Controvérsia sobre a perversão feminina / Controversy over female perversion

Há mulheres na perversão? Essa pergunta serve de título para o livro de Lígia Furtado Mendonça (2018), a qual é resultado de seu percurso significativo de pesquisa acadêmica dedicada à temática das perversões. O livro trata das relações possíveis entre a estrutura perversa e o feminino, a partir da Psicanálise. Como afirma a própria autora, o seu objetivo é o de confrontar posições teóricas, não unânimes, que reservam a possibilidade da existência de uma estrutura perversa ao campo do masculino. Encontra-se dividido em sete capítulos que orbitam em torno de três tópicos: o primeiro dedica-se ao modo como a perversão era compreendida antes do surgimento da Psicanálise, e por seu entendimento propriamente freudiano e lacaniano. De forma mais específica, diríamos que o livro retoma a teorização acerca das perversões em Freud a partir de um marco teórico lacaniano, o qual serve à delimitação das concepções diferencias do feminino e do masculino a partir da lógica da sexuação e de sua consequente aplicação ao domínio das perversões.

Moral judgment is important in COVID-19 pandemic.

The nature of moral judgment is not only of longstanding philosophical interest, but also it is a matter of immediate practical concern. Currently, when the information, the advice, even the science and the sequela of the pandemic COVID-19 are all consistently and rapidly changing, it creates inconsistency in our decision making. Nevertheless, we lack of a detailed scientific understanding of how people make moral decisions. The letter is an effort aimed at understanding moral decision-making during the present pandemic of COVID-19.

Distinguishing the Effects of Life Threat, Killing Enemy Combatants, and Unjust War Events in U.S. Service Members.

Although previous studies have identified behavioral health risks associated with combat exposure, it is unclear which types of combat events are associated with these risks, particularly regarding contrasts among the risks associated with life-threatening experiences, killing combatants, and exposure to unjust war events, such as killing a noncombatant or being unable to help civilian women and children. In the present study, we examined surveys from 402 soldiers following deployment (i.e., baseline) and again 13 months later (i.e., Year 1). Regression analyses were conducted across a range of behavioral health (e.g., posttraumatic stress disorder, depression, suicide ideation, anxiety, somatic, insomnia, aggression) and benefit-finding measures, each controlling for two combat event categories while assessing the predictive utility of a third. The results suggested that life-threatening events were associated with poor behavioral health at baseline, relative risk (RR) = 10.00, but not at Year 1, RR = 2.67. At both baseline and Year 1, killing enemy combatants was not associated with behavioral health, RRs = 1.67-3.33, but was positively associated with benefit-finding, RRs = 26.67-40.00. Exposure to unjust war events was associated with a transdiagnostic pattern of behavioral health symptoms at baseline, RR = 40.00, and Year 1, RR = 23.33. Overall, the results suggest unjust war event exposure is particularly injurious, above and beyond exposure to other combat-related events. Future research can build on these findings to develop clearer descriptions of the combat events that might place service members at risk for moral injury and inform the development of assessment and treatment options.

Attaining 95-95-95 through Implementation Science: 15 Years of Insights and Best Practices from the Walter Reed Army Institute of Research's Implementation of the U.S. President's Emergency Plan for AIDS Relief.

The Walter Reed Army Institute of Research (WRAIR) supports more than 350,000 people on lifesaving HIV treatment in Kenya, Nigeria, Tanzania, and Uganda through funding from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). Here, we review and synthesize the range of impacts WRAIR's implementation science portfolio has had on PEPFAR service delivery for military and civilian populations since 2003. We also explore how investments in implementation science create institutional synergies within the U.S. Department of Defense, contributing to broad global health engagements and improving health outcomes for populations served. Finally, we discuss WRAIR's contributions to PEPFAR priorities through use of data to drive and improve programming in real time in the era of HIV epidemic control and public health messaging that includes prevention, the 95-95-95 goals, and comorbidities.

Different influences of moral violation with and without physical impurity on face processing: An event-related potentials study.

