早期气管切开对非肺部疾病长期机械通气患者的影响

为了评价早期气管切开对非肺部疾病长期机械通气患者的影响,我们回顾性分析158例非肺部疾病长期机械通气患者,根据气管切开时间的早晚（气管插管7天为界）分为早期气管切开组（n=88）和延迟气管切开组（n=70）。比较两组患者的抗生素使用时间、镇静剂和镇痛剂用量、病死率、医院获得性肺炎发生率等。结果显示早期气管切开可以明显缩短患者机械通气时间和ICU住院时间,降低抗生素使用天数、减少镇痛剂的用量,降低总住院费用。所以,非肺部疾病长期机械通气患者可以从早期气管切开中获益。     

THE “GHOSTS” OF IRAS PAST AND THE CHANGING CULTURAL CONTEXT OF RELIGION AND SCIENCE

Beginning with our cosmic ancestors and the 1950s ancestors of Institute on Religion in an Age of Science (IRAS, the “Ghosts”), this essay highlights the wider, post‐World War II cultural context, including other science and religion organizations, in which IRAS was formed. It then considers eight challenges from today's context. From the context of science there are (1) the challenge of scale that leads us to question our place in the scheme of things and can lead to a challenge to morale concerning whether we make any difference; (2) the challenge of human variability that leads to the question whether there is a single human moral nature; and (3) the challenge of detailed explanation that leads to the question of what is the task of theology in relation to detailed scientific explanation. From the religion context there are (4) the challenge of objectivity—studying religion without practicing religion; and (5) the challenge of pluralism and the variety of cultural and religious perspectives. From the context of the growing and diverse science‐and‐religion enterprise, considered from the perspective of IRAS developed in the first part of this essay, there are the challenges of (6) apologetics and (7) intellectualization. Finally, from the context of our growing, worldwide consumerist culture that is contributing to the radical alteration of the planetary environment, leading to much suffering, there is (8) the challenge of becoming more motivated to act for the long‐term global good.     

A practitioner's notes on the free-associative method as existential praxis

Freud's pre-1914 texts demonstrate why he consistently asserted that his free-associative method was the sine qua non of his discipline. Prior to 1914, Freud's theorizing was intimately and inextricably connected to his lived experience with the discovery of this method. After 1914, he became more speculative in this thinking and writing; his models of the “mental apparatus” and its functioning drew increasingly on conceptual sources other than his experience with free association. The four fundamental coordinates of his discipline (the methodical disclosure that self-consciousness is repressive, the nonlinear “time of the mind,” the significance of our sensual embodiment or libidinality, and the formation of the repression barrier by the incest taboo) are all closely tied to free-associative experience. By contrast, post-1914 theoretical preoccupations (from object relations to the structural-functional model, and other formulations generated after Freud's life) are comparatively divorced from such experience. These conceptual edifices imply a conventional depiction of the theory–practice relationship, which is radically challenged by free-associative discourse. The notion of praxis is introduced as contesting the prevailing depiction of practice as an application of theory, and as serving to rescue psychoanalysis from the somewhat “sterile debates” over its scientific status and over the relevance of metapsychological speculation to clinical treatment. Against the normative ideology of theory and practice, the lived experience of free-associative discourse, with its potential for change and healing, can only be understood in terms of this notion of praxis, and this justifies Freud's claim to have initiated “a critical new direction in science.”     

“Working with Couples: Satir and the Tao,”

SUMMARY

One of Virginia Satir's greatest gifts to the world was the use of herself as an instrument of healing. By daring to use all of her-self-body, mind and spirit-the connections Virginia made with others were warm and real. Besides being authentically caring, Satir worked out of a pluralistic and comprehensive theoretical base to individualize each intervention. By co-creating strong, trusting relationships she inspirited others with her own life-force energy, and enabled them to become more fully human. Able to put her own ego needs aside, Virginia modeled how to join common sense with a sense of high purpose.     

