赋能教育在肺结核患者中的应用及对情绪障碍、心理韧性的影响

目的:探讨赋能教育在肺结核患者中的应用效果及对情绪障碍、心理韧性的影响。方法:将2017年1月-2018年1月收治的260例肺结核患者采用随机数表法分为观察组和对照组,每组各130例。两组均应用常规健康宣教等干预,观察组在此基础上增加赋能教育。干预前、干预3月后,评估两组疾病认知水平、情绪障碍[抑郁自评量表(SDS)、焦虑自评量表(SAS)、结核病相关病耻感量表]、心理韧性[心理弹性量表(CD-RISC)]、自我管理[自我照护能力量表(ESCA)]。结果:①干预前,两组疾病认知调查表得分对比差异无统计学意义(P0.05);干预3个月后,两组疾病认知调查表得分均高于干预前,观察组增幅大于对照组(t=12.479,P0.05);②干预前,两组SDS、SAS、结核病相关病耻感量表得分对比差异均无统计学意义(P0.05);干预3个月后,两组SDS、SAS、结核病相关病耻感量表得分均低于干预前,观察组降幅大于对照组(t=-3.224,-6.875,-9.970;P0.05);③干预前,两组CD-RISC中坚韧、力量、乐观维度得分对比差异均无统计学意义(P0.05);干预3个月后,两组CD-RISC中坚韧、力量、乐观维度得分均高于干预前,观察组增幅大于对照组(t=14.416,10.339,8.134;P0.05);④干预前,两组ESCA量表技能、责任感、自我概念、健康知识得分均无统计学意义(P0.05);干预3个月后,两组ESCA量表技能、责任感、自我概念、健康知识得分均高于干预前,观察组增幅大于对照组(t=15.025,18.597,14.642,25.088;P0.05)。结论:赋能教育应用于肺结核患者效果良好,有利于改善患者疾病认知程度、情绪障碍、心理韧性和自我干预能力。     

手术室实施心理干预对心脏手术患者围术期焦虑、抑郁状态的影响

目的:探究手术室实施心理干预对心脏手术患者围术期焦虑、抑郁状态的影响。方法:采用计算机随机数字法将92例心脏手术患者分为观察组和对照组各46例。对照组患者予以常规干预,观察组患者在此基础上予以手术室心理干预。观察两组患者干预前、干预8周后心理状态[症状自评量表(SCL-90)]、负性情绪[焦虑自评量表(SAS)、抑郁自评量表(SDS)、心理韧性[Connor-Davidson韧性量表(CD-RISC)]、应对方式[医学应对方式问卷(MCMQ)]等指标变化情况。结果:干预8周后,对照组患者各因子评分较干预前比较,差异无统计学意义,观察组各因子评分均较干预前降低(t=3.481,2.741,3.950,3.817,3.158,3.284,2.185,3.809,3.877;P0.05),且低于对照组(t=2.901,2.740,3.498,2.495,2.180,3.321,2.418,2.907,2.704;P0.05);两组患者SAS、SDS评分均较干预前降低(t=8.336,10.447,9.074,8.906;P0.05),且观察组低于对照组(t=2.595,3.207;P0.05);两组患者CD-RISC各因子评分及总分均较干预前升高(t=-20.412,-12.103,-13.102,-21.565,-8.903,-9.601,-6.754,-13.954;P0.05),且观察组高于对照组(t=9.249,6.668,6.710,11.186;P0.05);两组患者面对因子评分均较干预前升高,且观察组高于对照组,屈服、回避因子评分较干预前降低(t=-12.569,11.628,12.580,-11.889,10.797,9.800;P0.05),且观察组低于对照组(t=6.632,-5.194,-6.527;P0.05)。结论:手术室实施心理干预可有效减少心脏手术患者负性情绪,提高心理韧性,改善应对方式和心理状态,于术后康复有利。     

