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Comments on snake symbolism and mind-body relations.

In summary, the symbolic use of an object in part depends on which of its functional-structural qualities is emphasized in a given moment. For example, the snake may take on different symbolic meanings when emphasis is given to its eyes, tongue, fangs, anatomical form, or movement. Its various aspects constitute a complex system of references to unconscious (and conscious) mental and body self-configurations. These references frequently undergo transformations which make use of structurally related symbols. In the present paper, various aspects of the snake symbol were related to one another and to other symbolic transformations, including the elevator and flying. The structural principles underlying these analyses may be found to organize a wide range of phenomena and were here applied to Tausk's "influencing machine."

Animals↗

WHO KILLED LAIUS?: ON SOPHOCLES' ENIGMATIC MESSAGE.

Using Laplanche's basic conceptualisation of the role of the other in unconscious processes, the author proposes a reading of Sophocles' tragedy, Oedipus the King, according to basic principles of dream interpretation. This reading corroborates contemporary literary perspectives suggesting that Sophocles' tragedy may not only convey the myth but also provide a critical analysis of how myths work. Important textual inconsistencies and incoherence, which have been noted through the centuries, suggest the existence of another, repressed story. Moreover, the action of the play points to enigmatic parental messages of infanticide and the silencing of Oedipus's story, as well as their translation into primordial guilt, as the origins of the tragic denouement. Oedipus's self-condemnation of parricide follows these enigmatic codes and is unrelated to, and may even contradict, the evidence offered in the tragedy as to the identity of Laius's murderers. Moreover, Sophocles' text provides a complex intertwining of hermeneutic and deterministic perspectives. Through the use of the mythical deterministic content, the formal characteristics of Sophocles' text, mainly its complex time perspective and extensive use of double meaning, dramatise in the act of reading an acute awareness of interpretation. This reading underscores the fundamental role of the other in the constitution of unconscious processes.

Journal Article↗

Memory reactivation and consolidation during sleep.

Do our memories remain static during sleep, or do they change? We argue here that memory change is not only a natural result of sleep cognition, but further, that such change constitutes a fundamental characteristic of declarative memories. In general, declarative memories change due to retrieval events at various times after initial learning and due to the formation and elaboration of associations with other memories, including memories formed after the initial learning episode. We propose that declarative memories change both during waking and during sleep, and that such change contributes to enhancing binding of the distinct representational components of some memories, and thus to a gradual process of cross-cortical consolidation. As a result of this special form of consolidation, declarative memories can become more cohesive and also more thoroughly integrated with other stored information. Further benefits of this memory reprocessing can include developing complex networks of interrelated memories, aligning memories with long-term strategies and goals, and generating insights based on novel combinations of memory fragments. A variety of research findings are consistent with the hypothesis that cross-cortical consolidation can progress during sleep, although further support is needed, and we suggest some potentially fruitful research directions. Determining how processing during sleep can facilitate memory storage will be an exciting focus of research in the coming years.

Animals↗

A pain workshop: an approach to eliciting the views of young people with chronic pain.

Chronic pain is complex and there is still much to discover about the burden that it places on children and their families. The aim of this study was to explore the way in which the experience of chronic pain impacts on the lives of young people. Through the use of a pain workshop that involved a series of guided activities and a focus group, young people were able to share their experiences with each other and the facilitators/researchers. Data were analysed using a theoretical coding technique supported by Atlas.ti. Five key interlinked themes emerged from the data and each theme is expressed in the words of the young people themselves: 'no one's pain's the same', 'getting on with it', 'it's hard 'cos...', 'keeping with the dream', and 'it depends ... some are OK'. The young people did experience significant disruption in their lives as a result of their pain. Pain was experienced as if it was both a separate entity as well as an intrinsic part of them and, to a degree, blighted their future. Based on the experiences shared by the young people, professionals need to develop insight and strategies into the challenges young people with chronic pain face on a daily basis.

Activities of Daily Living↗

The portrayal of coma in contemporary motion pictures.

