Asymmetric role of green energy, innovation, and technology in mitigating greenhouse gas emissions: evidence from India.

The primary cause of environmental degradation, which poses a danger to the long-term viability of the ecosystem, is the emission of greenhouse gases (GHG). For this reason, the Glasgow Climate Pact (COP26) established a decarbonization goal in response to this ecological concern, for which all economic players have a responsibility. India is among the participants who have a target set for them to decarbonize their economies by the year 2060 via the use of green energy and the advancement of science and innovation. Nevertheless, the asymmetrical effect of green energy, technology, and innovation on India's decarbonization program was not sufficiently explored in the prior study; hence, this research aims to fill this literature vacuum by considering India's GHG emissions from 1990 to 2020 by leveraging the non-linear autoregressive distributed lag (NARDL) model. The findings reveal the asymmetric influences of variables of interest on GHG emissions during the short and long term and under positive and negative shocks. Regarding the positive shock, long-term findings demonstrate that innovation and technical know-how grow GHG emissions and accelerate environmental degradation. However, a negative shock in innovations and technological know-how is opposed to a positive shock and improving environmental conditions. Further, positive shocks in green energy boost environmental effectiveness by reducing GHG secretions in India. In contrast, the negative shock in green energy deteriorates the environment by triggering GHG releases. These factual findings compel the Indian government to prioritize green technologies in addition to green energy generation to decouple economic growth from greenhouse gas emissions and meet rising energy demands.

Neguentropia Algorítmica e a Gestão Digital do Gozo / Algorithmic Negentropy and the Digital Management of Jouissance / La Negentropia Algorítmica y la Gestión Digital del Goce

O algoritmo digital permitiu o manejo de dados dos usuários da web pelos conglomerados informacionais. De forma discreta e personalizada, a nova forma de governamentalidade coleta, organiza, permuta e devolve os dados ao próprio indivíduo na forma de mais informações. Cada vez mais, esbarra na dimensão singular, tocando o campo do gozo via proliferação de objetos a que, na teoria lacaniana dos discursos, assume a dupla função de perda e de incessante tentativa de suplementação de gozo. Com o incremento informacional, o objeto chega ao ápice social e o digital alcança patamar discursivo. Inserindo-se no mesmo nicho do saber, a informação digital se aproveita da divisão subjetiva, deixando pouco espaço para que o sujeito possa lidar com a entropia de seu gozo via desejo. Se a neguentropia é o atributo do saber que limita a dispersão de gozo, na informação tratada e retornada algoritmicamente tal processo sofre uma aceleração, agindo diretamente sobre a economia dos afetos. Com prejuízo para o sujeito, resta uma experiência de gozo cada vez mais direta, crua, menos mediatizada pelo saber e pelo Outro.

The digital algorithm has allowed the management of data from web users by informational conglomerates. In a discreet and personalized way, the new form of governmentality collects, organizes, exchanges and returns data to the individual in the form of more information. More and more, it comes up against the singular dimension, touching the field of jouissance via the proliferation of objects a which, in the Lacanian theory of discourses, assumes the double function of loss and an incessant attempt to supplement jouissance. With the increase in information, the object reaches the social apex and the digital reaches a discursive level. Inserting itself in the same niche of know [savoir], digital information takes advantage of the subjective division, leaving little space for the subject to deal with the entropy of his jouissance via desire. If negentropy is the attribute of savoir that limits the dispersion of jouissance, in the information processed and returned algorithmically this process is accelerated, acting directly on the economy of affections. To the detriment of the subject, what remains is an experience of jouissance that is increasingly direct, raw, less mediated by savoir and the Other.

El algoritmo digital permitió la gestión de datos de los usuarios de la web por parte de conglomerados informativos. De forma discreta y personalizada, la nueva forma de gubernamentalidad recolecta, organiza, intercambia y devuelve datos al individuo en forma de más información. Cada vez más, choca con la dimensión singular, tocando el campo del goce a través de la proliferación de objetos a que, en la teoría lacaniana de los discursos, asume la doble función de pérdida y de intento incesante de complementar el goce. Con el aumento de la información, el objeto alcanza el ápice social y lo digital alcanza un nivel discursivo. Insertándose en el mismo nicho del conocimiento, la información digital aprovecha la división subjetiva, dejando poco espacio para que el sujeto gestione la entropía de su goce vía deseo. Si la negentropía es el atributo del saber que limita la dispersión del goce, en la información procesada y devuelta algorítmicamente, este proceso se acelera, actuando directamente sobre la economía de los afectos. En detrimento del sujeto, lo que queda es una experiencia de goce cada vez más directa, cruda, menos mediatizada por el saber y el Otro.