积极心理学视域下团体心理辅导技术对提升研究生心理韧性的效果

目的:理论分析并通过实证干预探讨积极心理学理念指导的团体心理辅导技术对提升研究生心理韧性水平的效果。方法:深入思考团体心理辅导技术在培养提升研究生心理韧性的意义与价值。同时,采用不相等实验组控制组前后测准实验设计,选取心理韧性得分低于60分的30名研究生为被试,其中15名为团体心理辅导干预组,另15名为对照组。结合积极心理学理念设计团体心理辅导方案,对干预组被试进行为期4周,每周2次,每次3小时的团体心理干预,对照组在研究期间不接受任何心理辅导。两组被试在研究前后采用心理韧性量表中文版进行测评。结果:积极心理学理念的团体心理辅导对提高研究生的"我有"、"我是"、"我能"存在积极意义,也具有独特优势。实证干预研究结果发现,接受积极团体心理辅导的研究生干预后的心理韧性得分明显高于干预前(t=-5.142～-1.968,P0.05),对照组的前、后测得分不存在显著差异(P0.05);干预组与对照组研究生的心理韧性得分在干预前后的变化值存在显著差异,干预组的变化值明显大于对照组(t=6.052,P0.01)。结论:积极心理学理念指导的团体心理辅导技术对研究生心理韧性水平的提升具有积极效果。     

心理社会综合干预模式对精神分裂症患者家属生存质量的影响

目的:探讨心理社会综合干预对精神分裂症患者家属生存质量的影响。方法:上海市静安区在册管理的精神分裂症患者家属为研究对象,共126例,按所在街道分为研究组和对照组,各入组63例,实际完成研究例数分别为61例和63例。对照组接受常规社区精神卫生服务,研究组在常规社区精神卫生服务基础上联合心理社会综合干预。分别在入组前和干预1年末,采用Zarit护理负担量表(ZBI)调查照料负担,采用抑郁自评量表(SDS)、焦虑自评量表(SAS),简易应对方式问卷(SCSQ)、世界卫生组织生存质量测定量表简表(WHOQOL-BREF)和中国居民主观幸福感量表简本(SWBS-CC20)评定两组家属的照料负担、心理健康状况、应对方式、主观幸福感以及生存质量。结果:干预1年末,与干预前比较,研究组ZBI、SDS、SAS、SCSQ消极应对方式的得分降低(t=6.48,3.50,3.42,5.33;P0.01),SCSQ积极应对方式、WHOQOL-BREF总分以及SWBS-CC20中社会信心的得分增高(t=-6.37,-2.46,-2.02;P0.05);对照组WHOQOL-BREF的综合自评分的得分降低(t=4.73,P0.001);两组间比较,研究组ZBI、SDS、SAS、SCSQ消极应对方式的得分低于对照组(χ~2=4.66,t=-3.22,-2.35,-2.76,-2.15;P0.05),SCSQ积极应对方式、WHOQOL-BREF以及SWBS-CC20总分的得分高于对照组(t=2.46,2.31,2.43;P0.05)。结论:心理社会综合干预模式能够改善精神分裂症患者家属的心理健康水平,缓解其负性情绪,较多采用积极应对方式,减轻了患者家属照料负担,提高了他们主观幸福感和生存质量。     