BACKGROUND: Coma has been a theme of screenplays in motion pictures, but there is no information about its accuracy. METHODS: The authors reviewed 30 movies from 1970 to 2004 with actors depicting prolonged coma. Accurate depiction of comatose patients was defined by appearance, the complexity of care, accurate cause of coma and probability of awakening, and appropriate compassionate discussion between the physician and family members. Twenty-two key scenes from 17 movies were rated for accuracy by a panel of neurointensivists and neuroscience nurses and then were shown to 72 nonmedical viewers. Accuracy of the scenes was assessed using a Likert Scale. RESULTS: Coma was most often caused by motor vehicle accidents or violence (63%). The time in a comatose state varied from days to 10 years. Awakening occurred in 18 of 30 motion pictures (60%). Awakening was sudden with cognition intact, even after prolonged time in a coma. Actors personified "Sleeping Beauty" (eyes closed, beautifully groomed). Physicians appeared as caricatures. Only two movies had a reasonable accurate representation (Dream Life of Angels and Reversal of Fortune). The majority of the surveyed viewers identified inaccuracy of representation of coma, awakenings, and conversations on the experience of being in a coma, except in 8 of the 22 scenes (36%). Twenty-eight of the 72 viewers (39%) could potentially allow these scenes to influence decisions in real life. CONCLUSIONS: Misrepresentation of coma and awakening was common in motion pictures and impacted on the public perception of coma. Neurologic advice regarding prolonged coma is needed.

Adolescent↗

That which patients bring to analysis.

In this paper it is suggested that patients bring to analysis their damaged inner objects, and not only themselves, to undergo reparation because they are unable to do it. Stress is put on the very complex mechanisms used to keep damaged and dying inner objects alive whilst waiting for help to come. The contrast between concrete repair and psychic reparation appears to be very important and the defences necessitated by failed reparation efforts are described. Failed reparation manoeuvres must not be confused with resulting defences. Examples are given for various levels of personality organizations and pathology, including neurotic, borderline, psychotic, psychosomatic and hypochondriacal patients. A group of six neurotic patients is included.

Adult↗

Messages of professional empowerment from the land of Oz.

In the movie adaptation of Baum's book, Dorothy's whole adventure was a dream. But the movie told only a part of the original story. In the print version, Oz was a real place to which Dorothy eventually relocated after 3 more visits; Dorothy moved to Oz permanently in the sixth book (of 13 books) and became a princess. In many ways, critical care professionals are all living in a modern healthcare version of the story of Oz-facing tornadoes, wandering fields of intense expectations, traveling indistinct paths, manipulating wizardly technology, and confronting new enemies. To survive and thrive, we must have brains, heart, and courage. Despite everything that is going on around them, critical care professionals continue to have a sense of mission, a vision of continual improvement and professionalism, and a code of ethics that transcends the complex environment swirling around us. We can begin by creating a personal vision that we wish to achieve. This vision is not an academic exercise but rather a compelling statement that anticipates tomorrow without neglecting today. This vision will require commitment, teamwork, and involvement to make it a reality. Like the end of the original story of Oz, the end of this story is just the beginning. . . . Click your heels together 3 times and say, "It's a new century for critical care nurses!"

Critical Care↗

Metallabenzenes.

Many similarities exist between metallabenzenes and conventional arenes. Among these similarities are structural features such as ring planarity and the absence of bond length alternation, spectroscopic features such as downfield chemical shifts for ring protons, and chemical reactions such as electrophilic aromatic substitution and arene displacement from (arene)Mo(CO)3. All of these features, taken together, strongly support the thesis that metallabenzenes represent a new class of aromatic compounds, one in which metal d orbitals participate fully with carbon p orbitals in the formation of ring pi-bonds. However, it is also apparent that metallabenzenes are much more prone to isomerization reactions than are conventional arenes. This appears to be particularly true of first-row and second-row metallabenzenes, where the metal-carbon bond strengths are weaker. In these systems, carbene migratory insertion often leads to cyclopentadienyl-metal products. pi-Coordination of metallabenzenes to other metal centers generally stabilizes the metallabenzene moieties while maintaining their aromatic character. Among metallabenzenes coordinated in this way, there are representatives from all three transition-metal rows (Fe, Ni, Mo, Ru, and Ir). The metal atom in pi-coordinated metallabenzenes is displaced out of the ring and away from the complexing metal center. The reason for this displacement in most cases appears to be steric repulsion between ligands on the two metal centers. However, other subtle effects may contribute. For example, metal displacement leads to more favorable internal angles at the alpha-carbons and a better orientation of C alpha p orbitals toward the complexing metal center. While no dominant synthetic strategy for constructing metallabenzenes has emerged, cyclization reactions involving metal-thiocarbonyl, metal-alkylidyne, and metal-alkylidene precursors have proved useful. In addition, approaches involving pentadienyl reagents as the source of ring carbons have yielded notable successes. Vinylcyclopropene reagents have recently led to isolation of the first example of a metallabenzene valence isomer--a metallabenzvalene--and its subsequent conversion to a planar metallabenzene. Finally, interligand attacks of butadienyls on carbonyls have produced a variety of transient oxy- or alkoxy-substituted metallabenzene species. The development of new synthetic approaches, particularly systematic approaches that can be used with a variety of transition metals, is the key issue facing metallabenzene chemists. One hundred and thirty-five years after Kekulé's celebrated dream, aromatic chemistry continues to be a fascinating and provocative research topic. Metallabenzenes represent one of the "new frontiers" that promise to keep aromatic chemistry vibrant well into the 21st century.

