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PubMed1992

[The gynecologist and hysterectomy].

Often it is postulated by mass media that too much hysterectomies would be performed by gynaecologists. Hysterectomy is today a relatively safe routine intervention. This may tempt to a generous indication. Elective hysterectomy has been looked at critically. Two factors play an important role, firstly the position of the women to her uterus, i. e. how does the women settle down her fertility in her life and secondly the position of the gynaecologist, which will be transmitted from him to the patient cousciously or instinctively. Then our position to alternative methods like endometrial ablation by hysteroscopic laser coagulation or laser assisted or pelviscopic hysterectomies has been demonstrated.

Female↗

PubMed2003

Philosophical anthropology and psychiatry: typus melancholicus as a human disposition.

Key ideas of philosophical anthropology furnish the framework for a description of the personality type, typus melancholicus. These key ideas are: (1) all living beings are related to and interact with their environments, (2) all living beings must maintain their identities in distinction from their environments, (3) the biological constitution of human beings leaves them instinct-deficient, (4) the human-world relationship must therefore be partially determined by cultural shaping, and (5) social roles and norms determine the consciousness and behavior of human beings. "Dispositional vectors" are basic tendencies within human beings that move them toward particular forms of world-relatedness. These dispositional vectors are: over-identification with social norms (hypernomia), struggle with social norms (agonomia), under-identification with social norms (hyponomia), and over-identification with personal norms (idionomia). When the dispositional vector of hypernomia moves in a pathological direction, it becomes the personality type, typus melancholicus. The two fundamental features of typus melancholicus are hypernomia and intolerance of ambiguity.

Animals↗

PubMed2003

[Morbidity diagnosed in the general medicine public structures in Tunisia].

The study of morbidity in general medicine is very useful in order to adapt training curricula to the reality of medical practice in the first degree. The objective of this work was to describe the morbidity charted in general medicine in Tunisia's Sousse region. It consisted of a prospective and descriptive study involving six basic health centres in Sousse and was conducted over the course of 30 randomly selected days during the year 2000. There were 4022 consultations included in the study which were described according to the SOAP plan. The coding of the charted diagnoses was carried out according to the International Classification of Primary Care (CISP). There were 98% of the consultants who were self-referred and 84% of the consultations corresponded to new cases. The consultants' sex-ratio was 0.5 in favour of females with an average age of 27 years. There were 4,597 diagnoses noted utilising 336 codes from the CISP classification system. The "Respiratory" chapter took the first place on the list (39.6%) followed by the "Circulatory" chapter. The "Top 30" list of the most often charted diagnoses totaled 72% of the consultations among which the three most frequent health problems were pharyngitis (14.4%), acute bronchitis (8.3%) and arterial hypertension (7.4%). This study demonstrates that the practice of general medicine is characterised by instinctive first solutions and versatility. The predominance of cardiovascular and respiratory illnesses illustrates the double burden of morbidity which is faced by Tunisian general medicine practitioners. The "Top 30" list should serve as basis for planning pregraduate and continuing medical training.

Adult↗

PubMedDate not supplied

[W. D. Winnicott and the transitional object in infancy].

Donald Winnicott (1896-1971), specialist in children's diseases, psychology and psychotherapy, tried to put together his experience in all these fields. His theories can be put between the orthodox psychoanalytic thought and a "relational" paediatrics. He made his research on the "global reality" of child rather than being interested in the "internal objects". Both the orthodox analysts, who condemned his theories, and the specialists in children's diseases, who didn't recognize the scientific aspect of his genius, criticised and opposed Winnicott. Even if sometimes his theories have not an organic unity, they are the result of very detailed clinical observations, which are supported by a large experience with children at the Paddington Green Children Hospital and the Queen's Hospital for Children in London. With "transition", Winnicott means an intermediate development area between the psychic and external reality. There, we can find the "transitional object", which is the first element leading the child to face the external reality through the creation of symbols. Winnicott goes over the idea of the binomial mother-child, intended as instinctive development, and underlining the importance of real experiences. In his opinion, in the child development one has to stress the concept of "need" instead of that of "desire". A good environment and the empathic contact with "a fairly good mother", cause the passage from the primary narcissism to the object relationships. A fairly good mother must be able to perform holding, handling, and object presenting. Her duty is that of gradually undeceiving, and to do it she must give a sufficient opportunity of illusion. The mother, offering the right opportunity of illusion, puts the basis of symbols. Subsequently, she will go on a gradual disillusion. Winnicott disagrees Klein's ideas by stating that "playing is therapeutic in its own aspect", seeing it as a potential space between mother and child, which will become the place of analysis and transfer and, after on, that of cultural experience.

