The Facilitating Function of the Setting

This paper addresses the issue of what facilitates creativity in psychoanalytic work. Although creativity may seem to imply a creatively interpreting analyst/therapist, dictionary usage of the term ‘creativity’ supports an alternative reading. The author finds a more apt standpoint in the theory of the analytic site that Donnet has extrapolated from Freud's papers on technique. From this viewpoint, creativity in psychoanalysis is the autonomous or spontaneously flowing analytic process, and the factor that facilitates it is the carefully constructed and maintained setting, or site, and the patient's transformational introjection of it. A comparable standpoint applies to creativity in psychotherapy and psychodynamic social work. Provided that the setting/site proper to that treatment modality is adequately constructed and maintained, the psychoanalytical psychotherapy site and the even more radically different psychodynamic social work site can both be comparably introjected, resulting in each case in a spontaneously flowing or autonomous therapeutic process that is analogous to the analytic process. The author discusses the uniqueness of each ‘site’, and illustrates, from a once weekly psychotherapy, the patient's gradual, created/found encounter with elements of the psychoanalytical psychotherapy site and cumulative introjection of them to a critical point of metamorphosis that ushered in an autonomous therapeutic process.     

Moving Out – Disruption and Repair to the Internal Setting

Relocation can profoundly disturb the analyst's identity. When the analyst temporarily forgoes aspects of the external frame this can damage the internal setting. The author describes her experience of relocating from London to another English region where there were very few potential colleagues. Although papers exist on the impact of relocation on the patient, very little has been written on the impact of relocating on the analyst. The author links a relatively minor relocation with larger scale migration and with the leaving home of an adolescent, both representing trauma as well as achievement, as discussed in particular by the Grinbergs. She explores how the meaning of relocation differs from other circumstances in which the analyst disrupts the analysis. She distinguishes between guilt towards the patients she has to leave and shame and guilt in relation to the analyst's own ideals. She discusses the impact of this turmoil on her internal analytic identity, in particular how the loss of the familiar external frame and the external setting disturbs the analyst's internal setting. Clinical examples illustrate patients' unconscious perception of the disruption to the internal frame and its possible meanings for the analyst. Joseph Conrad's Heart of Darkness is used as an extended metaphor to explore the risk of grandiosity, or corruption of the superego, if the analyst becomes isolated and internally dislocated, so losing contact with sustaining internal objects.     

医疗消毒用品监控管理与展望

近年来,随着市场经济的发展,对于一些已经上市的消毒用品缺乏统一的管理和监督,给医疗服务和人民健康带来很大隐患.我们根据卫生部新颁发的〈消毒管理办法〉,按照其有关规定,对医疗卫生消毒用品采取索证、备案、检验、认可、网络的管理模式.抓住医院感染的重点环节,保证消毒用品的质量安全,以零缺陷为目标,对医院使用的医疗卫生消毒用品实施了有效的监控管理,取得了良好的社会效益,为严格控制伪劣消毒产品对社会造成的危害,减少医院感染和医疗事故的发生起到了积极作用.     

上海市发热门诊现状调查

[目的]研究SARS和人感染高致病性禽流感疫情后上海市在发热门诊设置和运行等方面存在的问题,为建立有效应对突发公共卫生事件的发热门诊合理模式提供参考。[方法]以上海市2006年调整后的136家医疗机构发热门诊设置点为研究对象,采用定性调查和定量调查相结合的方式进行调查。定性调查包括:对20家不同级别医疗机构的分管领导或防保科负责人、发热门诊医务人员以及19个区县卫生监督所的传染病防治工作人员进行访谈。定量调查包括:对发热门诊设置点设置和运行方式、就诊病例数、发热门诊医护人员情况进行问卷调查。[结果]全市发热门诊存在如下问题:①发热门诊设置、运行存在问题,部分医院因改、扩建等原因,已停止发热门诊运行;②发热病人就诊流程不明确,特别是预检分诊制度落实不到位;③多数医院发热门诊投入大量人力物力,而就诊病人少,造成医疗资源浪费。[结论]应调整发热门诊分布,使全市发热门诊监测网络覆盖全市所有人群。医疗机构应尽量利用现有条件,整合传染病诊疗相关资源,同时,严格执行感染性疾病关键的诊疗流程。     

补肾壮骨合剂对家兔骨缺损修复过程中血管内皮生长因子与转化生长因子β基因表达的影响

目的探讨血管内皮生长因子（VEGF）与转化生长因子β（TGF—β）基因在用“补肾壮骨合剂”治疗骨缺损过程中的表达及影响。方法普通级健康家兔48只,其中36只完全随机分成实验组和对照组,各18只,均在无菌条件下取右侧桡骨中下1／3用骨磨钻制成15mm的骨缺损模型;另外12只家兔处死后,取髂骨制成颗粒状骨,植入以上骨缺损处。实验组用“补肾壮骨合剂”复合饲料喂养。对照组用普通饲料喂养。分别于术后3d和1、2、4、6、8周处死实验组与对照组家兔各3只,取骨缺损处标本,应用聚合酶链反应技术检测VEGF和TGF—β基因的表达。结果VEGF和TGF—β的目的基因,在校正结果后,以对照组术后1周时测得的基因拷贝值为基础,其他各组与其比值：对照组VEGF的值分别为2．08、1．00、0．88、3．40、1．71、1．17,实验组VEGF的值分别为6．50、2．25、1．86、3．13、3．33、3．31;对照组TGF—β的值分别为0．57、1．OO、1．40、1．44、1．59、1．27,实验组TGF—β的值分别为0．58、2．05、2．35、2．59、3．18、2．67。实验组和对照组VEGF基因校正值分别为3．3±1．4比1．7±0．9,差异有统计学意义（t=-18．95,P〈0．05）,实验组和对照组TGF—β基因校正值分别为2．2±0．9比1．2±0．4,差异有统计学意义（t=-2．594,P〈0．05）。结论补肾壮骨合剂能促进VEGF与TGF—β基因的表达。     

Titanium dioxide nanoparticles addition to a conventional glass-ionomer restorative: influence on physical and antibacterial properties

Objectives

The aim of this study was to evaluate the addition of titanium dioxide (TiO₂) nanoparticles to a conventional glass-ionomer (GI) on physical and antibacterial properties.

