computer key following a visual stimulus. The score is established by evaluating the number of correct answers (correct responses score) and the median reaction time for 30 trials (response times score). The range score was 0–30.The second test, “Speed and Accuracy,” measures the reaction time related with a choice. The task measures speed and accuracy of response to complex stimuli and requires pushing the key correspondent to one of a set of stimuli. The stimuli are numbers (from 1 to 7) presented at the centre of the screen in randomized sets (from 3 to 5 elements). In each trial of the task, one number of the set appears ringed round. The child is instructed to push a key correspondent to the ringed round number. The scores are established by evaluating the number of correct answers  and median time of answer (response time score).The third test includes auditory and visual tasks and measures selectivity and maintenance on auditory, visual and visual spatial dimensions. The “Auditory Recognition” test measures auditory selectivity and requires recognizing auditory target among vocal distractors. This task consists of pushing a particular key following a vocal stimulus. The stimuli are letters . The target is letter “o”. The scores are established by evaluating the number of correct answers  and median time of answer (response time score).The “Visual Recognition” test includes two different tasks. The first, “Visual Recognition” task, requires recognizing a visual target among group of distractors appearing in sequence. The stimuli are images of common objects . The child is required to push a key when a star appears on the screen. The scores are the number of correct answers  and median time of answer (response time score). The second, “Visual-Spatial Selectivity” task, is a computerized version of symbols barrage test. The child has to delete a particular symbol of a set of stimuli. In the screen a set of stimuli appears and each stimulus is sequentially ringed round. The subject has to push a particular key when the target is circled. The range scores is: 0–15.The fourth test, “Digit Span,” is an adjustment of the classic Digit Span. It comprises, as in well-known Wechsler Scale subtest, two different tasks: digit forward, and digit backward. The task requires repeating each digit sequence exactly as it is given in forward test, in reversed order in backward test. The tasks measure a simple immediate attention span. The range scores is 0-9- The fifth test evaluates divided attention by a double contemporaneous task .The sixth test, “Colour Word Interference Task,” measures selectivity and the capacity to inhibit interference of non pertinent signals. It is an adjustment of classic Stroop test (1935) that requires the naming of the colour of ink used to print a word describing a different color (for example “red” written using blue ink), overcoming the interference originating from the habit of reading the word. The computerized adaptation of this test consists of two sequential tasks, the first, base line task, used as baseline and the second, interference task, as interference test. In this study this test was not used, considering that participants were not able to read.The seventh test, “Attention Shifting” test, measures the attentional shifting through two search tasks, one of verbal symbols and one of visual-spatial symbols. For each task the scores are established by evaluating correct answers  and median time of answer (response time score).r values comprised between .82 and .92 for the different tests) and concurrent validity  are satisfactory  of the AQS was used. The AQS items describe the secure-base behaviour of one- to five-year-olds at home or at indoor/outdoor public places. Version 3.0 of the AQS consists of 90 statements that describe a young child's behaviour during caregiver interactions. Its items were designed to provide a comprehensive description of “secure-base” behaviour with caregivers. Similar to other Q-sorts, the AQS is performed by sorting the 90 items into categories using a fixed distribution. An attachment security score is derived by comparing the resulting descriptions with the behavioural profile of a prototypical secure child as provided by several attachment theory experts. The AQS can be sorted by trained observers or by the attachment figure who is being assessed . and inter-observer agreement Pearson r = .70) were satisfactory , was used. The similarity between this criterion sort (an array of n-item means) and the q-sort description of a particular participant  is used as the participant’s attachment score. This similarity is usually measured by correlating the n-item array of criterion sort scores with the n-item array of scores that describe the participant. These correlation coefficients are used as the participants' scores on the construct.r scores), these scores were converted to z scores using Fisher's r to z transformation to increase their linearity. The sampling distribution of Pearson’s r is not normal. . The sequence of observations and test administration were counterbalanced by all the participants. Institutional review approval by school office was obtained, and parental consent for each child was obtained.Trained observers monitored the children for a prolonged time in their classroom. Tests were administered in a familiar, well-known setting at the preschool away from distracting noises. The trained observers were women with university degrees in “infancy education” and specific training on the observation techniques of child behavior. Moreover, these observers had previous experience with the observational measure used in this study. Before beginning data collection, observers participated in a training session to familiarize themselves with the procedures. Two observers systematically and independently observed each child. The agreements between the AQS observers were satisfactory  and “visual spatial recognition” . Present data evidenced that sex differences in attention skills appeared precociously in the life span. This finding is consistent with previous studies, showing that males and females differed in some aspects of attention, such as selective attention . These results were similar to that obtained by Howes and Smith (Table nd Smith  in a stup < .001). These findings were expected, considering the developmental characteristics of attention skills. There were no significant differences in the AQS criterion sort scores between children aged 4 and children aged 5.Significant age related differences were observed for the most of the “Attention and Concentration” battery scores , “auditory