Journal Article↗

Individualised cancer therapeutics: dream or reality?

Traditional measures for treating metastatic cancer involve identification of the originating organ from which the neoplasm arose and empirical treatment with cytotoxic chemotherapy. Arguably, with the exception of haematological malignancies, demonstration of efficacy in solid tumours has been limited. Over the past half-decade, theoretical and technological advances have resulted in greater application of molecular science to drug design, which has enabled development of new 'targeted' therapeutics. However, generic chemotherapy paradigms have not changed. Establishment of the optimal population for 'targeted' therapeutics based on molecular diagnostics (i.e. genomic and proteomic characterisation) to identify sensitive tumour-host ecosystems in individual patients at the 'bedside', is not being done as part of routine oncology management. This review focuses on the concept of designing individualised therapeutics based on genomic and proteomic profile of malignant tissue. Genetic and epigenetic perturbations in signal pathways drive cancer growth, survival, invasion and metastatic spread. The burgeoning evidence which supports the concept that each patient's cancer has a unique complement of pathogenic genetic and molecular derangements is reviewed. Such evidence supports the strategy of individualised selection of a therapeutic complex from a menu of targeting options that best complements the specific oncomolecular profile of the 'tumour-host' system.

Antineoplastic Agents↗

The "something more" than interpretation revisited: sloppiness and co-creativity in the psychoanalytic encounter.

Features of dynamical systems thinking can illuminate insufficiently recognized levels of psychoanalytic process. A central aspect of dynamical models is that changes in complex systems are unpredictable and arise out of the interaction of elements. Examination of the moment-by-moment micro-foreground, or local level, of psychoanalytic sessions led to the conclusion that indeterminacy and surprise are inherent properties of intersubjective systems. This indeterminacy, or sloppiness, comprises several interrelated features of the dialogue: "fuzzy" intentionalizing, unpredictability, improvisation, variation, and redundancy. Audiotaped transcripts of two analytic sessions illustrate how these sloppy features generate unpredictable and potentially creative elements that contribute to psychotherapeutic change.

Communication↗

Functional neuroimaging of normal human sleep by positron emission tomography.

Functional neuroimaging using positron emission tomography has recently yielded original data on the functional neuroanatomy of human sleep. This paper attempts to describe the possibilities and limitations of the technique and clarify its usefulness in sleep research. A short overview of the methods of acquisition and statistical analysis (statistical parametric mapping, SPM) is presented before the results of PET sleep studies are reviewed. The discussion attempts to integrate the functional neuroimaging data into the body of knowledge already acquired on sleep in animals and humans using various other techniques (intracellular recordings, in situ neurophysiology, lesional and pharmacological trials, scalp EEG recordings, behavioural or psychological description). The published PET data describe a very reproducible functional neuroanatomy in sleep. The core characteristics of this 'canonical' sleep may be summarized as follows. In slow-wave sleep, most deactivated areas are located in the dorsal pons and mesencephalon, cerebellum, thalami, basal ganglia, basal forebrain/hypothalamus, prefrontal cortex, anterior cingulate cortex, precuneus and in the mesial aspect of the temporal lobe. During rapid-eye movement sleep, significant activations were found in the pontine tegmentum, thalamic nuclei, limbic areas (amygdaloid complexes, hippocampal formation, anterior cingulate cortex) and in the posterior cortices (temporo-occipital areas). In contrast, the dorso-lateral prefrontal cortex, parietal cortex, as well as the posterior cingulate cortex and precuneus, were the least active brain regions. These preliminary studies open up a whole field in sleep research. More detailed explorations of sleep in humans are now accessible to experimental challenges using PET and other neuroimaging techniques. These new methods will contribute to a better understanding of sleep functions.

Animals↗

How changes in computer technology are revolutionizing the practice of chemistry.

