Ethics in infectious diseases: latent challenges. Part I / Ética en enfermedades infecciosas: retos latentes. Parte I

Abstract Infectious diseases socially imply individual and community medical problems. Therefore, they require actions aimed at social processes that affect the well-being of the individuals without losing sight of social groups. Faced with this panorama, we ask ourselves: is there a direct relationship between ethics and infectious diseases? To elucidate an answer, let us remember the peak period of the COVID-19 pandemic when guidelines based on ethical principles were issued to facilitate medical decisions on allocating scarce resources in periods of maximum demand. In those moments, since there was no inclusive component of society, the decisions made produced massive criticism. The reactions demonstrated the need to analyze in detail the criteria that had been considered correct. Consequently, we affirm that bioethical principles are transcendental in medical decisions and must be examined, not only for the individual but also with a view to public health. Moreover, the acquired immunodeficiency syndrome (AIDS) epidemic has lived with us for decades, and it continues to show its tragic face in the form of new cases, chronic illnesses, and deaths. Joint United Nations Programme on HIV/AIDS brings us closer to a complex reality where the fight against disease and global health are interrelated with other problems, such as the need to reduce inequality, for which human rights, gender equality, social protection, and the development of research projects, where the ethics committees in research in community processes are constituents.

Resumen Las enfermedades infecciosas implican problemas médicos individuales y comunitarios, por lo que requieren acciones dirigidas a procesos sociales que incidan en el bienestar de los individuos, sin perder de vista a los grupos sociales. Nos preguntamos: ¿existe relación directa entre la ética y las enfermedades infecciosas? Para dilucidar una respuesta, recordemos el periodo más álgido de la pandemia por COVID-19, cuando se emitieron guías fundamentadas en principios éticos para facilitar las decisiones médicas en la asignación de recursos escasos en periodos de máxima demanda. Al no haber un componente inclusivo con la sociedad, las decisiones que se tomaron produjeron críticas masivas, que demostraron la necesidad de analizar a detalle los criterios que se habían considerado correctos. En consecuencia, afirmamos que los principios bioéticos son trascendentales en las decisiones médicas y deben ser examinados, no solo frente al individuo, sino de cara a la salud pública (bien común e individualidad). Por otra parte, la epidemia del SIDA (síndrome de inmunodeficiencia adquirida) convive con nosotros desde hace décadas. ONUSIDA (Programa Conjunto de las Naciones Unidas sobre el VIH/SIDA) nos acerca una realidad compleja, como es que la lucha contra la enfermedad y por la salud global se interrelaciona con otros problemas como la necesidad de reducer la desigualdad, por los derechos humanos, la igualdad de género, la protección social y el desarrollo de proyectos de investigación, donde los comités de Ética en investigación en procesos comunitarios son constituyentes.

Cross-sectional study of individual and environmental factors associated with life-space mobility among community-dwelling independent older people

BACKGROUND@#Life-space mobility is reflected in comprehensive longevity and health outcomes and is also an important indicator for preventing mortality and decline in well-being among older people. However, a comprehensive framework of life-space mobility and modifiable individual and environmental factors has not been well validated among community-dwelling independent older people, for primary prevention. We examined individual and environmental factors affecting life-space mobility among community-dwelling independent older people.@*METHODS@#This cross-sectional study included 3500 community-dwelling independent older people randomly selected using the National Basic Resident Registration System in Japan. Life-space mobility was measured using the Japanese version of the Life-Space Assessment (LSA) instrument, which is used to assess an individual's pattern of mobility. Negative multivariate binomial regression analysis was performed in a final sample of 1258 people. Individual factors (including physical, mental, and social characteristics) and environmental factors (including the social and material environment) were measured and analyzed as potential factors.@*RESULTS@#Negative multivariable binomial regression analysis, adjusted for demographics, showed that LSA score was associated with locomotive syndrome (β = - 0.48, 95% confidence interval [CI] = - 0.24 to - 0.73), depression (β = - 0.29, 95% CI = - 0.03 to - 0.55), health literacy (β = 0.20, 95% CI = 0.39-0.01), and participation in community activities (β = 0.23, 95% CI = 0.03-0.43) among individual factors, and receipt of social support (β = - 0.19, 95% CI = 0.00 to - 0.38) and social network (β = 0.29, 95% CI = 0.48-0.10) among environmental factors.@*CONCLUSIONS@#Our findings suggest that modifiable individual factors and environmental factors are related to life-space mobility among community-dwelling older people.

Anti-vacinação, um movimento com várias faces e consequências / Anti-vaccination, a movement with multiple faces and its consequences

The anti-vaccination movement has gained worldwide strength despite the undeniable advances in vaccines in drastically reducing the incidence of contagious diseases. The causes for this breakthrough are still issues of discussion and research, but ignorance, ease of dissemination of false information, and the rise of populist policies have been implicated. The major challenge for the future will be the dichotomy between the interest of public health and individual freedoms. (AU).

El movimiento contra la vacunación ha ganado fuerza en todo el mundo a pesar de los innegables avances en las vacunas para reducir drásticamente la incidencia de enfermedades contagiosas. Las causas de este avance aún son temas de discusión e investigación, pero la ignorancia, la facilidad de difusión de información falsa y el auge de las políticas populistas han sido implicados. El principal desafío para el futuro será la dicotomía entre el interés de la salud pública y las libertades individuales. (AU).

O movimento anti-vacinação tem ganhado força no mundo inteiro, apesar dos inquestionáveis avanços obtidos com as vacinas na redução drástica da incidência das doenças contagiosas. As causas para este avanço ainda são temas de discussão e pesquisa, mas a ignorância, a facilidade da disseminação de informações falsas e a ascensão de políticas populistas têm sido implicadas. O grande desafio para o futuro será a dicotomia entre o interesse da saúde pública e as liberdades individuais. (AU).