Imagining ethical globalization: The contributions of a care ethic

Approaches to global ethics have drawn on a number of diverse theoretical traditions, such as Kantianism and utilitarianism. While emerging frameworks contribute to a growing awareness of and interest in ethics within a global society, the values that they prioritize are not adequate for realizing a just, equitable and fair system of global governance. This article considers the possibilities of an alternative ethic—a feminist ethic of care—and explores how it can bear on present circumstances, including global inequity and injustice. This care ethic has been put forward as a viable normative approach to politics and policy. Little attention, however, has been paid to the potential of a care ethic within the globalization and ethics debate. This article illustrates how the values and corresponding principles of care, grounded in relationships and responsibilities, are essential to responding adequately to the current challenges of globalization. By examining the relevance of care in this context, the article seeks to broaden dominant ethical worldviews and contribute to the articulation of normative tools for examining globalization while at the same time avoiding the trappings of conventional universality—the abstract and a priori thinking typically associated with conceptions of global ethics.     

Relational dynamics of charismatic organization: The complementarity of love and power

Abstract: This paper outlines a new theory of structural transformation in charismatic systems by postulating a complementary relationship between love and power. Radical reorganization of social organization, the function of charismatic systems, requires mobilizing and realigning enormous amounts of social energy. The source of this social energy is love. When patterned as communion, love fuses the group into an undifferentiated whole and releases the social energy previously locked up as institutionalized structure.

Released from structure or form, however, social energy is highly volatile and produces immense pressures towards instability. Counterbalancing the pressure from communion, a strong, collective order of power functions to harness and align the energy, thereby promoting group stability and enhancing the prospects for structural transformation. Data from a national study of sixty urban communal organizations are used to ground key aspects of the theory.     

The rise of information in an evolutionary universe

This paper outlines the grand scenario of cosmic evolution by examining the ongoing changes among radiation, matter and life in standard, big‐bang cosmology. Using aspects of non‐equilibrium thermodynamics and information science, we argue that it is the contrasting temporal behavior of various energy densities that have given rise to the environments needed for the emergence of galaxies, stars, planets, and life forms. We furthermore argue that a necessary (though perhaps not sufficient) condition—a veritable prime mover—for the emergence of such ordered structures of growing complexity is the expansion of the Universe itself. Neither demon‐strably new science nor appeals to non‐science are needed to explain the impressive hierarchy of developmental change, from quark to quasar, from microbe to mind.     

Microstructure and mechanical properties of Mg–8Al alloy fabricated by room-temperature multi-directional forging

As-extruded Mg–Al alloy was multi-directionally forged (MDFed) at room temperature to cumulative strain of ΣΔ??=?2.0 at maximum by employing a pass strain of Δ??=?0.1. The coarse initial grains were subdivided gradually to ultra-fine ones by mechanical twinning. The MDFed Mg alloy showed superior mechanical properties of 530?MPa yield and 650?MPa ultimate tensile strengths with ductility of 9%. The relatively large ductility was induced by grain orientation randomization due to multiple twinning and the small pass strains which suppressed the sharp basal-texture evolution.     

Electron spin resonance of hydrogenated amorphous silicon-carbon alloy films prepared by magnetron sputtering

Abstract

New electron spin resonance (ESR) lines with g¹ = 2·0017 and g₂ and g₃ = 2·0006 have been found in the ESR spectra of as-deposited a-Si_1–x C_x:H films prepared by magnetron sputtering of silicon in the gas mixtures of methane and argon. Similarities between the observed spectra and those for the E′ centre in glassy SiO₂ are discussed.     

But Is It a Basin? Science,Controversy, and Conspiracy in the Fight for Mirador,Guatemala

The ancient Maya city of Mirador, located in the northeastern corner of Guatemala's Maya Biosphere Reserve, is at the heart of a raging scientific and political controversy. On the surface, the conflict centers around the geological definition of a ‘basin’ surrounding the magnificent site. One side uses the existence of a basin—backed up by satellite images and analyses—to push for redrawing the boundaries of the reserve, arguing that the feature naturally delineates key archaeological and ecological sites and that current reserve management is failing the forests. The other side insists that there is no geological basin—a contention also backed by satellite images and analyses—and that redrawing the lines would undermine more than 20 years of conservation efforts. On both sides of the fight, rumors abound about secret agendas, manipulated data, backroom political deals, and other shady business. These conspiracy stories reveal how paranoid thought is simultaneously a powerful epistemology and a practical political strategy, both of which shape the production and interpretation of scientific facts. Rather than contrasting irrational political rumor with logical scientific fact, or considering the former as simply context for the latter, the case of Mirador demonstrates how the two are deeply entangled ways of acting on and making sense of a complex landscape.