Treatment for tobacco use is efficacious and beneficial to health. Although guidelines recommend that all patients who use tobacco are offered treatment as a part of their clinical care, implementing treatment has proven challenging. In the case of surgical patients, this lack of treatment is particularly unfortunate, as the benefits of abstinence from tobacco are immediate in terms of reducing the risk of surgical complications, including cardiovascular, respiratory, and wound related complications. Surgery also presents an opportunity for patients to quit for good and reduce the long term health risk. This review examines the principles of tobacco use treatment, the rationale for tobacco use treatment in the perioperative period, and how treatment can be incorporated into the routine care of surgical patients. The discipline of implementation science helps to frame these efforts by seeking to better understand how changes in clinical practice occur, and it has the potential to guide an evidence based approach to embedding tobacco treatment into the routine clinical care of surgical patients. This review uses the consolidated framework for implementation research, which includes five major domains, as a representative conceptual framework. A basic understanding of factors potentially important to successful implementation can help to guide clinicians who accept the challenge of implementing tobacco use treatment in surgical care.
Girard has recently shown how Winnicott supplies metapsychology with factual foundations. In this article, starting from an analysis of Winnicott’s assertion that metapsychological terms give the appearance of understanding whereas such understanding does not exist, the author upholds, on the one hand, the idea that metapsychological theorization corresponds to a speculative superstructure of psychoanalysis which is simply a set of auxiliary theoretical constructions aimed at describing the phenomena and their relations; and, on the other, that in psychoanalysis there is the proposition of a factual theorization comprised of concepts that are not proposed as being of a speculative nature, a theorization that claims to offer a succinct description of the phenomena and their relations. In a dialogue with Girard, Green, and Assoun, the author proposes that there is reason to distinguish two types of referents for the term metapsychology: one speculative and the other factual. That being so, it is possible to affirm that Winnicott rejected speculative metapsychological theorization, thereby indicating a distinction that can contribute to carrying out the task of integrating knowledge (factual) derived from several theoretical systems of psychoanalysis.
Due to the increased life expectancy and continual improvements in cardiological treatment options, diseases of the tricuspid valve, in particular tricuspid valve insufficiency will become increasingly more recognized as an interventional target. While tricuspid stenosis is rare and can be effectively treated with balloon valvuloplasty, no effective transcatheter approach to tricuspid regurgitation (TR) has yet been established. As the tricuspid annulus is a complex and highly dynamic structure that offers little resistance, orthotopic long-term fixation of transcatheter valves with the current techniques is challenging and has not yet been performed in human patients. Alternative treatment concepts include transcatheter caval valve implantation (CAVI) to address the regurgitation of blood into the caval veins, which has resulted in hemodynamic improvement and is currently undergoing further clinical investigation. Other interventional treatment concepts are aimed at tricuspid valve repair, e.g. by annular plication with the Mitralign™ device or the TriCinch™ system. In the medium-term it can be assumed that percutaneous systems and therapy options will become available for these indications whereby the functional and prognostic effects of these treatment procedures will be corroborated in the appropriate patient groups by corresponding studies.
After reviewing the pertinent philosophical and psychoanalytic writings on the concept of dignity, this paper proposes three categories of dignity. Conceptualized as phenomenological clusters, heuristic viewpoints, and levels of abstraction, these include (i) metaphysical dignity which extends the concept of dignity beyond the human species to all that exists in this world, (ii) existential dignity which applies to human beings alone and rests upon their inherent capacity for moral transcendence, and (iii) characterological dignity which applies more to some human beings than others since they possess a certain set of personality traits that are developmentally derived. The paper discusses the pros and cons of each category and acknowledges the limitations of such classification. It also discusses the multiple ways in which these concepts impact upon clinical work and concludes with some remarks on the relationship of dignity to choice, narcissism, and suicide.
