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"Fuchs, Thomas"
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Vulnerability and resilience to natural hazards
\"In recent years there has been growing recognition that disaster risk cannot be reduced by focusing solely on physical hazards without considering factors that influence socio-economic impact. Vulnerability: the susceptibility to the damaging impacts of hazards, and resilience: the ability to recover, have become popular concepts in natural hazard and risk management. This book provides a comprehensive overview of the concepts of vulnerability and resilience and their application to natural hazards research. With contributions from both physical and social scientists it provides an interdisciplinary discussion of the different types of vulnerability and resilience, the links between them, and concludes with the remaining challenges and future directions of the field. Examining global case studies from the US coast to Austria, this is a valuable reference for researchers and graduate students working in natural hazard and risk reduction from both the natural and social sciences\"-- Provided by publisher.
Book
Clinical-grade computational pathology using weakly supervised deep learning on whole slide images
The development of decision support systems for pathology and their deployment in clinical practice have been hindered by the need for large manually annotated datasets. To overcome this problem, we present a multiple instance learning-based deep learning system that uses only the reported diagnoses as labels for training, thereby avoiding expensive and time-consuming pixel-wise manual annotations. We evaluated this framework at scale on a dataset of 44,732 whole slide images from 15,187 patients without any form of data curation. Tests on prostate cancer, basal cell carcinoma and breast cancer metastases to axillary lymph nodes resulted in areas under the curve above 0.98 for all cancer types. Its clinical application would allow pathologists to exclude 65–75% of slides while retaining 100% sensitivity. Our results show that this system has the ability to train accurate classification models at unprecedented scale, laying the foundation for the deployment of computational decision support systems in clinical practice.
Journal Article
Gestalt Theory and Sexuality
The understanding of sexuality (and sex therapy) depends very much on whether a more narrowly somatic or more broadly phenomenal perspective is adopted. The presentation transfers the fundamental concern of Critical Realism, namely to take a position on the question of the connection between the soul and the body, to the field of sexuality. Essential classical terms of Gestalt theory (reference system, centring) and newer concepts (multiple-field approach) are transferred to sexual events. A Gestalt-theoretical perspective on sexuality as a phenomenon isolated from the whole of human life and coexistence is inconceivable: sexuality is therefore also considered in terms of its function in relationship and attachment. This also applies to the relationship between patient and therapist. The implications of this perspective are discussed in regard to the practical therapeutic approach.
Journal Article
From Self-Disorders to Ego Disorders
While the concept of disorders of basic self-experience as the clinical core of schizophrenia spectrum disorders has gained increasing significance and empirical support, several questions remain still unresolved. One major problem is to understand how the basic and prodromal self-disturbances are related to Schneider's first rank symptoms, in particular to the so-called ‘ego disorders' found in acute psychotic episodes. The study of the transition from prodromal to first rank symptoms, for example from alienated thoughts to thoughts aloud or thought insertions, is of particular importance for understanding the nature and course of schizophrenia. The paper analyses the emergence of ego disorders from basic self-disorders in phenomenological terms, taking the examples of motor passivity experiences and thought insertion. It is argued that full-blown delusions of alien control are ultimately based on a disturbance of the intentionality of thinking, feeling and acting. This disturbance, for its part, may be traced back to anomalies of self-experience in prodromal stages of schizophrenia.
Journal Article
A foundation model for clinical-grade computational pathology and rare cancers detection
The analysis of histopathology images with artificial intelligence aims to enable clinical decision support systems and precision medicine. The success of such applications depends on the ability to model the diverse patterns observed in pathology images. To this end, we present Virchow, the largest foundation model for computational pathology to date. In addition to the evaluation of biomarker prediction and cell identification, we demonstrate that a large foundation model enables pan-cancer detection, achieving 0.95 specimen-level area under the (receiver operating characteristic) curve across nine common and seven rare cancers. Furthermore, we show that with less training data, the pan-cancer detector built on Virchow can achieve similar performance to tissue-specific clinical-grade models in production and outperform them on some rare variants of cancer. Virchow’s performance gains highlight the value of a foundation model and open possibilities for many high-impact applications with limited amounts of labeled training data.
Trained on 1.5 million whole-slide images from 100,000 patients, a pathology foundation model is shown to improve performance of specialized models in detection of rare cancers.