recognition” , “visual recognition” , “visual spatial recognition” , “divided attention” ,and “multiple search”  tests compared with less securely attached children , “auditory recognition” ; “visual recognition” , “divided Attention” . Results showed the significant contribution to the model of all the variables  AQS scores were significant predictors for “speed and accuracy” , “auditory recognition” (correct responses and times), “visual recognition” (time), and “divided attention” (correct responses) scores.The present study highlights several interesting points concerning the relationships that occur among attachment to preschool teachers and attention. Preliminary sex and age difference analyses showed males and females differ with regard to reaction times, in which females outperformed males, and with regard to visual spatial selectivity and maintenance, in which male outperformed female. These data were consistent with the scientific literature that has found that males and females perform differently in some cognitive domains Kaufman . As expeWith regard to the principal aim of this research, the findings showed that child/preschool teacher attachment is related to attentional performance. This observation confirms the hypothesis that socio-emotional development could significantly contribute to influence attentional skills (Gillath, Giesbrecht, and Shaver, Gillath et al. A positive bond between children and their teachers probably encourages children to direct, maintain and distribute their attention correctly, increasing their general cognitive performances. In this regards, it is important to consider that the relationship between attachment and cognitive abilities is bidirectional. Attention skills support the child relationship with adult and peers, and encourage his social-emotional adjustment, ameliorating child’s ability to understand and copy the behavioral demands of the school. Children with high attention skills may be able to distribute visual attention spatially, deploy attention over time, and allocate attention to visual objects. This increases their ability to recognize the significant aspects of a situation, and the ability to respond to the requests of the teachers. Thus, teachers find it easier to respond, react sensitively and create secure relationships with these children. For this reason, attachment has at least two functions pertinent to classrooms: providing feelings of security and socializing with other children (Bergin and Bergin The correlation analyses support these considerations. Correlation analysis showed that the security of attachment is correlated with visual and auditory selectivity and maintenance, divided attention, and voluntary shifting. The relationship among attachment security and attentional skills confirms the numerous observations that positive child–teacher relationships could increase school adjustment and success (Hamre and Pianta Finally, multiple regression analyses showed that attachment to professional caregivers was significantly related to the attention skills. Particularly, the results showed that “AQS criterion sort” scores were significant predictors of the reaction times related to a choice, of the visual and auditory selectivity and maintenance, and of the divided attention. As expected, “age” and “sex” were significant predictors for many Attention and Concentration battery scores. It is predictable that children of different ages present different attentional performances, and is known that male and female present differences in attention skills. However, even if age and sex are well-known variables in determining cognitive development, the quality of attachment influences attention significantly. Interestingly, attachment security is a better predictor with respect to “sex” for reaction times related to a choice, auditory and visual maintenance, and divided attention.Although the nature of my data does not allow me to formulate a directional hypothesis, this last issue is of high interest because current theories emphasize the role that socio-emotional variables play in cognitive performances and in school achievement. An early assessment of the quality of the relationship between children and their preschool teachers might assist in identifying children who are not well-adapted to preschool, with the aim to improve the quality of their socio-emotional adjustment. This could have positive consequences in the children cognitive performances.The results of the present study revealed that children’s secure base behaviour, in relationship with their preschool teachers, is related to attention skills. Considering the role of attention skills in all cognitive and behavioural performances, a non-secure child/teacher bond might reduce children’s participation in collaborative learning activities and influence scholastic achievement adversely (Sthulman and Pianta The findings of this study might also have clinical relevance. Attachment to a teacher can be easily measured in preschool, and its assessment might allow us to identify children who are able to benefit from the social and cognitive stimuli that increase their attention skills, explorative behaviour, and environmental adaptability. Indeed, all of these aspects are connected to the development of cognitive and behavioural skills. In particular, attention plays a pivotal role in the effectiveness of each mental process, thus energizing the activity of the cognitive functions. In conclusion, the precocious assessment of the child/preschool teacher relationships might reveal a relationship pattern that hinders the optimization of their learning occasions.This study has several limitations. First, caution needs to be taken when interpreting my findings. Indeed, the relationships between attachment and attention are complex and difficult to examine. In addition, the use of an observational instrument has some well known limitations, and observer effects may occur. However age of participants and the characteristics of the preschool setting make these measures appropriate for this study.Despite these limitations, the present study suggests interesting applications. These findings emphasize the potential usefulness of screening all preschoolers and kindergarteners for potential behavioural and emotional problems. The early identification of insecurely attached children and the adoption of subsequent prompt and effective measures may increase their attentional functioning and may be critical to prevent scholastic difficulties. Intensive prevention trials centred on social and emotional skills are relatively inexpensive and could easily be realized in school.