It has been widely accepted that moral violations that involve impurity (such as spitting in public) induce the emotion of disgust, but there has been a debate about whether moral violations that do not involve impurity (such as swearing in public) also induce the same emotion. The answer to this question may have implication for understanding where morality comes from and how people make moral judgments. This study aimed to compared the neural mechanisms underlying two kinds of moral violation by using an affective priming task to test the effect of sentences depicting moral violation behaviors with and without physical impurity on subsequent detection of disgusted faces in a visual search task. After reading each sentence, participants completed the face search task. Behavioral and electrophysiological (event-related potential, or ERP) indices of affective priming (P2, N400, LPP) and attention allocation (N2pc) were analyzed. Results of behavioral data and ERP data showed that moral violations both with and without impurity promoted the detection of disgusted faces (RT, N2pc); moral violations without impurity impeded the detection of neutral faces (N400). No priming effect was found on P2 and LPP. The results suggest both types of moral violation influenced the processing of disgusted faces and neutral faces, but the neural activity with temporal characteristics was different.

Rethinking Educational Space(s): Exploring the Impact of Co-Curricular Programming on Undergraduate Belonging, Career Exploration, and Interprofessional Education.

This mixed-methods study examined the impact of educational space on undergraduate belonging and learning by analyzing the post-event evaluations of 259 healthcare living-learning program (LLP) students who attended co-curricular programming designed to enhance belonging, career exploration, and interprofessional awareness. Students were broken into two groups based on program location. Post-event evaluations were analyzed using a Mann Whitney U-test and thematic analysis. Themes of career exploration and interprofessional awareness/identity formation emerged in the open-ended responses of both groups. Belonging was enhanced/muted by program location. Seemingly superficial, this variable actually reflects the institution's performance of educational space. The study includes a short discussion regarding the goal of constructing more inclusive educational spaces that support student belonging and success for all students.

Regret among primary care physicians: a survey of diagnostic decisions.

BACKGROUND: Experienced and anticipated regret influence physicians' decision-making. In medicine, diagnostic decisions and diagnostic errors can have a severe impact on both patients and physicians. Little empirical research exists on regret experienced by physicians when they make diagnostic decisions in primary care that later prove inappropriate or incorrect. The aim of this study was to explore the experience of regret following diagnostic decisions in primary care. METHODS: In this qualitative study, we used an online questionnaire on a sample of German primary care physicians. We asked participants to report on cases in which the final diagnosis differed from their original opinion, and in which treatment was at the very least delayed, possibly resulting in harm to the patient. We asked about original and final diagnoses, illness trajectories, and the reactions of other physicians, patients and relatives. We used thematic analysis to assess the data, supported by MAXQDA 11 and Microsoft Excel 2016. RESULTS: 29 GPs described one case each (14 female/15 male patients, aged 1.5-80 years, response rate < 1%). In 26 of 29 cases, the final diagnosis was more serious than the original diagnosis. In two cases, the diagnoses were equally serious, and in one case less serious. Clinical trajectories and the reactions of patients and relatives differed widely. Although only one third of cases involved preventable harm to patients, the vast majority (27 of 29) of physicians expressed deep feelings of regret. CONCLUSION: Even if harm to patients is unavoidable, regret following diagnostic decisions can be devastating for clinicians, making them 'second victims'. Procedures and tools are needed to analyse cases involving undesirable diagnostic events, so that 'true' diagnostic errors, in which harm could have been prevented, can be distinguished from others. Further studies should also explore how physicians can be supported in dealing with such events in order to prevent them from practicing defensive medicine.

Ligament Laxity in Nonerosive Immune-Mediated Polyarthritis in Dogs: Five Cases (2009-2017).