Radiological protection in human research ethics using a case study: toward update of the ICRP Publication 62.

The benefits of biomedical research involving humans are well recognised, along with the need for conformity to international standards of science and ethics. When human research involves radiation imaging procedures or radiotherapy, an extra level of expert review should be provided from the point of view of radiological protection. The relevant publication of the International Commission for Radiological Protection (ICRP) is now three decades old and is currently undergoing an update. This paper aims to provoke discussions on how the risks of radiation dose and the benefits of research should be assessed, using a case study of diagnostic radiology involving volunteers for whom there is no direct benefit. Further, the paper provides the current understanding of key concepts being considered for review and revision-such as the dose constraint and the novel research methods on the horizon, including radiation biology and epidemiology. The analysis revisits the perspectives described in the ICRP Publication 62, and considers the recent progress in both radiological protection ethics and medical research ethics.

The right not to know: Non-disclosure of primary genetic test results and genetic counselors' response.

As part of clinical genetic counseling practice, patients may request that their primary genetic test results be disclosed to someone else, such as a relative or referring provider, or request that results be disclosed to no one (non-disclosure). In making these requests, patients employ the ethical principle of the "right not to know," which argues that autonomous individuals can choose not to know relevant health information. Although the right not to know has been well-studied in medicine in general, and in the return of genomic secondary findings, we are not aware of other studies that have explored the return of primary genetic test results when patients request non-disclosure or disclosure to another individual. This study aimed to describe common clinical scenarios in which these requests occur, how genetic counselors respond, and what ethical considerations they employ in their decision-making process. We recruited participants from the National Society of Genetic Counselors' (NSGC) "Student Research Surveys and Reminders" listserv and conducted semi-structured interviews with 11 genetic counselors in the United States who described genetic counseling cases where this occurred. Interviews were transcribed and coded inductively, and themes were identified. Case details varied, but in our study data the requests for non-disclosure were most commonly made by patients with poor, often oncologic, prognoses who requested their test results be disclosed to a family member instead of themselves. Genetic counselors considered similar factors in deciding how to respond to these requests: patient autonomy, medical actionability of results for the patient and family, the relationship between the patient and the person to whom results might be disclosed, and legal or practical concerns. Genetic counselors often made decisions on a case-by-case basis, depending on how relevant each of these factors were. This study adds to the growing body of literature regarding patients' "right not to know" and will hopefully provide guidance for genetic counselors who experience this situation in clinical practice.

Bridging the "Know-Do" Gaps in Five Non-Communicable Diseases Using a Common Framework Driven by Implementation Science.

According to the United Nations High-Level Meeting 2018, five non-communicable diseases (NCDs) including cardiovascular diseases, chronic respiratory diseases, diabetes mellitus, cancer, and mental health conditions accounted for two-thirds of global deaths. These five NCDs share five common risk factors including tobacco use, unhealthy diets, physical inactivity, alcohol use, and air pollution. Low- and middle-income countries (LMICs) face larger burden of NCDs than high-income countries (HICs), due to differences in ecological, technological, socioeconomic and health system development. Based on high-level evidence albeit mainly from HICs, the burden caused by NCDs can be reduced by affordable medicines and best practices. However, "know-do" gaps, ie, gaps between what we know in science and what we do in practice, has limited the impact of these strategies, especially in LMICs. Implementation science advocates the use of robust methodologies to evaluate sustainable solutions in health, education and social care aimed at informing practice and policies. In this article, physician researchers with expertise in NCDs reviewed the common challenges shared by these five NCDs with different clinical courses. They explained the principles of implementation science and advocated the use of an evidence-based framework to implement solutions focusing on early detection, prevention and empowerment, supplemented by best practices in HICs and LMICs. These successful stories can be used to motivate policymakers, payors, providers, patients and public to co-design frameworks and implement context-relevant, multi-component, evidence-based practices. In pursuit of this goal, we propose partnership, leadership, and access to continuing care as the three pillars in developing roadmaps for addressing the multiple needs during the journey of a person with or at risk of these five NCDs. By transforming the ecosystem, raising awareness and aligning context-relevant practices and policies with ongoing evaluation, it is possible to make healthcare accessible, affordable and sustainable to reduce the burden of these five NCDs.