O ódio primário e os processos de individualização / Primary hatred and individualization processes / El odio primario y los procesos de individualización / La haine primaire et les processus d'individualisation

O artigo desenvolve a ideia da existência de um ódio primário e estruturante, a partir dos conceitos freudianos concernentes à segunda tópica, principalmente os conceitos de pulsão de vida e pulsão de morte. Acrescentam-se contribuições de André Green e de outros autores sobre os processos de ligação e desligamento, relacionando as frustrações decorrentes do desencontro entre a demanda do bebê e o desejo materno, com o incremento de angústias do início da vida que repercutirão no destino das pulsões e na vida do sujeito. Por um lado, a pulsão de vida gera ligações e desperta o desejo, estando na base dos processos identificatórios. Por outro, a pulsão de morte, atenuada pelas ligações a representações, será expressa por desejos destrutivos em relação ao objeto. Chamamos esse processo de ódio primário, e entendemos que ele contribuiria, de maneira não menos importante, para o processo inicial de individualização. Se as ligações do ser com o objeto estabelecem a identidade (ser idêntico), os processos relacionados à destrutividade fornecem as marcas psíquicas para a construção da individualidade (aquilo que não se divide).

Drawing on Freudian concepts concerning the second topic, and particularly the concepts of life drive and death drive, this paper develops the idea of existence of a structuring primary hatred. Additional contributions include views by André Green and others on attachment and detachment processes, where frustrations arising from the mismatch between the baby's demands and maternal desire are related with an increase in early life anxieties that will have impacts on the fate of drives and the subject's life. The life drive generates connections and awakens desire, being at the base of identificatory processes. On the other hand, the death drive, being attenuated by its connections with representations, will be expressed as destructive desires toward the object. Having termed this process "primary hatred," we understand it as contributing, no less importantly, to establishing the early individualization process. While the bonds between being and object establish an identity-i.e., being identical-the processes related to destructiveness provide the psychic marks for the construction of individuality- i.e., the indivisible.

El artículo desarrolla la idea de la existencia de un odio primario y estructurante, a partir de los conceptos freudianos concernientes a la segunda tópica, principalmente los conceptos de pulsión de vida y pulsión de muerte. Añadimos contribuciones de André Green y otros autores, sobre los procesos de conexión y separación, relacionando las frustraciones derivadas del desencuentro entre la demanda del bebé y el deseo materno, con el incremento de angustias del inicio de la vida que repercutirán en el destino posterior de las pulsiones y en la vida del sujeto. Por un lado, la pulsión de vida genera vínculos y despierta el deseo, estando en la base de los procesos de identificación. Por otro, la pulsión de muerte, atenuada por las conexiones a representaciones, será expresada por deseos destructivos en relación al objeto. Llamamos a este proceso "odio primario" y entendemos que contribuiría, de forma no menos importante, a establecer el proceso inicial de individualización. Si las conexiones del ser con el objeto establecen la identidad - ser idéntico, los procesos relacionados a la destructividad proporcionan las marcas psíquicas para la construcción de la individualidad - que no se divide.

L'article développe l'idée de l'existence d'une haine primaire et structurante, basée sur les concepts freudiens concernant la deuxième topique, principalement les concepts de pulsion de vie et de pulsion de mort. Nous ajoutons des contributions d'André Green et d'autres auteurs sur les processus de liaison et de déliaison par rapport aux frustrations découlant du déséquilibre entre la demande du bébé et le désir maternel, avec l'augmentation des angoisses du début de la vie, ce qui affectera le destin des pulsions et la vie du sujet. D'une part, la pulsion de vie génère des liens et éveille le désir, étant à la base des processus d'identification. En revanche, la pulsion de mort, atténuée par les liens avec les représentations, s'exprimera par des désirs destructeurs vis-à-vis de l'objet. Nous appelons ce processus "la haine primaire" et nous entendons qu'il contribuerait d'une manière tout autant importante, à établir le processus initial d'individualisation. Si les liens de l'être avec l'objet établissent l'identité - être identique -, les processus liés à la destructivité fournissent les marques psychiques pour la construction de l'individualité - ce qui ne se divise pas.

Research progress and application of 3D printing technology in preparation process / 中草药

With the development of high and new technology, such as material chemistry and computer technology, the formulation process is also constantly innovating and improving. In recent years, 3D printing technology has become a research hotspot in the formulation industry. Different from traditional preparation methods, 3D printing technology can realize personalized production and solve storage problems of drugs. Because of its advantages of simple production, convenient carrying, low cost and strong patient compliance, it may change the design and production mode of drugs in the future and have good development prospects in the field of preparation. This paper reviews principles, the latest research progresses, advantages and challenges of 3D printing by searching CNKI, SCI, Springer databases and collating relevant literatures, and forecasts the development of 3D printing technology in the field of traditional Chinese medicine preparations, aiming to provide some references for the application of the technology in the traditional Chinese medicine preparation industry.

