The Form of Play in the Shape and Unity of Self

In The Three Essays, Sigmund Freud advances a radical account of gender, sexuality, and knowledge. The power and implications of his account remain underappreciated, even within contemporary psychoanalysis. Freud portrays masculinity and femininity as equally problematic and painfully acquired social constructs. Concepts such as the unconscious and desire further undermine conventional ideas about masculinity and femininity, sexuality and rationality. Despite objectionable statements about women, Freud's ideas subvert traditional justifications for male dominance. Freud makes the equally radical claim that there is no intrinsic relationship between anatomical difference and sexual desire. Heterosexuality is neither the “natural” expression of the drive for pleasure nor a consequence of anatomical difference. Conventional gender arrangements and sexual identities reflect socially conditioned channeling of desire. Despite the supposed pervasiveness of psychoanalytic thinking, such ideas contravene conventional Western thinking. Taken seriously they undermine dominant notions of gender relations, ideologies of the family, and theories of knowledge and the mind. Such still scandalous ideas partially account for the persistent disrepute of Freud's ideas.     

DNAxs/DNAStatistX: Development and validation of a software suite for the data management and probabilistic interpretation of DNA profiles

The data management, interpretation and comparison of sets of DNA profiles can be complex, time-consuming and error-prone when performed manually. This, combined with the growing numbers of genetic markers in forensic identification systems calls for expert systems that can automatically compare genotyping results within (large) sets of DNA profiles and assist in profile interpretation. To that aim, we developed a user-friendly software program or DNA eXpert System that is denoted DNAxs. This software includes features to view, infer and match autosomal short tandem repeat profiles with connectivity to up and downstream software programs. Furthermore, DNAxs has imbedded the ‘DNAStatistX’ module, a statistical library that contains a probabilistic algorithm to calculate likelihood ratios (LRs). This algorithm is largely based on the source code of the quantitative probabilistic genotyping system EuroForMix [1]. The statistical library, DNAStatistX, supports parallel computing which can be delegated to a computer cluster and enables automated queuing of requested LR calculations. DNAStatistX is written in Java and is accessible separately or via DNAxs. Using true and non-contributors to DNA profiles with up to four contributors, the DNAStatistX accuracy and precision were assessed by comparing the DNAStatistX results to those of EuroForMix. Results were the same up to rare differences that could be attributed to the different optimizers used in both software programs. Implementation of dye specific detection thresholds resulted in larger likelihood values and thus a better explanation of the data used in this study. Furthermore, processing time, robustness of DNAStatistX results and the circumstances under which model validations failed were examined. Finally, guidelines for application of the software are shared as an example. The DNAxs software is future-proof as it applies a modular approach by which novel functionalities can be incorporated.     

Accuracy of appendicular radiographic image interpretation by radiographers and junior doctors in Ghana: Can this be improved by training?

IntroductionAccess to image interpretation in Ghana remains a challenge with the limited number of radiologists. Radiographers with the right skills and knowledge in image interpretation could help address this challenge. The aims of the study were to determine and compare the ability (accuracy, sensitivity and specificity) of radiographers and junior doctors in interpreting appendicular trauma radiographs both before and after training.MethodsAn action research study involving a pre and post training test was carried out to determine the level of accuracy, sensitivity and specificity in abnormality detection by radiographers after undergoing training when compared to junior doctors. Eight radiographers and twelve junior doctors were invited to interpret an image bank of 30 skeletal radiographs, both before and upon completion of an educational program. The participants’ tests were scored against a reference standard provided by an experienced radiologist. Pre and post-test analysis were carried out for comparison.ResultsPost training mean accuracy (radiographers 83.3% vs 68.8%, p = 0.017; doctors 81.9% vs 71.6%, p = 0.003), sensitivity (radiographers 83.3% vs 69.2%, p = 0.042; doctors 77.2% vs 67.8% p = 0.025) and specificity (radiographers 83.3% vs 68.3%, p = 0.011; doctors 86.7% vs 75.6% p = 0.005) of both groups significantly improved. No significant differences were recorded between the radiographers and doctors after the training event.ConclusionThe study revealed that, with a well-structured training program, radiographers and junior doctors could improve on their accuracies in radiographic abnormality detection and commenting on trauma radiographs.     