Community based multi-disease health screening as an opportunity for early detection of HIV cases and linking them to care.

BACKGROUND: The 95-95-95 UNAIDS global strategy was adapted to end the AIDS epidemic by 2030. The target is based on the premise that early detection of HIV-infected persons and linking them to treatment regardless of their CD4 counts will lead to sustained viral suppression. HIV testing strategies to increase uptake of testing in Western and Central Africa remain inadequate. Hence, a high proportion of people living with HIV in this region do not know their status. This report describes the implementation of a community based multi-disease health screening (also known as "Know Your Status" -KYS), as part of basic science research, in a way that contributed to achieving public health goals. METHODS: A community based multi-disease health screening was conducted in 7 communities within the Eastern region of Ghana between November 2017 and April 2018, to recruit and match HIV seronegative persons to HIV seropositive persons in a case-control HIV gut microbiota study. Health assessments included blood pressure, body mass index, blood sugar, Hepatitis B virus, syphilis, and HIV testing for those who consented. HIV seronegative participants who consented were consecutively enrolled in an ongoing HIV gut microbiota case-control study. Descriptive statistics (percentages) were used to analyze data. RESULTS: Out of 738 people screened during the exercise, 700 consented to HIV testing and 23 (3%) were HIV positive. Hepatitis B virus infection was detected in 4% (33/738) and Syphilis in 2% (17/738). Co-infection of HIV and HBV was detected in 4 persons. The HIV prevalence of 3% found in these communities is higher than both the national prevalence of 1.7% and the Eastern Regional prevalence of 2.7 in 2018. CONCLUSION: Community based multi-disease health screening, such as the one undertaken in our study could be critical for identifying HIV infected persons from the community and linking them to care. In the case of HIV, it will greatly contribute to achieving the first two 95s and working towards ending AIDS by 2030.

Baseline characteristics of participants enrolled in the KoreaN cohort study for Outcomes in patients With Pediatric Chronic Kidney Disease (KNOW-Ped CKD).

BACKGROUND: We developed the KoreaN cohort study for Outcomes in patients With Pediatric Chronic Kidney Disease (KNOW-Ped CKD) as a subcohort of KNOW-CKD to investigate the different characteristics of pediatric CKD between countries and races. METHODS: Children aged younger than 18 years with stage 1 ~ 5 CKD were recruited at seven major pediatric nephrology centers in Korea. Blood and urine samples, as well as demographic and clinical data, were collected. From 2011 to 2016, 458 children were enrolled, and the baseline profiles of 437 children were analyzed. RESULTS: The median age of the cohort was 10.9 years old, and 68.0% were males. The median estimated glomerular filtration rate was 53.1 mL/min/1.73 m2. The most common etiology of CKD was congenital anomalies of the kidney and urinary tract (42.6%), followed by glomerulopathies (25.6%). CONCLUSION: We report a cross-sectional analysis of the overall baseline characteristics such as age, CKD stage, and underlying kidney disease of the KNOW-Ped CKD. The cohort will be longitudinally followed for ten years. "A higher resolution version of the Graphical abstract is available as Supplementary information."

O supervisor suposto saber: perspectivas lacanianas sobre a análise de controle / The supervisor supposed to know: Lacanian perspectives on control analysis / El supervisor supuesto saber: perspectivas lacanianas sobre el análisis de control / Le superviseur supposé savoir: perspectives lacaniennes concernant l'analyse de contrôle

