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PubMedDate not supplied

[The patient with Hansen's disease confronts his distress].

This article is about the effect of Hansen's disease on the personality of 29 patients of the Institute of Applied Leprology of Dakar, Foundation of the Order of Malta. This approach to the distress of these patients was done by an inquiry based on sociocultural and clinical variables and compared to a study composed of tubercular and psychiatric patients. This study reports four distress levels (loss of identity, loss of object, forlornness, culpability) which are distinguished by sex and age. The actual analysis of the experience of this distress shows the importance of support of the traditional representation of these leprous patients' psychology.

Guilt↗
PubMed1979

Psychosexuality and the representational world.

The sensual experiences, fantasies and enactments that occur in the course of normal development are seen as psychic organizers which contribute vitally to the structuralization of the representational world. In the sexual perversions which occur in structurally deficient, developmentally arrested individuals, this function of early psychosexual experiences has been retained and is regressively relied upon in order to restore or sustain the cohesion and stability of crumbling, fragmenting or disintegrating self and object representations. Analytic exploration of the details of perverse fantasies and acts, their origins and functions, reveals the particular ways in which they compensate for specific structural weaknesses in patients' representational worlds. Some clinical illustrations and therapeutic implications of these formulations are briefly presented.

Fantasy↗
PubMed2001

Cognitive perspectives on unresolved loss: insights from the study of PTSD.

The authors begin by reviewing recent work on attachment disorganization and its association with parental unresolved loss. They draw connections between this literature and recent theoretical and empirical work on trauma and posttraumatic stress disorder (PTSD). They propose that unresolved loss involves intrusion and avoidance phenomena similar to those of PTSD. Specifically, they develop a model based on the notion that unresolved loss involves the failure to integrate representations of self and the world following a loss. The features of unresolved loss can be understood as emerging as a result of the activation of unintegrated representations of the loss experience and cognitive and behavioral avoidance processes. In this model, the sudden intrusion of memories, cognitions, and emotions associated with the loss automatically captures attention and initiates behavioral dispositions that are incompatible, and hence interfere, with caregiving behavior. Lack of attentional resources and incompatible response-tendencies can also result from safety behaviors directed at avoiding the perceived negative consequences of activating trauma memory. The authors propose that these processes offer a novel way of understanding the disturbances in behavior and speech that are evident in parents who are classified as unresolved with respect to loss in the Adult Attachment Interview.

Adult↗
PubMed2002

Fluid dynamics of the left ventricular filling in dilated cardiomyopathy.

Modifications in diastolic function occur in a broad range of cardiovascular diseases and there is an increasing evidence that abnormalities in left ventricular function may contribute significantly to the symptomatology. The flow inside the left ventricle during the diastole is here investigated by numerical solution of the Navier-Stokes equations under the axisymmetric assumption. The equation are written in a body-fitted, moving prolate spheroid, system of coordinates and solved using a fractional step method. The system is forced by a given volume time-law derived from clinical data, and varying the two-degrees-of-freedom ventricle geometry on the basis of a simple model. The solution under healthy conditions is analysed in terms of vorticity dynamics, showing that the flow field is characterised by the presence of a vortex wake; it is attached to the mitral valve during the accelerating phase of the E-wave, and it detaches and translate towards the ventricle apex afterwards. The flow evolution is discussed, results are also reported as an M-mode representation of colour-coded Doppler velocity maps. In the presence of ventricle dilatation the mitral jet extends farther inside the ventricle, propagation velocity decreases, and the fluid stagnates longer at the apex.

Blood Flow Velocity↗
PubMed2003

Young children traumatized by organized violence together with their mothers--the critical effects of damaged internal representations.

Three examples of young Kosovar children who were exposed to brutal violence together with their mothers are presented to illustrate how important it is to understand the impact of traumatic events on young children's development from the perspective of the parent-child relationship. The traumatized mothers' internal representations of self and self-being-together-with-child were damaged, and this in turn led to their care-giving system and internal representations of the children being negatively affected. No longer being able to see themselves as protective and loving parents, the mothers were unable to respond to their children with care-giving behaviour. The traumatized children's increased attachment behaviour and posttraumatic symptoms functioned as a trigger for posttraumatic symptoms in the mothers and contributed to a disengagement of the care-giving system. The on-going process disrupted the previous attachment pattern in mother-child interaction and a disorganized attachment pattern developed.