‘Everyone has an agenda’: Professionals’ understanding and negotiation of risk within the Guardianship system of Victoria,Australia

It is frequently asserted that pressures to assess and manage risk have eroded the therapeutic, rights‐based foundation of the human services profession. Some argue that human service workers operate in a culture of fear in which self‐protection and blame avoidance, rather than clients’ needs, primarily drive decision‐making. In the field of Adult Guardianship, it has been suggested that organisational risk avoidance may be motivating applications for substitute decision‐makers, unnecessarily curtailing clients’ rights and freedoms. However, the absence of research examining the operation of risk within Guardianship decision‐making inhibits verifying and responding to this very serious suggestion. This article draws on semi‐structured interviews conducted with 10 professionals involved in the Victorian Guardianship system, which explored how issues of risk are perceived and negotiated in everyday practice. Risk was found to be a complex and subjective construct which can present both dangers and opportunities for Guardianship practitioners and their clients. While a number of participants reported that Guardianship might sometimes operate as an avenue for mitigating the fear and uncertainty of risk, most participants also valued positive risk‐taking and were willing, in their clients’ interests, to challenge conservative logics of risk. These findings highlight the need for further research which examines how service providers and policy makers can create spaces that support open discussions around issues of risk and address practitioners’ sense of fear and vulnerability.     

《金匮要略》“纳药鼻中”之“药”考释

[目的] 探讨《金匮要略·痉湿暍病脉证并治第二》“纳药鼻中”之“药”所指的具体方药。[方法] 从历代注家注疏入手,对不同观点进行源流上的梳理。同时,通过文字学考证,对“药”字在古汉语中的含义展开探讨。[结果] 对于“纳药鼻中”之“药”,历代注家观点大致可归纳为三类,即随文注解、认为“药”为具有某些特性的药物、认为“药”为瓜蒂散或其类方,其中认为“纳瓜蒂于鼻中”的观点流传较广。通过文字学考证,“药”在楚方言中有指代“白芷”之意,“纳药鼻中”即是“纳白芷于鼻中”,白芷治疗鼻病也为历代医家所习用。[结论] “纳瓜蒂于鼻中”与“纳白芷于鼻中”两种观点都具有一定证据支持,但从文献学角度和仲景书体例而言,“纳药鼻中”原意应为“纳白芷于鼻中”。     

对JAMA“针刺辅助治疗慢性稳定型心绞痛随机临床试验”一文的讨论

成都中医药大学梁繁荣教授团队于2019年7月29日在JAMA内科子刊发表Acupuncture as adjunctive therapy for chronic stable angina:a randomized clinical trial(针刺辅助治疗慢性稳定型心绞痛随机临床试验)的论文,对针灸辅助治疗轻度、中度慢性稳定型心绞痛的安全性、有效性给予肯定。为此,海内外16位专家就该文的研究设计、评估方法、原理机制、临床意义及对未来针灸研究的启示进行了认真的讨论,并对针灸进一步走向世界、获得国际认可提供了一些切实可行的建议。     

2012年我院儿科药品不良反应报告分析

目的 了解我院儿科不良反应（ADR）发生的特点,为儿科合理用药提供参考.方法 对我院儿科2012年收集到的62例药品不良反应报告进行统计学分析.结果 62例药品不良反应报告中,抗生素占首位,87.1%.静脉给药方式为主要途径.临床表现以皮肤损害最常见.结论应加强ADR的监测,有ADR征兆时及时处理,以免发生更严重的ADR.     

Quantitative assessment of transient left ventricular asynergy in coronary artery disease

The purpose of this study was to determine the diagnostic value of quantitative two-dimensional echocardiography during transesophageal atrial pacing in assessing the presence and severity of coronary artery disease. Apical four- and two-chamber views were registered at rest and at different pacing rates. Computerized quantitative evaluation of left ventricle wall motion was performed. On the basis of left ventricle wall motion analysis data of 22 individuals with no coronary pathology, as assessed by angiography and with negative exercise ECG and transesophageal atrial pacing ECG test, nomograms for assessment of wall motion abnormalities and for calculation of asynergy area as a measure of wall motion abnormality extent were obtained. The method revealed new transient wall motion abnormalities during pacing or exacerbation of old ones present at rest in 83 of the 89 patients with angiographically proven coronary artery stenosis greater than or equal to 70% and in 3 of the 32 controls with no changes in their coronary angiograms. Thus, it showed high sensitivity (93%), specificity (91%), predictive value of positive result (96%), predictive value of negative result (83%), and efficiency of the test (93%). These values appeared to be higher than those calculated for transesophageal atrial pacing ECG, recorded simultaneously with echocardiographic images (81, 87, 95, 62, and 83%, respectively) and for exercise ECG test which was performed in 66 coronary patients and in 29 controls (68, 86, 92, 54, and 74%, respectively). The extent of pacing-induced left ventricular regional wall motion abnormalities appeared to be directly correlated to the extent of coronary artery disease.(ABSTRACT TRUNCATED AT 250 WORDS)