Esquemas de gênero do autoconceito e perfil idiocêntrico-alocêntrico em atletas de futebol / Gender schema of self concept and idiocentric-allocentric profile of soccer athletes / Esquemas de género de autoconcepto y perfil idiocentrico-alocéntrico de jugadores de fútbol

O objetivo do presente estudo foi analisar diferenças entre as posições ocupadas em campo por jogadores de futebol com relação à classificação dos esquemas de gênero do autoconceito e do perfil Idiocêntrico-Alocêntrico, e os fatores que compõem ambos os construtos. Participaram do estudo 152 atletas homens com idade entre 14 e 20 anos. Foram avaliados os esquemas de gênero e perfil idiocêntrico-alocêntrico. A estatística utilizada foi o teste de Qui Quadrado, Exato de Fisher e Kruskall-Wallis e Teste Dunn. Quanto aos resultados, o grupo se caracterizou como isoesquemático e isocêntrico, sem diferenças significantes entre as posições. Entretanto, ressalta-se que em relação à distância emocional da equipe, os meios-campistas diferiram dos atacantes. Conclui-se que os atletas estudados se apresentam de forma geral como isoesquemáticos e isocêntricos, com algumas peculiaridades no que diz respeito a fatores que compõem sua personalidade.

The aim of this study was to analyze differences between the positions occupied in the field by football players regarding the classification of gender schemas of self and Idiocentric-Alocentric profile, and the factors that make up both constructs. Participated in the estudo152 male athletes aged between 14 and 20 years. We evaluated gender schemas and idiocentric--allocentric profile. The statistic used was the chi square test, Fisher's exact and Kruskall Wallis with Dunn posthoc. As for the results the group was characterized as isoesquematic and isocentric no significant differences between the positions. However, it is emphasized that in relation to the emotional distance of the team the midfielders differed from the attackers. : We conclude that the studied athletes present in a general way isoesquematics and isocentric, with some peculiarities regarding the factors that make up your personality.

El objetivo de este estudio fue analizar las diferencias entre las posiciones ocupadas en el campo de los jugadores de fútbol en cuanto a la clasificación de los esquemas de género de autoconcepto y perfil idiocéntrico-alocéntrico y los factores que componen ambas construcciones. Participó en los estudo 152 atletas varones de edades comprendidas entre los 14 y los 20 años. Se evaluaron esquemas de género y el perfil idiocentrico-alocéntrico. El estadístico utilizado fue la prueba de chi cuadrado, prueba exacta de Fisher y Kruskall Wallis con post hoc de Dunn. En cuanto a los resultados del grupo se caracterizó por ser isoesquemático y isocéntrica no hay diferencias significativas entre las posiciones. Sin embargo, se resalta que en relación a la distancia emocional del equipo los medios campistas diferían de los atacantes. : Se concluye que los atletas estudiados presentan de una manera general y isoesquemáticos isocéntricos, con algunas peculiaridades con respecto a los factores que conforman su personalidad.

Extraversion/introversion and age-related differences in speed-accuracy tradeoff / Diferenças de extroversão/introversão e idade na troca velocidade-precisão / Diferencias de extroversión/introversión y edad en el cambio velocidad-precisión

ABSTRACT Introduction: Extraversion/introversion and age differences might influence speed-accuracy tradeoff. Objective: The speed-accuracy tradeoff was investigated in extroverted and introverted female children, young adults and older adults. Method: Participants carried out an alternative version of Fitts' task, which involved making alternate clicks with the mouse held in the dominant hand, moving as fast as possible, on two rectangular targets on a computer screen in order to make twelve attempts at six random levels of difficulty (twelve combinations of target widths and distances between targets). Each of the three groups was composed of 16 introverted and 16 extroverted subjects, based upon Brazilian versions of Eysenck's questionnaire. Results: Elderly introverts fell short of the target more often and committed more overall errors than the elderly extroverts. Additionally, compared to their younger adult counterparts, the elderly subjects fell short of the target more often and committed more overall errors, besides taking longer to complete the task with higher levels of difficulty. Conclusion: The findings were interpreted in light of theories designed to explain the main processes underlying extroversion/introversion and age-related differences. Level of Evidence II; Lesser quality prospective study.

RESUMO Introdução: Diferenças de extroversão/introversão e idade podem influenciar na troca velocidade-precisão. Objetivo: A troca velocidade-precisão foi investigada em garotas, jovens adultas e idosas extrovertidas e introvertidas. Método: As participantes realizaram uma versão alternativa da tarefa de Fitts, a qual consistia em clicar alternadamente com a mão dominante no mouse, o mais rápido possível, em dois alvos retangulares na tela do computador, a fim de fazer doze tentativas em seis níveis aleatórios de dificuldade (doze combinações de larguras e distâncias entre os alvos). Cada um dos três grupos era composto por 16 introvertidas e 16 extrovertidas, com base nas versões brasileiras do questionário de Eysenck. Resultados: As idosas introvertidas acertaram menos o alvo com mais frequência e cometeram mais erros gerais em comparação às idosas extrovertidas. Ainda, as idosas acertaram menos o alvo com mais frequência e cometeram mais erros gerais, além de demorarem mais tempo para concluírem as tarefas com níveis maiores de dificuldade quando comparadas com as jovens adultas. Conclusão: Os achados foram interpretados com base nas teorias criadas para explicarem os principais processos sobre as diferenças relacionadas à extroversão/introversão e à idade. Nível de Evidência II; Estudo prospectivo de menor qualidade.

RESUMEN Introducción: Las diferencias de extroversión/introversión y edad pueden influir en el cambio velocidad-precisión. Objetivo: El cambio velocidad-precisión fue investigado en mujeres jóvenes adultas y de la tercera edad introvertidas y extrovertidas. Método: Las participantes realizaron una versión alternativa de la tarea de Fitts, que consistía en hacer clic alternadamente con el ratón, usando la mano dominante, lo más rápidamente posible, en dos objetos rectangulares en la pantalla de la computadora, a fin de realizar doce tentativas con seis niveles aleatorios de dificultad (doce combinaciones de anchos y distancias entre los objetos). Cada uno de los tres grupos fue compuesto por 16 introvertidas y 16 extrovertidas, con base en las versiones brasileñas del cuestionario de Eysenck. Resultados: Las mujeres de tercera edad introvertidas acertaron menos el objeto con más frecuencia y cometieron más errores generales en comparación a las mujeres de tercera edad extrovertidas. Además, las mujeres de tercera edad acertaron menos el objeto con más frecuencia y cometieron más errores generales, además de demorar más tiempo para concluir las tareas con niveles mayores de dificultad cuando comparadas con las mujeres jóvenes adultas. Conclusión: Los hallazgos fueron interpretados con base en las teorías creadas para explicar los principales procesos sobre las diferencias relacionadas a la extroversión/la introversión y a la edad. Nivel de Evidencia II; Estudio prospectivo de menor calidad.