Adult↗
PubMed2006

Modeling the health care costs of geriatric inpatients.

This paper extends a method for modeling the survival of patients in hospitals to allow the expected cost to be estimated for the patients' accumulated duration of time in care. An extension of Bayesian network (BN) theory has previously been developed to model patients' survival time in hospitals with respect to the graphical and probabilistic representation of the interrelationships between the patients' clinical variables. Unlike previous BN techniques, this extended model can accommodate continuous times that are skewed in nature. This paper presents the theory behind such an approach and extends it by attaching a cost variable to the survival times, enabling the costing and efficient management of groups of patients in hospitals. An application of the model is illustrated by considering a group of 4260 patients admitted into the geriatric department of a U.K. hospital between 1994-1997. Results are derived for the distribution for their length of stay in the hospital and associated costs. The model's practical use is highlighted by illustrating how hospital managers could benefit using such a method for investigating the influence of future decisions and policy changes on the hospital's expenditure.

Computer Simulation↗
PubMed2000

Towards content-based image retrieval in a HIS-integrated PACS.

Development of a Picture Archiving and Communications System (PACS) with a large and diverse set of medical images will lead to large digital libraries that can be accessed to provide improved support for patient care, research and education. New representational and retrieval models for clinical images are required to address these issues. The PACS at the Georges Pompidou Hospital (GPH) is integrated in the hospital information system (HIS), and several modalities from medical imaging departments have been attached to it. The two main axes of the GPH PACS project were 1) HIS-integration to allow hospital-wide access to the images based on demographic and procedure-type information and 2) the development of content-based image retrieval to enhance the medical impact of image retrieval in daily practice.

Breast↗
PubMed1997

The value of setup portal films as an estimate of a patient's position throughout fractionated tangential breast irradiation: an on-line study.

PURPOSE: To determine if portal setup films are an accurate representation of a patient's position throughout the course of fractionated tangential breast irradiation. METHODS AND MATERIALS: Thirteen patients undergoing external beam irradiation for T1-T2 infiltrating ductal carcinoma of the breast following excisional biopsy and axillary dissection were imaged using an on-line portal imaging device attached to a 6 MV linear accelerator. Medial and lateral tangential fields were imaged and a total of 139 fractions, 225 portal fields, and 4450 images were obtained. Interfractional and intrafractional variations for anatomical parameters including the central lung distance (CLD), central flash distance (CFD), and inferior central margin (ICM) were calculated from these images. A pooled estimate of the random error associated with a given treatment was determined by adding the interfractional and intrafractional standard deviations in quadrature. A 95% confidence level assigned a value of two standard deviations of the random error estimate. Central lung distance, CFD, and ICM distances were then measured for all portal setup films. Significant differences were defined as occurring when the simulation-setup difference was greater than the 95% confidence value. RESULTS: Differences between setup portal and simulation films were less than their 95% confidence values in 70 instances indicating that in 90% of the time these differences are a result of random differences in daily treatment positioning. CONCLUSIONS: In 90% of cases tested, initial portal setup films are an accurate representation of a patients daily treatment setup.

Breast Neoplasms↗
PubMed1984

Mourning distinct from melancholia: the resolution of bereavement.

The premise that mourning has been satisfactorily completed when symptoms associated with the response to loss subside is rejected. The emphasis on the bereaved's behavioural functioning in adjustment to loss has tended to overshadow the recollected relationship to the deceased as a major dimension in the resolution of loss. Elaborating the two-track model of bereavement (Rubin, 1981), the author focuses upon the relationship to the representations of the deceased from the object relations point of view. The active relationship between representations of the deceased and the bereaved's self-representations define resolution of loss. Two cases are presented to illustrate the thesis.

Adaptation, Psychological↗
PubMed1995

Protein sequence randomness and sequence/structure correlations.