Ligament laxity is a known complication of erosive immune-mediated polyarthritis (IMPA) in dogs. The purpose of this study was to describe the occurrence and clinical features of carpal or tarsal ligament laxity in cases of nonerosive IMPA in dogs for the first time. Five client-owned dogs with a diagnosis of nonerosive IMPA and carpal or tarsal ligament laxity in which the influence of corticosteroids was excluded were identified. Medical records were reviewed, and data including signalment, investigative findings, and treatment regimen (e.g., surgical management) was extracted. Primary care practices were contacted to obtain follow-up, and the data was descriptively analyzed. The affected joints were either carpi and tarsi (n = 3) or carpi only (n = 2). In three cases, surgical arthrodesis was performed. Three dogs were euthanized (1 mo, 12 mo, and 5 yr) as a result of the severity of clinical signs and poor control. In the four dogs surviving >6 mo, multiple episodes of relapse were recorded, and multimodal immunosuppression was needed. The prognosis for the dogs described was poor, with none achieving control of the disease without ongoing immunosuppressive therapy. Damage to soft-tissue periarticular structures may be related to prolonged clinical disease or a more severe presentation. Jaccoud's arthropathy in humans with systemic lupus erythematosus may represent a homologous presentation.

Maternal proximity to extremely low frequency electromagnetic fields and risk of birth defects.

Causes of birth defects are unclear, and the association with electromagnetic fields is inconclusive. We assessed the relationship between residential proximity to extremely low frequency electromagnetic fields from power grids and risk of birth defects. We analyzed a population-based sample of 2,164,246 infants born in Quebec, Canada between 1989 and 2016. We geocoded the maternal residential postal code at delivery and computed the distance to the nearest high voltage electrical transmission line or transformer station. We used log-binomial regression to estimate risk ratios (RR) and 95% confidence intervals (CI) for the association of residential proximity to transmission lines and transformer stations with birth defects, adjusting for maternal and infant characteristics. The prevalence of birth defects within 200 m of a transmission line (579.4 per 10,000 per live births) was only slightly higher compared with distances further away (568.7 per 10,000). A similar trend was seen for transformer stations. Compared with 200 m, a distance of 50 m was not associated with the risk of birth defects for transmission lines (RR 1.00, 95% CI 1.00-1.01) and transformer stations (RR 1.01, 95% CI 1.00-1.03). There was no consistent association when we examined birth defects in different organ systems. We found no compelling evidence that residential proximity to extremely low frequency electromagnetic fields from electrical power grids increases the risk of birth defects. Women residing near electrical grids can be reassured that an effect on the risk of birth defects is unlikely.

The predictive value of the prognostic staging system in the 8th edition of the American Joint Committee on Cancer for triple-negative breast cancer: a SEER population-based analysis.

AIM: To examine the stage changes and survival differences among triple-negative breast cancer (TNBC) patients based on the prognostic staging system. METHODS: We used the SEER database to identify eligible patients with TNBC diagnosed between 2010 and 2014. Kaplan-Meier curves were drawn for comparison. The primary end point was breast cancer-specific survival. RESULTS: The median follow-up time was 26 months for 19,608 patients. The stages of all TNBC patients increased or remained unchanged during rearrangement from anatomic staging to prognostic staging. Stage IIA, IIIA and IIIC comprised the majority of patients. Several patients did not have prognostic staging. Stage IIIC incorporated six substages that contributed to high heterogeneity. Overall, the Kaplan-Meier curves still showed the favorable differentiation among stages and substages, with the exception of stage IIB and substage IIIA (T2N0, grade 2-3) patients. CONCLUSION: The prognostic information for breast cancer patients provided by the novel prognostic staging system may be less accurate for TNBC patients in our independent analysis. Moreover, stage IIB and substage IIIA (T2N0, grade 2-3) should possibly undergo further evaluation.

A multi-institutional report of peri-operative and functional outcomes after robot-assisted partial nephrectomy in patients with a solitary kidney.