Individualidade moderna como particularidade / Modern individuality as particularity / Individualidad moderna como particularidad

Resumo O objetivo do ensaio é apresentar a proposição segundo a qual a individualidade moderna se coloca como uma categoria particular que medeia, na prática concreta dos homens, a relação entre os indivíduos concretos e a generidade ( Gattungsmässigkeit ) . Apresenta-se, assim, a individualidade moderna como exercitação do egoísmo racional sobretudo na personificação de categorias econômicas. Essa exercitação tendencial em bases de uma sociabilidade capitalista coabita com contratendências, o que permite apreender a individualidade concreta em constante assentamento tensionado com tendências da individualidade moderna por efeito sobretudo da compulsão econômica regente da sociabilidade presente.

Abstract The objective of this essay is to argument the modern individuality is a particular category which mediates through men's practical action, the relationship between concrete individuals and species-in-itself ( Gattungsmässigkeit ). The paper shows the modern individuality as the rational egoism exercitation, specially into economic categories. This tendential exercitation cohabits with countertendencies, which allows apprehend the concrete individuality in a constant tensioned putting with modern individuality tendencies as an effect of economic compulsion which rules the present sociability.

Resumen El objetivo del ensayo es presentar la propuesta según la cual la individualidad moderna se coloca como una categoría particular que media, en la práctica concreta de los hombres, la relación entre los individuos concretos y el ser genérico (Gattungsmässigkeit). Se presenta, así, la individualidad moderna como ejercicio del egoísmo racional, sobre todo en la personificación de categorías económicas. Este ejercicio tendencial sobre bases de una sociabilidad capitalista cohabita con contra-tendencias, lo que permite asimilar la individualidad concreta en constante asentamiento tensionado con tendencias de la individualidad moderna por efecto, sobre todo, de la compulsion económica reactiva de la sociabilidad presente.

Cuidado de enfermagem na perspectiva do sujeito do inconsciente e sua contribuição ao Projeto Terapêutico Singular / Nursing care based on the perspective of the subject of the unconscious and its contribution to the Singular Therapeutic Project / Cuidado de enfermería pautado en la perspectiva del sujeto del inconsciente y su contribución al Proyecto Terapéutico Singular

OBJETIVO: construir uma proposta de cuidado de enfermagem a partir da leitura do sujeito do inconsciente, por meio do método da Construção de Caso Clínico em Saúde Mental, apontando sua contribuição para o Projeto Terapêutico Singular. MÉTODO: realizou-se a construção de caso clínico de um paciente frequentador de um Centro de Atenção Psicossocial da rede municipal de saúde de Campinas. RESULTADOS: foram ordenados, por cotejamento, os principais significantes do discurso do sujeito, da família e da instituição. CONCLUSÃO: o cuidado de enfermagem ao paciente psicótico, fundamentado na singularidade, possibilita construir novos efeitos terapêuticos, pode favorecer que o paciente retome sua posição de sujeito e traz a contribuição do enfermeiro ao Projeto Terapêutico Singular.

OBJECTIVE: to build a proposal of nursing care from the perspective of the subject of the unconscious through the method of the Construction of Clinical Case in Mental Health and pointing out its contribution to the elaboration of the Singular Therapeutic Project. METHOD: the clinical case of a patient attending a CAPS of the municipal health services of Campinas was carried out. RESULTS: the main signifiers of the subject, family and institution discourse were ordered by collation. CONCLUSION: Nursing care for the psychotic patient based on the singularity allows the construction of new therapeutic effects, which may favor the restoration of the patient in his position of subject and bring the nurse's contribution for the Singular Therapeutic Project.

OBJETIVO: construir propuesta de cuidado de enfermería a partir de la lectura del sujeto del inconsciente por el método de la Construcción de Caso Clínico en Salud Mental y señalar su contribución en elaborar el Proyecto Terapéutico Singular. MÉTODO: se realizó la construcción de caso clínico de un paciente frecuentador de un CAPS de la red municipal de salud de Campinas. RESULTADOS: fueron ordenados, por el cotejo, los principales significantes del discurso del sujeto, de la familia y la institución. CONCLUSIÓN: El cuidado de enfermería al paciente psicótico fundamentado en la singularidad posibilita la construcción de nuevos efectos terapéuticos, pudiendo favorecer la reanudación del paciente en su posición de sujeto y aporta la contribución del enfermero al Proyecto Terapéutico Singular.

Conflict and desire into question: The tension of individualization in couple relationship experience in Chilean young adults / Sin conflicto y sin deseo: las tensiones de la individualización en la experiencia de pareja de jóvenes chilenos

Resumen Este artículo busca conocer y comprender las tensiones en las dimensiones de amor, sexualidad e intimidad en la experiencia de pareja en jóvenes hombres y mujeres de nivel socioeconómico medio y bajo, residentes en la ciudad de Santiago de Chile. La sociedad chilena ha vivido importantes transformaciones sociales y culturales que han impactado las formas de parentesco, en particular, las relaciones de pareja. Desde una perspectiva fenomenológico-hermenéutica, se analizaron e interpretaron los relatos de vida y el material recogido mediante grupos focales de hombres y mujeres entre 18 y 25 años. Los resultados evidencian tensiones y ambivalencias en el lugar dado al otro de la pareja en jóvenes chilenos. Los quiebres de los mandatos sobre la pareja, vinculados a la experiencia del conflicto, dependencia y deseo sexual, implican el despliegue de estrategias de regulación que tienden a minimizar las diferencias ya sea a través de la comunicación que intenta hacer transparente el mundo interno al otro, la evitación del conflicto o la suspensión de la relación.

