Survey on the awareness and application of radiation shielding specifications for γ-ray radiotherapy room / 中国职业医学

Objective: To investigate the implementation of GBZ/T 201.3-2014 Radiation Shielding Specification for Radiotherapy Room--Part 3: Radiotherapy Room of γ-ray Sources (hereinafter referred to GBZ/T 201.3-2014). Methods: A total of 129 personnels, who were involved in the approval and supervision of radiation diagnosis and treatment construction projects in 19 provincial administrative agencies, engaged in radiation protection testing and evaluation of γ-ray radiotherapy rooms in radiation health technology service institutions, and used GBZ/T 201.3-2014 in other institutions (environmental impact assessment, education and scientific research), were selected as the participants using a stratified random sampling method. A questionnaire survey was conducted to assess their awareness and application of the standard. Results: The participants' awareness of GBZ/T 201.3-2014 was ≥63.6%, but the training rate was only 9.1% to 50.0%. The familiarity with the various chapters of the standard was over 86.4%. And 42.6% of the participants reported using the standard at least once a year. Regarding the applicability of the standard, all of the participants believed that the standard meets the needs of approval, supervision, testing, or evaluation, and adapts to the updated development of radiotherapy equipment and technology. And 94.6% of the participants believed that the use of the standard could improve the level of protection design and management, and 92.2% believed that the standard was widely applied. Regarding the adequacy of the standard, 97.7% of the participants believed that the standard's reference for ambient dose equivalent rate was reasonable, while 34.1% believed that the standard needs revision. Conclusion: The participants are satisfied with the standard and believe its applicability. They have a good level of awareness of the standard, but there is a room for improvement in their familiarity with the shielding calculation related content of the standard. The promotion, training, and practicality of the standard need to be strengthened.

Analysis and evaluation of the application of polymyxin B in inpatients based on clinical guidelines and consensuses / 中国药房

OBJECTIVE To evaluate the rationality of clinical application of polymyxin B in the inpatients of a third grade class A hospital，so as to provide evidence for the optimization of clinical scheme of the drug. METHODS A retrospective method was conducted on the electronic medical records of inpatients treated with Polymyxin B sulfate for injection from January 2020 to March 2022 to collect the basic information of patients， inpatient departments and time， infection diagnosis， results of pathogenic bacteria test， laboratory test indicators， usage and dosage， and combined medication，etc. Based on the drug instructions， according to relevant guidelines and consensus， the rationality， efficacy and safety of polymyxin B in inpatient were evaluated. RESULTS & CONCLUSIONS A total of 101 inpatients were included， respiratory system infection was the main cause （62.4%）. All patients had received the etiological examination， and the pathogen with the highest detection rate was carbapenem‑resistant Acinetobacter baumannii （40.6%）. One hundred patients were treated by intravenous drip， and 4 patients were treated by combination of aerosol inhalation or intrathecal injection； 99 patients were given the dose of 500 thousand units by continuous intravenous infusion， q12 h. Totally 51.5% of patients were treated for 7-14 days； and 77 patients were treated with other anti-Gram-negative drugs. There were unreasonable phenomena including too short time of medication （29.7%）， no combination of medication （23.8%）， and no indication of medication （17.8%）. The clinical effective rate of 101 patients treated with polymyxin B was 49.5%， and 16 patients （15.8%） had acute kidney injury during the treatment. Clinical pharmacists should actively participate in the clinical treatment of polymyxin B， formulate individualized treatment plans according to the guidelines/consensus and in combination with the patient’s condition and infection status to improve the rationality of clinical medication.

Technical Reflection and Ethical Care Based on Clinical Practice / 中国医学伦理学

While modern medical technology improves human health, it also changes people’s ethical ways of understanding life, weighing interests, planning for a good life, and building public order and good customs. Technical reflection and clinical evidence-based practice are highly complementary. On the one hand, the cognitive purport of clinical practice changes from "causality" to "correlation". On the other hand, technical reflection opens the review perspective of ethical care. Technical reflection helps medical professionals improve working methods through technical control and ethical care, promote the transition of clinical practice from "cognitive domain" to "ethical domain", and then respond to the basic questions of "what should be done" and "how should be done" in clinical practice.

Value Rational Return of Medical Humanities Education under the Concept of People First / 中国医学伦理学

The concept of people first has important inspirations for the value rational return of medical humanities education in the new era. It is consistent with the educational value, curriculum attribute, and practical attribute of medical humanistic education, and puts forward new requirements for the value rational return of medical humanities education in terms of educational supply content, practical curriculum setting, educational development form, and educational effect evaluation. Medical colleges and universities should further adhere to the medical humanities education concept centered on people’s health, optimize the practice curriculum of medical humanistic education, innovate the practice platform of medical humanistic education, and construct a value evaluation mechanism of medical humanistic education, so as to promote the value rational return of medical humanities education under the concept of people first.