Affect↗

PubMed2003

Innovating for cash.

Despite companies' almost fanatical worship of innovation, most new products don't generate money. That's because executives don't realize that the approach they take to commercializing a new product is as important as the innovation itself. Different approaches can generate very different levels of profit. Companies tend to favor one of three different innovation approaches, each with its own investment profile, profitability pattern, risk profile, and skill requirements. Most organizations are instinctively integrators: They manage all the steps needed to take a product to market themselves. Organizations can also choose to be orchestrators: They focus on some parts of the commercialization process and depend on partners to manage the rest. And finally, companies can be licensers: They sell or license a new product or idea to another organization that handles the commercialization process. Different innovations require different approaches. Selecting the most suitable approach, the authors' research found, often yields two or three times the profits of the least optimal approach. Yet companies tend to rely only on the mode most familiar to them. Executives would do better to take several different factors into account before deciding which tack to take, including the industry they're trying to enter, the specific characteristics of the innovation, and the risks involved in taking the product to market. By doing so, companies can match the approach to the opportunity and reap the maximum profit. Choosing the wrong approach, like Polaroid did, for example, can lead to the failure of both the product and the company. Optimizing their approaches, as Whirlpool has done, helps ensure that companies' innovations make money.

Decision Making, Organizational↗

PubMed1992

The effect of maternal exposure to dioxolane on prenatal and postnatal development in rats.

Female rats were given by gavage every other day from days 8-20 of gestation an aqueous solution of dioxolane at daily doses equal to 0.025, 0.1 and 0.2 LD50 (first series--prenatal development) or from days 2-20 of gestation at daily doses equal to 0.025, 0.075 and 0.15 LD50 (second series--postnatal development). At doses toxic or subtoxic to maternal rats (0.1 and 0.2 LD50) dioxolane did not cause increased embryo or fetus intrauterine death rates or congenital defects, it did cause, however, dose-related delays in fetal development. Dioxolane does not cause impairment of physical development or behavioral disturbances. Exposure to higher doses of the compound (0.2 LD50) leads to increased perinatal death rates in the offspring, without causing, however, disturbances in the maternal instinct. The exposure of pregnant rats to dioxolane decreased haemoglobin levels in 5-week-old offspring. At a dose 1.15 g/kg (0.2 LD50) the chemical significantly increased exploratory motor activity of female offspring at the age of 8 weeks, but did not affect significantly locomotor activity of males and the active avoidance acquisition of adult offspring.

Animals↗

PubMed1965

SURFING INJURIES.

Skurfboarding is currently enjoying a phase of popularity, but it is not without hazards. Among 75 consecutive cases of skurfboard injuries seen in an emergency department, 29 fractures were encountered, 16 of which were in the region of the ankle and foot. The majority of injuries, however, consisted of sprains, contusions and abrasions. Six patients required hospital admission, three for operative management of fractures and three because of head injuries.The concrete playground, the instability of the board, the lack of protective clothing and the exhibitionist instincts of the teen-age enthusiast are suggested as factors responsible, at least in part, for the injuries sustained on skurfboards.

Adolescent↗

PubMed2003

[Morphological parameters for endothelial cells under shear stress].

Shear stresses acting on vascular endothelial cells due to blood fluid flow play an vital role in regulating their morphology, structure, growth rate and functions. The change in morphology is an instinctive response to biomechanical environment and is an indicator for the functional changes in the cells. In this paper, the morphological research literatures of endothelial cells in the recent years are reviewed and the common morphological parameters are described in detail. At the end, the difficulties of quantitative study of endothelial cell morphology and the future direction of morphological parameters research are also discussed.

