呼吸危重症临床决策中的若干问题

在临床实践中,呼吸危重症的诊断和治疗存在着一些不同的观点。就其中某些热点问题,如慢性阻塞性肺疾病合并哮喘的诊断和机械通气的指征、肺栓塞的诊断、急性呼吸窘迫综合征的治疗、呼吸重症监护病房的建设和呼吸危重症的伦理学问题进行阐述,以期提高对呼吸危重症的认识。     

从能量观疾病

能量在机体的各种离子、分子、细胞、器官、组织、系统间协调分布,共同维持着健康状态。某一病因作用于人体后,“协调分布”会被不同程度地打破,当超过一定的阈值,就会产生疾病。对于人体,各种能量的直接表现形式和能量的携带者——各种营养物质,都与疾病之间有着千丝万缕的联系。从“能量”角度,我们既可进一步探讨尚未阐述清楚的疾病发生机制,又可以设计更为完美的治疗方案与医学仪器。     

The indissociable unity of psyche and soma: A view from the Paris Psychosomatic School1

Depending on whether or not psyche/soma is seen as singular or dual, one may construct different systems explaining man and the world, life and death. In the author's view, the discoveries of psychoanalysis offer a perfectly cogent and unique solution to the famous mind/body problem. In transferring the duality psyche/soma on to the duality of drives, psychoanalysis places the origin of the thought process in the body. In Beyond the pleasure principle, Freud discusses the drastic effect of a painful somatic illness on the distribution and modalities of the libido. He provides a starting point for the Paris Psychosomatic School's psychoanalytical approach to patients affl icted with somatic illnesses. To illustrate the technical implications of this theory the author relates two clinical cases.     

类皮亚杰数量守恒任务中的负启动效应

采用负启动研究范式,考察九岁儿童在类皮亚杰数量守恒任务中的负启动效应。实验一重复了Houdé等人的实验过程,发现我国儿童在解决类皮亚杰数量守恒任务中也存在负启动效应,负启动量为310.9ms;实验二改进了Houdé等人研究的实验材料,排除实验材料形状的干扰,发现依然存在负启动效应,负启动量为200.04ms。实验结果表明,成功完成类皮亚杰数量守恒任务需要认知抑制过程的参与。     

Rethinking NIMBYism: The role of place attachment and place identity in explaining place‐protective action

The ‘NIMBY’ (Not In My Back Yard) concept is commonly used to explain public opposition to new developments near homes and communities, particularly arising from energy technologies such as wind farms or electricity pylons. Despite its common use, the concept has been extensively critiqued by social scientists as a useful concept for research and practice. Given European policy goals to increase sustainable energy supply by 2020, deepening understanding of local opposition is of both conceptual and practical importance. This paper reviews NIMBY literature and proposes an alternative framework to explain local opposition, drawing upon social and environmental psychological theory on place. Local opposition is conceived as a form of place‐protective action, which arises when new developments disrupt pre‐existing emotional attachments and threaten place‐related identity processes. Adopting a social constructivist perspective and drawing on social representation theory, a framework of place change is proposed encompassing stages of becoming aware, interpreting, evaluating, coping and acting, with each stage conceived at multiple levels of analysis, from intrapersonal to socio‐cultural. Directions for future research and potential implications of the place‐based approach for public engagement by energy policy‐makers and practitioners are discussed. Copyright © 2009 John Wiley & Sons, Ltd.     

Breaks and Links. Prospects for Russian Religious Philosophy Today

An analytical review of the current situation of Christian philosophyin Russia is presented, aiming to explain, why so much expectedrenaissance of this philosophy in the post-soviet period did nottake place. Russian philosophy is shown to be structurally a synthesis of the Western conceptual framework and Eastern Christian discourse,the latter being, in turn, the synthesis of patristic and asceticdiscourse, including two basic paradigms, deification (theosis)and sacralisation, and having energy as its dominant category.The key role of ascetic experience in Eastern Christian discourseis stressed. Topical problems related to the study of thisexperience, as well as concepts of energy and theosis, are discussed.     

Conceptual framework from the Paris Psychosomatic School: A clinical psychoanalytic approach to oncology1

This article presents further clinical material from the Paris Psychosomatic School ( Aisenstein, 2006 ). The Freudian foundations of psychosomatics are detailed and post-Freudian developments focusing on the contribution of the Paris Psychosomatic School are outlined, in particular, the somatizing process as a result of regression and the somatizing process as a result of drive unbinding. The authors argue that the latter possibly gives rise to progressive and serious illness leading to death. The relationship of classical psychoanalysis to psychotherapeutic treatment from the angle of the Paris school is commented on. The authors then turn to two clinical presentations of women suffering from breast cancer. The method of evaluating the patients’ capacities for undergoing psychotherapeutic treatment and their mental capacity for healing is discussed. The face-to-face psychoanalytic treatment undertaken with the second case is discussed. Finally, the authors recall Freud’s insistence after 1920 on the opposition of the life drives and the death drives, which placed self-destruction at the centre of psychic functioning. They conclude that current research in biology and medicine, notably research concerning programmed cell death, will converge with psychoanalytic psychosomatics to illuminate somatizing processes and demonstrate the relevance of psychoanalytic treatment to patients who are capable of mental reorganization in the course of their illness and medical treatment.     

A self-instructional manual for installing low-cost/no-cost weatherization materials: Experimental validation with scouts

In this study, we describe the development and evaluation of a self-instructional program for installing 10 low-cost/no-cost weatherization materials (e.g., weatherstripping, caulking). This program was a weatherization and retrofit manual (WARM) providing step-by-step instructions and illustrations. Boy and Girl Scouts participated and used either the WARM or existing product instructions (EPI) to apply the materials. Scouts installed the materials properly only when they used the WARM.     

A behavioral analysis of peaking in residential electrical-energy consumers

This study was concerned with "peaking", which is the tendency for electrical-energy users to consume at high rates for brief periods during the day. Peaking results in the inefficient use of generating facilities, which may lead to unfavorable effects on the environment, such as the construction of new energy producing facilities or the activation of older, less safe, generating units. A continuous data collection system to monitor consumption of electrical energy was installed in the homes of three volunteer families. Information, feedback, and incentives were evaluated for their effects on peak energy consumption. A combination of feedback plus incentives was most effective and reduced peaking about 50%. Removal of experimental treatments resulted in a return to pre-treatment patterns of consumption.