To evaluate peri- and post-operative outcomes after robotic partial nephrectomy (RPN) in patients with a solitary kidney. A multi-institutional database of 1868 patients was used to identify 35 patients with a solitary kidney who underwent RPN at six different centers from 2007 to 2016. Peri-operative outcomes were summarized with descriptive statistics. We assessed the change in eGFR over time with a linear mixed-effects model. Median operative time, ischemia time, and estimated blood loss were 172 min, 16 min, and 113 mL, respectively. There were no positive surgical margins. The median length of stay was 1 day (range 1-7), and over half (54.3%) of patients were discharged one post-operative day 1. Seven post-operative complications occurred in six patients (17.1%); of which four were Clavien I, two were Clavien II, and one was Clavien III. The linear decline in eGFR up to 24 month post-RPN was marginal and not significant (ß = - 0.14; 95% CI = - 0.51, 0.23; p = 0.453), with predicted mean eGFR decreasing from 59.2 to 55.8 mL/min/1.73 m2 at 24 months. These results suggest that, in patients with a solitary kidney, RPN is a safe and feasible treatment option. In patients with a solitary kidney, RPN did not significantly compromise renal function for up to 2 years after surgery.

Timely Referral to Hospice Care for Oncology Patients: A Retrospective Review.

Hospice care is medical care provided to terminally ill patients with a life expectancy of 6 months or less. Hospice services include symptom control, pain management, palliative care, and other supportive services such as providing for home equipment or oxygen; however, it does not provide for life-prolonging therapies such as chemotherapy. Although oncologic benchmarks suggest patients should be enrolled in hospice 3 months prior to death, studies show that most hospice referrals are being made too late. These shorter stays in hospice result in increased cost of care especially at the end of life with most patients dying on aggressive treatments in the hospital. Thus, identifying barriers to hospice placement is critical in improving the referral process and enhancing the quality of end-of-life care. This retrospective study collected data on 418 oncologic patients who passed in 2015 and categorized patients based on hospice status at the time of death. Our study found that the demographics between hospice and nonhospice patients were not significantly different. Hospice patients spent a median of 10 days in hospice and 71% (n = 161) of patients were in hospice 30 days or less. Additionally, 56% of patients were in hospice 10 days or less. Increased education for patients and health-care providers along with better utilization of palliative care services and incorporating a nurse navigator to help with transitioning patients to hospice would improve earlier referral to hospice care and enhance patients' quality of life.

Who's to blame? Dissimilarity as a cue in moral judgments of observed ostracism episodes.

When observing an ostracism episode, observers may wish to know whether ostracism is justified or not. If ostracism appears unjustified, observers will likely blame the sources and sympathize with the target; if it appears justified, observers will likely blame and devalue the target. Here we introduce the "social dissimilarity rule," which holds that observers base their moral judgments on dissimilarities between the members of the observed group. In five studies, participants either recalled observed ostracism episodes or observed group interactions in which one group member was ostracized (e.g., in a chat or a group-working task). Results show that if similar persons exclude a dissimilar target (target is an "odd-one-out"), observers attribute ostracism to malicious motives of the ostracizers, such as ingroup favoritism, and devalue the ostracizers. However, if ostracism cannot be explained by social dissimilarity between the sources and the target, observers assume that the target is being punished for a norm deviation (punitive motive) and devalue the target. Use of the social dissimilarity rule was neither moderated by cognitive load (Study 3) nor by the perceived essentiality of the group distinction (Study 4). But if participants knew that the target previously deviated from a norm, knowledge about the situation had a stronger effect on moral judgments (Study 5) than social dissimilarity. These findings further our understanding of how observers make moral judgments about ostracism, which is important given that an observer's moral judgment can strongly impact bystander behavior and thus target recovery and well-being. (PsycINFO Database Record

Habitual tea drinking associated with a lower risk of type 2 diabetes in Vietnamese adults.