De forma a preservar o ímpeto evolutivo e o alcance da psicanálise, a tarefa da análise de controle é prevenir o estabelecimento da inércia que busca o menor denominador comum e a degeneração de ideias e práticas em evolução na direção de banalizações e preconceitos. A uma instituição psicanalítica é necessário manter padrões mínimos e simultaneamente preservar-se como ambiente vibrante e dinâmico para o contínuo desenvolvimento e regeneração da psicanálise enquanto estrutura viva e simbólica. Através de uma análise de controle, cada analista adquire um estilo analítico único, que não se refere a preferências e idiossincrasias egoicas, mas a uma singular e nova articulação subjetiva dos elementos preexistentes na estrutura tradicional. Sem a realização de uma análise pessoal, a análise da contratransferência e da identificação projetiva em supervisão pode operar como resistência à análise pessoal, essa última o mais importante fator para a autoautorização do analista dentro da organização psicanalítica. O analista não é autorizado pela supervisão ou pelo supervisor, mas pela experiência analítica pessoal com o inconsciente, o sintoma e seus efeitos pós-analíticos sob a forma do que Lacan nomeia de sinthoma. Lacan diz que, ao término da análise, o analisando ou futuro analista não se identifica com o analista, mas sim com seu sinthoma.

The task of control analysis is to preserve the evolutionary impetus and edge of psychoanalysis and prevent the inertia towards the lowest common denominator, and the degeneration of evolved ideas and practices into common assumptions and prejudices. A psychoanalytic organization needs to maintain standards while also preserving the organization as a vibrant and dynamic site for the continuing development and re-invention of psychoanalysis as a living symbolic structure. Through a control analysis every analyst acquires a unique analytical style that does not refer to ego preferences and idiosyncrasies, but to a singular and new subjective articulation of the pre-existing elements of a traditional structure. Without a personal analysis, the analysis of the countertransference and of projective identification in supervision can function as a resistance to the personal analysis which is the most important factor for the self-authorization of the analyst within a psychoanalytic organization. The analyst is not authorized by supervision or the supervisor, but by the personal analytical experience with the unconscious, the symptom, and its post-analytical effects in the form of what Lacan calls the sinthome. Lacan said that at the end of analysis, the analysand or the future analyst does not identify with the analyst, but rather with his/her sinthome.

Con el fin de preservar el ímpetu evolutivo y el alcance del psicoanálisis, la tarea del análisis de control es evitar el establecimiento de inercias que buscan el mínimo común denominador y la degeneración de ideas y prácticas en la evolución en la dirección de trivializaciones y prejuicios. Para una institución psicoanalítica es necesario mantener estándares mínimos y simultáneamente preservarse como un entorno vibrante y dinámico para el desarrollo continuo y la regeneración del psicoanálisis como una estructura viva y simbólica. A través de un análisis de control, cada analista adquiere un estilo analítico único que no se refiere a preferencias del ego e idiosincrasias, sino a una singular y nueva articulación subjetiva de los elementos preexistentes en la estructura tradicional. Sin realizar un análisis personal, el análisis de la contratransferencia y la identificación proyectiva en la supervisión puede operar como resistencia al análisis personal, este último el factor más importante para la auto autorización del analista dentro de la organización psicoanalítica. El analista no está autorizado por la supervisión o el supervisor, sino por la experiencia analítica personal con el inconsciente, el síntoma y sus efectos posanalíticos en forma de lo que Lacan llama sinthoma. Lacan dijo que al final del análisis, el analista o analista futuro no se identifica con el analista, sino con su sinthoma.

De façon à préserver l'élan évolutif et l'étendue de la psychanalyse, la tâche de l'analyse de contrôle est celle de prévenir l'établissement de l'inertie qui cherche le plus petit dénominateur commun et la dégénération d'idées et de pratiques en évolution dans la direction des banalisations et des préjugés. Il faut qu'une institution psychanalytique maintienne des étalons minimaux et simultanément se préserver en tant qu'une ambiance vibrante et dynamique pour le développement continu et régénération de la psychanalyse considérée comme une structure vive et symbolique. Par l'intermédiaire d'une analyse de contrôle, chaque analyste acquiert un style analytique unique qui ne se réfère pas à des préférences et des idiosyncrasies égoïques, mais à une nouvelle articulation singulière et subjective des éléments préexistant dans la structure traditionnelle. Sans mener une analyse personnelle, l'analyse du contre-transfert et de l'identification projective en supervision peuvent opérer en tant que résistance à l'analyse personnelle, cette dernière le plus important élément pour l'auto autorisation de l'analyste chez l'organisation psychanalytique. L'analyste n'est pas autorisé par la supervision ou par le superviseur, mais par l'expérience analytique personnelle du surmoi, du symptôme et de ses effets postanalytiques, sous la forme de ce qui Lacan nomme sinthome. Lacan dit que, à la fin de l'analyse, l'analysant ou le futur analyste ne s'identifie pas à l'analyste, mais à son sinthome.