Pain is the primary outcome measurement in osteoarthritis, and its assessment is mostly based on its intensity. The management of this difficult chronic condition could be improved by using pain descriptors to improve analyses of painful sensations. This should help to define subgroups of patients based on pain phenotype, for more adapted treatment. This study draws upon patients’ descriptions of their pain, to identify and understand their perception of osteoarthritis pain and to categorize pain dimensions.This qualitative study was conducted with representative types of patients suffering from osteoarthritis. Two focus groups were conducted with a sample of 14 participants, with either recent or chronic OA, at one or multiple sites. Focus groups were semi-structured and used open-ended questions addressing personal experiences to explore the experiences of patients with OA pain and the meanings they attributed to these pains.Two main points emerged from content analyses: -A major difficulty in getting patients to describe their osteoarthritis pain: perception that nobody wants to hear about it; necessity to preserve one’s self and social image; notion of self-imposed stoicism; and perception of osteoarthritis as a complex, changing, illogical disease associated with aging. -Osteoarthritis pains were numerous and differed in intensity, duration, depth, type of occurrence, impact and rhythm, but also in painful sensations and associated symptoms. Based on analyses of the verbatim interviews, seven dimensions of OA pain emerged: pain sensory description, OA-related symptoms, pain variability profile, pain-triggering factors, pain and physical activity, mood and image, general physical symptoms.In osteoarthritis, pain analysis should not be restricted to intensity. Our qualitative study identified pain descriptors and defined seven dimensions of osteoarthritis pain. Based on these dimensions, we aim to develop a specific questionnaire on osteoarthritis pain quality for osteoarthritis pain phenotyping: the OsteoArthritis Symptom Inventory Scale (OASIS). In Europe, 20 % of chronic pain is related to osteoarthritis (OA)  and painMelzack  introducVery few papers have described pain dimensions in OA, and there is little or no consensus concerning these dimensions. Some authors have analyzed night pain in knee osteoarthritis  and the In this context, it was clearly important to gain insight into the patients’ own descriptions of their OA pain, and to consider all the pain sensations described by the patients, to obtain an extensive description of OA pain quality. Indeed, such descriptions should improve evaluation of the various dimensions of OA pain. Our aim was to develop a framework for a patient-centered evaluation of OA pain, allowing an in-depth description of pain, and in further steps, the development of a specific questionnaire, the OsteoArthritis Symptom Inventory Scale (OASIS) for assessing OA pain quality, as a complement to the ICOAP questionnaire, which focuses on OA pain impact. We thus conducted an exploratory qualitative study (i.e. an open-enquiry approach) to investigate how people suffering from OA perceive and describe pain and associated changes.Qualitative research methods were used to investigate participants’ perceptions and descriptions of their OA pain ,15. ThesAll subjects were informed of the goals and design of the study and assured of confidentiality before they gave their written informed consent to participate in the study. Data were rendered anonymous to ensure confidentiality. This study was carried out in accordance with the Helsinki Declaration. Approval was obtained from the institutional review board 5Comité Consultatif sur le Traitement de l’Information en Matière de Recherche), and the French data protection agency  before enrollment. Focus groups were conducted by a female PhD psychologist (SD), trained in qualitative procedures, with considerable experience in qualitative studies. No prior relationship with respondents was established before data collection. Two focus groups were conducted in Paris, France, with 14 respondents. These respondents had suffered severe OA for a number of years, and 10 of them were over 60 years old. Participants were drawn from investigators’ clinical practices, from university hospital and private-practice rheumatologists, and informed about the purpose of the study (i.e to improve our understanding of OA pain). Those eligible to participate were: French-speaking men and women with painful hip, knee or hand OA, who had not experienced joint injury within the last year, or a joint replacement of the symptomatic joint. Anyone with any other type of inflammatory arthritis, fibromyalgia, chronic low back pain, or another chronic pain disorder, such as diabetic neuropathy, was excluded. About 80% of the recruited individuals agreed to participate. Those who refused did so mainly because of time contingencies. They did not differ from those who accepted in terms of sociodemographic and clinical characteristics. Respondents were remunerated (€50) for participation. Participant selection was intended to ensure that a range of experiences could be investigated; a purposive sample was thus selected, with participants chosen so as to ensure a diverse sample in terms of age, sex and experience and to provide additional insight, based on data from the literature ,18,19,20In qualitative studies, the number of participants is usually determined by purposive sampling, i.e. by the need to encompass the range of possible responses  and to aThe format of the focus groups was semi-structured and used open-ended questions  so that Basically, throughout the interviews, participants were asked to “describe as graphically as possible all the different types of pains you experience from your osteoarthritis”. A list was made, each respondent participating by adding one or several types of pain. Each “type of pain” was then described as precisely as possible by the person who first mentioned it, and those who recognized that they “felt the same” then added to the initial description, with specific undertones or sometimes, very small or major differences . All interviews were taped and transcribed verbatim, with field notes taken during and after participants’ meetings.The qualitative analysis began with close readings of the transcripts. On the basis of these transcripts, thematic content analysis led to the identification of categories and themes . Data weUsing patient-generated data via the interviews and verification of interpretation by a multidisciplinary group of researchers, we were able to assess the reliability of the data . In shorAll subjects were informed of the goals and design of the study and assured of confidentiality before formally agreeing to participate. Data were rendered anonymous to ensure confidentiality. The authors took care to conform to the ethical standards