Prospects and Suggestions for the Application of ChatGPT in Medical Ethics Education / 中国医学伦理学

ChatGPT represents the approaching singularity, which brings opportunity to medical ethics education, but is also constrained by issues such as unfairness, discrimination, and loss of autonomy caused by technological logic. This paper explored the intermediary relationship model of generative AI in medical ethics education, and analyzed the potential positive and negative values of this technology as a human creation, as well as the challenges that ChatGPT brings to medical ethics education. Based on this, suggestions are put for ward from the following four aspects. First, The role division and construction of different responsible subjects was explored based on the change in teacher-student relationship. Second, we shonld cultivate students’ ability to think and question. Third, the forward-looking responsibility was discussed based on the future development of intelligent education. Fourthly, from the perspective of technical logic, it presupposes the coexistence of human-machine dual subjects.

Epicurus’ View of Life and Death and Its Contemporary Enlightenment / 中国医学伦理学

Epicurus’ view of life and death is based on the atomism of naturalism and the epistemology of sensationalism in ancient Greek. He advocated that people should face death calmly, and separate death from the pain of feeling by explaining the true meaning of death to break people’s fear of death. He claimed that people should face desires with rational thinking and pursue a happy life. His view of life and death helped people to treat life and death rationally, alleviate death anxiety, make people actively face the difficulties in life, correctly identify desires and needs, and help individuals pursue a healthy and happy life.

"Conscience Epistemology" Based on "Loving-kindness Theory": The Basic Role of "Strengthening Conscience" in Moral Education / 中国医学伦理学

Based on the new ontology of the "loving-kindness theory", it is confirmed that the "conscience" of human beings (with internal natural law guidance and moral force) is "loving-kindness", which is the "needs/intrinsic driving force of life" as the "first cause" of human existence. It provides force for the realization of morality, yardstick of the natural necessity for moral judgment and practice, and value basis for virtue and norms. Therefore, "strengthening conscience", that is, recognizing, activating and strengthening conscience and its function and expression, is the foundation and key link of moral education. Its lack is the reason for the failure of "spiritual midwifery-style" or intellectual moral education. Revealing "conscience epistemology" with universal knowledge is the prerequisite of "strengthening conscience", and the fundamental field of moral education and moral philosophy that urgently needs to be explored. This paper revealed the "conscience epistemology" with universal knowledge, including that the precondition for revealing the "strengthening conscience" was to obscure or transcend "survival fear"; revealed the the appearance of conscience in terms of life rational emotions, personality, attitude to life, and behavior mode (i.e. "phase" and "different"); revealed the cognitive life rational pedigree of cognitive conscience (i.e. opening up human existence); revealed the principle of "strengthening conscience". Among them, all kinds of life rationality and life rational emotion are the unity of sensibility and reason, the unity of freedom and morality, and also with universality.

Prescription auditing using the WHO drug prescribing indicators in a tertiary care hospital: An observational retrospective study

Background: Prescription auditing is an important tool to assess and evaluate the drug utilization pattern and rational use of medicines. A successful prescription audit is crucial for health care workers, patients, and the community to ensure that their patients receive the best possible treatment. The purpose of drug audit is to improve patients care and to avoid potential fatal errors. Aim and Objectives: This study has been conducted to evaluate and analyze existing prescription errors in tertiary care hospital of Rajasthan and their magnitude. Materials and Methods: A retrospective observational study was carried out in Jhalawar Medical College, a tertiary care hospital in Rajasthan. Around 1000 prescriptions were collected randomly from medical college pharmacies. Outpatient prescriptions from all the major clinical departments available at hospital pharmacies were analyzed using the WHO prescribing indicators. Information regarding the patient, doctor, drug, and legibility of the prescription were obtained. Results: In our study, we found that most common age group mentioning in prescriptions were 18� years (55.7%), most common gender are males (60.2%). Generic names were prescribed in all prescriptions (100%). Patient information was mentioned in 73.2% prescriptions. Warning signs were not mentioned in any prescription whereas 10.2% prescription mentioned medicines name in capital letter. Average number of medicines per prescription was 4.1. Prescription with drugs prescribed from essential drug list was 88%. Conclusions: In our study, we found many insufficiencies, lack of clarity and important instructions in different parts of prescriptions. There is immediate requirement of improvement in prescribing habits of doctors. Proper steps such as workshops, practical training, and continuing medical education should be needed to guide the physicians to promote rational prescription.

