The Limit of Intimacy and the Intimacy of Limit: Play and its Relation to the Bad Object

Attachment to the bad object has remained a durable, undertheorized clinical problem. With an extended clinical example, the experience of limit, in both patient and analyst, is examined as part of a dense undercurrent in the relationship, including transference, that gives rise to shifts in understanding the attachment to an unsatisfying internal object. Importantly, the patient's and the analyst's experiences of limit are "in play" during the process of changes in the patient's attachment to the bad object. The relation of patient and analyst to the patient's internal objects, including bad and unsatisfying objects, is where play itself begins. Limit itself is constitutive of play. The analyst's attempt to analyze his own thoughts and experience regarding limits in maintaining an empathic connection to the patient's psychic reality influences the patient's capacity to take in a new part of his or her experience.

Smartphone-Based Artificial Intelligence-Assisted Prediction for Eyelid Measurements: Algorithm Development and Observational Validation Study

BACKGROUND

Margin reflex distance 1 (MRD1), margin reflex distance 2 (MRD2), and levator muscle function (LF) are crucial metrics for ptosis evaluation and management. However, manual measurements of MRD1, MRD2, and LF are time-consuming, subjective, and prone to human error. Smartphone-based artificial intelligence (AI) image processing is a potential solution to overcome these limitations.

OBJECTIVE

We propose the first smartphone-based AI-assisted image processing algorithm for MRD1, MRD2, and LF measurements.

METHODS

This observational study included 822 eyes of 411 volunteers aged over 18 years from August 1, 2020, to April 30, 2021. Six orbital photographs (bilateral primary gaze, up-gaze, and down-gaze) were taken using a smartphone (iPhone 11 Pro Max). The gold-standard measurements and normalized eye photographs were obtained from these orbital photographs and compiled using AI-assisted software to create MRD1, MRD2, and LF models.

RESULTS

The Pearson correlation coefficients between the gold-standard measurements and the predicted values obtained with the MRD1 and MRD2 models were excellent (r=0.91 and 0.88, respectively) and that obtained with the LF model was good (r=0.73). The intraclass correlation coefficient demonstrated excellent agreement between the gold-standard measurements and the values predicted by the MRD1 and MRD2 models (0.90 and 0.84, respectively), and substantial agreement with the LF model (0.69). The mean absolute errors were 0.35 mm, 0.37 mm, and 1.06 mm for the MRD1, MRD2, and LF models, respectively. The 95% limits of agreement were -0.94 to 0.94 mm for the MRD1 model, -0.92 to 1.03 mm for the MRD2 model, and -0.63 to 2.53 mm for the LF model.

CONCLUSIONS

We developed the first smartphone-based AI-assisted image processing algorithm for eyelid measurements. MRD1, MRD2, and LF measures can be taken in a quick, objective, and convenient manner. Furthermore, by using a smartphone, the examiner can check these measurements anywhere and at any time, which facilitates data collection.

Effects of limits in milking capacity, housing capacity, or fat quota on economic optimization of dry period lengths

The economically optimal dry period length (DPL) of dairy cows remains a topic of interest. Increasing daily milk production and improved management of the transition period require frequent evaluation of the optimal DPL. The economically optimal DPL also depends on the most limiting farm resource such as milking capacity, housing capacity, or fat quota. Therefore, the objective of this study was to determine economically optimal DPL under farm constraints on milking capacity, housing capacity, and fat quota given variations in 12 input factor levels. We developed a deterministic whole herd simulation model, including a nonlinear optimizer of the DPL in the first 3 parities. The model included estimates of milk, fat, and protein yield deviations in the subsequent parity and hazard ratios of culling risk and pregnancy rates as functions of the DPL in the current parity. The DPL could vary between 20 and 90 d with step size of 1 d. In addition to a one-factor-at-a-time analysis, we used a definitive screening design and a space-filling design with Latin hypercube sampling to determine important linear and curvature effects of input factors and their interactions. Results indicated that the economically optimal DPL were typically between 35 and 50 d under a large variation in input factor levels. The opportunity costs of equal DPL in all parities were small compared with optimal policies where the DPL were allowed to vary between parities. The DPL under the parlor constraint were generally less than 5 d longer than the optimal DPL under the housing constraint. The optimal DPL under the quota constraint were between those under the parlor and housing constraints. Opportunity costs compared with 50 d dry were often small, but in some cases large. A formal global sensitivity analysis revealed important interactions of input factors that were not discovered with one-factor-at-a-time analyses. In conclusion, economically optimal DPL were often shorter than typically are recommended. Adding uncertainty about the date of calving at the date of dry-off might extend these optimal DPL by some days depending on the risk attitude of the decision maker.

Loss of Smell and Taste in Patients With Suspected COVID-19: Analyses of Patients' Reports on Social Media

BACKGROUND

The year 2020 was the year of the global COVID-19 pandemic. The severity of the situation has become so substantial that many or even most of the patients with mild to moderate symptoms had to self-isolate without specific medical treatments or even without being tested for COVID-19. Many patients joined internet membership groups to exchange information and support each other.

OBJECTIVE

Our goal is to determine the benefits and limits of using social media to understand the symptoms of patients with suspected COVID-19 with mild to moderate symptoms and, in particular, their symptoms of anosmia (loss of the sense of smell) and ageusia (loss of the sense of taste). The voluntary reports on an internet website of a membership group will be the platform of the analyses.

METHODS

Posts and comments of members of an internet group known as COVID-19 Smell and Taste Loss, founded on March 24, 2020, to support patients with suspected COVID-19 were collected and analyzed daily. Demographic data were collected using the software mechanism called Group Insights on the membership group website.