Aportes del uso de Simuladores educativos en aula como una herramienta para mejorar la calidad del aprendizaje de los alumnos de la Facultad de Psicología de la UAQ / Contributions of the use of educational simulators in the classroom as a tool to improve the quality of learning in the students of the faculty of psychology of the UAQ

Dentro de este magnífico mundo de enseñanza ­aprendizaje existen muchos elementos de influencia más allá de solo un maestro, un alumno o un aula; crear ambientes de aprendizaje dinámicos, efectivos y orientados a la generación de aprendizaje significativo es tarea de todos los profesionales de la educación; para ello debemos romper esquemas, modelos anacrónicos y pensar en estrategias propositivas adaptadas a las nuevas y diferentes formas de aprender de las generaciones actuales y futuras creando entornos amigables, prácticos y efectivos. Este artículo plantea la utilización de simuladores en los ámbitos educativos, como una forma de facilitar el aprendizaje mediante el uso de los métodos y herramientas de transmisión de conocimiento adaptadas a las necesidades de aprendizaje actuales, es decir, de explotar las herramientas propias de la época en la que vivimos; en este caso las tecnológicas; esto se vuelve necesario considerando que tanto los métodos de enseñanza ­aprendizaje, como los sistemas educativos de hoy en día, ya no son del todo suficientes para cubrir las expectativas de educación actuales, debido a que hoy en día en muchos países aún se siguen utilizando métodos y estrategias educativas diseñadas para cubrir las necesidades de las sociedades del siglo pasado. En este documento se habla sobre la necesidad actual de contar con herramientas que potencialicen la calidad y efectividad del proceso de enseñanza ­aprendizaje en las aulas y de la propuesta de un método de investigación participativa en la cual es posible identificar cómo la implementación de herramientas TIC por medio del uso de simuladores en aula, es efectiva y benéfica para mejorarla adquisición y dominio de conocimiento en los estudiantes de la licenciatura de Psicología del trabajo de la Universidad Autónoma de Querétaro, logrando en ellos un mejor desempeño profesional y mayor éxito en las actividades propias de su profesión.

Around the magnific world of the teaching -learning, exist many influencing elements more than the only a professor, a student or an classroom; work to make a dynamic and effective learning environments and oriented to create significative learning is a job of all the professionals of learning, to do that, we have to broke schemes, anachronic models and think In propositives strategies aligned to the new and different ways of learn of the actually and future generations, creating friendly, practical and effective environments. This article proposes the use of simulator systems in educational environments, is a way to facilitate the learning through the use of methods and tools to help the transmission of knowledge adapted to current learning needs, that is to, exploit the modern tools; the technology tools. That becomes necessary considering that both the teaching ­learning methods and the actually educational systems, are very far from covering the current education expectations and needs because in many countries are using educational methods and strategies designed to comply the needs of the last century societies. This article, talk about the current need to count with tools that enhance the quality and effectiveness of the teaching -learning process in the classrooms and the proposal of a participatory investigation method with which is possible to identify how the implementation of TIC tools across the use of simulators in classroom is effective and beneficial to get better and acquire mastery of learning on the psychology students of autonomous university of Querétaro, achieving a better professional performance in them and greater success in professional activities.

La ética profesional, entre la tiranía del saber y el campo normativo. De lo idéntico a lo desconocido / Professional Ethics, between the tyranny of knowledge and the normative fieldf.From the identical to the unknown

El reciente lanzamiento en Argentina del documental Tres idénticos desconocidos (Wardle, 2018) nos permite problematizar uno de los experimentos más atroces de la historia de la psicología en los Estados Unidos. Para dilucidar la incidencia de distintos modos de crianza en gemelos con idéntica estructura genética, el psiquiatra Peter Neubauer y su colega Viola Bernard condujeron durante años una oscura investigación, desatendiendo una serie de objeciones éticas en la experimentación con seres humanos, y demostrando así la disyunción entre el campo normativo y ciertos discursos científicos comandados por la exigencia insensata del todo saber, especialmente cuando la valoración ética de las prácticas profesionales queda únicamente supeditada a un análisis posterior de sus efectos.

