Sexual Surrogate Partner Therapy: Legal and Ethical Issues

The Ben Lewin film The Sessions has drawn attention again to the potential role for sexual surrogate partners and sex workers in enabling persons with disabilities and impairments to give expression to their sexual needs and desires. However, away from the big screen, the ethics of registered health practitioners in themselves engaging in such therapies are highly problematic. Difficult too is the role of such practitioners in being ‘the therapist’ responsible for enabling or brokering sexual contact between their patients and those offering such services for financial reward. In some jurisdictions, arrangements involving sexual surrogate therapy (especially where the therapist benefits from it financially) may not be lawful. Further, in spite of many assertions one way and the other, there are no data enabling evaluation of the success rates of the interventions of sexual surrogates or sex workers. Whether positive outcomes to such interactions are likely in most circumstances, given that the provision of services is predicated upon idealised attachments, is questionable. It is also unclear whether sexual surrogates’ adherence to an ethical code effectively ameliorates the potential for counter-therapeutic consequences from the commodification of intimacy, and it is far from straightforward to identify what steps should be taken by the referring health practitioner to select a suitable provider of sexual services to their patient or client, and then to monitor whether the arrangement is achieving its objectives.     

Dream as Transaction: An Exercise in Interpersonal Theory

The author explores the multiple meanings for her of analyst disclosures and the application of a fixed analytic frame. She challenges the idea that most analytic rules, outside of the context of a particular and ever-changing clinical situation, can universally hold true. She believes that questions pertaining to “right” and “wrong” are, perhaps, an inapt line of inquiry in this regard. Drawing material from reflections on her own developmental history in relation to disclosure and risk, as these factors play out in the dyadic interactions of a particular, out-of-the-ordinary, highly charged clinical case, she highlights a distinction between a potentially inappropriate application of generic analytic “rules” and a necessary steadying personal connection with a hierarchy of ethical principles.     

Improving the Conductivity of the PEDOT:PSS Layers in Photovoltaic Cells Based on Organometallic Halide Perovskites

Among conductive polymers, PEDOT films find the widest application in electronics. For photovoltaic applications, studies of their optical properties, stability, and electrical conductivity are of greatest interest. However, the PEDOT:PSS transport layers, when used in photovoltaic cells, have a high electrical resistance, which prevents solar cells from increasing their efficiency. One of the promising ways to improve their electrical properties is the use of composite materials based on them, in which the conductivity can be increased by introducing various additives. In this work, conductive polymer films PEDOT:PSS (poly (3,4-ethylenedioxythiophene):polystyrene sulfonate acid) doped with a number of amines (Pentylamine, Octylamine, Diethylamine, Aniline with carbon nanotubes) were obtained and studied. It is shown that, depending on the concentration of dopants, the electrical conductivity of PEDOT:PSS films can be significantly improved. In this case, the light transmission of the films practically does not change. The process of improving the conductivity by treating the surface of the finished film with amines, followed by heat treatment, was studied. It is assumed that the improvement in conductivity is the result of the self-assembly of monolayers of organic molecules on the surface of the PEDOT:PSS film leading to its p-doping due to intermolecular interaction.     

Fathers and Daughters

In this discussion I attempt to link some of Tennes's ideas with those preexisting in psychoanalysis, in particular those of Loewald, Matte-Bianco, and Bion; I also elaborate on some of the connections with modern physics. I believe that by going beyond intersubjectivity, it is important to integrate the transpersonal with the intersubjective so that intuition and intimations remain connected with the psychic reality of other people.     

Study of photodegradation kinetics of melatonin by multivariate curve resolution (MCR) with estimation of feasible band boundaries

Multivariate curve resolution—alternating least squares (MCR‐ALS) has been applied to data collected from UV spectrophotometric analysis of melatonin samples exposed to light with varying irradiance power. MCR‐ALS was able to explain the degradation kinetics of this drug, deducing the pure spectra and concentration changes of the different species present throughout the entire process. Possible rotational ambiguities associated with MCR solutions were investigated and their extent was evaluated. The extent of the rotation ambiguity was estimated from the band boundaries of feasible solutions calculated using the MCR‐BANDS procedure. The use of a non‐linear fitting routine allowed improving kinetic information and provided a method of evaluation of the rate constants of the degradation process. The degradation pathway was found to follow a first‐order reaction model, in which melatonin underwent photo‐oxidation of the indole ring to give a formylamine group. Kinetics of the reaction was shown to be dependent on irradiation conditions, with an increase of the rate constants when light power also increased. Copyright © 2011 John Wiley & Sons, Ltd.     