Methods

TiO₂ nanoparticles were incorporated into the powder component of Kavitan^® Plus (SpofaDental, Czech Republic) at 3%, 5% and 7% (w/w). Unblended powder was used as control. Fracture toughness, compressive strength, flexural strength and microtensile bond strength were evaluated using a universal testing machine. Surface microhardness was measured using Vickers microhardness tester. Setting time was determined as specified in the ISO standard. The antibacterial activity was evaluated using direct contact test against Streptococcus mutans. Fluoride release and SEM analysis were carried out. Data were analysed using ANOVA and Tukey's test.

Results

GI-containing 3% and 5% (w/w) TiO₂ nanoparticles improved the fracture toughness, flexural strength and compressive strength compared to the unmodified GI. However, a decrease in the mechanical properties was found for GI-containing 7% (w/w) TiO₂ nanoparticles. GI-containing 5% and 7% (w/w) TiO₂ nanoparticles compromised the surface microhardness. Setting time of GI-containing TiO₂ nanoparticles decreased but the values remained within ISO limits. The addition of TiO₂ nanoparticles to the conventional GI did not compromise its bond strength with dentine or fluoride release of the GI. GI-containing TiO₂ nanoparticles possessed a potent antibacterial effect.

Conclusions

GI-containing 3% (w/w) TiO₂ nanoparticles is a promising restorative material with improved mechanical and antibacterial properties. This novel experimental GI may be potentially used for higher stress-bearing site restorations such as Class I and II.     

水利血吸虫病防治工程控制钉螺效果评价

目的 评价安徽省水利血吸虫病防治工程控制钉螺的效果.方法 选择不同类型水利血防工程,收集工程实施后的螺情资料,并于2007～2011年对工程及对照区进行钉螺调查,用GPS测定工程和有螺框位置,用GIS绘制电子地图.按照项目的效果指标评价标准,对工程效果进行评价.结果 4个工程完工后,钉螺密度和活螺框出现率均降为0.降滩护坡工程实施后至今未发现钉螺,其对照环境则保持有螺状态.沉螺池工程尽管外围江滩每年螺情严重,而与工程相连下游河道连续20年未发现钉螺;2009年的一次不当操作导致了钉螺通过沉螺池,但及时的处理后迅速地防止了钉螺的扩散,2010起下游河道又处于无螺状态.沟渠硬化环境工程完工后2年内未发现钉螺,第3年出现钉螺,且钉螺密度和钉螺框出现率呈现逐年增高趋势;硬化环境的有螺框出现率低于邻近未硬化对照环境,差异有统计学意义.结论 水利血防工程有较好的防螺控螺效果,但后期管理和维护是非常必要的.     

Students' Drinker Prototypes and Alcohol Use in a Naturalistic Setting

Background:  Perceptions about the type of people who drink, also referred to as drinker prototypes, may strengthen young people's motivation to engage in alcohol use. Previous research has shown that drinker prototypes are related to alcohol consumption in both adolescents and young adults. However, the evidence for the strength of these relationships remains inconclusive. One of the caveats in former studies is that all insights about prototype relations are based on self-reported data from youngsters themselves, mostly gathered in a class situation, which may contain bias due to memory distortions and self-presentation concerns.
Methods:  The present study examined the impact of drinker prototypes on young adults' drinking patterns by using a less obtrusive measure to assess alcohol consumption, i.e. ad lib drinking among friend groups in the naturalistic setting of a bar lab. Drinker prototypes, self-reported alcohol use in the past, and observed alcohol intake in the bar lab were assessed among 200 college students. Relations between participants' drinker prototypes and their self-reported and observed drinking behavior were examined by computing correlations and conducting multilevel analyses.
Results:  Drinker prototypes were related to both self-reported and observed alcohol use. However, the drinking patterns of friend group members had a strong impact on participants' individual drinking rates in the bar lab. After these group effects had been controlled for, only heavy drinker prototypes showed relations with observed alcohol intake in the bar lab.
Conclusions:  These findings further establish the value of drinker prototypes in predicting young adults' drinking behavior and suggest that people's motivation to drink alcohol in real-life drinking situations is related to their perceptions about heavy drinkers.     

程序、优先和决策：美国俄勒冈州药品报销目录制定方式

依照居民和社会对卫生服务的偏好,将药品和治疗方案按照不同的优先级别进行排序,从而决定进入目录内名单是俄勒冈州药品报销目录制定的主要特点。在报销目录制定程序中,采用电话访问以及召开社区会议和听证会的形式,积极采纳居民的意见,确保药品目录符合患者需求。当优选完成后,对药品报销目录政策按照一定的周期,进行重新审核和进一步调整,使其适应医学技术的发展与疾病谱的变化。