promoted in the Declaration of Helsinki. Institutional review board and French data protection agency approval  was obtained before subject enrollment. Fourteen participants were included: 10 women and four men, aged 40 to 75 years. The sample included individuals with various professional qualifications. Seven respondents had diffuse OA, three had isolated knee OA, two had isolated hand OA, one had knee and hand OA, and 1 had isolated hip OA. Eight respondents were retired, one was on sick leave for disability, and five respondents were still actively working.The interview-reviewing process identified a major difficulty in getting arthritic people to describe their arthritis pains. Several reasons for this difficulty emerged from content analysis: the impossibility of comparing personal perceptions with a gold standard; the perception that nobody wants to hear about OA pains; the need to preserve one’s self and social image; the representation of OA; the notion of self-imposed stoicism; and the perception of OA as a complex, changing, illogical disease.This difficulty was related to the subjective experience of pain: “The difficulty in describing osteoarthritis pain is that I have never been ill. I’ve never felt pain, but I thought, I will try and work with what I know and that everybody has felt once in one’s life: toothache and labor and childbirth”. Therefore, when asked to describe OA pains, most respondents felt at a loss: how could they express, or describe, what they feel? It was even harder when the pain first began, with respondents tending to ignore OA pains, because they were not entirely sure that they existed at all. Indeed, these pains could be described as starting “low”, below the level of consciousness, so that when pain was not acute, but dull and constant, respondents generally reported mistaking the pain for a general state of “not being so well”: “It’s like a suspicion of pain more than a real pain, at the beginning. You don’t know that you are in pain, really. You just don’t stay there wondering: am I in pain or not? You just go ahead with your life, think of something else”. This perception concerned doctors and nurses, according to the respondents: they either cannot or will not do anything about pain: “The physiotherapist said: that’s life!”. Often, uncaring audiences were both professional and friends and family. “My son doesn’t want to know if I’m not well. And of course he could do nothing about it. He says: “you will bury all of us! You are not really ill, you look fine!” What can I say?” And, when someone cared enough to notice, respondents would try to hide their pain, even deny it. Fear of giving pain to the ones they love and who care was then emphasized. The models the individual grew up with also contributed to this perception that nobody wants (or needs) to hear about OA pains: “Our grandparents had osteoarthritis. They never complained. I feel I owe it to them to be as brave and dignified as they were”.Another added problem was that respondents sometimes talked about their pains but were not heard because nothing was visible on the X ray. The distrust displayed by healthcare professionals tended to make things worse. “Doctors say: ‘if you really had something, it would show on the X ray’. Nothing shows? Well, you’re all right then. You look crazy. People tell you it’s in your head, you’re a psychological case. So you’re in pain, and the way people look at you makes it worse!”This necessity was expressed in various ways in the context of an illness seen as associated with age, loss of mobility, decaying autonomy and health. It stressed the manifold aspects of this dimension of self-image and included the preservation of social status, social life and relations with friends, as well as of self-image, and intimate image. As this patient indicated it: “I don’t talk about it to my wife because I always have the feeling that I exaggerate. I think I can be a bit of a hypochondriac, like most men, though I do think there really is something”. Another reason for not talking about OA pains concerned the “natural” image of osteoarthritis. OA was felt to be a natural and inevitable phenomenon, related to aging, that neither patients nor doctors and science can fight, and not a matter of scientific research and progress. It nurtured a feeling of doom: “The fact that I came here and that we talk about it, I feel less isolated. I never talk about it to my colleagues, it’s an illness for the very old”. As such, it raised feelings of hopelessness, when faced to the first stigmata of age and the end of youthful health. “I work at an optician’s. Some women, who come for their first glasses around 40, they cry. Because they know they are getting… less young. I feel the same. I’m 40, I can’t run with my children, it’s over”. Patients try to decrease the pain they feel by not thinking about it: this mechanism of dealing with pain was practiced by all respondents in this study. It was expressed in different ways: one was to insist on the importance of being optimistic: “I wonder sometimes if I exaggerate what I feel. One doesn’t live any more if you always think about your pain”; another way was to ignore pain, to decrease pain awareness so as to deal with the pain and go on with one’s life; and finally, in some instances, stoicism was induced by guilt, with overweight patients, for example, feeling “guilty” about their illness. They felt they “deserved” pain and should not complain about it, as this patient put it: “I also thought, this could be because I’m overweight, and the doctors insist on that, I’m 110 kilos, each of my knees manage 55. It’s a form of guilt that is imposed on us, of course it’s for our own good, we should lose weight, but vexation aside, it’s not that simple. I’m a good cook; I know how to cook light.” These examples show how self-imposed stoicism was part a show of inner strength and resilience, part autohypnosis. It may thus offer a double benefit: it improves self image, and effectively decreases the pain felt.OA was described as not always feeling the same; its pains are different according to the moment of the day, the place where it hurts, or the weather. Variations were also described as unpredictable, with no clue as to their cause . Moreover, older respondents emphasized that they had other diseases and therefore could not “really” know what was due to OA, and what was caused by another illness entirely.In summary, respondents stressed the difficulties they experienced in talking about their pain, related to the absence of a clear concept to describe pain and of an accurate vocabulary: pain is not only a matter of intensity or duration. OA pains are numerous, and differ in respondents’ words in various respects, including painful sensations, type of occurrence, mode of initial impact, rhythm, and varied associated symptoms. It may also incapacitate the person totally or only partially