The parent?infant dyad and the construction of the subjective self

Developmental psychology and psychopathology has in the past been more concerned with the quality of self-representation than with the development of the subjective agency which underpins our experience of feeling, thought and action, a key function of mentalisation. This review begins by contrasting a Cartesian view of pre-wired introspective subjectivity with a constructionist model based on the assumption of an innate contingency detector which orients the infant towards aspects of the social world that react congruently and in a specifically cued informative manner that expresses and facilitates the assimilation of cultural knowledge. Research on the neural mechanisms associated with mentalisation and social influences on its development are reviewed. It is suggested that the infant focuses on the attachment figure as a source of reliable information about the world. The construction of the sense of a subjective self is then an aspect of acquiring knowledge about the world through the caregiver's pedagogical communicative displays which in this context focuses on the child's thoughts and feelings. We argue that a number of possible mechanisms, including complementary activation of attachment and mentalisation, the disruptive effect of maltreatment on parent-child communication, the biobehavioural overlap of cues for learning and cues for attachment, may have a role in ensuring that the quality of relationship with the caregiver influences the development of the child's experience of thoughts and feelings

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Fibres found in the eye during and after phacoemulsification cataract surgery

PURPOSE: Fibres are regularly found within the delivery cartridge (DC) and in the anterior chamber (AC) during phacoemulsification cataract surgery (PCS) and postoperatively. The purpose of this study was to identify their frequency and possible significance. SETTING: Dedicated ophthalmic day surgery. DESIGN: Prospective, consecutive, single-surgeon, cohort study. METHODS: In 639 eyes undergoing PCS, the presence of fibres was documented in or on both the DC and in the AC intraoperatively, and in the AC postoperatively. The intraoperative method of fibre removal was documented. Corrected distance visual acuity (CDVA) was recorded preoperatively, and at day 1, week 1, and week 4 postoperatively. The incidence of clinical cystoid macular oedema (CMO) and endophthalmitis in the retained fibre subcohort was compared with that of the non-fibre subcohort. RESULTS: A total of 5.2% of the operated eyes had a fibre or fibres in or on the DC, which in all cases was removed with forceps intraoperatively. A total of 14.6% of operated eyes had a fibre or fibres in the AC intraoperatively; these were removed by irrigation/aspiration. Postoperatively, five eyes (0.78%) had a fibre in the AC. There was no significant difference in postoperative CDVA between the fibre and non-fibre subcohorts (P=0.26), and no clinically significant CMO or endophthalmitis in either subcohort. CONCLUSIONS: Most fibres seen on the DC or in the eye are sterile and non-inflammatory. However, there have been reports of endophthalmitis attributed to retained fibres. In this study, there were no complications attributable to the fibres, but their removal may minimise any adverse potential.Z E McPherson, J Jung-Yeon Ku, E Chong, S Amjadi, K E Francis, J L Lauschke, A W Kam, H Tsang, and I C Franci