The recent release of the documentary Three Identical Strangers (Wardle, 2018) in Argentina allows us to problematize one of the most atrocious experiments in the history of North American psychology. To elucidate the incidence of different nurturing in twins with identical genetic structure, the psychiatrist Peter Neubauer and his colleague Viola Bernard conducted an obscure investigation for years, disregarding a series of ethical objections in the experimentation with human beings, and demonstrating the disjunction between the normative field and certain scientific discourses commanded by the insane demand of all knowledge, especially when the ethical evaluation of professional practices is only subject to a subsequent analysis of their effects.

The regulatory technology "RegTech" and money laundering prevention in Islamic and conventional banking industry.

This study aims to illustrate the impact of adopting Regulatory technology (RegTech) innovations in banks on money laundering prevention effectiveness using Bahrain as a case study. Bahrain has strived to position itself as the banking center of the Arabian Gulf, hence the results of this novel research are informative of the practices in the region. The primary data for this study was collected through a survey instrument distributed to 100 bankers working in Bahrain with expertise in compliance. The results of multivariate analysis indicate that transactions monitoring through RegTech and cost- and time-saving aspects of RegTech, drive money laundering prevention effectiveness to a highly statistically significant extent. However, electronic know your customer (KYC) technologies are insignificant as drivers. This research not only sheds light on the efficacy of RegTech but also raises general awareness concerning the adoption and integration of RegTech platforms for fighting money laundering. In particular, the findings provide specific insights about the deployment of RegTech capabilities in banks in regional banking centers of modest scale.

Transformações do/no analista: assombrações e assombros / Transformations of/in the analyst / Transformaciones del/en el analista / Transformations de/chez l'analyste

Neste trabalho a autora procura pensar a experiência clínica com dois pacientes, com os quais surgiram vivências estranhas e ameaçadoras, que ela nomeia de início como assombrações. Suas reflexões sugerem que as transformações que o analista pode fazer dessas assombrações - suas intuições, seu pensamento onírico e funcionamento alfa - podem trazer desenvolvimentos úteis à dupla analítica, como o surgimento de novos vértices, a ampliação do espaço mental e a possibilidade de digerir e elaborar fortes emoções, movimentos mais ligados à noção de assombro, pensado como propiciador do conhecer e do ser. O trabalho aborda também as transformações vividas pelo analista em sua formação, as transformações propiciadas pela escrita analítica, bem como as transformações existenciais durante a vida do analista, que podem dificultar sua função analítica, necessitando constantes cuidados e reanálises.

In this article the author seeks to reflect on the clinical experience with two patients who lived through strange and threatening episodes, which, right from the very start, the author named as hauntings. Her considerations suggest that these hauntings may be transformed - through the analyst's intuition, oneiric thought and alpha function - and the result of these transformations may bring useful unfoldings to the analytical pair, such as the springing of new vertex, the amplification of the mental space and the possibility to digest and elaborate strong emotions, movements closer to the notion of haunt regarded as a sponsor for knowledge and for being. This article also approaches the transformations experienced by the analyst in their formation, the transformations the analytical writing may provide, as well as existential transformations in the analyst's own life, which may hamper the analytical activity, demanding constant care and reanalyses.

En el presente trabajo, la autora plantea la experiencia clínica con dos pacientes, en la que surgen experiencias extrañas y amenazantes, que inicialmente denomina apariciones. Sus reflexiones sugieren que las transformaciones de estas experiencias que el analista puede llevar a cabo (sus intuiciones, su pensamiento onírico y su funcionamiento alfa) pueden aportar desarrollos útiles al dúo analítico, como la aparición de nuevos vértices, la expansión del espacio mental y la posibilidad de digerir y elaborar emociones fuertes, movimientos más vinculados a la noción de asombro, pensado como propiciador del saber y del ser. El trabajo también aborda las transformaciones experimentadas por el analista en su formación, las transformaciones proporcionadas por la escritura analítica, así como las transformaciones existenciales durante la vida del analista, que pueden obstaculizar su función analítica, lo que requiere un cuidado constante y reanálisis.