Prescription pattern and rationality of fixed dose combinations in a tertiary care hospital – Record-based cross-sectional study

Background: Fixed dose combinations (FDCs) are combinations of two or more active drugs in a single pharmaceutical formulation. The rationality of FDC is a controversial and challenging issue in today’s practice of medicine. Aims and Objectives: The aim of the study was to assess the prescription pattern and rationality of FDCs in a tertiary care hospital. Materials and Methods: This is a record-based cross-sectional study conducted in the Department of Pharmacology, Government Medical College, Thrissur. The data were collected from the case records of 183 patients admitted under various departments during the month of January 2019. The FDCs prescribed were listed and the prescription pattern was assessed. All the FDCs were evaluated for rationality with the help of a comprehensive seven-point criteria by Panda et al. The data were analyzed using Epi info 7. Descriptive statistics were used to analyze the data. Results: Out of 183 case records, 39.3% contained at least one FDC, 13.1% contained two FDCs, and 4.4% contained three FDCs. The different drug classes prescribed as FDCs include anti-infective drugs 45%, vitamins and minerals 33%, analgesics 9%, and miscellaneous drug combinations 13%. The most prescribed anti-infective drug FDC is amoxicillin with clavulanic acid combination (56%). In our study, 92.5% of the antibacterial FDCs prescribed were rational and 7.5% irrational. According to the World Health Organization rationality criteria, 62% of the FDCs prescribed were rational and 38% were irrational. Conclusion: The present study showed the increased use of FDCs in tertiary care teaching hospital and most of the FDCs prescribed were rational (62%).

A comparative quantitative evidence-based chronopharmacological efficacy research between metformin monotherapy and metformin combination therapy, and a systematic review and meta-analysis on the application rationalities of metformin pharmacotherapeutics

Background: This comparative efficacy quantification research between metformin monotherapy and metformin combination therapy, and the subsequent systematic review, along with a consecutive meta-analysis of the different as well as wide-ranged study literature on oral hypoglycemic application rationality of metformin pharmacotherapeutics were performed, for a better comprehension of multicenter maintenance of rational pharmacotherapeutic aspects in the regular antidiabetic mono- and combination therapies prescribed to the new Type II diabetic patients. Aim and Objective: This clinical research study was conducted with the objective for a comparative quantitative evidence-based chronopharmacological efficacy research between metformin monotherapy and metformin combination therapy, and a systematic review, along with an accompanying meta-analysis, on the application rationalities of metformin pharmacotherapeutics. Materials and Methods: In this comparative quantitative evidence-based chronopharmacological efficacy research study, 100 patients suffering from newly detected early moderate grade Type II diabetes mellitus, were allotted into Group A consisting of 50 patients and Group B consisting of 50 patients. The Group A patients were prescribed the anti-diabetic treatment of orally administered metformin 500 mg, to be taken once daily for a span of 30 days, as metformin 1st line (only) monotherapy. The Group B patients were prescribed an oral hypoglycemic drug other than metformin, as 1st line anti-diabetic treatment, for the 1st 30 days, and then these Group B patients were gradually transferred to oral metformin combination therapy with another oral hypoglycemic drug, as metformin 2nd line (only) combination therapy, for the next 30 days. The derived study findings of comparative percentage efficacy quantification were statistically analyzed, on the basis of comparison between both the deduced results, for obtaining the comparative quantitative evidence-based chronopharmacological efficacy between metformin monotherapy and metformin combination therapy. Systematic review as well as meta-analysis is clinical research methods, comprising of a detailed, systematic and interpretative method of collecting, assessing and synthesizing the various medical evidences, to elaborate the research solution to a well-defined research question, in the form of a well-structured qualitative research review as well as quantitative analytical interpretations. Results: In this study, it was derived that the evidence-based chronopharmacological comparative percentage efficacy quantification of anti-diabetic metformin treatment showed 53% of percentage efficacy, when metformin was administered as 1st line (only) monotherapy, and 47% of percentage efficacy, when metformin was administered as 2nd line (only) combination therapy, with other oral hypoglycaemic drugs, prescribed in diabetes mellitus type II treatment regimens. The systematic review as well as meta-analysis in this study deduced 2482 refined, and also relevant, medical research database records, from total 3211 medical research database records, with a comprehensive qualitative and quantitative research database analyses. Conclusions: In this study, it was concluded that there was a slightly greater pharmacological efficacy of metformin 1st line (only) monotherapy than metformin 2nd line (only) combination therapy. The systematic review as well as meta-analysis derived a refined and conclusive medical research analysis, which was qualitatively synthesised, along with quantitative interpretations, on the various application rationalities of metformin pharmacotherapeutics.