and may be “noisy” or not. As this participant pointed out: “It is hard to describe, qualify my pain. There is this notion of orchestra: some bassoon, then along comes the clarinet”.Despite this difficulty getting people suffering from OA to talk about pain and their feeling of a lack of accurate vocabulary to describe OA pains, content analysis made it possible to identify and list various characteristics of OA pains, some of which were common to most respondents  and otheOA pains were often presented as very intense, with descriptions of violent, intense, brutal, acute, fierce pain. However, as noted above, OA pain is not only a matter of intensity and there are many different types of pain, described in the patients’ words, in terms of intensity, duration , or depth (muscle-deep vs. bone-deep). This sensation could develop into ‘abrupt paralysis’ combining pain intensity and anxiety related to the feeling of “being ravaged from the inside”. The importance of this perception of a physically penetrating/tearing element was further stressed by the presentation of ‘pain as an electrical shock’. Background pain was present in all patients, described as starting low and then becoming more present/stronger, acute. It was presented as a sort of oozing pain, with a dull pitch and a variable intensity. “Starting pains” were described by all participants, with getting up (or standing up after a prolonged period in a sitting position) taking time because of pain. These pains were described as “mechanical”, a bit like trying to start up an old, rusty machine. Morning starting pains did not last long, but the sheer anxiety of it may make it feel longer: “When you unfold your knees, it’s 10 seconds of an awful pain. Then, it goes away. But you remember the pain”.seized” by OA pain, and they described it as feeling like a “totally rusted” mechanical device . This last characteristic also added to the feeling that OA pains were ‘psychological’, i.e. whimsical, and therefore difficult to take seriously.OA pain was described as possibly related to external factors, including the weather in particular, with cold and wet weather conditions being the worst (hot and dry was a relief for the respondents), and bringing an extension of OA pains, both in intensity and in localization. The participants felt their whole body was “awaken” the pain and make it acute and bring it very much into the foreground.The first pain described by all participants was the background pain: the one you have to ignore to go on living, because it is always there. Patients tended to try and “tame” the pain by restricting their activities, their movements, or whatever they felt could “Anxiety could be provoked by the intensity of pain (like in ‘tearing pain’), potentially leading to a feeling of threat against bodily integrity (as in ‘stabbing pain’). However, anxiety may also arise independently of pain intensity, as related to the feeling of “alien things inside” that ‘deep pain’ located close to or within the bone may create. Images of OA pain were frequently associated with older age and, in many cases, these pains were seen as the first sign of becoming old, and possibly isolated. Various associated symptoms were described, such as a swollen knee, skin that was re, or warm to the touch, or too tight, and contracted limbs. A ‘missing limb’ sensation was often mentioned, presented as more of a physical discomfort than a pain, but causing anxiety nevertheless. OA pain may have repercussions for global behavior . As in most chronic pain, OA pain can be debilitating, exhausting and may cause sleep disorders. For some participants, background pain was akin to extreme, long-lasting tiredness. In summary, these seven dimensions highlight the major importance of pain sensations and descriptors. They highlight OA-related local symptoms, pain variations, triggers, physical activity and global physical repercussions of OA pain. They also emphasize the contribution of an emotional dimension. The “name of the pain”  the variety of OA pains was clear from the difficulty the OA patients had talking about their pain and describing it during the interviews. It is particularly important to provide initial encouragement to be candid and spontaneous in dealing with the subject at hand, and this encouragement should be reinforced and repeated, because respondents were initially reluctant to talk about “how painful exactly” their OA was. The respondents systematically required repeated assurances that such talk did indeed have a scientific aim and use, and that it would not be futile, or a “whining” about what they felt, but could actually help improve medical knowledge of OA. Trapped by stoicism, ideas about the nature of the disease , and the lack of pre-existing words or concepts that could be applied to it, respondents not only did not know how to describe their pain, but were also convinced that doctors were not interested and could do nothing about the pain in any case, as also reported by Jinks et al.  in a quaThe type of metaphor used provided further clues to the emotional/ psychological impact of pain. The respondents’ wording clearly stressed that pain was not limited to physical suffering, either in terms of its consequences or the actual experience of pain sensations, which also raised mental images and specific feelings . Which iThe development of an instrument for improving the qualification of painful sensations in OA might help to improve the patient-tailored management of OA . Pain treatments in OA are poorly effective, and outcome measures are based mostly on pain VAS or on questionnaires assessing pain purely in terms of its intensity, without taking into account its quality. In several pain conditions, different authors have developed questionnaires or more objective techniques, such as quantitative sensory testing (QST), for identifying predictors of treatment efficacy . This maIdentifying patients’ representations and taking them into account is also a key issue in the patient-centered management of OA, which aims to improve patients’ knowledge of the disease and their compliance with treatment ,47. In oThis study provides insights into the types of pain experienced by people with osteoarthritis, but the limitations of its design and outcomes should be recognized. In particular, as in many studies, the transferability of the findings is limited. As in all qualitative studies, our study sample was small and transferability may thus be limited to people and settings with characteristics similar to those investigated in this study. Moreover, exploring the experiences of individuals with OA pain and the meanings they attribute to these pains requires recall, and the participants’ responses may thus be limited by recall bias. This study was based on interviews with a diverse group of respondents on OA pain experience, an apparently common topic that is, however, rarely