We investigated protein sequence/structure correlation by constructing a space of protein sequences, based on methods developed previously for constructing a space of protein structures. The space is constructed by using a representation of the amino acids as vectors of 10 property factors that encode almost all of their physical properties. Each sequence is represented by a distribution of overlapping sequence fragments. A distance between any two sequences can be calculated. By attaching a weight to each factor, intersequence distances can be varied. We optimize the correlation between corresponding distances in the sequence and structure spaces. The optimal correlation between the sequence and structure spaces is significantly better than that which results from correlating randomly generated sequences, having the overall composition of the data base, with the structure space. However, sets of randomly generated sequences, each of which approximates the composition of the real sequence it replaces, produce correlations with the structure space that are as good as that observed for the actual protein sequences. A connection is proposed with previous studies of the protein folding code. It is shown that the most important property factors for the correlation of the sequence and structure spaces are related to helix/bend preference, side chain bulk, and beta-structure preference.

Amino Acid Sequence↗
PubMed1999

Distribution of tactile learning and its neural basis.

The brain's sensory processing systems are modified during perceptual learning. To learn more about the spatial organization of learning-related modifications, we trained rats to utilize the sensory signal from a single intact whisker to carry out a behavioral task. Once a rat had mastered the task, we clipped its "trained" whisker and attached a "prosthetic" one to a different whisker stub. We then tested the rat to determine how quickly it could relearn the task by using the new whisker. We observed that rats were immediately able to use the prosthetic whisker if it were attached to the stub of the trained whisker but not if it were attached to a different stub. Indeed, the greater the distance between the trained and prosthetic whisker, the more trials were needed to relearn the task. We hypothesized that this "transfer" of learning between whiskers might depend on how much the representations of individual whiskers overlap in primary somatosensory cortex. Testing this hypothesis by using 100-electrode cortical recordings, we found that the overlap between the cortical response patterns of two whiskers accounted well for the transfer of learning between them: The correlation between the electrophysiological and behavioral data was very high (r = 0.98). These findings suggest that a topographically distributed memory trace for sensory-perceptual learning may reside in primary sensory cortex.

Animals↗
PubMed2000

Reapproaching Mahler: new perspectives on normal autism, symbiosis, splitting and libidinal object constancy from cognitive developmental theory.

Margaret Mahler's seminal work on the psychological birth of the infant has generated more critical discussion than most other psychoanalytic theories of early development. But while the empirically, theoretically, and methodologically based criticisms of Mahler's theory are generally justified, her critics fail at times to consider some of the intriguing and creative insights that her theoretical formulations tried to capture. This paper attempts to reformulate these insights using the new conceptual tools that current cognitive developmental theory provides. Mahler's stage of normal autism is reconsidered in the light of contingency detection theory as an initial phase of primary preoccupation with self-generated perfectly response-contingent stimulation. Her concept of normal symbiosis is recast with the help of attachment theory's views on homeostatic regulation and the social biofeedback model of affect-reflective mirroring interactions with parents. Finally, her ideas about the development of splitting and libidinal object constancy are reconsidered according to recent theories of early representational development and mentalization.

Adult↗
PubMed1985

Determinants of object choice in adulthood: a test case of object-relations theory.

A clinical example of the effects of the absence of the father during the early childhood of a male analysand and its consequences for his later object choice is presented. This patient's biological father left the household when the patient was only a few months old, and his mother did not remarry until he was five years of age. Unconscious fantasies of the lost father, with whom the patient had no contact in reality, and longing for him organized the patient's drives and determined his self-identity as well as his later object choice. The patient developed both a positive and negative identification with the lost father. The identification was with a fantasy object not a real one. The case highlights the need to use a precise term in talking of the object, namely the mental representation of the object which may or may not be built up out of experiences with the real object.

Adult↗
PubMed1984

Topographic variations in the rabbit and primate internal limiting membrane.