Comprensión Hermenéutica de una Ontologia del Presente en la Era Digital / Hermeneutic Understanding of an Ontology of the Present in the Digital Age / Compreensão Hermenêutica de uma Ontologia do Presente na Era Digital

Resumen EL presente como categoría filosófica, expresa un carácter conductual, que se asume como una actitud (ethos) frente a un mundo digital. Este "ethos" configura una relacionalidad entre Lo humano y La máquina, construye puentes de apertura (apertus) que consolida unidades de posibilidad existencial a través de prácticas que manifiestan, no una digitalización, sino, una digitalización, esto es, una praxis particular y singular que, en el marco digital, pretende comprender intencionalmente el campo existencial del ser humano en las lógicas digitales. Esta digitalización como práctica, configura, "el presente" que en el marco de lo digital se constituye en una racionalidad, una especie de capacidad que tienen los seres humanos de analizar a través de un ejercicio mental la realidad existencial de sí mismo y de su entorno.

Abstract The present as a philosophical category, expresses a behavioral character, which is assumed as an attitude (ethos) towards a digital world. This "ethos" configures a relationship between the human and the machine, builds bridges of opening (apertus) that consolidates units of existential possibility through practices that manifest, not a digitization, but a digitiza-tion, that is, a praxis particular and unique that, in the digital framework, intends to intentionally understand the existential field of the human being in digital logics. This digitaliza-tion as a practice configures "the present" that in the digital framework constitutes a rationality, a kind of capacity that human beings have to analyze through a mental exercise the existential reality of themselves and of your environment.

Resumo O presente como categoria filosófica expressa um caráter comportamental, que se assume como uma atitude (ethos) em relação a um mundo digital. Esse "ethos" configura uma relação entre o humano e a máquina, constrói pontes de abertura (apertus) que consolida unidades de possibilidade existencial por meio de práticas que manifestam, não uma digitalização, mas uma digitalização, ou seja, uma práxis particular e única que, no quadro digital, pretende compreender intencionalmente o campo existencial do ser humano nas lógicas digitais. Essa digitaliza-ção como prática configura "o presente" que no quadro digital constitui uma racionalidade, uma espécie de capacidade que os seres humanos têm de analisar por meio de um exercício mental a realidade existencial de si e de seu ambiente.

Racionalidad y sensibilidad ética en el cuidado enfermero al paciente internado en un hospital público peruano de Nivel II-2 / Rationality and ethical sensitivity in nursing care for patients admitted to a Peruvian public hospital of Level II-2

Introducción: En enfermería, la vivencia ética connota ser siempre afectivo-reflexiva, al ejercerse en contextos de fragilidad y vulnerabilidad de los pacientes, exigiendo a los profesionales del cuidado y la salud a actuar con tales criterios beneficiando a las personas cuidadas. Objetivo: Describir la racionalidad y sensibilidad ética en el cuidado de enfermería al paciente de un hospital público peruano de nivel II-2. Material y métodos: Se asumió el enfoque cualitativo, de tipo descriptivo bajo diseño de análisis hermenéutico. La muestra fue de 15 enfermeros, obtenido en muestreo no probabilístico por conveniencia, quienes trabajaron en el área de Medicina Interna del hospital público mencionado. Se recolectó la información mediante entrevista semiestructurada aplicada por medios digitales, previo consentimiento informado. Los datos se procesaron a través del análisis de contenido. Resultados: a) Disponibilidad y esfuerzo hacia un cuidado compasivo y solidario, b) Equilibrando deberes y afectos hacia el bien global del enfermo, c) Comprensión interactiva, confianza y buen trato hasta el final de la vida. Conclusión: Los resultados destacan la capacidad de la enfermera para aplicar la afectividad, la empatía, la comunicación afectiva, la mirada atenta y el contacto físico; así como la disponibilidad para oír e interpretar las necesidades, además de comprender la angustia, sufrimiento, miedos y dolor de la persona cuando está internada en un nosocomio.

Background: In nursing, the ethical experience connotes being always affective-reflexive, when exercised in contexts of fragility and vulnerability of patients, requiring care and health professionals to act with such criteria, benefiting the people cared for. Objective:To describe the rationality and ethical sensitivity in nursing care for patients in a level II-2 Peruvian public hospital. Material and methods: The qualitative, descriptive approach was assumed under hermeneutic analysis design. The sample consisted of 15 nurses, obtained through non-probabilistic convenience sampling, who worked in the Internal Medicine area of the aforementioned public hospital. Information was collected through a semi-structured interview applied by digital means, with prior informed consent. The data was processed through content analysis. Results: a) Availability and effort towards compassionate and supportive care, b) Balancing duties and affections towards the global good of the patient, c) Interactive understanding, trust and good treatment until the end of life. Conclusion: The results highlight the nurse's ability to apply affectivity, empathy, affective communication, attentive gaze and physical contact; as well as the availability to listen and interpret the needs, in addition to understanding the anguish, suffering, fears and pain of the person when they are admitted to a hospital.