During the early 1980s, two major developments in computer technology changed the way chemists approached their science. The advent of the micropressor and then the PC changed experimental chemistry, while the availability of two classes of computer, the superminicomputer and supercomputer, greatly influenced computational chemistry. In the past two years, graphics workstation computers have begun to affect the practice of chemistry by combining fast, high-resolution, multiwindow graphics with superminicomputer power. In 1988, the advent of a new class of computer--the graphics supercomputer--offers extraordinary promise to both theoretician and experimentalist. In these systems, near-Cray compute power is combined with ultrahigh-speed 3-dimensional graphics for unparalleled visualization of molecular processes and other complex events. This is made practical not just by computing and graphics power but by use of ultrahigh internal bandwidths inside the graphics supercomputers. Another major development in scientific computing is the evolving concept of the laboratory computer network. Current network designs include hierarchical configurations incorporating various levels of computers--through supercomputers--either locally or via national or regional networks. New software methods are also having impact on chemical research, allowing, for example, the scientist to better abstract information from noisy or incomplete experimental data. Use of parallelism (multiple CPUs) in new design workstation computers will extend their power, by the early 1990s, past that of current supercomputer mainframes. Within five years the chemist will have $10 million of 1985 computer power on his desk, for considerably less than $100,000, along with visualization tools and software only dreamed of in 1985.(ABSTRACT TRUNCATED AT 250 WORDS)

Chemical Phenomena↗

Can thiazolidinediones delay disease progression in type 2 diabetes?

BACKGROUND: Type 2 diabetes results from increasing insulin resistance coupled with progressive loss of beta-cell function. Further deterioration of beta-cell function is associated with progression of diabetes and the potential development of microvascular and macrovascular complications. SCOPE: This review examines current knowledge of beta-cell function and uses this information to assess how the results of ongoing trials could increase our understanding of disease progression and potential interventions. Data were derived from a Medline search using the search terms 'beta-cell dysfunction', 'IGT', 'thiazolidinediones', 'metformin', and 'sulfonylurea'. RESULTS: The mechanisms that underlie beta-cell dysfunction are complex and most likely involve the interplay of a range of factors that reduce both beta-cell mass and secretory function. These include detrimental effects associated with hyperglycemia itself, elevated free fatty acids, and inflammatory responses linked to adipocyte-derived cytokines, with apoptosis a key underlying mechanism. Early intervention with treatments that address these defects, and preserve beta-cell function while improving insulin sensitivity, may delay disease progression in patients with type 2 diabetes and also prevent the development of diabetes in 'at-risk' individuals. Two of the studies examining the effects of interventions on development and progression of diabetes that are due to report shortly are ADOPT (A Diabetes Outcome Progression Trial), comparing a thiazolidinedione, metformin and a sulfonylurea in patients with type 2 diabetes not previously treated with oral hypoglycemic agents, and DREAM (Diabetes REduction Assessment with ramipril and rosiglitazone Medication), assessing the effects of a thiazolidinedione and an angiotensin-converting enzyme inhibitor in subjects with impaired glucose tolerance and/or impaired fasting glucose. CONCLUSIONS: Although we do not have a full understanding of the mechanisms driving progression of type 2 diabetes, there is growing evidence that we may be able to modulate them and thereby improve patient outcomes.

Diabetes Complications↗

Advances in molecular genetics of glaucoma: a perspective for the clinician.

Extraordinary progress has been made over the last 5 years in improving our understanding of the molecular causes of various glaucomas. Identification of the myocilin gene and of 5 additional genetic loci that play a role in development of primary open angle glaucoma provides us with an opportunity to reclassify this complex phenotype based on underlying cause of disease. Clinicians who obtain a detailed family history from their patients and who have referred families with glaucoma to laboratory investigators are at the forefront of this revolution in molecular genetics. As a result, all clinicians will soon be poised to profit from genetic discoveries by being able to order diagnostic tests that will identify specific genetic mutations. These mutations will provide a detailed understanding of the natural history of the patient's glaucoma, as well as information for genetic counseling. Individuals at risk in the family will be able to be identified, permitting closer follow-up and earlier institution of glaucoma therapy. A new understanding of pathophysiology is developing and will provide the basis for more rational pharmacological and gene therapy approaches in the future. The hope of primary prevention for various glaucomas, once a distant dream, may become reality within our lifetimes.

Chromosomes, Human, Pair 1↗

On the countertransference of the patient: Transformations of the psychoanalyst's 'theoretical self' and their possible articulations with the vicissitudes of the analytic relationship.