基于复元理念的个案管理康复服务对社区精神分裂症的作用

目的:探讨基于复元理念的个案管理康复服务对社区精神分裂症患者的疗效及可行性。方法:将符合入组标准的社区精神分裂症患者140例随机分为干预组和对照组各70例,干预组应用基于复元理念的个案管理康复服务,对照组接受常规的精神康复服务。用阳性阴性症状量表(PANSS)评定精神症状严重程度,生活满意度量表(LSIA)评定生活满意度,生活质量量表(SQLS)评定生活质量,个人和社会功能量表(PSP)评定个人和社会功能及人际关系,自尊量表(SES)评定自尊。用复发率和再住院率评价患者的复发情况。结果:两组间比较:干预6个月后,干预组阴性症状分、PSP得分、SES得分、SQLS得分及心理社会分量表得分与对照组比较差异有统计学意义(t=-2.06,2.205,2.082,2.194,-2.221;P0.05),LSIA得分与对照组差异无统计学意义(t=0.751,P0.05)。组内比较:干预组PANSS得分、PSP得分、SES得分在基线与半年后比较差异有统计学意义(t=6.759,P0.01;t=-4.878,P0.01;t=-2.524,P均0.05),干预组SQLS得分、LSIA得分在基线与半年后比较差异无统计学意义(t=-1.540,0.549;P0.05);对照组PANSS得分、PSP得分、SES得分、SQLS得分及LSIA得分在基线与半年后比较差异无统计学意义(t=0.806,-1.855,1.698,-0.248,-1.650;P均0.05)。干预半年后,干预组复发率低于对照组。结论:对社区精神分裂症患者进行基于复元理念的个案管理康复服务具有可行性和有效性,有助于其康复。     

团体心理干预在社区精神分裂症患者高情感表达家属中的应用

目的:探讨团体心理干预对社区精神分裂症患者高情感表达家属的影响。方法:将社区精神分裂症患者高情感表达的家属55例分成研究组(29例)和对照组(26例),研究组给予团体心理干预,在干预前和干预后3个月,采用CFI-CV量表、LSI量表及SES量表对患者家属进行评估,比较两组患者家属的情况。结果:干预3个月后,研究组高情感表达分值比之前降低(t=5.570,P0.01),生活满意度分值比之前提高(t=-5.095,P0.01),具有统计学差异;对照组高情感表达分值较前降低(t=1.766,P0.05),生活满意度分值较前提高(t=-0.420,P0.05),无统计学差异。结论:团体心理干预可降低社区精神分裂症患者高情感表达家属的高情感表达性,同时可以提高家属的生活满意度。     

叙事心理疗法对腹腔镜多囊卵巢综合征围手术期心理状态的影响

目的:探讨叙事心理疗法对腹腔镜多囊卵巢综合征患者围手术期心理状态的影响。方法:以我院诊断为多囊卵巢综合征并予以腹腔镜术治疗的120例患者为研究对象,参照随机对照表分为对照组与观察组,每组各60例。患者均予以腹腔镜术治疗,其中对照组采用常规围手术期护理,观察组在对照组护理基础上加用叙事心理疗法护理,内容包括生理、心理及社会全方位心理疗法。干预前后采用Kolcaba舒适状况量表(GCQ)进行舒适度评估,改良症状自评量表(SCL-90)评价其心理变化,并采用抑郁自评量表(SDS)、焦虑自评量表(SAS)评估其负性心理情绪。结果:干预后对照组GCQ评分中生理、心理、精神、社会文化及环境均显著低于观察组(t生理=4.65,P0.01;t心理=2.19,P0.05;t精神=4.13,P0.05;t社会文化及环境=4.96,P0.05);干预后观察组心理状况(t情绪波动=5.34,P0.01;t性格变化=6.88,P0.01;t角色认知冲突=3.29,P0.01)、行为习惯评分显著低于对照组(t睡眠紊乱=2.72,P0.01;t饮食不节=4.31,P0.01);干预后对照组SAS、SDS均显著高于观察组(t=3.33,3.53;P0.05)。结论:叙事心理疗法可有效改善腹腔镜多囊卵巢法患者悲观、抑郁等负面情绪,通过倾诉、分析、引导等心理治疗,促使患者调节其生活方式,避免情绪波动,有助于手术治疗。     