Racionalidad pugilistica y supremacismo médico-legal. Una controversia argumental sobre la violencia consensuada

Este artículo presenta una revisión crítica de algunos de los principales argumentos esgrimidos por detractores y defensores en el denominado debate sobre el boxeo. Se examinan las posturas planteadas por destacados representantes del activismo médico-legal a favor de la abolición total del boxeo y se confronta particularmente el mito de la naturaleza salvaje e irracional de dicho deporte. Se contrasta tal concepción con el abordaje etnográfico propuesto por Lois Wacquant y su mentor, Pierre Bourdieu, sobre la existencia de una racionalidad pugilística forjada en el habitus corporal del boxeador. Se recorren aspectos importantes del problema como es el hecho de que la Pedagogía, a través de la cual se enseña a boxear, dista de ser consciente, reflexiva, teorizadora e intelectualista (lo cual alimenta la apariencia de una supuesta ausencia de formación y cultivo de un saber que es eminentemente práctico). Asimismo, se muestra la dualidad de la argumentación médica al moverse sutilmente del plano epistémico al plano ético-moral y las implicaciones que tal opacidad arrastra. El objetivo del artículo no es cerrar la controversia en detrimento de las preocupaciones del sector médico-sanitario, sino mostrar la complejidad filosófica que le subyace.

Este artigo apresenta uma revisão crítica de alguns dos principais argumentos apresentados por adversários e apoiadores no chamado debate do boxe. Ela examina as posições apresentadas por destacados representantes do ativismo médico-legal em favor da abolição total do boxe e enfrenta em particular o mito da natureza selvagem e irracional do esporte. Esta concepção é contrastada com a abordagem etnográfica proposta por Lois Wacquant e seu mentor, Pierre Bourdieu, sobre a existência de uma racionalidade pugilística forjada no hábito corporal do boxeador. Aspectos importantes do problema são explorados, como o fato de que a pedagogia através da qual o boxe é ensinado está longe de ser consciente, reflexiva, teorizante e intelectual (o que alimenta a aparência de uma suposta ausência de treinamento e cultivo de um conhecimento que é eminentemente prático). Ela também mostra a dualidade da argumentação médica ao passar sutilmente do plano epistêmico para o plano ético-moral, e as implicações que tal opacidade implica. O objetivo do artigo não é fechar a controvérsia em detrimento das preocupações do setor médico-sanitário, mas mostrar a complexidade filosófica que lhe está subjacente.

This article presents a critical review of some of the main arguments put forward by detractors and defenders in the so-called boxing debate. It examines the positions put forward by prominent representatives of medico-legal activism in favor of the total abolition of boxing and particularly confronts the myth of the savage and irrational nature of the sport. This conception is contrasted with the ethnographic approach proposed by Lois Wacquant and his mentor, Pierre Bourdieu, on the existence of a pugilistic rationality forged in the boxer's bodily habitus. Important aspects of the problem are discussed, such as the fact that pedagogy, through which boxing is taught, is far from being conscious, reflective, theorizing and intellectualistic (which feeds the appearance of a supposed absence of training and cultivation of a knowledge that is eminently practical). It also shows the duality of medical argumentation by subtly moving from the epistemic plane to the ethical-moral plane and the implications that such opacity entails. The aim of the article is not to close the controversy to the detriment of the concerns of the medical-health sector, but to show the philosophical complexity that underlies it.

Una aproximación metaetnográfica a la racionalidad y emotividad en los procesos de atención y cuidado en hospitales de Latinoamérica / A metaethnographic approach to rationality and emotionality in the health care processes in hospitals in Latin America

Resumen Los procesos de atención y cuidado de la salud-enfermedad en los hospitales se configuran en torno a diferentes dimensiones relacionales entre los actores implicados. En las sociedades occidentales se han naturalizado a estas instituciones como espacios que suponen una estructura vertical, dominada por la racionalidad biomédica. Este artículo se basa en la revisión de la bibliografía y muestra que las prácticas de atención y cuidado involucran distintos vínculos, saberes y emociones que configuran aspectos por fuera de lo normado desde la institución. El objetivo consiste en indagar en los procesos de atención y cuidado desarrollados en los hospitales de Latinoamérica, colocando el foco en las tensiones entre la racionalidad que impone la norma y las emociones que emergen en el proceso de trabajo. Para ello se realizó una metaetnografía, que permitió sintetizar investigaciones cualitativas y producir una nueva interpretación del problema estudiado. De este modo, se conformó un corpus de 36 artículos científicos a partir de las búsquedas en las bases de la Biblioteca Virtual en Salud (BVS), PubMed, SciELO y Scopus. Los resultados muestran que las racionalidades y las emociones intervienen como dimensiones estructurales de los procesos de atención y cuidado en los hospitales.

