重症医学科临床思维几点探讨

重症医学科危重病患者病情变化的错综复杂和诊治方法的特殊性对重症医学科医生的临床思维提出了新的要求,哲学的思维方法显得非常重要;本文对重症医学科医生临床思维中需经常面临的系统与局部、循证与经验、多学科协作、临床与人文之间的关系等重要问题进行初步的哲学思考。     

Foucault and the Imperatives of Education: Critique and Self-Creation in a Non-Foundational World

This article outlines Foucault’s conception of critique in relation to his writings on Kant. In that Kant saw Enlightenment as a process of release from the status of immaturity in that we accept someone else’s authority to lead us in areas where the use of reason is called for, it is claimed in this article that Foucault’s notion of critique reveals his own conception of maturity. Whereas Kant sees maturity as the rule of self by self through reason, Foucault sees it as an attitude towards ourselves and the present through an historical analysis of the limits, and the possibility of transgression, of going beyond. Critique is thus a permanent interrogation of the limits, an escape from normalization, and a facing-up to the challenges of self-creation while seeking to effect changes in social structures on specific regional issues of concern. The article concludes by suggesting that the problem of historical and epistemological relativism, which a conception of total critique gives rise to, may not be as insurmountable as some critics of Foucault have claimed.     

Strategic Maneuvering with Dissociation

This paper explores the possibilities for strategic maneuvering of the argumentative technique that Perelman and Olbrechts-Tyteca (The New Rhetoric. A Treatise on Argumentation, University of Notre Dame Press, Notre Dame/London, 1969) called dissociation. After an exploration of the general possibilities that dissociation may have for enhancing critical reasonableness and rhetorical effectiveness, the use of dissociation in the successive stages of a critical discussion is examined. For each stage, first, the dialectical moves that dissociation can be employed in are specified, then, the specific ways in which dissociation contributes to fulfilling the dialectical tasks that are associated with these moves are delineated, and, finally, the rhetorical gain that␣dissociation can bring in the fulfillment of these tasks is discussed. Some general conclusions are drawn for research that aims at understanding the potential of an argumentative technique for strategic maneuvering.     

ICU的形成与发展

危重病医学从简单的监测与护理到当今发展成为较系统的危重病医学理论、一系列先进的监测手段和救治技术,经过了半个多世纪几代人的努力。ICU的建立和发展是现代医学进步的显著标志之一。危重病医学的贡献在于,在积极治疗原发病的基础上,通过先进的生命支持手段,使许多过去认为已无法救治的危重患者得以存活或延长其生存时间。从ICU的形成、危重病医学学科建设、我国ICU队伍的建设到现阶段ICU的发展过程作简要阐述,并着重指出今后ICU发展中面临的任务与挑战,如ICU收治标准、住院费用、病人安全性,旨在促进我国乃至世界范围内ICU可持续健康的发展。     

铁过度负荷与疾病

铁是机体微量元素中含量最多的一种,是血红蛋白、肌红蛋白、细胞色素系统、呼吸链的主要复合物、过氧物酶和过氧化氢酶等的重要组成部分,广泛参与机体生理功能和生化反应,缺铁可导致贫血等疾病.体内铁过多,称为铁过度负荷.随着医疗条件改善、生活水平提高,源于生理性因素、病理性因素和外源性铁剂应用(治疗性应用、预防性应用),铁过度负荷相关疾病日益增多.铁过度负荷可对内分泌代谢、心血管、神经系统、肾脏、肝脏等系统器官产生损害,导致多种疾病或使疾病加重.目前铁过度负荷相关疾病的治疗措施主要有放血疗法和药物治疗.放血疗法,只可作于短期治疗.去铁胺作为目前较为有效的去铁剂,由于价格昂贵,不能广泛应用于临床.铁过度负荷对人体的影响和相关疾病尚未外起医学界的重视.深入研究以铁过度负荷为主要和次要病因相关疾病,探索正确补铁措施,是预防铁过度负荷相关疾病、增进人体健康的重要措施,也是临床面临床的新课题.     

Ethical dilemmas of Turkish counsellors: a critical incidents study

Ethical dilemmas from a national purposive sample of Turkish counsellors (N = 172) were collected using critical incidents technique. Content analysis was performed with open coding guided by the classification of American Counseling Association code of ethics. Incidents regarding confidentiality and privacy (56.4%), with 37.1% involving incidents of reporting child sex abuse, had the highest percentage of prevalence. Dilemmas involving conflicts with school principals ranked second (16.3%), while incidents regarding dual relationships and boundaries (14%) ranked third. Implications for the development of a research-based and culturally sensitive code of counselling ethics in Turkey are discussed, and recommendations for future research are provided.     

IS QUANTUM INDETERMINISM REAL? THEOLOGICAL IMPLICATIONS

Quantum mechanics (QM) studies physical phenomena on a microscopic scale. These phenomena are far beyond the reach of our observation, and the connection between QM's mathematical formalism and the experimental results is very indirect. Furthermore, quantum indeterminism defies common sense. Microphysical experiments have shown that, according to the empirical context, electrons and quanta of light behave as waves and other times as particles, even though it is impossible to design an experiment that manifests both behaviors at the same time. Unlike Newtonian physics, the properties of quantum systems (position, velocity, energy, time, etc.) are not all well‐defined simultaneously. Moreover, quantum systems are not characterized by their properties, but by a wave function. Although one of the principles of the theory is the uncertainty principle, the trajectory of the wave function is controlled by the deterministic Schrödinger equations. But what is the wave function? Like other theories of the physical sciences, quantum theory assigns states to systems. The wave function is a particular mathematical representation of the quantum state of a physical system, which contains information about the possible states of the system and the respective probabilities of each state.     

Locked into the System? Critical Community Psychology Approaches to Personal Debt in the Context of Crises of Capital Accumulation

The considerable and sustained boom in personal debt recently has in many countries around the world led to experiences of over‐indebtedness that are associated with very considerable distress and suffering. This article explores critical perspectives that situate personal debt, material deprivation and suffering, and specific ways of knowing and acting, within the context of recent political and economic practices. There is a need to focus on positioning people's experiences of debt within a broader matrix of factors of national and international practices and policies, including globalisation, changing labour markets, and poorly regulated financial industries. These factors appear to have allowed a network of international financial institutions to adopt practices that have proved successful in creating personal debt. Yet, an individualised discourse of financial capability has been propagated, configuring personal debt as a problem of irresponsible individual consumption. In order to explore ways of resisting reactionary and individualised modes of addressing personal debt, proposals will be made of alternative paradigms for responding to personal debt, defined by two dimensions of community psychological practice, with examples. This article aims to increase collective awareness of the systemic character of debt and the collective responses required. Copyright © 2014 John Wiley & Sons, Ltd.     

Turning students into scholars: using digital methods to teach the critical study of religion

Incorporating digital tools into Religious Studies courses provides experiences and conditions that transform students into scholars. In this essay we discuss two courses we taught in conjunction with the Religious Soundmap Project of the Global Midwest, a collaborative digital humanities project that we co-directed from 2014 to 2016. Engaging students as contributors to a collaborative digital research project helped them to appreciate some of the key practical, theoretical, and ethical challenges that we face as scholars of religion. In particular, our work together brought to the fore critical questions about definition, classification, and representation. Even more, because they knew their work would be accessible to broader audiences outside the classroom, potentially including the very communities whom they were studying, students were able to perceive the stakes of these questions in ways we had not previously experienced. Incorporating digital tools enabled our students to see themselves as scholars of religion.