Is the self of the infant preserved in the adult?

Medicine, Health Care and Philosophy - What does a confrontation between philosophy and psychoanalysis look like? My task is a philosophical investigation of a psychoanalytic concept. Thus, I offer...     

Is the future in the cards?

Smart cards have yet to catch on in health care. Applications for data security and marketing, however, could boost their use.     

More donation: through the community, the government or the market?

In previous research it has been established that the number of organ donors would increase if trained donation specialists were made available to assist families during the donation process. The amount to be gained would, however, not be sufficient to solve the problem of donation shortfall. Possibly the government needs to play a more active role, for example by means of a 'no objection, unless' system. The present political climate in The Netherlands does not appear for the time being to support such an initiative. Finally, the number of donors could be increased via the market by financial stimulus, but it is questionable whether this would be regarded as morally justified by the community.     

How about the uncertainty in the haplotypes in the population-based KORA studies?

In the KORA surveys, numerous candidate genes in the context of type 2 diabetes, myocardial infarction, atherosclerosis or obesity are under investigation. Current focus is on genotyping single nucleotide polymorphism (SNPs). Haplotypes are also of increasing interest: haplotypes are combinations of alleles within a certain section of one chromosome. Analysing haplotypes in genetic association studies is often more efficient than studying the SNPs separately. A statistical problem in this context is the reconstruction of the phase: genotyping the SNPs determines the alleles of an individual at one particular locus of the DNA, but does not reveal which allele is located on which one of the two chromosomes. This information is required when talking about haplotypes. There are statistical approaches to identify the most likely two haplotypes of an individual given the genotypes. However, a certain error in prognosis is unavoidable. There are also errors in the genotypes. These errors are assumed to be small for one SNP but can accumulate over the SNPs involved in one haplotype and thus can induce further uncertainty in the haplotype. It is therefore the aim of our project to quantify the uncertainties in the haplotypes particularly for genes investigated in the KORA surveys. We conduct computer simulations based on the haplotypes and their frequencies observed in the KORA individuals and compare the results with simulations based on mathematical modelling of the evolutionary process ("coalescent models"). The uncertainties in the haplotypes have an impact on the search for association between genes and disease: an association may not be detected as the haplotype uncertainty obscures the haplotype frequency differences between cases and controls. It is a further aim of our project to elucidate the extent of this problem and to develop strategies for reducing it.     

Can the science of communication inform the art of the medical humanities?

CONTEXT There is increasing interest in establishing the medical humanities as core integrated provision in undergraduate medicine curricula, but sceptics point to the lack of evidence for their impact upon patient care. Further, the medical humanities culture has often failed to provide a convincing theoretical rationale for the inclusion of the arts and humanities in medical education. DISCUSSION Poor communication with colleagues and patients is the main factor in creating the conditions for medical error; this is grounded in a historically determined refusal of democracy within medical work. The medical humanities may play a critical role in educating for democracy in medical culture generally, and in improving communication in medical students specifically, as both demand high levels of empathy. Studies in the science of communication can provide a valuable evidence base justifying the inclusion of the medical humanities in the core curriculum. A case is made for the potential of the medical humanities – as a form of ‘adult play’– to educate for collaboration and tolerance of ambiguity or uncertainty, providing a key element of the longer‐term democratising force necessary to change medical culture and promote safer practice. CONCLUSION The arts and humanities can provide important contextual media through which the lessons learned from the science of communication in medicine can be translated and promoted as forms of medical education.     

rm the management system,strengthen the tec

[目的]研究维吾尔族及汉族乳腺癌患者中BRCA1、P53及Ki-67蛋白的表达及其意义。[方法]选取100例维吾尔族和25例汉族乳腺癌根治标本,对照组为126例维汉族乳腺良性病变(纤维腺病及纤维腺瘤)及乳腺癌旁非癌组织;运用免疫组化Evision二步法检测BRCA1、P53及Ki-67蛋白的表达。[结果](1)在乳腺良性病变及乳腺癌旁非癌组织中,BRCA1蛋白均定位于细胞核内。在乳腺癌组织中,93例完全表达为细胞浆阳性,阳性率为74.4%,32例表达缺失。(2)BRCA1蛋白的表达与组织学分级、患者的年龄、淋巴结转移及民族有明显相关性(P﹤0.05)。(3)乳腺癌中P53蛋白和Ki-67的表达呈正相关(P﹤0.01);BRCA1蛋白与P53及Ki-67的表达呈负相关(P﹤0.01)。(4)乳腺癌中P53及Ki-67蛋白的阳性表达率(53.6%;28.92±16.90)明显高于乳腺良性病变(1.59%,5.38±3.43)(P﹤0.01)。[结论]BRCA1蛋白、P53和Ki-67蛋白阳性表达可能在乳腺良性病变恶性转化及乳腺癌的发生中具有重要作用,有可能成为临床预测预后的重要指标之一。