In this paper the author examines one of the many levels of the analyst/analysand relationship: the possible interaction between the analyst's mental routes in relation to theories (also meant, but not only, as internal objects) and the vicissitudes of the psychoanalytic relationships with his patients. The author assumes that an important variable affecting the transformation of certain therapeutic relationships is the change that takes place in the relationship between the analyst and that part of his internal world where his theories find their place. He names this part of his internal world 'theoretical self', and 'precipitates of the analyst's theoretical self' those complex formations, akin to more or less cohesive conglomerates, that are formed by his relationship to theories and to psychoanalytic institutions, and by the various, 'personal' internalised objects. The psychoanalyst will relate to these precipitates in a variety of ways, and he will make use of them mostly at an unconscious level in his analytical work; and his patient is likely to 'react' to them, almost chemically. The author also offers some working indications: the psychoanalyst, despite his knowledge of some aspects of his own countertransference, is in fact lacking in knowledge, unless he constantly does some extra work focusing on how his mental position (i.e. the relationship with the precipitates of his theoretical self) may intervene in any of the therapeutic relationships that he establishes--not necessarily in the same way in each of them. The author also illustrates his reflections and conceptualisations by reporting dreams and excerpts from sessions taken from three psychoanalytic treatments in the course of several years.

Countertransference↗

Synthetic peptides as cancer vaccines.

Effective cancer therapy or prevention has been the dream of physicians and scientists for many years. Although we are still very far from our ultimate goal of cancer prevention, significant milestones have been realized in terms of our knowledge base and understanding of the pathogenesis of cancerous cells and the involvement of the immune system against both self- and virus-associated tumor antigens. Immunotherapeutic strategies are now accepted to being superior in terms of the exquisite specificity that they offer in targeting only tumor cells as opposed to the existent chemotherapy or radiation therapy that is more general and invasive with many associated side effects. There are several immunotherapeutic strategies that are currently under investigation. This review primarily focuses on the significant advances made in the use of synthetic peptides in the development of subunit cancer vaccines. We have attempted to highlight some of the fundamental issues regarding antigen processing and presentation, Major Histocompatibility Complex (MHC) restriction, T-cell help, structural determinants in antibody recognition, and the use of these concepts in the rational design and delivery of peptide vaccines to elicit protective humoral and cell mediated immune responses. The recent use of costimulatory molecules and cytokines to augment immune responses also has been discussed along with the contributions of our laboratory to the field of synthetic peptide vaccine development.

Adjuvants, Immunologic↗

Analysis of the transference neurosis in a child with transsexual symptoms.

This paper touches on two issues that have been disputed by child analysts: the genesis of the transsexual symptom complex, and the question of transference neurosis in child analysis. My observation, as reported previously (Loeb and Shane, 1980) and shown in the present case, is that the transsexual symptom complex can develop out of intrapsychic conflict and can be resolved in a fully developed transference neurosis. In the analysis of a four-and-a-half-year-old boy with transsexual symptoms, I was abstinent--not benevolent or supportive--and both positive and negative transference feelings developed into a full-blown transference neurosis. Then, as I interpreted its elements, we worked through his conflicts, which manifested themselves as acting out of his identification with his aggressive, seductive, and castrating grandmother. As he came to understand his conflicts, the boy's transsexual symptoms vanished.

Child, Preschool↗

The experience of living with fibromyalgia: confronting an invisible disability.

Fibromyalgia (FM) is a complex, chronic, painful musculoskeletal syndrome which is characterized by extreme fatigue, disordered sleep, and other associated physical and cognitive problems. Because its etiology is unknown, and because no specific pathophysiological mechanisms have been found to underlie the syndrome, making a diagnosis is very difficult. FM adversely affects the quality of life, and the societal costs based on medical expenses, lost wages, lost tax revenue and compensation expenditures are very significant. The purpose of this phenomenological study was to describe and enhance the understanding of the experience of living with FM. The participants included nine women ranging in age from 30 years to 56 years who had been diagnosed with the condition for more than a year. Data were collected by means of unstructured interviews. Thematic analysis, using van Manen's (1990) methodology, identified eight themes: (a) pain-the constant presence, (b) fatigue-the invisible foe, (c) sleep-the impossible dream, (d) thinking of a frog (e) dealing with a flare-up, (f) longing for a normal life, (g) the power of naming-seeking a diagnosis, and (h) living within the boundaries. These themes were integral parts of the whole story, and through their interrelationships, the essence confronting an invisible disability was captured. The findings of this qualitative study have implications for nursing practice, education and research. It has become an increasing challenge for our health care system to adequately cope with the large numbers of persons diagnosed with chronic illnesses. Administrators of these systems can benefit from the information learned during this study.

Activities of Daily Living↗