Usages et fonctions du numérique dans les (auto-)traitements psychotiques

ObjectivesIn the last fifty years, digital devices have been the subject of many disciplinary studies in the humanities and social sciences. Various theoretical approaches have thus been mobilized, to delimit and highlight the effect of digital device on subjects. However, published research about the uses of these devices and their psychic effects for subjects encountered in a clinical setting are still infrequent. This article aims to reflect subjective logics that can be developed through digital activities, when they are brought by the patient in a clinical setting. It is also about providing clinical positions to support the work of the patient with these new devices as closely as possible to the logic of the subject. Thus, this article proposes to examine, in the light of three clinical cases, the uses of digital objects and virtual worlds that can be made by certain psychotic subjects within the framework of the elaboration of (self-)treatments.MethodsThis approach, considering the psychotic structure as potentially a (self)treatments resource, is in line with the Freudian tradition of delirium considered as an attempt to recover. We also provide a brief overview of the many follow-up and contributions made to this thesis (M. Müller, J. Lacan, J.-A. Miller). The three clinical cases are encountered in two different clinicial settings: a private and multi-disciplinary office and a weekly digital workshop with a child psychiatry unit. We propose that digital may be a new place of this attempt for (self)treatement of psychotic symptoms (Trichet, 2011), thus, it implies discussing the therapeutic benefits that clinicians can extract from these practices when they are carried out in clinical settings.ResultsDigital devices and digital constructions can be both a support for the patient (according to the logic of (self-)treatment) but also for the work with the therapist, where it is a question of identifying with the subject the support that this creative activity can provide for him. We will then distinguish these uses according to the psychic “externalities” at stake, and the degree of stability that they can induce for the structure of psychoses. These “three externality” are described par Miller (Miller, 2009) and imply the body, the social bond and the subjectivity as a personal construction. Theses dimensions are identified also from the three clinical cases exposed.ConclusionsDigital devices, and in particular the “screen”, can provide the subject with a kind of intimate space, necessarily linked to fantasy, as Freud had conceptualized it. In psychosis, the lack of this fantasmatic functioning leads the subject to confront some anguishing phenomena, which affect the limits of the body, the regulation of the link to the others, and the stability of identity. If studies in the human sciences have clearly shown that digital technology was involved in all these aspects, clinical psychology still has to take into account the singular uses that can be established by certain psychotic subjects in this context. For some of them, and based on their testimonies, we could then talk about digital self-treatment.     

Commentary: Technology,power and inequalities – achieving a humane approach to the digital divide – a commentary on Aboujaoude and Gega (2021)

This paper provides a critical reflection on how a myopic focus by researchers on internet addiction as a possible explanation for children’s behaviour has led to a missed opportunity to probe the impact of digital exclusion for children with a range of complex vulnerabilities. Holt reflects upon the work of Aboujaoude and Gega (2021), Missing the forest for the trees: How the focus on digital addiction diverted attention away from wider adverse effects. Screen time is far more complex; it’s use in child protection as a form of surveillance is linked to poverty, inequality and risk. Importantly, the focus of international research must explore both digital exclusion and how this can be managed, and the increased use of digital surveillance, to provide an important lens in respect of power and inequalities in society.     

Digital Breast Tomosynthesis Implementation: Considerations for Emerging Breast Cancer Screening Bundled Payment Models

PurposeBundled payments have been touted as mechanisms to optimize quality and costs. A recent feasibility study evaluating bundled payments for screening mammography episodes predated widespread adoption of digital breast tomosynthesis (DBT). We explore a similar model reflecting emerging acceptance of DBT in breast cancer screening.MethodsUsing 4-year data for 59,094 screening episodes from two large facilities within a large academic health system, we utilized published methodology to calibrate Medicare national allowable reference prices for women undergoing screening mammography before and after practice-wide implementation of DBT.ResultsExcluding DBT, Medicare-normalized bundled prices for traditional breast imaging 364 days downstream to screening mammography are extremely similar pre- and post-DBT implementation ($182.86 in 2013; $182.68 in 2015). The addition of DBT increased a DBT-inclusive bundled price by $53.16 (an amount lower than the $56.13 Medicare allowable fee for screening DBT) but was associated with significantly reduced recall rates (13.0% versus 9.4%; P < .0001). Without or with DBT, screening episode bundled prices remained sensitive to bundle-included services and varied little by patient age, race, or insurance status.ConclusionsPrior non-DBT approaches to bundled payment models for breast cancer screening remain viable as DBT becomes the standard of care, with bundle prices varying little by patient age, race, or insurance status. Higher DBT-inclusive bundled prices, however, highlight the need to explore societal costs more broadly (eg, reduced time away from work from fewer recalls) as bundled payment models evolve.     