Abstract This paper intends to learn and understand tensions in love, sexuality, and intimacy dimensions according to the experience of couples ranked in middle and low socioeconomic status, which inhabit in Santiago de Chile. Chilean society has gone through significant social and cultural changes that have had an impact on kinship forms, especially in couple relationships. From a phenomenological and hermeneutic perspective, life narratives and material collected from focus groups of men and women between 18 and 25 years old were analyzed. Results evidenced pressure and ambivalence in regards to the Chilean young´s conception about the role of the other. Breakdowns in couple agreements, associated with conflict, dependence, and sexual desire involve in motion of regulatory strategies tending to minimize differences, either through communication, that might see through the other's inner world, or conflict avoidance, or the end of the relationship.

Meta analysis of three-dimensional printing patient-specific instrumentation versus conventional instrumentation in total knee arthroplasty / 中华外科杂志

Objective@#To evaluate the effects of three-dimensional printing patient-specific instrumentation(PSI) versus conventional instrumentation(CI) in the total knee arthroplasty.@*Methods@#According to "patient-specific" , "patient-matched" , "custom" , "Instrumentation" , "Guide Instrumentation" , "cutting blocks" , "total knee arthroplasty" , "total knee replacement" , "TKA" and "TKR" , the literature on PubMed, EMbase, Cochrane library, CBM and WanFang were searched. According to the inclusion and exclusion criteria, the high quality randomized control trial (RCT) studies about three-dimensional (3D) printing patient-specific instrumentation versus conventional instrumentation in the total knee arthroplasty were collected. The post-operative limb mechanical axis outlier, the position of the components outlier, post-operative knee function, operative time, post-operative blood transfusion and complications were analyzed by RevMan 5.3 software.@*Results@#A total of 13 high quality RCT studies were included. The results of Meta-analysis show that there were no statistical differences in the post-operative limb mechanical axis outlier(Z=0.55, P=0.58, 95% CI: 0.78 to 1.56), femoral coronal component outlier(Z=0.38, P=0.71, 95% CI: 0.69 to 1.72), tibia coronal component outlier(Z=1.95, P=0.05, 95% CI: 1.00 to 3.38), femoral rotation angle outlier(Z=0.36, P=0.72, 95% CI: 0.49 to 1.64), post-operative knee function(Z=1.18, P=0.24, 95% CI: -0.66 to 2.63), post-operative blood transfusions(Z=0.74, P=0.46, 95% CI: -0.10 to 0.05) and complications(Z=0.18, P=0.86, 95%CI: -0.07 to 0.05) between the PSI group and the CI group. But there are statistical differences in the operation time(Z=2.66, P=0.01, 95% CI: -15.97 to -2.41)and tibia sagittal component outlier (Z=3.69, P=0.00, 95% CI: 1.43 to 3.18)between the PSI group and the CI group.@*Conclusions@#In the primary total knee arthroplasty the PSI is not superior over the CI for the knee without severe knee varus or valgus deformity or contracture deformity, without the deformity around the knee and without the knee bone loss and obesity. The use of PSI in the primary total knee arthroplasty are not recommend.

An Intervention Model to Help Clients to Seek Their Own Hope Experiences: The Narrative Communication Model of Hope Seeking Intervention / 한국호스피스완화의료학회지

The paper describes The Narrative Communication Model of Hope Seeking Intervention developed by the authors as an approach to help clients to have individually specific hope experiences. The Model is founded upon the existential conceptualization of hope that views hope as subjective, unique experiences of meaning and processes. The Model has been developed based on the findings both in the literature and the authors' work on the nature of hope and hope experiences and integrating the concept of hope as subjective meanings and experiences, the processes of story-telling and the concept of narrative configuration as a way to engage in person-specific experiences, and person-centered communication. The results of the experiences with the application of the model in a study are used to clarify the model further. The Model incorporating story-telling and narrative construction through person-centered communication is identified in three components–the story-telling, the narrative intervention, and the communication components. These components are processed as an intervention to culminate into person-specific hope experiences in which active participation of clients as the story-teller and of interventionist as the communicative facilitator is required to produce narratives of hope with individual specific thematic plots that become the basis for hope experiences. The application of the Model has shown positive outcomes in clients with successful seeking of own hope experiences. The success of the Model application seems to depend upon interventionists' understanding of the model and the competency with the application of person-centered communication strategies.