艺术团体心理危机干预对灾后儿童心理健康状况的改善效果

目的:探讨以艺术疗法为媒介的团体心理危机干预对地震灾后儿童心理健康状况的改善作用。方法:采用方便取样,选取亲历地震60名儿童,随机分为艺术团体干预组和对照组。干预组接受艺术团体心理危机干预,对照组处于常态。干预前后进行SCL-90、SAS和SDS测试,评估团体干预效果。结果:1干预后,艺术团体干预组的SCL-90总分及各个因子得分(t=-3.41~-7.83,P0.05)、SAS(焦虑无助情绪)总分(t=-9.51,P0.001)和SDS(悲观哀伤情绪)总分(t=-6.40,P0.001)显著低于对照组;艺术团体干预组后测的SCL-90总指数明显低于干预前测(t=5.67,P0.001);而干预前两组间各量表得分无显著性差异,对照组干预前后测得分无统计学差异;2艺术团体干预组成员SCL-90阳项均分(t=5.50,P0.001)、躯体化(t=4.94,P0.001)、强迫症状(t=3.88,P0.01)、人际关系(t=3.93,P0.01)、忧郁(t=6.44,P0.001)、焦虑(t=4.34,P0.001)、敌对(t=3.44,P0.01)、恐怖(t=5.31,P0.001)、偏执(t=2.14,P0.05)、精神病性(t=3.98,P0.001)和其他得分均有所下降(t=3.28,P0.01),SAS、SDS等指标有明显好转,后测分数显著低于前测,差异具有统计学意义,而对照组前后测分数差异无统计学意义。结论:艺术团体心理危机干预是地震灾后儿童心理辅导的一种有效干预技术,明显改善灾后儿童的心理健康状况。     

心理支持性治疗联合音乐疗法对冠心病心绞痛患者心电图、心理状况及疼痛的影响

目的:研究心理支持性治疗联合音乐疗法对冠心病心绞痛患者心电图、心理状况及疼痛的影响。方法:将我院2016年1月-2018年1月收治的80例冠心病心绞痛患者随机分为观察组(传统干预+心理支持性治疗+音乐疗法,n=40)与对照组(传统干预,n=40),观察两组心电图疗效、心理状况、心绞痛发作情况、血浆NO、cGMP水平与满意度。结果:观察组心电图治疗有效率显著高于对照组(χ~2=4.02,P0.05);干预后,观察组和对照组SAS得分(t=12.95,8.00;P0.05)、SDS得分(t=13.41,9.84;P0.05),均较干预前显著降低,且观察组干预后SAS得分(t=-4.29,P0.05)、SDS得分(t=-3.73,P0.05)均显著低于对照组;干预后,两组心绞痛发作频率(t=34.87,22.82;P0.05),VAS疼痛得分(t=20.58,15.42;P0.05),持续时间(t=18.13,9.58,P0.05),均较干预前降低或缩短,且观察组干预后心绞痛发作频率(t=-9.97,P0.05),VAS得分(t=-5.37,P0.05),持续时间(t=-4.99,P0.05)均显著低于或短于对照组;干预后,两组血浆NO水平(t=-26.11,-20.63;P0.05),cGMP水平(t=-10.22,-6.55;P0.05),均较干预前显著提高,且观察组干预后,血浆NO(t=4.02,P0.05),cGMP(t=1.87,P0.05)均显著高于对照组;观察组心理辅导(t=2.51,P0.05),态度(t=2.37,P0.05),管理(t=4.98,P0.05)及总得分(t=5.75,P0.05)均显著高于对照组。结论:心理支持性治疗联合音乐疗法可有效缓解冠心病心绞痛患者焦虑、抑郁情绪,减少其心绞痛发生频率与持续时间,可有效控制患者病情。     

团体心理干预对精神分裂症康复期的价值探讨

目的:探讨对康复期精神分裂症患者实施团体心理干预的临床效果。方法:选择2016年1月-2018年1月在某院接受治疗的300例男性精神分裂症患者作为研究对象,随机分为观察组(n=150)和对照组(n=150)。对照组给予抗精神病药物进行治疗,观察组在此基础上给予团体心理干预,比较两组患者的阳性和阴性症状量表、简明精神病量表、住院慢性精神分裂症社会功能评定量表、自尊量表、自我和谐量表评分。结果:干预后,观察组患者PANSS(t=-8.0394,P0.01)、BPRS(t=-18.9509,P0.01)、SSSI(t=-8.5849,P0.01)、SCCS(t=-31.1712,P0.01)评分均显著低于对照组,SES评分(t=9.5183,P0.01)显著高于对照组。结论:团体心理干预有助于提高精神分裂症患者的临床疗效、社会功能和自尊,具有良好的推广应用价值。     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

What will studies of Fulani individuals naturally exposed to malaria teach us about protective immunity to malaria?