Image forgery detection based on physics and pixels: a study

With the phenomenal development in processing power and the dropping cost of high-resolution imaging devices and computer hardware, coupled with the availability of sophisticated user-friendly image manipulation programs, the instances of forgery in digital images has increased manifold. In the current scenario, Digital Image Forensics is an area that has gained immense importance and is instrumental for detecting image forgery. Digital image forgery detection includes Blind or Passive techniques that don’t require any previous information of an image, as the tampered image carries inconsistencies that can be used to detect forgery. Imaging devices and processing techniques, however different from each other, carry a consistent pattern in the image which, if tampered would introduce a deviation from the original pattern. This deviation enables one to detect forgery of images. In this paper, various passive forgery detection techniques are discussed with a special focus on pixel- and physics-based techniques. This paper aims is to deliver an overview of emerging techniques in the field of Image Forgery Detection.     

一种通用型肠道病毒微滴式数字PCR检测方法的建立及应用

目的 建立一种肠道病毒通用型微滴式数字PCR（ddPCR）的定量检测方法,以实现肠道病毒的量化检测。方法 利用肠道病毒标准品对ddPCR反应中的探针浓度、退火温度进行优化,并确定ddPCR的检测范围。利用已优化好的反应条件对28份临床样本进行病毒载量检测。结果 本研究确定ddPCR的最佳探针浓度为0.4 μmol/L,退火温度为51.0 ℃,核酸检测范围为3.02~3.59×10⁶ copies/μL,检出限为3.02 copies/μL。ddPCR方法线性相关系数为0.993 8,呈良好的线性关系。结论 本研究建立基于ddPCR肠道通用型的定量方法,可有效地对临床样本中不同血清型的肠道病毒临床样本进行拷贝数定量分析,为临床研究病毒载量的测定提供一种技术。     

The added value of systematic biopsy in men with suspicion of prostate cancer undergoing multiparametric MRI-targeted biopsy

Purpose

Incorporation of multiparametric magnetic resonance imaging (mpMRI) and targeted biopsy (TBx) in the diagnostic pathway for prostate cancer (CaP) is rapidly becoming common practice. In men with a prebiopsy positive mpMRI a TBx only approach, thereby omitting transrectal ultrasound-guided systematic biopsy (SBx), has been postulated. In this study we evaluated the additional clinical relevance of SBx in men with a positive prebiopsy mpMRI (Prostate Imaging Reporting and Data System [PI-RADS] ≥ 3) undergoing TBx for CaP detection, Gleason grading and CaP localization.

Comparison of non-contrast vessel wall imaging and 3-D time-of-flight MRA for atherosclerotic stenosis and plaque characterization within intracranial arteries

PurposeWe compared the ability of intracranial high-resolution vessel wall imaging (VWI) without gadolinium and 3-D time-of-flight (3D-TOF) MRA techniques to characterize intracranial arterial stenosis and arterial wall plaque consistent with atherosclerotic plaque.MethodsConsecutive intracranial VWI examinations performed within 2 months of a 3D-TOF exam with at least 1 noted plaque was included. Examinations assessed 17 vessel segments for plaque and diameters of stenotic and normal segments using double oblique reformatted images. Results were compared with the VWI and 3D-TOF exams considered the reference standard for plaque and luminal stenosis, respectively.ResultsAssessed segments totaled 286 from 17 patients. Proximal segment sensitivity and specificity for luminal stenosis detection with VWI was 92.5% and 82.1%, respectively, whereas for assessing plaque with 3D-TOF it was 59.4% and 98.3%, respectively. The mean intra-rater difference in luminal diameter measurements between VWI and 3D-TOF at normal segments and at the area of maximal stenosis was 0.02 mm (SD 0.51 mm) and 0.08 mm (SD 0.66 mm), respectively.ConclusionsIntracranial VWI demonstrated reasonably high sensitivity and specificity for luminal stenosis assessment using 3D-TOF as a reference standard, while 3D-TOF demonstrated low sensitivity for plaque detection. Our results suggest that VWI can be used for simultaneous assessment of luminal stenosis and plaque in the intracranial arteries.     

脑动脉瘤的CTA和MRA及DSA对照分析研究

目的:比较CTA、MRA、DSA三种方法诊断动脉瘤的优缺点,探讨非侵入性CTA和MRA取代DSA的可行性。方法:对收治的25例怀疑动脉瘤惠者同时作CTA、DSA检查,比较其影像学结果,对收治的22例怀疑动脉瘤惠者同时作MRA、DSA检查,比较其影像学结果。结果:CTA基本上可以发现大多数的动脉瘤。为后续的手术或者栓塞提供足够的影像学信息;MRA对较小动脉瘤(直径≤10mm)的诊断仍然存在一定难度,容易漏诊。结论:CTA可作为蛛网膜下腔出血以及可疑动脉瘤患者的初选检查方法,必要时再行DSA进行确诊。随着更多三雏重建技术的推广,其敏感性和特异性会更加提高,在不久的将来CTA可能会成为动脉瘤术前检查的首选。