A novel integrated patient specific instrumentation system and its application for total knee arthroplasty / 中华骨科杂志

Objective To study the accuracy of preoperative planning and postoperative satisfaction of prosthesis posi?tion by applying the personal surgical cutting guide (PSCG) to total knee arthroscopy (TKA) based on 3D printing technique. Meth?ods In this randomized study, 20 patients were selected from August 2014 to October 2015, who were randomly divided into two groups. In PSCG group, 4 males and 6 females were enrolled, with a mean age of 70.9±6.69 (from 59 to 78) years. In con?ventional instrumentation group, 2 males and 8 females were enrolled, with a mean age of 69.9 ± 6.35 (from 58 to 77) years. The conventional instrumentation group was treated with conventional TKA, while the PSCG group was treated with personal surgical cutting guides. Then the knee valgus angle of patients, the angle between prosthesis components on the coronal and the sagittal plane of two groups were evaluated. Subsequently the correlation of the actual osteotomy amount, the valgus angle, caster angle, external rotation angle between intra? and preoperative planning were compared in the PSCG group. Results Compared with the ideal value of each angle, the mean deviation of the hip?knee?ankle angle 0.77°±0.51°, frontal femoral compo?nent angle 0.37° ± 0.53° and frontal tibial component angle 0.11° ± 0.24° showed statistically significant difference between two groups (P0.05). The actual osteotomy amount, the valgus angle, caster angle, external rotation angle corre?lated well between intra?and preoperative planning (t=-2.547, 3.864, 0.537,-0.040,-1.290, P>0.05). Conclusion TKA assist?ed by PSCG can make lower extremity alignment and accuracy of prosthesis implantation more accurate compared with convention?al TKA, especially in hip?knee?ankle angle, frontal femoral component angle and frontal tibial component angle.

Principios filosóficos de la homeopatía / Philosophical principles of homeopathy

De una manera clara, directa y muy didáctica, los autores de este trabajo realizan un recorrido por los principios que configuran la estructura de la filosofía homeopática, rescatando muchos de los conceptos inscritos en algunas de las obras literarias del célebre Higinio G. Pérez, fundador de la Escuela Libre de Homeopatía, y del fisiólogo norteamericano Walter Bradford Cannon, los cuales, por supuesto, son coincidentes con muchos de los preceptos hipocráticos y hahnemaniannos. Para complementar su análisis, los investigadores refieren las opiniones de algunos otros científicos (fisiólogos y biólogos) y citan de manera textual diversos parágrafos del doctor Samuel Hahnemann, al tiempo que expresan su opinión sobre la vigencia de dichas premisas en la época moderna...

In a clear direct and very didactic manner the authors of this paper perform a journey by the principles that configure the philosophical structure of homeopathy, recovering many of the concepts written in various of the literary works of the notorious physician Higinio G. Pérez, founder of the Homeopathic Free Scholl and from the north American physiologist Walter Bradford Cannon, which of course, are coincidental with most of the Hippocratic an Hanemanniann precepts. In order to complete their analysis, these researchers refer the opinions of some other scientists (Physiologist and Biologists) and quoted verbatim various paragraphs of Dr. Samuel Hahnemann, at the same time, that they state their personal opinion on the validity of these assumptions in modern times...

Unicismo, Pluralismo y Complejismo / Unicism, Pluralism and complexism

Durante mucho tiempo se ha discutido a veces acaloradamente acerca de la manera más adecuada de prescribir un medicamento homeopático. El reconocido médico Tarsicio Escalante describe de manera muy clara lo que es la prescripción unicista, la pluralista y la complejista, y acepta que el médico homeópata debe ser reconocido como tal, independientemente de la modalidad que haya elegido, “siempre y cuando tenga el cuidado de administrar como factor curativo al semejante”. El autor expone, asimismo, la posibilidad de que los tres tipos de especialistas mencionados puedan dejar de hacer Homeopatía a pesar de usar el semejante. Si nos referimos a los unicistas, porque existe la duda acerca de la cantidad de veces que se puede dividir la materia y, por lo tanto, incertidumbre acerca de la eficacia del medicamento homeopático. En el caso de los pluralistas, se cuestiona la validez de prescribir varios remedios para cubrir en su totalidad la tipología del paciente; finalmente, cuando se habla de los complejistas se infiere que no hay pruebas contundentes para demostrar que el organismo es capaz de elegir la sustancia más adecuada de entre varios remedios mezclados previamente. El artículo desglosa cómo los unicistas defienden los postulados del doctor Samuel Hahnemann, en el sentido de que recetar más de un medicamento propicia que el efecto de uno de ellos se diluya o desaparezca por completo. Los complejistas, deduce el especialista, podrían acudir al precepto hahnemanniano de la individualidad morbosa y decir que cada enfermo responde de manera diferente y, por tanto, no habría razón para que no surtiera efecto un remedio múltiple. Resulta una realidad, concluye el artículo, que la actitud de los unicistas en contra de los complejistas es tan anticientífica como la que muestran los alópatas que detestan a la Homeopatía. En ambos casos, parecería que se conociera a profundidad el funcionamiento de este método clínico terapéutico.

It has long been discussed, sometimes heatedly, about the best way to prescribe a homeopathic medicine. The renowned doctor, Tarcisio Escalante describes very clearly what the unicist, pluralist and complexist prescription are, and agrees that the homeopath must be recognized as such, regardless of the mode he has chosen, “provided that he has the care of administering the similar as the healing factor”. The author also presents the possibility that the three mentioned types of specialists may stop doing Homeopathy despite using the similar. If we refer to the unicists, because there is doubt about the amount of times you can divide the matter and, therefore, uncertainty about the effectiveness of homeopathic medicine. In thecase of pluralists, the validity of the prescription of several remedies to fully cover the type of patient is questioned; finally, when speaking of complexist it follows that there is no conclusive evidence to show that the body is able to choose the best of the several previously mixed remedies. The articles analyzes how unicists defend the tenets of Dr. Samuel Hahnemann, in the sense that to prescribe more than one drug may cause that the effect of one of them may be diluted or may disappear completely. The complexists, points out the specialist, may look to Hahnemann precepts about morbid individuality and say that each patient responds in a different manner, therefore, there would not be a reason not to take effect a multiple remedy. The article concludes that it is a reality, that the attitude of unicists against complexists is as unscientific as the allopathic attitude of those who detest Homeopathy. In both cases, it seems like it may be known, at a very profound level, the operation of this clinical therapeutic method.