Social relationships and interactions contribute to daily emotional well-being. The emotional benefits that come from engaging with others are known to arise from real events, but do they also come from the imagination during daydreaming activity? Using experience sampling methodology with 101 participants, we obtained 371 reports of naturally occurring daydreams with social and non-social content and self-reported feelings before and after daydreaming. Social, but not non-social, daydreams were associated with increased happiness, love and connection and this effect was not solely attributable to the emotional content of the daydreams. These effects were only present when participants were lacking in these feelings before daydreaming and when the daydream involved imagining others with whom the daydreamer had a high quality relationship. Findings are consistent with the idea that social daydreams may function to regulate emotion: imagining close others may serve the current emotional needs of daydreamers by increasing positive feelings towards themselves and others.
This article investigates how neuroscience in general, and neuroscience of creativity in particular, can be used in teaching “applied creativity” and the usefulness of this approach to creativity training. The article is based on empirical data and our experiences from the Applied NeuroCreativity (ANC) program, taught at business schools in Denmark and Canada. In line with previous studies of successful creativity training programs the ANC participants are first introduced to cognitive concepts of creativity, before applying these concepts to a relevant real world creative problem. The novelty in the ANC program is that the conceptualization of creativity is built on neuroscience, and a crucial aspect of the course is giving the students a thorough understanding of the neuroscience of creativity. Previous studies have reported that the conceptualization of creativity used in such training is of major importance for the success of the training, and we believe that the neuroscience of creativity offers a novel conceptualization for creativity training. Here we present pre/post-training tests showing that ANC students gained more fluency in divergent thinking (a traditional measure of trait creativity) than those in highly similar courses without the neuroscience component, suggesting that principles from neuroscience can contribute effectively to creativity training and produce measurable results on creativity tests. The evidence presented indicates that the inclusion of neuroscience principles in a creativity course can in 8 weeks increase divergent thinking skills with an individual relative average of 28.5%.
‘Communication’ between abiotic nanoscale chemical systems is an almost-unexplored field with enormous potential. Here we show the design and preparation of a chemical communication system based on enzyme-powered Janus nanoparticles, which mimics an interactive model of communication. Cargo delivery from one nanoparticle is governed by the biunivocal communication with another nanoparticle, which involves two enzymatic processes and the interchange of chemical messengers. The conceptual idea of establishing communication between nanodevices opens the opportunity to develop complex nanoscale systems capable of sharing information and cooperating.
Social exclusion is a concept that has been widely debated in recent years; a particular focus of the discussion has been its significance in relation to health. The meanings of the phrase “social exclusion”, and the closely associated term “social inclusion”, are contested in the literature. Both of these concepts are important in relation to health and the area of primary healthcare in particular. Thus, several tools for the measurement of social exclusion or social inclusion status in health care settings have been developed.
- Proceedings of the National Academy of Sciences of the United States of America
- Published 6 months ago
We give an overview of our philosophy of pictures in mathematics. We emphasize a bidirectional process between picture language and mathematical concepts: abstraction and simulation. This motivates a program to understand different subjects, using virtual and real mathematical concepts simulated by pictures.
- The British journal of psychiatry : the journal of mental science
- Published almost 3 years ago
BackgroundInformed consent in research is partly achieved through the use of information sheets. There is a perception however that these information sheets are long and complex. The recommended reading level for patient information is grade 6, or 11-12 years old.AimsTo investigate whether the readability of participant information sheets has changed over time, whether particular study characteristics are related to poorer readability and whether readability and other study characteristics are related to successful study recruitment.MethodWe obtained 522 information sheets from the UK National Institute for Health Research Clinical Research Network: Mental Health portfolio database and study principal investigators. Readability was assessed with the Flesch reading index and the Grade level test.ResultsInformation sheets increased in length over the study period. The mean grade level across all information sheets was 9.8, or 15-16 years old. A high level of patient involvement was associated with more recruitment success and studies involving pharmaceutical or device interventions were the least successful. The complexity of information sheets had little bearing on successful recruitment.ConclusionsInformation sheets are far more complex than the recommended reading level of grade 6 for patient information. The disparity may be exacerbated by an increasing focus on legal content. Researchers would benefit from clear guidance from ethics committees on writing succinctly and accessibly and how to balance the competing legal issues with the ability of participants to understand what a study entails.