Abstract Healthcare process that take place in hospitals are shaped around different relational dimensions between the actors involved. Western societies have naturalized these institutions as spaces of presumed vertical structure, ruled by biomedical rationality. This literature review shows that care practices entail different relations, knowledge and emotions, which configure aspects found outside the institution's standards. It investigates the healthcare processes developed in Latin America hospitals, focusing on the tensions between the rationality imposed by the norm and the emotions that emerge in the work process. For this purpose, a metaethnography was carried out to summarize qualitative research and produce new interpretations on the topic. A total 36 scientific papers was obtained by searching the BVS, PubMed, SciELO and Scopus databases. Results show that rationalities and emotions function as structural dimensions of healthcare processes in hospitals.

Do racional desregramento de todos os sentidos de Rimbaud ao sentimento de racionalidade em James / From Rimbaud's rational derangement of all the senses to James' sentiment of rationality / Du raisonné dérèglement de tous les sens chez Rimbaud au sentiment de rationalité chez James / Del razonado desarreglo de todos los sentidos de Rimbaud al sentimiento de racionalidad en James

Resumo Este ensaio traz o método do racional desregramento de todos os sentidos, do poeta Arthur Rimbaud, como ponto de partida para uma reflexão sobre a relação entre razão e afeto e para um possível diálogo com a noção de sentimento de racionalidade, do psicólogo e filósofo William James, sob a perspectiva teórico-metodológica do construtivismo semiótico-cultural em psicologia. Aborda-se o experimento de inalação do óxido nitroso de James como uma experiência de desregramento dos sentidos que proporcionou a ele uma compreensão sobre a questão da unidade e da variedade, ajudando a enriquecer sua cosmovisão empirista e pluralista, em oposição ao racionalismo monista de Hegel.

Abstract This essay uses Rimbaud's rational derangement of all the senses as a starting point for its reflection on the relationship between reason and affection, and for possible dialogues with psychologist and philosopher William James' sentiment of rationality, from the perspective of semiotic-cultural constructivism in psychology. James' experiment of nitrous oxide inhalation is seen as an experience of derangement of the senses that gave him insight on the question of unity and variety, thus enriching his empiricist and pluralist worldview opposed to Hegel' s monistic rationalism.

Résumé Cet essai utilise le raisonné dérèglement de tous les sens de Arthur Rimbaud comme point de départ de sa réflexion sur la relation entre raison et l'affection, et des dialogues possibles avec le sentiment de rationalité du psychologue et philosophe William James, dans la perspective du constructivisme sémiotique-culturel en psychologie. L'expérience d'inhalation d'oxide nitreux de James est considérée comme une expérience du dérèglement des sens qui lui a donné un aperçu de la question de l'unité et de la variété, enrichissant ainsi sa vision empiriste et pluraliste du monde, opposée au rationalisme moniste de Hegel.

Resumen Este ensayo toma el método del racional desarreglo de todos los sentidos del poeta Arthur Rimbaud como punto de partida para una reflexión sobre la relación entre la razón y el afecto, y un posible diálogo con la noción del sentimiento de la racionalidad del psicólogo y filósofo William James, bajo la perspectiva teórico-metodológica del constructivismo semiótico-cultural en psicología. El experimento de la inhalación de óxido nitroso de James se aborda como una experiencia de desarreglo de los sentidos que le proporcionó una comprensión de la unidad y la variedad, contribuyendo a enriquecer su cosmovisión empirista y pluralista en oposición al racionalismo monista de Hegel.

Trayectorias del pensamiento crítico social y ambiental en la investigación. Caso Maestría de Desarrollo Sostenible y Medio Ambiente / Trajectories of critical social and environmental thinking from the investigation. Master's case of Sustainable Development and Environment / Trajetórias de pensamento social e ambiental crítico na pesquisa. Caso do Mestrado em Desenvolvimento Sustentável e Meio Ambiente