Stochastic developmental variation, an epigenetic source of phenotypic diversity with far-reaching biological consequences.

This article reviews the production of different phenotypes from the same genotype in the same environment by stochastic cellular events, nonlinear mechanisms during patterning and morphogenesis, and probabilistic self-reinforcing circuitries in the adult life. These aspects of phenotypic variation are summarized under the term‘stochastic developmental variation’ (SDV) in the following. In the past, SDV has been viewed primarily as a nuisance, impairing laboratory experiments, pharmaceutical testing, and true-to-type breeding. This article also emphasizes the positive biological effects of SDV and discusses implications for genotype-to-phenotype mapping, biological individuation, ecology, evolution, and applied biology. There is strong evidence from experiments with genetically identical organisms performed in narrowly standardized laboratory set-ups that SDV is a source of phenotypic variation in its own right aside from genetic variation and environmental variation. It is obviouslymediated bymolecular and higher-order epigeneticmechanisms. Comparison of SDV in animals, plants, fungi, protists, bacteria, archaeans, and viruses suggests that it is a ubiquitous and phylogenetically old phenomenon. In animals, it is usually smallest for morphometric traits and highest for life history traits and behaviour. SDV is thought to contribute to phenotypic diversity in all populations but is particularly relevant for asexually reproducing and genetically impoverished populations, where it generates individuality despite genetic uniformity. In each generation, SDV produces a range of phenotypes around a well-adapted target phenotype, which is interpreted as a bet-hedging strategy to cope with the unpredictability of dynamic environments. At least some manifestations of SDV are heritable, adaptable, selectable, and evolvable, and therefore, SDV may be seen as a hitherto overlooked evolution factor. SDV is also relevant for husbandry, agriculture, and medicine because most pathogens are asexuals that exploit this third source of phenotypic variation tomodify infectivity and resistance to antibiotics. Since SDV affects all types of organisms and almost all aspects of life, it urgently requires more intense research and a better integration into biological thinking.

Reference change values and quality standards for thyroid function assay / 国际检验医学杂志

Objective To evaluate the reference change values (RCV),individual indexes of TSH,T4,T3,FT3,and FT4 and the limitations of population-based reference ranges.Furthermore,to determine the quality standards based on the biological varia-tion.Methods Acorrding to intra-and inter-individual biological variations,and analytical variations ,RCV and individual indexes of TSH,T4,T3,free T3,and free T4 were calculated,and analytical variations of quality standards based on biological variation were induced.Results RCV of TSH,T4,T3,FT3,and FT4 is 54.0%,16.8%,26.8%,42.8%,23.8%,respectively.Individ-uality index is 0.78,0.45,0.49,0.47,0.45,respectively,and satisfied analytical variation based on biological variation is less than 9.6%,2.5%,4.4%,2.9%,4.0%,respectively.Conclusion When monitoring thyroid functions,the RCV values should be considered.It is important to recognize population-based reference ranges limitations for use in individuals.Quality standards based on biological variation should be meeted when laboratory analysis of variance is determined.

Spontaneous approach and apparent play solicitation by a young free-living tayra eira barbara (carnivora: mustelidae) in responseto the observer's presence

In a fragment of Atlantic Forest in Eldorado, Mato Grosso do Sul, Central-West Region of Brazil, a juvenile tayra (Eira barbara) spontaneously approached the observer while he was coursing a trail alone. The animal walked in a normal pace and, upon reaching his boots, alternatingly sniffed them and receded afterwards, assuming a posture that much resembles the play bow, a play signal displayed almost exclusively by canids. This is a rare report of a free-living animal that sought interaction with a human in a non-agonistic manner, instead of avoiding it as expected. It may also be one of the few examples of interspecific play in the wild, in case the observed posture was indeed a play bow. Interactions between humans and other animals are usually observed in situations in which the animal is used to the presence of people and often obtains food from these interactions, or when humans are not recognized as threatening by the animal. None of these scenarios seem to explain the observed behavior; individual traits such as boldness or, most likely, exploratoriness, on the other hand, may do so.

Em um fragmento de Mata Atlântica em Eldorado, Mato Grosso do Sul, Centro-Oeste do Brasil, testemunhou-se a aproximação espontânea de uma irara (Eira barbara) jovem ao observador. Ao alcançar suas botas, alternadamente as cheirava e depois recuava, assumindo uma postura muito semelhante ao play bow, utilizado quase exclusivamente por canídeos como sinal de brincadeira. Trata-se de um raro relato em que o animal procurou a interação com o humano de maneira não agonística, ao invés de evitá-la como seria esperado. Pode ser também um dos poucos exemplos de brincadeira interespecífica na natureza, caso a postura observada seja de fato um play bow. Interações entre humanos e outros animais são comumente observadas quando o animal está acostumado com a presença de pessoas e frequentemente obtém recompensas dessas interações, ou quando humanos não são reconhecidos como ameaça pelo animal. Nenhuma dessas situações parece explicar o comportamento observado, enquanto traços individuais, como coragem e, principalmente, tendência a explorar, podem.

Produção de subjetividade em blogs e microblogs / Producción de subjetividad en blogs y microblogs / Production of subjectivity in blogs and microblogs

Blogs e microblogs estão entre as redes colaborativas da Web 2.0. Embora aparentados, possuem especificidades. Ambos promovem a abertura, a imersão, a participação e a criação de laços entre os integrantes das redes que constituem. O mais bem-sucedido dos microblogs, o Twitter, é exemplar das características diferenciais dessas ferramentas, tais como a brevidade das mensagens, a mobilidade, a captação em tempo real, a modificação na natureza da mediação. Isso implica em variações nas formas de expressão de si e nos modos como os indivíduos se relacionam com a realidade por meio de uma ou de outra ferramenta. Os usuários tanto podem tematizar suas experiências pela publicação breve e instantânea em microblogs, como podem fazê-lo de forma mais refletida nos blogs. Essas possibilidades de uso permitem identificar as maneiras pelas quais tais redes sociais proporcionam a objetivação de subjetividades...