Journal Article
Novel artificial intelligence system increases the detection of prostate cancer in whole slide images of core needle biopsies
Prostate cancer (PrCa) is the second most common cancer among men in the United States. The gold standard for detecting PrCa is the examination of prostate needle core biopsies. Diagnosis can be challenging, especially for small, well-differentiated cancers. Recently, machine learning algorithms have been developed for detecting PrCa in whole slide images (WSIs) with high test accuracy. However, the impact of these artificial intelligence systems on pathologic diagnosis is not known. To address this, we investigated how pathologists interact with Paige Prostate Alpha, a state-of-the-art PrCa detection system, in WSIs of prostate needle core biopsies stained with hematoxylin and eosin. Three AP-board certified pathologists assessed 304 anonymized prostate needle core biopsy WSIs in 8 hours. The pathologists classified each WSI as benign or cancerous. After ~4 weeks, pathologists were tasked with re-reviewing each WSI with the aid of Paige Prostate Alpha. For each WSI, Paige Prostate Alpha was used to perform cancer detection and, for WSIs where cancer was detected, the system marked the area where cancer was detected with the highest probability. The original diagnosis for each slide was rendered by genitourinary pathologists and incorporated any ancillary studies requested during the original diagnostic assessment. Against this ground truth, the pathologists and Paige Prostate Alpha were measured. Without Paige Prostate Alpha, pathologists had an average sensitivity of 74% and an average specificity of 97%. With Paige Prostate Alpha, the average sensitivity for pathologists significantly increased to 90% with no statistically significant change in specificity. With Paige Prostate Alpha, pathologists more often correctly classified smaller, lower grade tumors, and spent less time analyzing each WSI. Future studies will investigate if similar benefit is yielded when such a system is used to detect other forms of cancer in a setting that more closely emulates real practice.
Journal Article
The Temporal Structure of Intentionality and Its Disturbance in Schizophrenia
Working memory, attention and executive control functions are central areas of neuropsychological research in schizophrenia. These concepts implicitly refer to the basic temporal structure of mental life as an integration of past, present and future. From a phenomenological point of view, they may be paralleled to the structure of internal time consciousness as analyzed by Husserl, consisting of a retentional, presentational and protentional function. These synthetic functions, operating at the most basic layer of consciousness, are capable of integrating the sequence of single moments into an ‘intentional arc’, enabling us to direct ourselves towards objects and goals in a meaningful way. On this background, basic symptoms of schizophrenia such as formal thought disorder, loss of automatic performances and disturbances of self-awareness may be conceived as caused by a weakening and dissolution of the intentional arc. A failure of the continuous intertwining of succeeding moments, and especially of the protentional function, leads to a loss of the tacit or operative intentionality that carries the acts of perceiving, thinking and acting. The loss of tacit, implicit functions undermines the common-sensical understanding of reality and has to be compensated by the deliberate, hyperreflexive reconstruction of everyday performances. Phenomenological analyses may thus establish a link between experimental research on single mental dysfunctions on the one hand and the higher level of the patient’s subjective experience on the other.
Journal Article
Fragmented Selves: Temporality and Identity in Borderline Personality Disorder
The concept of narrative identity implies a continuity of the personal past, present and future. This concept is essentially based on the capacity of persons to integrate contradictory aspects and tendencies into a coherent, overarching sense and view of themselves. In ‘mature’ neurotic disorders, this is only possible at the price of repression of important wishes and possibilities for personal development. Patients with borderline personality disorder lack the capacity to establish a coherent self-concept. Instead, they adopt what could be called a ‘post-modernist’ stance towards their life, switching from one present to the next and being totally identified with their present state of affect. Instead of repression, their means of defence consists in a temporal splitting of the self that excludes past and future as dimensions of object constancy, bonding, commitment, responsibility and guilt. The temporal fragmentation of the self avoids the necessity of tolerating the threatening ambiguity and uncertainty of interpersonal relationships. The price, however, consists in a chronic feeling of inner emptiness caused by the inability to integrate past and future into the present and thus to establish a coherent sense of identity. The paper outlines the concept of narrative identity and explores its disturbances in borderline personality disorder. Finally, the increasing prevalence of these disorders is linked to the development of a mainly externally driven, fragmented character in post-modern society.
Journal Article
Gestalt Theoretical Psychotherapy – A Clinical Example
The case of an anorectic patient is presented to demonstrate how well-known symptomatic phenomena such as a supposedly distorted body perception can be understood. Further theoretical suggestions are made to explain the motive to starve, without making complicated psychodynamic assumptions. To do so, genuine gestalttheoretical concepts such as ‘centring’ and ‘reference system’ are used. This leads to hints for a temporarily perception-focused formation of the therapeutic relationship.
Journal Article