Exploring historical conflicts between midwives and nurses: a perspective from Chile

Abstract

This article explores issues of historical disputes between nurses and midwives based in Chile. The interaction of these two professions in that country has become an arena of competition which leads to conflicts periodically, such as those related to the ownership of the care of new-borns, and that of projects aimed at relieving nurse shortages by enhancing midwives’ nursing skills. Specifically, this article aims to build on historical and contemporary resources analysed from a sociological perspective, and present comparatively a rationale concerning nursing/midwifery jurisdictional conflicts through a social history account. Our analysis suggests that nurses/midwives interaction has been shaped by social-historical transformations and the continuous evolution of the healthcare system as a whole, resulting in a race towards technologisation. These interprofessional conflicts can be explained partly by mechanisms of boundary expansion within an organisational/interpretive domain, as well as varying degrees of medicalisation; and partly by a competition possibly originating from a middle-class consciousness. An eventual merger of the two professions might lead to the enhancement of the political power of the caring professions and integrated care.     

Blurring boundaries: professional perspectives of the emergency nurse practitioner role in a major accident and emergency department

The role of the emergency nurse practitioner (ENP) has increasingly become part of mainstream healthcare delivery in major accident and emergency departments in the United Kingdom. Although some research data are available in this field, there has been little attempt to evaluate the impact of the implementation of the ENP role from the perspective of those healthcare professionals most closely involved at local level. This paper describes one part of a case study evaluation of the role in an accident and emergency department in the South Thames English region. Nine face-to-face semi-structured interviews were carried out with the key multidisciplinary stakeholders in the organization. Five major themes emerged from the data analysis: blurring role boundaries; managing uncertainty; individual variation; quality vs. quantity; and the organizational context. Whilst some professional consensus was evident regarding the benefits of the role, such as improved waiting times and patient satisfaction, there appeared also to be a degree of ambivalence, particularly regarding current role configuration, value for money, and the extent to which the role should be expanded in the future. These issues are discussed in terms of professional identity, changing role boundaries, and professional personhood. It is argued that the benefits and pitfalls of the ENP role need to be considered within the context of local service provision. The growing emphasis on clinical governance reinforces the need for ongoing audit of role effectiveness in order to meet the challenges and uncertainties of increasingly blurred professional boundaries.     

A 3D generalization of user-steered live-wire segmentation

We have been developing user-steered image segmentation methods for situations which require considerable human assistance in object definition. In the past, we have presented two paradigms, referred to as live-wire and live-lane, for segmenting 2D/3D/4D object boundaries in a slice-by-slice fashion, and demonstrated that live-wire and live-lane are more repeatable, with a statistical significance level of P < 0.03, and are 1.5-2.5 times faster, with a statistical significance level of P < 0.02, than manual tracing. In this paper, we introduce a 3D generalization of the live-wire approach for segmenting 3D/4D object boundaries which further reduces the time spent by the user in segmentation. In a 2D live-wire, given a slice, for two specified points (pixel vertices) on the boundary of the object, the best boundary segment is the minimum-cost path between the two points, described as a set of oriented pixel edges. This segment is found via Dijkstra's algorithm as the user anchors the first point and moves the cursor to indicate the second point. A complete 2D boundary is identified as a set of consecutive boundary segments forming a "closed", "connected", "oriented" contour. The strategy of the 3D extension is that, first, users specify contours via live-wiring on a few slices that are orthogonal to the natural slices of the original scene. If these slices are selected strategically, then we have a sufficient number of points on the 3D boundary of the object to subsequently trace optimum boundary segments automatically in all natural slices of the 3D scene. A 3D object boundary may define multiple 2D boundaries per slice. The points on each 2D boundary form an ordered set such that when the best boundary segment is computed between each pair of consecutive points, a closed, connected, oriented boundary results. The ordered set of points on each 2D boundary is found from the way the users select the orthogonal slices. Based on several validation studies involving segmentation of the bones of the foot in MR images, we found that the 3D extension of live-wire is more repeatable, with a statistical significance level of P < 0.0001, and 2-6 times faster, with a statistical significance level of P < 0.01, than the 2D live-wire method, and 3-15 times faster than manual tracing.     

Quantitative Nissl study of the neuronal types, and recognition of cytoarchitectural subdivisions, within the rabbit periaqueductal gray.

A quantitative analysis of 4,621 Nissl-stained neurons within the periaqueductal gray of the rabbit found that there were four main cell types (stellate/round, ovoid, spindle, and triangular) distributed throughout this complex. Further statistical analysis on these neurons confirmed that there were morphological grounds to subdivide the periaqueductal gray into four cytologically distinct regions: ventral, lateral, dorsal, and medial. Neurons in the narrow medial zone, which completely surrounds the aqueduct, were orientated essentially parallel to the aqueduct. The majority of these neurons were small, ovoid, or spindle in shape, and highly basophilic. The cells in this region had the lowest packing density of those in any periaqueductal gray subdivision. The dorsal subdivision, a small midline region, contains the largest cells of any division and the highest packing density of glial cells. The neurons in this region show no preference for orientation, tend to be round, and are moderately basophilic. Cells in the lateral zone are also quite large and demonstrate a preferred orientation either parallel or perpendicular to the aqueduct. The average cell density within lateral PAG is considerably higher than in other regions. Most of these neurons are round or ovoid, and moderately basophilic. Neurons in the ventral zone are mainly ovoid, of medium size, highly basophilic, and lie fairly sparsely arrayed and are orientated essentially parallel to the aqueductal surface.