RESULTS

Membership groups on social media have become rare sources of support for patients with suspected COVID-19 with mild to moderate symptoms. These groups provided mental support to their members and became resources for information on COVID-19 tests and medicines or supplements. However, the membership was voluntary, and often the members leave without notification. It is hard to be precise from the free voluntary reports. The number of women in the group (6995/9227, 75.38% as of October 12, 2020) was about three times more than men (2272/9227, 24.62% as of October 12, 2020), and the peak age of members was between 20-40 years in both men and women. Patients who were asymptomatic other than the senses comprised 14.93% (53/355) of the total patients. Recovery of the senses was higher in the patients who were asymptomatic besides having anosmia and ageusia. Most (112/123, 91.06%) patients experienced other symptoms first and then lost their senses, on average, 4.2 days later. Patients without other symptoms tended to recover earlier (P=.02). Patients with anosmia and ageusia occasionally reported distorted smell and taste (parosmia and dysgeusia) as well as experiencing or perceiving the smell and taste without the sources of the smell or taste (phantosmia and phantogeusia).

CONCLUSIONS

Our analysis of the social media database of suspected COVID-19 patients' voices demonstrated that, although accurate diagnosis of patients is not always obtained with social media-based analyses, it may be a useful tool to collect a large amount of data on symptoms and the clinical course of worldwide rapidly growing infectious diseases.

[Continuity and work in nurseries]

Continuity of care is a fundamental element in enabling a child to build himself on the psychological level. It is encouraged by professional reflection but can, however, take place at an irregular pace. Meeting with Mathilde Sauvervald, director in training of a day-care centre.

A Review of Wood Dust Longitudinal Health Studies: Implications for an Occupational Limit Value

Numerous studies reporting on the health effects of wood dust have been published over many decades. For the clear majority of these studies, their use for setting a science-based occupational exposure level is problematic due generally to insufficient exposure measurement data, inadequate participant follow-up, and lack of control for confounding variables. However, there exists a robust data set from a large longitudinal lung function study that provides a scientifically sound basis for establishing an occupational limit of 5 mg/m³ inhalable wood dust. The choice of this data set and its application for this purpose are presented in this review.

[The caregiver's commitment and its limits]

The question of commitment and its limits can be envisaged from the point of view of supervision in healthcare institutions or in home hospital care. When the commitment appears to be frustrated in the healthcare relationship, it must be supported and its limits should be defined.

[Limit landscapes in the era of technicality]

In the era of technicality, man seems to have lost the sense and true dimension of the limit: it has thus become something to be annihilated and a point that needs to move further and further not only for human curiosity but also because of profit economic development that governs globalized progress. In this scenario, the Author reflects on the most authentic sense of the limit and tries to defend it because our gender identity is bound to be limited.

[Hospital-at-home at the end of life, challenges and limits]

The requests for hospital-at-home palliative care are made by health professionals as well as by patients and their families. Nurse coordinators assess them in order to identify the limits and assure high-quality care. Team meetings enable professionals to decide on a joint approach and provide support to the caregivers where necessary.

[The risk/benefit ratio in psychiatry]

The risk/benefit ratio weighs up on the one hand the expected advantages and on the other the potential risks of a procedure. It is taken into consideration with every therapeutic decision, whether it concerns medication-based treatments, psychotherapy or any other type of treatment. The ethical dimension is a critical element which must be taken into account during team deliberations, whenever these are possible.

["There can be no unnecessary risks"]

The psychoanalytical point of view regarding the notion of risks helps us to understand the concept of transference and counter transference. Practice analysis groups provide an opportunity for collective discussion and the sharing of experience of clinical situations. Interview with Didier Gauchy, a psychiatrist-psychoanalyst in Lyon.

The Peto odds ratio viewed as a new effect measure

Meta-analysis has generally been accepted as a fundamental tool for combining effect estimates from several studies. For binary studies with rare events, the Peto odds ratio (POR) method has become the relative effect estimator of choice. However, the POR leads to biased estimates for the OR when treatment effects are large or the group size ratio is not balanced. The aim of this work is to derive the limit of the POR estimator for increasing sample size, to investigate whether the POR limit is equal to the true OR and, if this is not the case, in which situations the POR limit is sufficiently close to the OR. It was found that the derived limit of the expected POR is not equivalent to the OR, because it depends on the group size ratio. Thus, the POR represents a different effect measure. We investigated in which situations the POR is reasonably close to the OR and found that this depends only slightly on the baseline risk within the range (0.001; 0.1) yet substantially on the group size ratio and the effect size itself. We derived the maximum effect size of the POR for different group size ratios and tolerated amounts of bias, for which the POR method results in an acceptable estimator of the OR. We conclude that the limit of the expected POR can be regarded as a new effect measure, which can be used in the presented situations as a valid estimate of the true OR.

Boundaries, borders, and limits. A phenomenological reflection on ethics and euthanasia

The subject of euthanasia divides both people and nations. It will always continue to do so because the arguments for and against this issue are intrinsically related to each other. This paper offers an analysis of the interrelation of the arguments, departing from a phenomenology of boundaries. From the participant perspective the boundary of euthanasia appears as a limit. From a helicopter perspective it appears as a border. Reflecting on both perspectives they turn out to complement each other: the positive effects of the former correspond to the negative effects of the latter. In order to see how this interrelation of viewpoints works out in the case of euthanasia a paradigmatic case is analysed from the perspective of the patient, the doctor, and the family. This phenomenological analysis does not directly lead to normative conclusions. It helps by both paying attention to, and dealing with, the complexity of the issue with intellectual honesty.