RESUMEN Se presentan los resultados del estudio documental que tuvo como objetivo interpretar las trayectorias del pensamiento crítico social y ambiental en las tesis de la Maestría en Desarrollo Sostenible y Medio Ambiente de la Universidad de Manizales. La metodología utilizada fue cualitativa con alcance interpretativo, para lo cual se empleó la revisión sistemática de literatura y el análisis categorial como recursos metodológicos; las fases de la investigación fueron la exploración y el análisis documental de 76 tesis desarrolladas entre 2007 y 2018, con una organización en dos categorías: la racionalidad social y la racionalidad ambiental. Respecto a la racionalidad social se encontró un enfoque del desarrollo humano a partir de la postura de los investigadores para el examen crítico de sí mismo y de las propias tradiciones, la habilidad para un pensamiento desde la diversidad y la pluralidad y la necesidad de entender los sufrimientos ajenos. Y en la racionalidad ambiental, los investigadores demuestran su postura en torno a la racionalidad sustantiva, teórica, técnica y cultural para identificar y reducir las problemáticas ambientales. Se idéntico la línea del pensamiento lógico disciplinar para posteriores estudios.

ABSTRACT The results of the documentary study that aimed to interpret the trajectories of critical social and environmental thought in the theses of the Master's Degree in Sustainable Development and Environment at the University of Manizales are presented. The methodology used was qualitative with an interpretative scope, for which the systematic literature review and categorical analysis were used as methodological resources; the phases of the research were the exploration and documentary analysis of 76 theses developed between 2007 to 2018; with an organization in two categories: social rationality and environmental rationality. Regarding social rationality, an approach to human development was found from the position of researchers for the critical examination of themselves and their own traditions, the ability to think from diversity and plurality and the need to understand the sufferings of others. And in environmental rationality, researchers show their position around substantive, theoretical, technical and cultural rationality to identify and reduce environmental problems. The line of disciplinary logical thought was identical for later studies.

RESUMO Apresentamos os resultados do estudo documental que visou interpretar as trajetórias do pensamento crítico social e ambiental nas teses do Mestrado em Desenvolvimento Sustentável e Meio Ambiente da Universidade de Manizales. A metodologia utilizada foi qualitativa com escopo interpretativo, para a qual a revisão sistemática da literatura e a análise categórica foram utilizadas como recursos metodológicos; as fases da pesquisa foram a exploração e análise documental de 76 teses desenvolvidas entre 2007 e 2018, com uma organização em duas categorias: racionalidade social e racionalidade ambiental. Com relação à racionalidade social, encontramos uma abordagem do desenvolvimento humano baseada na postura dos pesquisadores para o exame crítico de si mesmos e de suas próprias tradições, a capacidade de pensar a partir da diversidade e pluralidade e a necessidade de compreender o sofrimento dos outros. E na racionalidade ambiental, os pesquisadores demonstram sua posição sobre a racionalidade substantiva, teórica, técnica e cultural para identificar e reduzir as questões ambientais. A linha de pensamento lógico disciplinar é identificada para estudos futuros.

The impact of attitudes on behavioural change: a multilevel analysis of predictors of changes in consumer behaviour / El impacto de las actitudes en el cambio comportamental: un análisis multinivel de los predictores de los cambios en el comportamiento del consumidor

Abstract Introduction/objective: The paper sought to identify the predictor variables of changes in habits and behaviours of responsible consumption in students of Pedagogy of History and Geography in the city of Temuco, Chile. Method: The sample comprised of 110 students divided into an experimental (n = 68) and a control (n = 42) group. Pre-and post-intervention measurements were considered, within the framework of a pilot financial education programme for students of Pedagogy of History and Geography. Analyses included Multilevel Mixed Effects Analyses, which evaluated the predicting power of attitudes towards purchasing, materialism, self-discrepancy and levels of financial literacy regarding behavioural change in responsible consumption. Results: The results set forth rationality (a subscale of attitudes toward purchasing), and centrality (a subscale of materialism) as significant predictors of behavioural changes in purchasing. Conclusions: These results suggest guidelines for interventions to promote responsible consumption in university students.

Resumen Introducción/objetivo: Este artículo buscó identificar las variables predictoras de los cambios en hábitos y conductas de consumo responsable en estudiantes de Pedagogía en Historia y Geografía en la ciudad de Temuco, Chile. Método: La muestra se conformó por 110 estudiantes divididos en un grupo experimental (n = 68) y uno control (n = 42). Se consideraron mediciones pre y post intervención, en el marco de un programa piloto de educación financiera para estudiantes de Pedagogía en Historia y Geografía. Se incluyeron análisis de efectos mixtos multinivel, que evaluaron el poder de predicción de las actitudes hacia la compra, el materialismo, la discrepancia del yo, y los niveles de alfabetización financiera sobre el cambio en las conductas de consumo responsable. Resultados: Los resultados mostraron que racionalidad (una subescala de las actitudes hacia la compra) y centralidad (una subescala de materialismo) son los predictores significativos de los cambios comportamentales en la compra. Conclusiones: Estos resultados sugieren posibles pautas de intervención para promover el consumo responsable en estudiantes universitarios.

