It is suggested that intuitive knowing (tacit, relatively swift processing) guiding a clinician's hands-on behaviour is presently marginalised in favour of a focus upon "reflective practice" ...(deliberative, relatively slow processing), despite recurrent highlighting that a skilled therapist routinely displays moments of intuitive wisdom, and also the decision-making and moral cognition literatures which, respectively, investigate the importance of tacit judgement. Relatedly, it is further suggested that a skilled clinician's deft perspicacity, as well as their competency with reflective determinations, are influenced by an evolving, selfhood-based personal philosophy. In this latter regard, existential/humanistic positions are drawn-out to elucidate the commitment possible when selfhood and personal beliefs overlap. In conclusion, building on the assumption that sense-making in life (including clinical practice) relies upon rational (conscious) and non-rational (intuitive) thought processes, attention is given to psychotherapy as an art, and thereby the necessity to cultivate a clinician's non-rational sensibility to complement their rational analytic thought processes.
Key Points
What is already known about this topic:
Research into intuitive processing is in its infancy. However, the decision-making and moral cognition literatures respectively investigate intuitive judgement.
Clinical training in the occurrence and usefulness of intuitive judgement is marginalised in favour of an emphasis upon "reflective practice".
Skilled clinicians are seen to routinely display moments of intuitive wisdom during therapy.
What this topic adds:
It is suggested that intuitive judgement and reflective practice are both informed by a clinician's personal philosophy.
Several existential/humanistic positions are examined to illustrate their 'sense-making' qualities, thereby to suggest the conviction with which personal beliefs may be held, and, in this regard, to also suggest that integrity, genuineness and humanity are existential virtues.
It is suggested that effective psychotherapy is an art which draws upon rational (conscious) and non-rational (intuitive) processing.
Aims
Disproportionality analysis is a common pharmacovigilance tool to detect safety signals of type 2 diabetes medications from spontaneous drug reporting databases. The aim was to demonstrate the ...impact of using active‐comparator restricted disproportionality analysis (ACR‐DA), wherein the reference group is restricted to reports with a clinically appropriate active comparator.
Methods
Using reports from the Food and Drug Administration Adverse Event Reporting System, we assessed if sodium/glucose cotransporter 2 (SGLT2) inhibitors are associated with higher reporting of 5 potential adverse events: acute kidney injury, genitourinary tract infections, diabetic ketoacidosis, fractures, and amputations. For each adverse event, we calculated the proportional reporting ratio (PRR) and adjusted reporting odds ratio (aROR 95% confidence interval, CI) using 3 types of reference groups: no SGLT2 inhibitor (background risk reference), other diabetes drugs (therapeutic class reference), and dipeptidyl peptidase 4 inhibitors (active comparator reference).
Results
Based on ACR‐DA, we did not detect a safety signal for acute kidney injury (PRR 0.92 0.81–1.04; aROR 0.78 95% CI 0.72–0.85) or fractures (PRR 0.4495% CI 0.17–1.15; aROR 0.74 95% CI 0.61–0.91) associated with SGLT2 inhibitors compared to dipeptidyl peptidase 4 inhibitors. However, we detected safety signals for genitourinary tract infections (PRR 2.752.02–3.76; aROR 2.542.26–2.86, diabetic ketoacidosis (PRR 63.8539.37–103.53; aROR 91.4970.66–118.48), and amputations (PRR 52.60 19.66–140.75; aROR 22.64 15.32–33.42.
Conclusion
The use of the proposed ACR‐DA to detect safety signals of type 2 diabetes medications may reduce false positive safety signals through careful selection of the comparator which is expected to reduce channelling bias.