Animals↗

PubMed2003

[Structuralistic and meta-psychological approaches to ambivalence in schizophrenia].

The word "ambivalence" generally signifies a psychic state in which a subject holds a contradictory or conflicted attitude towards an object. The literal meaning of the word is that two valences occur simultaneously, and this connotes the epistemological and ethical problem of where and how the valences arise. The concept of ambivalence implies that the relationship between the subject and the world is ambivalent, that the subject has free will in the alternative evaluation, and that the meanings of the two valences derive from the meta-level outside the world. These reflections lead us to the supposition that ambivalence is closely associated with the function of language. The ambivalent attitude of the subject divides the significance of the object; the appearance of the given ambivalent meanings is the moment of the subject's choice. This phenomenon of division, choice, and given meanings is more than analogous to F. de Saussure's conception of language in terms of sign, différenciation, and l'arbitraire de langue. A view of ambivalence as a fundamental phenomenon concerning subject, world, and language affords insight specifically into ambivalence in schizophrenia. For people with schizophrenia, ambivalent conflict often takes the form of a dichotomy between "good and bad". The more severe the ambivalent symptom, the more similar it seems to a philosophical question about the nature of existence in the world. When schizophrenic people raise philosophical questions directly such as "Is my existence good or bad?" or "To be or not to be?", they seek approval for their existence, assaying to live with "good" intentions. Unfortunately they come to be blamed for harbouring "bad" intentions. When they have an interrogative attitude even to everyday matters, they cannot resolve such questions as "Is the red cup good or bad?", or "Is the green cup good or bad?", and hence "Which cup should I use?". If the projection of the self into the world is essentially the choice of a daily behavior as its own praxis, such indecisiveness thus entails existential conflict. The alternatives of choice appear before them as a tollgate to the world. Wishing admission to the world, they choose the thing that they think "good", but which later turns out to be "bad". These consequences sometimes occur in their inner conflicts and sometimes in their paranoidhallucinatory experiences. We have observed that in these processes, there is an inversion between "good and bad", and "bad" predominates, driving patients to despair. Rethinking E. Bleuler's conception of the ambivalence of schizophrenia, we have found that it is accessible to structuralistic and meta-psychological interpretations. From the viewpoint of linguistic semiology, ambivalence can be considered as a disorder of exclusive differentiation in the associative system resulting from the appearance of antithetical meanings, a phenomenon that is also common in primal words and children's thinking. In the context of psycho-analysis, it is suggested that the dominance of the negative side in ambivalence may be caused by death instinct. These interpretations are consistent with both the philosophical considerations and the clinical observations introduced above, but the problem of schizophrenic specificity is still opened beside the affinity between philosophical conflict and schizophrenic ambivalence. References to ethical and philosophical thinking shed light on the sources of the dichotomous existential conflict and the characteristic inversion between "good and bad" that schizophrenic patients experience. Descriptions of the root of ambivalence can be traced back to ancient times. In the Ecclesiastes of the Apocrypha, Jesus, son of Sirach, elucidates the fundamental ambivalence of will, teaching that the subject has the power of its own choice: at its most extreme, the choice between life and death. In the modern age, L. Wittgenstein offers a strict description of this ambivalence in his "Notebooks 1914-1916". Wittgenstein doubted the possibility of pure subjectivity without individual will and furthermore argued that the will is either good or evil, that is, the bearer of good and evil. In his view, good and evil are somehow connected with the meaning of the world, and meaning ("Sinn" in German) is discerned from significance ("Bedeutung" in German). He went on to write that the meaning does not lie in the world but outside it. As K. Shingu has noted, Wittgenstein's conception is essentially consistent with psycho-analysis. The subject recognizes the world with ambivalent will, the world appears with ambivalent significance, but its ambivalent meaning is given from outside the world, that is, from the meta-level. For E. Husserl's concept of intentionality, it is said that the fundamental disorder of schizophrenia is a preverbal or pre-predicative problem that is connected with intentionality. Yet one wonders whether or not pure, neutral intentionality is really possible. Presumably, intentionality has an intrinsic ambivalence, since the fundamental relationship between the subject and the world may itself be ambivalent. When one becomes conscious of a thing, the potential exists to divide one's intentionality between "good and bad", and the thing thus appears as "good" or "bad". In the healthy psyche, this intrinsic ambivalence emerges only in ethical or philosophical thinking. In schizophrenia, however, the ambivalence of intentionality is explicitly engaged in diverse situations. The inversion of "good and bad" observed in the clinical context signifies that the will of the patient shifts from "good" to "bad", alluding to a contradiction between the subject and the world that is logically inevitable due to the structure of their relationship. The subject objectivfies the world positively, yet is contained by the world passively. That the subject simultaneously announces and is announced in the language system also reflects this paradoxical relationship. Thus, ambivalence of dichotomy between "good and bad" is the very basic phenomenon of consciousness, and the inversion of "good and bad" is a reflection of the structure of the relationship of the subject and the world. If the schizophrenic specificity exists, it may involve the exposure of this intrinsic ambivalence and this paradoxical structure in confrontations with the tellgate into the world under the dominance of the negative side.