The internal limiting membrane (ILM) and cortical vitreous of the rabbit and primate were studied with transmission electron microscopy following staining with the cationic dye, Alcian blue GX. An unusual feature of the cortical vitreal collagen fibril was its displacement from the ILM: it did not insert into the lamina densa. The separation between vitreal collagen and the ILM was especially noticeable in the rabbit eye, which possessed an extremely strong vitreal retinal attachment in the posterior fundus. The lack of fibril insertion was observed in rabbit tissue that had been fixed by quick freezing on a helium-cooled copper block. The similarity in the appearance of tissue fixed by glutaraldehyde, glutaraldehyde supplemented with Alcian blue, or by quick freezing suggested that the lack of collagen fibril insertion into the ILM was an accurate representation of the relationship between collagen and the ILM. It was found that these two animal species had radically different ILM's; the rabbit ILM was a thin basement membrane throughout all areas of the posterior fundus, whereas the ILM of the cynomolgus monkey was a thick basement membrane in the peripapillary region and a thin basement membrane in the region of the fovea centralis. The topographic variations in the primate ILM thickness and appearance followed the pattern observed in human eyes. Like man, the thickening of the cynomolgus ILM in the posterior fundus was age related. The similarity between the cynomolgus and human ILM suggests that this animal would be more suitable than the rabbit for studying age-related changes or alterations in the strength of vitreal attachment following trauma.

Alcian Blue↗
PubMed1985

A general Newtonian simulation of an n-segment open chain model.

This paper presents a set of general Newtonian equations which govern the simulation of movement of a body represented by n open chain links. The input for the simulation consisted of the joint moment of force histories, lengths, masses and moments of inertia, the initial absolute angular displacements and velocities and, for the fixed or constrained axis of the nth segment, the acceleration history. Angular accelerations were then determined by solving n linear equations simultaneously, and angular velocities and displacements determined by integrating forwards. The final output was in the form of a graphical display of the linked figure. Applications of the simulation were demonstrated using three-segment representations of movements of the upper and lower extremities and a five-segment representation of a jump. Good agreement was achieved between the displayed angular displacements for the original and simulated movements. The potential for varying the input data has been examined and the implications of anticipating the effects of changed torques, inertial characteristics including attached prosthetic or sports implements and/or the initial conditions for a movement are discussed.

Acceleration↗
PubMed2004

Rapid processing of cast and attached shadows.

We used a visual-search method to investigate the role of shadows in the rapid discrimination of scene properties. Targets and distractors were light or dark 2-D crescents of identical shape and size, on a mid-grey background. From the dark stimuli, illusory 3-D shapes can be created by blurring one arc of the crescent. If the inner arc is blurred, the stimulus is perceived as a curved surface with attached shadow. If the outer arc is blurred, the stimulus is perceived as a flat surface casting a shadow. In a series of five experiments, we used this simple stimulus to map out the shadow properties that the human visual system can rapidly detect and discriminate. To subtract out 2-D image factors, we compared search performance for dark-shadow stimuli with performance for light-shadow stimuli which generally do not elicit strong 3-D percepts. We found that the human visual system is capable of rapid discrimination based upon a number of different shadow properties, including the type of the shadow (cast or attached), the direction of the shadow, and the displacement of the shadow. While it is clear that shadows are not simply discounted in rapid search, it is unclear at this stage whether rapid discrimination is acting upon shadows per se or upon representations of 3-D object shape and position elicited by perceived shadows.

Depth Perception↗
PubMed1992

[In pursuit of an object].

The author proposes an extension of the transitional phenomenon concept. Beginning with Winnicott's well known description, the author reviews the successive transformations of transitional space, first materialized and then increasingly "intrapsychic" and which persists in the individual all life long in various forms. Transformations go from the gross blanket to a more figurative little bear, then to play activities, creative drawing of the child, and finally to hypotheses and theories. This progressive hold on the object involves the mediation of transitional space--first found then created--and is instrumented through age-specific different means: concrete handling; certain characteristics of baby-talk such as voice intonation, use of the past tense before playing and the conditional in playing; redundancies, parentheses and abstractions. In the course of this paper, the author gives his personal view on the subtle differences between figuration and representation, and on the relationship between abstraction and aesthetical feeling.

Child Development↗