Blogs y microblogs son algunas de las redes construidas de forma colaborativa en la Web 2.0. A pesar de sus semejanzas, existen diferencias relevantes. Los dos promueven la abertura, la inmersión, la participación y la creación de lazos entre los integrantes de las redes que las componen. Uno de los microblogs más exitosos es Twitter y constituye un ejemplo de la especificidad de este tipo de herramientas. Entre sus características más imortantes pueden mencionarse la brevedad de los mensajes, la movilidad y captación en tiempo real y la modificación de la naturaleza de la mediación. Como consecuencia de su configuración, se generan variaciones en las formas de expresión de si y en las formas como los individuos se relacionan con la realidad por medio de una o de otra herramienta. Los usuarios pueden al mismo tiempo tematizar sus experiencias por la publicación breve e instantánea en microblogs, y también realizarlo por medio de los blogs. Estas posibilidades de utilización permiten identificar las formas a través de las cuales las redes sociales proporcionan la objetivación de las subjetividades...

Blogs and microblogs are among the collaborative networks of Web 2.0. Although related, they have specificities. Both promote openness, immersion, participation and creation of links between networks' members who constitute it. The most successful of microblogs, Twitter, is exemplary of the differential characteristics of these tools, such as brevity of the messages, mobility, real-time capture, change in the nature of the mediation. It results in variations in the way of expressing yourself and in the way individuals relate to reality, through one tool or another. The users can thematize their experiences through short and instantaneous publications in microblogs or do it in more reflected way as well. These possibilities of use enable identifying manners in which such social networks provide the objectification of subjectivity...

Casais de dupla carreira nos anos iniciais do casamento: compreendendo a formação do casal, papéis, trabalho e projetos de vida / Dual career couples in the early years of marriage: understanding the formation of the couple, roles, work and life projects

O enlace conjugal é um fenômeno que se perpetua na atualidade devido ao desejo dos jovens de casar. Novas demandas se impõem ao casamento além da tarefa fundamental da formação do casal. O presente estudo teve como objetivo compreender a formação do casal, papéis, trabalho e projetos de vida nos anos iniciais do casamento tendo em vista as mudanças do contexto social, econômico e cultural. Foi realizado um estudo de casos múltiplos com seis casais heterossexuais, de primeira união com até cinco anos de relacionamento conjugal, com idades entre 24 e 34 anos, sem filhos, residentes em Porto Alegre/RS e região metropolitana, caracterizados como dupla carreira. Os instrumentos utilizados foram: questionário de dados sociodemográficos, entrevista semi-estruturada com o casal abrangendo questões referentes à conjugalidade e entrevista semi-estruturada individual com cada cônjuge. Com base na análise dos casos, identifica-se a brevidade com que aparece o período do namoro, a importância do casamento como uma relação satisfatória e a falta de tempo como uma das maiores dificuldades entre os cônjuges no cotidiano do casamento. Os resultados deste estudo apontam para a necessidade de mais pesquisas no intuito de entender como se estabelece o processo de formação do casal frente às especificidades dos cônjuges na atualidade.

The marriage is a phenomenon that is perpetuated nowadays due to the desire of young people to marry. New demands are imposed on the marriage beyond the fundamental task of forming a couple. The present study aimed to understand the formation of the couple, roles, work and life projects in young couples in view of the social, economic and cultural context changes. We conducted a multiple study case with six heterosexual couples, first-marriage with five years of marital relationships, aged between 24 and 34, no children, living in Porto Alegre/RS, and the metropolitan area, characterized as dual-career. The instruments used were: sociodemographic questionnaire, semi-structured interview with the couple about issues related to marital and individual semi-structured interviews with each spouse. Based on the analysis of the cases, it identifies the brevity with which it appears the period of courtship, the importance of marriage as a satisfying relationship and lack of time as one of the greatest difficulties between spouses in everyday wedding. The results of this study point to the need to more research in the area to understand how the process of formation of couple before the specificities of spouses today is established.

El enlace matrimonial es un fenómeno que se fija en la actualidad debido al deseo de casarse de los jóvenes. Nuevas demandas se lo imponen al matrimonio además de la tarea fundamental de la formación de la pareja. El presente estudio tuve como objetivo compreender la formación de la pareja, sus encargos y proyectos de vida en los años iniciales del matrimonio, teniendo en vista los cambios en el contexto social, económico y cultural. Fue realizado un estudio de casos múltiplos con seis parejas heterosexuales, de primera unión com hasta cinco años de relación conyugal, con edades entre 24 y 34 años, sin hijos, residentes a Porto Alegre/RS y su región metropolitana, caracterizados como doble carrera. Los instrumentos usados fueran: cuestionario de datos socio-demográficos, entrevista semi estructurada con la pareja sobre cuestiones referentes a vida juntos y entrevista semi estructurada individual con cada cónyuge. Con base en la análisis de los casos, se identifica la brevedad con la que aparece el periodo del enamoro, la importancia del matrimonio como una relación satisfactoria y la falta de tiempo entre los cónyuges en el cotidiano del casamiento. Los resultados de este estudio apuntan para la necesidad de más pesquisas con el intuito de que se entienda como se establece el proceso de formación de la pareja frente a las especificidades de los cónyuges en la actualidad.