investigated from the patients’ point of view, i.e. using the respondents’ own description of how they perceive and describe pain and the related changes. The focus groups were conducted by a psychologist who was not a healthcare provider and had no prior relationship either with the respondents or with the multidisciplinary team before data collection, to try to minimize the risk of overlooking responses too close to or far from the expectations of healthcare providers. We convened the multidisciplinary group of researchers  to review the findings, to minimize the risk of missing important contextual information in the focus groups and to contribute to the understanding of clinical situations .It is common for people to normalize joint pain and not to consult a doctor, and our patients’ interviews help to understand why people do not speak about their OA pain. Even if patients with OA pain do not express their pain spontaneously, this study demonstrates that pain should not be analyzed solely in terms of its intensity, because many painful sensations and associated symptoms were reported by patients with osteoarthritis. Our qualitative research led to the definition of seven dimensions in OA pain. Based on these dimensions, we aim to develop a specific questionnaire on OA pain quality, for OA pain phenotyping: the OsteoArthritis Symptom Inventory Scale (OASIS). This new questionnaire, based on patient-reported experiences of pain, will be in line with IMMPACT recommendations, which promote the use of patient-reported outcome measures in the assessment of pain and pain management . Subgrou


The Insect Chorus. “They are all his world, so, to his mind, all things become saturated with their presence―crickets lurk in the depths of the grass, the shadows of the trees conceal fantastic creatures, and the boy looks with fear at the black interior of the arbor, not knowing what terrible thing might be there.”“It is late Sunday afternoon in August. A child stands alone in the garden listening to the metallic sounds of insects,” reads Charles Burchfield’s own description of The Insect Chorus, one of several works on the same theme, was painted during what Burchfield called his “golden year,” when he was fresh out of art school and back home in Salem, Ohio, in 1917. The work is a good example of his take on en plein air painting. An avid admirer of the outdoors, he immersed himself in it. He liked everything about it, even the annoying parts that most nature lovers merely tolerate for the sake of beauty. His artistic approach was a unique blend of naturalism, emotion, and imagination. “Surrounded by the familiar scenes of my boyhood, there gradually evolved the idea of recreating impressions of that period, the appearance of houses, the feelings of woods and fields, memories of seasonal impressions….”The Song of the Katydids on an August Morning (1917), he wrote, “A stagnant August morning during the drought season, as the pitiless sun mounts into the mid-morning sky, and the insect chorus commences, the katydids and locusts predominating. Their monotonous, mechanical, brassy rhythms soon pervade the whole air, combining with the heat waves of the sun, and saturating trees and houses, and sky.” Of The August North (A memory of childhood), he wrote, “As the darkness settles down, the pulsating chorus of night insects commences swelling louder and louder until it resembles the heartbeat of the interior of a black closet.”Nature and its creatures remained of great interest to Burchfield all his life. He felt their sounds and captured them with extraordinary draftsmanship in his trademark watercolors. On the back of “Well, at one time I did think I was going to be a writer―when I was in high school and even the early years in art school I thought I was going to be a nature writer in somewhat the sense, you know, that Teale writes and Harold Borland, and so forth. And if I did anything with art work, I would make my own illustrations. But I soon realized that my outlook was visual rather than otherwise. But I mean it still… I did these short things.” He wrote impressions in his copious journals and descriptions on the back of his watercolors: “Crabbed old age sits in front of the black doorway without hope for the future, brooding. Spiders lurk in dark corners. The dying plants reflect her mood. The romantic outer moon rises just the same.” He even illustrated his own words, as in his notebook “Conventions for Abstract Thoughts,” his personal iconography, “A graphic shorthand of youth,” he called it, which came to be viewed by some as a visual vocabulary of American modernism.Aside from colors and words, other forces also marked Burchfield’s output. “I get more out of music probably than I do out of other artists’ paintings, although I have many great admirations there,” he acknowledged. “It seems pertinent to me to insert here some thoughts on how interwoven music is with my painting. To many works, and even for whole periods of time, a definite piece of music or composition seemed to belong, though there might be no connection whatsoever between the music and what I was doing.”Burchfield’s sensitivity to all that surrounded him nurtured his imagination and culminated in hundreds of works filled with a vibrant vision of the world, a vision in which humans and their creations were secondary and paled against the overpowering presence of nature. His style engaged whatever tools would bring forward this vision. “There are ideas that come to me that can be interpreted only in terms of patterns, and I derive much pleasure in working them out.” He defined his occupation in clear terms, “I like to think of myself—as an artist—as being in a nondescript swamp, up to my knees in mire, painting the vital beauty I see there, in my own way, not caring a damn about tradition, or anyone’s opinion.”The Insect Chorus, Burchfield paints summer in the outdoors, seen through the eyes of a child. The psychedelic spectacle transcends visual barriers to express the sweltering heat and humidity, along with the sounds of summer, its mystery and music. The alarming closeness of the clapboard household to the vegetation, which seems possessed by unknown forces, adds to the drama. Drooping ferns frame the canopy and its mysterious depths underneath the cool-color arabesques. Elaborate patterns―fluid lines, broad curves, cones―along with symbols to indicate sound and movement, transform a commonplace scene to a steaming hallucinogenic vision filled with emotion. V shapes in the grass mimic the jagged flight of crickets, and zigzag paths simulate their metallic sound, which Burchfield named “high shrill pin-point cricket chorus.”In By the early 1900s, mosquitoes were shown to transmit yellow fever and malaria from person to person, and human malaria was endemic in the United States. When Burchfield’s imaginary boy “looks with fear at the black interior of the arbor, not