Discussion on rationality of Yinpian commodity grades--Sophora flavescentis as an example / 中国中药杂志

In recent years, the establishment of the commercial grade of Yinpian [traditional Chinese medicine(TCM) pieces for decoction] in the TCM industry has been hotly disputed. In this article, Sophorae Flavescentis Radix(SFR) was selected as a representative example to investigated. Through systematic comparison and analysis, the different grades of SFR slices were traced, verified and evaluated. According to the current published local grade standards of SFR slices, the results showed that the first-class of SFR slices were mostly derived from the wild medicinal materials, the second-class were mostly originated from the cultivated materials in 3-4 years, and the third-class products were from a small number of lateral roots and short-growing years or harsh habitat of wild medicinal materials. On the basis of identifying the sources of different grades of SFR slices, the contents of the active components, including matrine, oxymatrine, oxysophocarpine, sophoridine, N-methyl-cytisine, sophocarpine, were quantitatively determined in typical samples, it was found that the grades were inversely proportional to the contents of active ingredients. In order to ensure the universality of the conclusion, the contents of different grades of commercial SFR slices were determined, and the conclusion was verified as "the commercial grades of SFR slices were inversely linked to their contents of active ingredients". This phenomenon is common in the determination of the commercial grade of Yinpian of radix and rhizome. Therefore, we propose that the method or standard of the commercial grade of Yinpian of radix and rhizome based on the size of Yinpian maybe not proper. Whether and how to classify Yinpian commercial grade is not only a multi-disciplinary issue, especially in combination with clinical efficacy, but also a big problem need to consider the production, commercial circulation and other processes link of quality risk and quality assurance, and should be treated with great caution.

Exploration on rationality evaluation approach of drug combination medication based on sequential analysis and machine learning / 中国中药杂志

Drug combination is a common clinical phenomenon. However, the scientific implementation of drug combination is li-mited by the weak rational evaluation that reflects its clinical characteristics. In order to break through the limitations of existing evaluation tools, examining drug-to-drug and drug-to-target action characteristics is proposed from the physical, chemical and biological perspectives, combining clinical multicenter case resources, domestic and international drug interaction public facilities with the aim of discovering the common rules of drug combination. Machine learning technology is employed to build a system for evaluating and predicting the rationality of clinical drug combinations based on "drug characteristics-repository information-artificial intelligence" strategy, which will be debugged and validated in multi-center clinical practice, with a view to providing new ideas and technical references for the safety and efficacy of clinical drug use.

Effects of Pharmaceutical Management Intervention on Clinical Use of TCM Injection in Primary Medical Insti- tutions / 中国药房

OBJECTIVE：To investigate the effects of pharmaceutical management intervention on the use of TCM injection in primary medical institutions. METHODS ：Twenty grass-roots health centers in Yichun city ，Jiangxi province were randomly selected. Relying on Department of Pharmacy and Health Services of the Municipal Health Committee and the Quality Control Center for Pharmacy Affairs of the City ，Yichun People ’s Hospital took the lead in establishing the prescription evaluation criteria for TCM injection ，training pharmaceutical service skills ，conducting special reviews on prescriptions/medical orders ，improving control measures ，obtaining relevant data of drug use in primary health centers by issuing questionnaires on the use of TCM injection and randomly selecting prescriptions/medical orders for comments. The relevant data without drug administration （before intervention）from Jan. to Jun. 2018 were taken as the non-intervention group ，and the relevant data with drug administration （after intervention）from Jan. to Jun. 2019 were taken as the intervention group. The use of TCM medicine injection ，DDDs，DDC and sequencing ratio were compared before and after intervention. At the same time ，the prescriptions/medical orders of TCM injections before（1 222 copies）and after （1005 copies）intervention were randomly selected for comment and the reasonable situations of the prescriptions/medical orders were compared before and after the intervention. RESULTS ：After intervention ，total amount ， consumption sum and DDDs of top 10 TCM injections in the list of amount were significantly decreased. The reasonable rate of prescriptions and medical orders was 48.04％ before intervention ， but increased to 70.65％ after intervention. Besides ， unreasonable situations before and after intervention all manifested as inappropriate indications. After the intervention ，the unreasonable rates of Xuesaitong powder for injection （lyophilized），Xueshuantong injection ，Xingnaojing injection （two specifications），Shengmai injection ，Xueshuantong for injection （lyophilized）and Qingkailing injection were significantly lower than before intevention （P＜0.05）. CONCLUSIONS ：Pharmaceutical administration intervention can reduce the total amount and the consumption sun of TCM injection in primary medical institutions ，and promote rational drug use in the clinic.