There are an estimated over 200 million yearly cases of malaria worldwide. Despite concerted international effort to combat the disease, it still causes approximately half a million deaths every year, the majority of which are young children with Plasmodium falciparum infection in sub-Saharan Africa. Successes are largely attributed to malaria prevention strategies, such as insecticide-treated mosquito nets and indoor spraying, as well as improved access to existing treatments. One important hurdle to new approaches for the treatment and prevention of malaria is our limited understanding of the biology of Plasmodium infection and its complex interaction with the immune system of its human host. Therefore, the elimination of malaria in Africa not only relies on existing tools to reduce malaria burden, but also requires fundamental research to develop innovative approaches. Here, we summarize our discoveries from investigations of ethnic groups of West Africa who have different susceptibility to malaria.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.     

Guidelines for the Validation and Use of Immunoassays for Determination of Introduced Proteins in Biotechnology Enhanced Crops and Derived Food Ingredients

Recent advancements in agricultural biotechnology have created a need for analytical techniques to determine introduced proteins in crops enhanced through modern biotechnology techniques. These proteins are expressed in plant tissues and may be present in food ingredients. Immunoassays are ideally suited for protein detection and may be used as both quantitative and threshold methods. Microplate ELISA and lateral flow devices are two of the most commonly used immunoassay formats for agricultural biotechnology applications. This paper provides general background information and a discussion of criteria for the validation and application of immunochemical methods to the analysis of proteins introduced into plants and food ingredients using biotechnology methods. It is the result of a collaborative effort of members of the Analytical Environmental Immunochemical Consortium. This collaborative effort represents the combined expertise of several organizations to reach consensus on establishing guidelines for the validation and use of immunoassays. Further, the paper offers developers and users a consistent approach to adopting the technology as well as aid in producing accurate and meaningful results.     

Ultracryotomy: development and application (with examples from the yeast cytology) (author's transl)

The preparation steps usually necessary for obtaining ultrathin frozen sections of biological material (chemical prefixation, enclosing, cryoprotective treatment, freezing, sectioning, and post-staining the sections for transmission electron microscopy) are submitted to a critical analysis. The application of cryo-ultramicrotomy, in particularly for cytochemical purposes, is reviewed. Fundamental considerations of chemical prefixation and poststaining are supported by examples from yeast cytology. Furthermore, the efficiency of the cryo-ultramicrotomy (electron optical resolution of ultrastructural details) is demonstrated on yeast cells and protoplasts.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.     

The universal muscular chamber. A basic unit of the genitourinary, cardiovascular, gastro-intestinal, skeletal, cutaneous, respiratory and other systems, endocameral hypertension; and spasm, the key to their idiopathic diseases and arthropathies

Starting with the integument, we see many organs are contractile sacs or multiples thereof, which tubes or bags constitute the major part of the entire body. Recognition of this basic unit and its characteristics sheds new light, individually and collectively, on many disorders previously considered unrelated. Muscular tears and perforations develop in the walls of these chambers, being no way peculiar to those organs, wherein, hydrochloric acid occurs. So, it is not necessary to explain the absence of excessive acid from patients who exhibit holes in the gastric, uterine, aortic, duodenal, rectal, pulmonary, retina, and other walls. Muscle, not acid is the great common factor relating idiopathic disorders in the gastrointestinal tract to each other and to similar diseases in other systems. When the units are linked together, the lesions tend to appear as arthropathies, i.e. at the joints. Rephrasing common-place observations, frees us from conventional, conceptual cul-de-sacs. An observation is only as good as its interpretation, so all possibilities must be considered, otherwise, we will remain blinded by our misconceptions.