Humans↗

PubMedDate not supplied

Learning intuition--less college and more kindergarten: the leader's challenge.

Learning to think instinctually and to depend on our intuition means, for many of us, going back to kindergarten and focusing more on our instinctual side to balance the linear approach that we've learned in many college and business school courses. It also means building time into our lives for reflection and allowing our brains the time to reorganize the events of our lives into patterns that we will recognize in the future. The process of the incubating experience and data in our minds over time will build the intuition and instincts that will help us all to learn how to be great leaders (Gardner, 1995). We can learn much from the training of clinicians in pattern recognition and intuitive analysis of clinical situations. Many of us who were clinicians first understand the intuitive side of clinical practice and of administrative practice because we were educated in both worlds. We have the advantage of knowing the concepts of intuitive thinking and must remember to apply those concepts daily to our practices in leadership. Toffler said "You can use all the quantitative data you can get, but you still have to distrust it and use your own intelligence and judgment" (Boone, 1999, p. 80). As we acquire more experience and wisdom, we learn to trust our own intelligence and judgment. What we came to know in kindergarten is as valuable as the analytical knowledge we have since acquired. In leadership, we will do well to remember our clinical roots and to continually hone our skills in intuition and thinking with our gut.

Education↗

PubMed2003

Controversies in differentiating thrombotic thrombocytopenic purpura and hemolytic uremic syndrome.

The diagnoses of thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS) often remain questionable, forcing the clinician to make the difficult decision of initiating therapy based on symptomatology and clinical judgment and, sometimes, instinct. An increased awareness of characteristic symptoms and early diagnoses of TTP and HUS are of utmost importance, given the excellent results obtained with prompt plasma exchange therapy. Tremendous progress has been made in understanding TTP and HUS since TTP was first described more than 75 years ago at Mount Sinai. However, several questions are still not definitively answered. In this article, we will review background on both entities, and then describe the controversy in differentiating between them.

Diagnosis, Differential↗

PubMedDate not supplied

Learning intuition--less college and more kindergarten: the leader's challenge.

Humans↗

PubMed1992

An anatomical commentary on the concept of infantile oral sadism.

Although this paper is entitled 'An anatomical commentary on the concept of infantile oral sadism' it is also an attempt to examine hypotheses regarding the sources of oral sadism. Freud did not explicitly refer to an oral sadistic phase of development in early infancy, believing as he did that sadism was a component instinct. Abraham postulated that oral sadism arises when the teeth erupt and the jaw muscles function. Melanie Klein, however, came to claim that oral sadistic impulses operate from birth and arise from the infant's innate potential for fantasy. This hypothesis is akin to Freud's theory of primal fantasies. The anatomical record supports Abraham's theory of the source of oral sadism.

Female↗

PubMedDate not supplied

Managers and leaders: are they different?