A paper in the International Journal of Cancer analyzed Palestinian cancer registry data in the West Bank from 1998 to 2007, showing a cluster of elevated cancer incidence in rural villages in ...south‐west Hebron, with a 4.10 risk ratio for childhood lymphoma (p = 0.0023). The paper called for investigation of the environmental or genetic etiologies of this cluster in an otherwise unremarkable rural area.1 Our research in these same villages shows them to be the center of an extensive informal electronic and electrical waste (e‐waste) dismantling industry in Palestine, operating for almost two decades. This entails extensive open‐burning of e‐waste components to extract valuable metals or dispose of nonvaluable waste, releasing high concentrations of hazardous contaminants, which may be an important factor in the elevated cancer incidence. We offer a first step in assessing this link. We applied a novel multitemporal object‐based method to map the prevalence and intensity of e‐waste burn sites in the entire Hebron Governorate (1,060 km2) between 1999 and 2007. A weighted standard deviation ellipse of cumulative burn activity covers a smaller area (247 km2) very closely matching the childhood lymphoma cluster: it contains 85% of the core cluster area (RR of 4.1), and falls almost entirely (95%) within the broader area of elevated risk (RR of 2.8). Extensive international evidence linking informal e‐waste processing to elevated cancer incidence and this strong spatial association of e‐waste burning activity with a distinct unexplained cancer cluster in the Palestinian context signals the urgent need for investigation and intervention.
What's new?
Researchers have combined field study and remote sensing analysis to identify the likely cause of an unexplained childhood cancer cluster in a rural region of the West Bank. They developed a multitemporal mapping strategy of e‐waste burn sites, demonstrating a strong spatial association between a concentrated area of e‐waste burn sites and the cancer cluster. In light of this association, they recommend stopping, assessing, and remediating environmentally harmful e‐waste burning practices and hope for future success of their method in mapping e‐waste burning activities worldwide.
The enantioselective cobalt(III)‐catalyzed C−H alkylation was achieved through the design of a novel chiral acid. The cobalt(III)‐catalyzed enantioselective C−H activation was characterized by high ...position‐, regio‐ and enantio‐control under exceedingly mild reaction conditions. Thereby, the robust cooperative cobalt(III) catalysis proved tolerant of valuable electrophilic functional groups, including hydroxyl, bromo, and iodo substituents. Mechanistic studies revealed a considerable additive effect on kinetics and on a negative non‐linear‐effect.
CoIII goes chiral: Enantioselective Cp*CoIII‐catalyzed C−H functionalization was realized by synergistic cooperation with a newly developed chiral carboxylic acid for robust and versatile C−H activation.
As nanoparticle (NP)-mediated drug delivery research continues to expand, understanding parameters that govern NP interactions with the biological environment becomes paramount. The principles ...identified from the study of these parameters can be used to engineer new NPs, impart unique functionalities, identify novel utilities, and improve the clinical translation of NP formulations. One key design parameter is NP size. New methods have been developed to produce NPs with increased control of NP size between 10 and 200nm, a size range most relevant to physical and biochemical targeting through both intravascular and site-specific deliveries. Three notable techniques best suited for generating polymeric NPs with narrow size distributions are highlighted in this review: self-assembly, microfluidics-based preparation, and flash nanoprecipitation. Furthermore, the effect of NP size on the biological fate and transport properties at the molecular scale (protein-NP interactions) and the tissue and systemic scale (convective and diffusive transport of NPs) are analyzed here. These analyses underscore the importance of NP size control in considering clinical translation and assessment of therapeutic outcomes of NP delivery vehicles.
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Electronic waste (e-waste) policies have traditionally been based on extended producer responsibility (EPR) principles. In practice, EPR-based e-waste policies primarily involve the creation of ...regulated collection and recycling channels, with success tied to achieving high collection quotas. However, the majority of EPR programs, particularly those in the Global South, have achieved little success due to competition with the informal sector. Despite this, strikingly little is known of the scope and dynamics of informal e-waste flows and actors during the formulation of e-waste management policies. This study develops and pilots a replicable three-stage model for solid waste researchers, practitioners and policymakers to rapidly assess these informal e-waste systems. This model is demonstrated in Cuenca, Ecuador, and determined the destination of 50–80% of Cuenca’s e-waste over a period of three days. The methods used and findings that emerge from this study offer a strategy to rapidly quantify and understand the dynamics of informal e-waste systems to inform EPR-based policies in ways that place informal recyclers at the core of e-waste management. This not only provides creative opportunities for formal systems to achieve e-waste collection quotas through partnerships with the informal sector, but offers a pathway to preserve the livelihoods of marginalized populations reliant on e-waste recycling and decrease environmental harm.
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