Integrating research with NHS clinical practice: Unwelcome intrusion or constructive triangulation?

When embarking on research into the effectiveness of psychoanalytic psychotherapy in the NHS or the application of psychoanalytic principles, researchers come up against a number of hurdles: many clinicians still see empirical research as antithetical or disruptive to the practice of psychoanalytic psychotherapy; psychoanalytic psychotherapy has previously fared poorly in evidence-based policy guidelines and this can discourage ambition, and there are technical problems of research design, measurement and standardization. Nevertheless, in a political climate which stresses service evaluation, measurable outcomes and empirical evidence, psychoanalytic psychotherapy must participate to survive. There may be gains from conducting research beyond simply meeting the requirement to provide evidence of effectiveness. Research may be viewed by some clinicians as an unwelcome intruder but it may have the potential to offer triangulation, the perspective of the 'third', and so strengthen the foundations of clinical practice and the development of psychoanalytic thought

Ambivalence

The phenomenon of ambivalence is an important one for any philosophy of action. Despite this importance, there is a lack of a fully satisfactory analysis of the phenomenon. Although many contemporary philosophers recognize the phenomenon, and address topics related to it, only Harry Frankfurt has given the phenomenon full treatment in the context of action theory - providing an analysis of how it relates to the structure and freedom of the will. In this paper, I develop objections to Frankfurt's account, all revolving around the charge that his account contains a serious ambiguity between willing and identifying. With such objections in place, I then develop an analysis that avoids the difficulties and ambiguities that Frankfurt's analysis is prey to. I briefly distinguish ambivalence from other types of internal conflict. This paper aims to offer conceptual clarification on the phenomenon of ambivalence, which will then allow for discussions about the normative merits and demerits of ambivalence, the effects of ambivalence on autonomous action, and methods of resolution of ambivalenc

Two Types of Autonomy

Although I agree with Sabine Muller’s conclusion that we should first seek to find alternatives to amputation for patients suffering from Body Integrity Identity Disorder (BIID), I disagree with one of the major premises that she uses to argue for her claim. Muller argues that patients with BIID are likely not autonomous when they request that the limb be amputated. Muller’s argument that BIID suffers are not autonomous is flawed because she conflates philosophical conceptions of autonomy with the conception of autonomy that is operative in the context of medicine

Lensing by Lyman Limit Systems: Determining the Mass to Gas Ratio

We present a new method to determine the total mass-to-neutral gas ratio in Lyman-limits systems. The method exploits the relation between the neutral hydrogen column density and the magnification of background sources due to the weak gravitational lensing that these systems induce. Because weak lensing does not provide a direct measure of mass, one must use this relation in a statistical sense to solve for the average mass-to-gas ratio and its distribution. We use a detailed mock catalog of quasars (sources) and Lyman-limit systems (lenses) to demonstrate the applicability of this approach through our ability to recover the parameter. This mock catalog also allows us to check for systematics in the method and to sketch its limitations. For a universal constant mass-to-gas ratio and a sample of N quasars, we obtain an unbiased estimate of its value with 95% confidence limits (independent of its actual value) of +/- 140 {10^5/N)^0.5.Comment: 20 pages, 11 figures submitted to Ap

Do Gamma-Ray Burst Sources Repeat?

The demonstration of repeated gamma-ray bursts from an individual source would severely constrain burst source models. Recent reports (Quashnock and Lamb 1993; Wang and Lingenfelter 1993) of evidence for repetition in the first BATSE burst catalog have generated renewed interest in this issue. Here, we analyze the angular distribution of 585 bursts of the second BATSE catalog (Meegan et al. 1994). We search for evidence of burst recurrence using the nearest and farthest neighbor statistic and the two-point angular correlation function. We find the data to be consistent with the hypothesis that burst sources do not repeat; however, a repeater fraction of up to about 20% of the observed bursts cannot be excluded.Comment: ApJ Letters, in press, 13 pages, including three embedded figures. uuencoded Unix-compressed PostScrip

Potential implications of coronary artery calcium testing for guiding aspirin use among asymptomatic individuals with diabetes.

ObjectiveIt is unclear whether coronary artery calcium (CAC) is effective for risk stratifying patients with diabetes in whom treatment decisions are uncertain.Research design and methodsOf 44,052 asymptomatic individuals referred for CAC testing, we studied 2,384 individuals with diabetes. Subjects were followed for a mean of 5.6 ± 2.6 years for the end point of all-cause mortality.ResultsThere were 162 deaths (6.8%) in the population. CAC was a strong predictor of mortality across age-groups (age <50, 50-59, ≥60), sex, and risk factor burden (0 vs. ≥1 additional risk factor). In individuals without a clear indication for aspirin per current guidelines, CAC stratified risk, identifying patients above and below the 10% risk threshold of presumed aspirin benefit.ConclusionsCAC can help risk stratify individuals with diabetes and may aid in selection of patients who may benefit from therapies such as low-dose aspirin for primary prevention

Characteristics of a cohort of high-risk men who have sex with men on pre-exposure prophylaxis reporting transgender sexual partners.

Transgender people continue to be at high-risk for HIV acquisition, but little is known about the characteristics of their sexual partners. To address this gap, we examined sociodemographic and sexual characteristics of cisgender men who have sex with men (MSM) on pre-exposure prophylaxis (PrEP) reporting transgender sexual partners.A cohort of 392 MSM in southern California in a randomized clinical trial for PrEP adherence were followed from 2013 to 2016. Multivariable generalized estimating equation and logistic models identified characteristics of MSM reporting transgender sexual partners and PrEP adherence.Only 14 (4%) MSM reported having transgender sexual partners. MSM were more likely to report transgender partners if they were African American, had incident chlamydia, reported injection drug-using sexual partners, or received items for sex. Most associations remained significant in the multivariable model: African American (adjusted odds ratio [AOR] 11.20, P = .01), incident chlamydia (AOR 3.71, P = .04), and receiving items for sex (AOR 5.29, P = .04). There were no significant differences in PrEP adherence between MSM reporting transgender partners and their counterpart.MSM who report transgender sexual partners share characteristics associated with individuals with high HIV prevalence. Identifying this group distinct from larger cohorts of MSM could offer new HIV prevention opportunities for this group of MSM and the transgender community

Parallel quantized charge pumping

Two quantized charge pumps are operated in parallel. The total current generated is shown to be far more accurate than the current produced with just one pump operating at a higher frequency. With the application of a perpendicular magnetic field the accuracy of quantization is shown to be $<$20 ppm for a current of $108.9$pA. The scheme for parallel pumping presented in this work has applications in quantum information processing, the generation of single photons in pairs and bunches, neural networking and the development of a quantum standard for electrical current. All these applications will benefit greatly from the increase in output current without the characteristic decrease in accuracy as a result of high-frequency operation

A simple analytical model for dark matter halo structure and adiabatic contraction

A simple analytical model for describing inner parts of dark matter halo is considered. It is assumed that dark matter density is power-law. The model deals with dark matter distribution function in phase space of adiabatic invariants (radial action and angular momentum). Two variants are considered for the angular part of the distribution function: narrow and broad distribution. The model allows to describe explicitly the process of adiabatic contraction of halo due to change of gravitational potential caused by condensation of baryonic matter in the centre. The modification of dark matter density in the centre is calculated, and is it shown that the standard algorithm of adiabatic contraction calculation overestimates the compressed halo density, especially in the case of strong radial anisotropy.Comment: 5 pages, 3 figures. v3 - major improvements, another halo model introduced, discussion extende