The traditional view of management, back in 1977 when Abraham Zaleznik wrote this article, centered on organizational structure and processes. Managerial development at the time focused exclusively on building competence, control, and the appropriate balance of power. That view, Zaleznik argued, omitted the essential leadership elements of inspiration, vision, and human passion which drive corporate success. The difference between managers and leaders, he wrote, lies in the conceptions they hold, deep in their psyches, of chaos and order. Managers embrace process, seek stability and control, and instinctively try to resolve problems quickly--sometimes before they fully understand a problems significance. Leaders, in contrast, tolerate chaos and lack of structure and are willing to delay closure to understand the issues more fully. In this way, Zaleznik argued, business leaders have much more in common with artists, scientists, and other creative thinkers than they do with managers. Organizations need both managers and leaders to succeed, but developing both requires a reduced focus on logic and strategic exercises in favor of an environment where creativity and imagination are permitted to flourish.

Administrative Personnel↗

PubMedDate not supplied

A boy who stops taking stimulants for "ADHD": commentaries on a Pediatrics case study.

This article presents eight commentaries on a case study published in the journal Pediatrics in 2001. The case study, introduced in Pediatrics to highlight the issue of adolescents' compliance with drug treatment in a "high-prevalence neurobehavioral condition," briefly describes an adolescent boy who announces that he no longer needs the methylphenidate he was prescribed for ADHD and had been taking for the last five years. We invited experienced professionals from the disciplines of psychiatry, psychology, counseling, education, and occupational therapy to comment on the case and make recommendations to the adolescent boy in the case study, his family, and professionals. Their commentaries highlight issues rarely discussed in the mainstream literature, including: the extent to which ADHD is erroneously portrayed and vigorously managed as a disease; the lack of validity of the ADHD construct in adolescence; the widespread use of stimulants as performance-enhancing drugs; the need to respect an adolescent's gut instinct and developing decisions; the importance of family dynamics in ADHD-like situations; the need to ease stimulant withdrawal effects; and the human rights of children prescribed psychotropic drugs.

Adolescent↗

PubMed2004

[Lorenz was right, or does aggressive energy accumulate?].

Evidence supporting the fact that inherited mechanisms of regulation of aggressive behavior as a result of a repeated experience of aggression ending in victories are transformed into pathological mechanisms based on accumulation of neurochemical shifts in the brain, enhancing aggressiveness, and forming aggressive motivation in aggressive winners. This confirms the concept by Lorenz on the existence of a mechanism (but not instinct) of a spontaneous accumulation of aggressive energy that needs a discharge and formation of permanent attraction to manifestation of aggression.

Aggression↗

PubMed2004

How global brands compete.

It's time to rethink global branding. More than two decades ago, Harvard Business School professor Theodore Levitt argued that corporations should grow by selling standardized products all over the world. But consumers in most countries had trouble relating to generic products, so executives instead strove for global scale on backstage activities such as production while customizing product features and selling techniques to local tastes. Such "glocal" strategies now rule marketing. Global branding has lost more luster recently because transnational companies have been under siege, with brands like Coca-Cola and Nike becoming lightning rods for antiglobalization protests. The instinctive reaction of most transnational companies has been to try to fly below the radar. But global brands can't escape notice. In fact, most transnational corporations don't realize that because of their power and pervasiveness, people view them differently than they do other firms. In a research project involving 3,300 consumers in 41 countries, the authors found that most people choose one global brand over another because of differences in the brands'global qualities. Ratherthan ignore the global characteristics of their brands, firms must learn to manage those characteristics. That's critical, because future growth for most companies will likely come from foreign markets. Consumers base preferences on three dimensions of global brands--quality (signaled by a company's global stature); the cultural myths that brands author; and firms' efforts to address social problems. The authors also found that it didn't matter to consumers whether the brands they bought were American--a remarkable finding considering that the study was conducted when anti-American sentiment in many nations was on the rise.

Commerce↗

PubMed2004

Be sure to cover your REER: leader-manager models in health care integration of theory and practice.

Good daily management combines the prioritization tools of health care management with tested leadership visions that create a symbiosis for success. We introduce the concept of REER--revenues, expenses, efficiencies and risk--as daily benchmarks to guide managers and blend REER with other leadership premises. A complete REER model includes leadership elements that define the tools and when to use them. A vision for the business requires a broad spectrum of tools to succeed: integrity, persistence, energy, insight into people and the instinct to know when to focus on revenue and when to allocate for risk.

Administrative Personnel↗