knowing what terrible thing might be there,” he is probably not worried about crickets alone but about all manner of vermin that you cannot see yet know are there. In the heat of a “Sunday afternoon in August,” mosquitoes awaiting a blood meal would be lurking in the vegetation. Along with a silent chorus of ticks, fleas, and rodents, they are part and parcel of the season and the locale.Apart from nuisance and noise, the namesake insects of this painting rightly provoke fear. Many human pathogens infecting a large proportion of the world’s population and contributing to emerging disease are zoonotic and vector-borne. And many of these viruses, bacteria, protozoa, and rickettsia can be transmitted by blood-feeding arthropods. Depending on the geographic location, Burchfield’s vibrating canopy could play host to yellow fever, Rift Valley fever, Lyme disease, tularemia, malaria, typhus, Rocky Mountain spotted fever, to name only a few vector-borne infections that can begin with a summer buzz.Vectors, such as mosquitoes, bridge barriers that would prevent transmission by direct contact between humans and especially between animals and humans. These barriers are not only spatial but also behavioral and ecologic. This ability of vectors includes moving a pathogen from one region to another. Because of the complex epidemiology and adaptiveness of pathogens and arthropods, vector-borne diseases are difficult to control, much less to eradicate. Vaccines are only available for a few diseases, and even when they are available, as for yellow fever, prevention can still be difficult to achieve.Even previously successful strategies, such as pesticide impregnated bed-nets, can be compromised by human behavior and vector biology. With malaria, problems must be solved largely on the basis of local data because rarely do variables in one area behave in the same way as in another area, however closely the two regions may seem to resemble each other in topography and climate.“How slowly the ‘secrets’ of my art come to me,” Burchfield lamented near the end of his life. He might as well have been expressing the epidemiologists’ frustration when they realize that changes in climate, land use, and transport, a concert eons in the making, affect rates of pathogen emergence in ways we still do not rightly understand. The artist’s respect for the all-encompassing power of nature applies across the board.


This paper presents a collection of computational modules implemented with chemical reactions: an inverter, an incrementer, a decrementer, a copier, a comparator, a multiplier, an exponentiator, a raise-to-a-power operation, and a logarithm in base two. Unlike previous schemes for chemical computation, this method produces designs that are dependent only on coarse rate categories for the reactions (“fast” vs. “slow”). Given such categories, the computation is exact and independent of the specific reaction rates. The designs are validated through stochastic simulations of the chemical kinetics. On the computational front, there has been a wealth of research into efficient methods for simulating chemical reactions, ranging from ordinary differential equations (ODEs) The theory of reaction kinetics underpins our understanding of biological and chemical systems analysis: a set of chemical reaction exists, designed by nature and perhaps modified by human engineers; the objective is to understand and characterize its behavior. Comparatively little work has been done at a conceptual level in tackling the inverse problem of synthesis: how can one design a set of chemical reactions that implement specific behavior?Most of this work is from the vantage point of Of course, chemical engineers, genetic engineers and other practitioners strive to create novel functionality all the time. Generally, they begin with existing processes and pathways and modify these experimentally to achieve the desired new functionality computational processes: regardless of the complexity of the dynamics or the subtlety of the timing, such networks transform input quantities of chemical species into output quantities through simple primitive operations. The question of the computational power of chemical reactions has been considered by several authors. Magnasco demonstrated that chemical reactions can compute anything that digital circuits can compute et al. demonstrated that chemical reactions are Turing Universal, meaning that they can compute anything that a computer algorithm can compute Perhaps the most profound theoretical observation is that chemical reaction networks are, in fact, deductive point of view. This paper tackles the problem from an inductive point of view. We present a constructive method for designing specific computational modules: an inverter, an incrementer, a decrementer, a copier, a comparator, a multiplier, an exponentiator, a raise-to-a-power operation, and a logarithm in base two. This work builds upon our prior work that described constructs such as “for” and “while” loops Such prior work considered the computational power of chemical reactions from a In contrast to previous work, our method produces designs that are dependent only on coarse rate categories for the reactions . It does not matter how fast any “fast” reaction is relative to another, or how slow any “slow” reaction is relative to another – only that “fast” reactions are fast relative to “slow” reactions. Specifically, suppose that we design a module that requires rate-independent in the sense that the formula of what is computed, say a logarithm, does not include any of the kinetic rate constants. We do not mean to imply that the rates do not matter. If the separation between “slow” and “fast” is not sufficiently large, then errors will occur. However, for a sufficiently large separation, the errors are small.The result of the computation is Indeed, the error that occurs as a function of the separation between “fast” and “slow” is our main criterion of goodness for our design. As We adopt the model of discrete, stochastic chemical kinetics reactant and products.) Consider what this reaction accomplishes from a computational standpoint. Suppose that it fires until all molecules of Consider the reactionConsider the reactionWe will present constructs different arithmetical and logical operations in this vein. Each sets the final quantity of some molecular type as a function of the initial quantities of other types.Most of our designs consist of either unimolecular or bimolecular reactions, i.e., reactions with one or two reactants, respectively. A small subset of the reactions are trimolecular. Mapping these to chemical substrates might not be feasible, since the kinetics of reactions with more than two reactants are complex and often physically unrealistic. For all trimolecular reactions, we suggest the follow generic scheme for converting them into bimolecular reactions. .In this section, we