BACKGROUND AND OBJECTIVES: The association between tea consumption and type 2 diabetes risk remains inconsistent in Asian populations. This case-control study investigated the association between habitual tea consumption and the risk of type 2 diabetes among Vietnamese adults. METHODS AND STUDY DESIGN: A hospital-based case-control study was conducted during 2013-2015 in Vietnam. A total of 599 newly diagnosed diabetic cases (aged 40-65 years) and 599 hospital-based controls, frequency matched by age and sex, were recruited. Information about frequency, quantity, and duration of tea drinking, together with demographics, habitual diet and lifestyle characteristics, was obtained from direct interviews using a validated and reliable questionnaire. Unconditional logistic regression analyses were performed to assess the association between different metrics of tea consumption and the type 2 diabetes risk. RESULTS: Control subjects reported higher tea consumption levels than the cases in terms of duration, frequency, and quantity of tea drunk. After accounting for confounding factors, increasing tea consumption was found to be associated with a reduced risk of type 2 diabetes; the adjusted odds ratio (95% confidence interval) was 0.66 (0.49, 0.89) for participants drinking >2 cups/day, relative to those drinking <1 cup/day. Significant inverse dose-response relationships were also observed for average number of cups consumed daily and years of tea drinking (p<0.01). CONCLUSIONS: Habitual tea consumption is associated with a reduced risk of type 2 diabetes among Vietnamese adults.

Schemata, CONSORT, and the Salk Polio Vaccine Trial.

In this essay, we defend the design of the Salk polio vaccine trial and try to put some limits on the role schemata should play in designing clinical research studies. Our presentation is structured as a response to de Freitas and Pietrobon (de Freitas, R. S. and R. Pietrobon. 2007. Whoever could get rid of the context of discovery/context of justification dichotomy? A proposal based on recent developments in clinical research. Journal of Medicine and Philosophy 32:25-42.) who identified the CONSORT statement as a schema that would have, had it existed at the time, ruled out the design of the Salk polio vaccine trial of 1954 in favor of a completely randomized controlled clinical trial (RCT). We argue that large-scale public health interventions often require evidence beyond simple efficacy, the limit of what an RCT can provide, and that the design actually adopted for the Salk trial represented a reasonable-albeit imperfect-compromise. This is of more than historical interest in that many contemporary studies are of the scale and scope to require a more pragmatic, rather than explanatory, approach to study design (Kowalski, C. J. 2010. Pragmatic problems with clinical equipoise. Perspectives in Biology and Medicine 53:161-73.).

The development of intention-based sociomoral judgment and distribution behavior from a third-party stance.

The current study investigated children's intention-based sociomoral judgments and distribution behavior from a third-party stance. An actor puppet showed either positive or negative intention toward a target puppet, which had previously performed a prosocial or antisocial action toward others (i.e., children witnessed various types of indirect reciprocity). Children (3- and 5-year-olds) were asked to make sociomoral judgments and to distribute resources to the actor puppet. Results showed that 5-year-olds were more likely than 3-year-olds to be influenced by intention when they made their judgment and distributed resources. The target's previous actions affected only 5-year-olds' intent-based social preference. These results suggest that children's judgments about intent-based indirect reciprocity develop from ages 3 to 5 years.

Disclosing details about the medical treatment of a deceased public figure in a book: Who should have consented to the disclosures in Mandela's Last Days?

A recently published book by the head of Nelson Mandela's medical team made personal disclosures about his treatment of the late president in his final years up until his death. The author claimed that he had written the book at the request of family members. This was contested by some family members and the executors of Mandela's estate, and the book was subsequently withdrawn by the publishers. The Mandela book case raises ethical and legal questions about who should consent to publication of medical information about public figures after their death. The ethical rules of conduct of the Health Professions Council of South Africa (HPCSA) state that confidential information about a deceased person should only be divulged 'with the written consent of his or her next of kin or the executor of his or her estate'. 'Next of kin' is not defined, however, and problems arise when family members and the executors are divided about giving such written consent. It is recommended that in such cases the specific order of priority for consent by relatives in the National Health Act be followed. However, conduct that is unethical under the rules of the HPCSA may not necessarily be actionable under the law. For instance, the law does not protect the confidentiality of deceased persons, and generally when people die their constitutional and common-law personality rights - including their right to privacy and confidentiality - die with them. This means that the next of kin or executors of the estates of deceased persons may not bring actions for damages on behalf of such persons for breaches of confidentiality arising after their deaths. The next of kin may, however, sue in their personal capacity if they can show that the disclosures were an unlawful invasion of their own privacy. Conversely, if the privacy of interests of the next of kin are not harmed where there has been publication without their consent, they will not be able to sue for damages.