present a collection of constituent constructs for rate-independent computation: an inverter, an incrementer/decrementer, a copier, and a comparator. In the next section, we use some of these constructs to implement a multiplier, a logarithm operation, an exponentiator, and a raise-to-the-power operation. A reference of all reactions needed for these constructs can be found in absence indicator” type, which will be referred to as We implement an operation that is analogous to that performed by an inverter  in a digital system: given a non-zero quantity  we produce a zero quantity . Conversely, given a zero quantity, we produce a non-zero quantity. We accomplish this with a pair of chemical types: the given type, for example, The first reaction continuously generates molecules of We use this simple construct in many of our computational modules It is important to note that absence indicators generated by reactions 6–8 can only be used with “slow” reactions. If they were used by a “fast” reaction, it is possible that a false positive could be detected because a “fast” will compete with reaction 7. In situations where absence indicators need to be consumed by “fast” reactions, we can use an alternate two-step process to produce them.We describe constructs to implement incrementation and decrementation. These operations form the basis of more complex arithmetical operations, such as multiplication. The inputs consist of two molecular types: The system waits for the start signal It transfers the quantity of It sets It transfers all but one molecule of For a decrement, it removes the last molecule For an increment, it removes the last molecule of The following reactions implement this scheme. Given molecules of Reaction 21 also produces molecules of a supplementary type Finally, we include the following reaction to perform a decrement:In digital computation, one of the most basic operations is copying a quantity from one register into another. The programming construct is “set the value of In our construct, we have a “start signal” type The reactions for the copier construct are as follows. Firstly, in the presence of After We also generate absence indicators We note that, while this construct leaves the quantity of Using our copier construct, we can create a construct that compares the quantities of two input types and produces an output type if one is greater than the other. For example, let us assume that we want to compare the quantities of two types If the quantity of First, we create temporary copies, Now we compare Based upon the modules described in the previous section, we provide examples of how to implement more complex arithmetic: multiplication, logarithms in base two, exponentiation, and raising to a power. In order to elucidate the designs, we specify the sequence of operations for each of these module in pseudo-code. The pseudo-code operations consist of:Assignment, addition, and subtraction operations. The operands may be constants or variables.Decision-making constructs: while and if statements. The logical test for each of these constructs can be any one of the six conditions listed in Building upon the constructs in the last section, we show a construct that multiplies the quantities of two input types. Multiplication can be implemented via iterative addition. Consider the following lines of pseudo-code:Firstly, we have reactions that copy the quantity of As a second complex example, we show how to implement the operation To implement the operation We demonstrate the computation of a base-2 logarithm. The pseudo-code is shown in rate separation.) For each of the graphs below, the initial quantity of each type is zero, with the exception of the types specified.We validated our constructs using stochastic simulation. Specifically, we performed a time homogeneous simulation using Gillespie's “Direct Method” This paper presented a collection of specific computational constructs. More complex operations – multiplication, exponentiation, raising to a power, and logarithms – were built a collection of robust, primitive operations – absence indicators, incrementing and decrementing, copying, and comparing. The process by which we assembled these primitive operations could be readily generalized. Indeed, we are developing a chemical compiler that will translate any sequence of operations specified by pseudo-code into chemical reactions. The compiler will accept general pseudo-code written in the vein of that shown in The novelty and value of the constructs that we have demonstrated is that they are all rate independent. Here “rate independent” refers to the fact that, within a broad range of values for the kinetic constants, the computation does not depend on the specific values of the constants. Of course, outside of this range, the accuracy of the computation degrades. For rates within the target range, our results are remarkably accurate: in nearly all cases the errors are less than 1%. In many cases, the errors are much less than 1%. The actual value of the target range will depend on the chemical substrate used; in simulation, it was found that a ratio of 10,000∶1 of “fast” vs. “slow” produced nearly perfect results.in vivo systems, there are likely to be many experimental constraints on the choice of reactions in vitro computation as a potential application domain for our ideas.Our contribution is to tackle the problem of synthesizing computation at a conceptual level, working not with actual molecular types but rather with abstract types. One might question whether actual chemical reactions matching our templates can be found. Certainly, engineering complex new reaction mechanisms in any experimental domain is formidable task; for de novo approach to the design of biological functions. Potentially this approach is more general in its applicability than methods based on appropriating and reusing existing biological modules.Through a mechanism called DNA strand-displacement, a group at Caltech has shown that DNA reactions can emulate the chemical kinetics of nearly any chemical reaction network. They also provide a compiler that translates abstract chemical reactions of the sort that we design into specific DNA reactions All the models described in this paper are contained in an XML file. This file is available at:Gillespie's Direct Method for all simulations.The file is designed for use with Cain, a biochemical simulator from Caltech Supporting Information S1Appendix: Module Reference.(PDF)Click here for additional data file.Supporting Information S2Appendix: Multiplication Reactions.(PDF)Click here for additional data file.Supporting Information S3Appendix: Raise-to-a-Power Reactions.(PDF)Click here for additional data file.Supporting Information S4Appendix: Exponentiation Reactions.(PDF)Click here for additional data file.Supporting Information S5Appendix: Logarithm Reactions.(PDF)Click here for additional data file.