Dans ce travail, l'auteur essaie de réfléchir l'expérience clinique avec deux patients, où des expériences étranges et menaçantes ont émergé, qu'elle nomme d'abord comme des hantises. Ses réflexions suggèrent que les transformations que l'analyste peut faire de ces hantises - ses intuitions, sa pensée onirique et son fonctionnement alpha - peuvent apporter des développements utiles au duo analytique, tels que l'émergence de nouveaux sommets, l'expansion de l'espace mental et la possibilité de digérer et élaborer des émotions fortes, des mouvements plus liés à la notion d'étonnement, pensé comme apportant de la connaissance et de l'être. Le travail aborde également les transformations vécues par l'analyste dans sa formation, les transformations apportées par l'écriture analytique, ainsi que les transformations existentielles au cours de la vie de l'analyste, qui peuvent entraver sa fonction analytique, nécessitant des soins constants et réanalyses.

Diagnostic uncertainties, ethical tensions, and accounts of role responsibilities in genetic counseling communication.

Diagnostic uncertainties are intricately associated with genomic testing-especially concerning new technologies such as exome sequencing-with test results being either inconclusive or generating secondary findings or showing variants of uncertain significance. In the process of genetic counseling, diagnostic uncertainties have to be managed even when test results for an individual client are either positive or negative because of differential implications for family members. Previous studies have investigated diagnostic uncertainties in relation to clients wanting to know or not know the test results; here, we extend this line of research by addressing how genetic counselors and clients account for the management of diagnostic uncertainties vis-à-vis the attendant ethical tensions in the complex communicative environment in the clinic setting. Our dataset from the Norwegian context is longitudinal, consisting of ten audio-recorded pre-test genetic counseling sessions. It involves one extended family with a high burden of colorectal cancer. Through theme-oriented discourse analysis, we demonstrate how diagnostic uncertainties give rise to tensions concerning risks and benefits of knowing in both professional and familial spheres, which then map onto accounts of various role responsibilities. For instance, in looking for certainty via advanced genomic testing to reduce diagnostic uncertainty for clients, genetic counselors are confronted with tensions regarding what can be communicated and made known because of their role responsibilities toward what may be regarded as scientific others and clinical others. Likewise, clients are faced with tensions concerning wanting to know/not know, which invokes various familial others and may align or not align with genetic counselors' preferences, especially relating to management of diagnostic uncertainties and secondary findings.

Análise de teor de iodo em diferentes tipos de sal comercializados na cidade de Taubaté - São Paulo / Analysis of iodine content in different types of salt marketing in Taubaté - São Paulo

Objetivo ­ Determinar o teor de iodo presente em diferentes tipos de sal comercializados no município de Taubaté - SP, afim de verificar o cumprimento imposto pela RDC n. o 23, publicada no mês de abril de 2013. Métodos ­ Foi analisado o teor de iodo em cinco (5) amostras coletadas de diferentes tipos e marcas de sal comercializado no município de Taubaté ­ SP, sendo uma amostra do sal do Atacama, duas do sal do Himalaia vendidos selados com as informações da iodação, sendo um tipo moído e outro tipo grosso e duas amostras do sal do Himalaia vendido a granel, a análise foi feita através do método proposto pelo manual do Instituto Adolfo Lutz (2008). Resultados ­ Das 5 amostras analisadas, foram obtidos os seguintes resultados, 40% das amostras estão de acordo com legislação e 60% não atendem as exigências. As amostras A, B e E, sendo elas do sal do Atacama, sal do Himalaia moído e sal do Himalaia a granel II, respectivamente apresentaram valores fora do exigido pela legislação, sendo os seus resultados superiores ao limite máximo de 45 miligramas e apenas 2 amostras, C e D estão dentro do que é exigido pela RDC nº 23, de 24 de abril de 2013. Conclusão ­ Com os resultados obtidos neste trabalho evidenciaram a existência de problemas em relação à concentração de iodo em amostras comercializadas na cidade de Taubaté - SP, sendo que os 60% das amostras apresentam teor de iodo acima do recomendado, portanto não atendem e pode acarretar problemas de saúde aos consumidores, já que seu excesso está associado as doenças como hipertireoidismo, hipertensão arterial e doença de Hashimoto para a população em geral.

Objective ­ To determine the iodine content present in different types of salt sold in the city of Taubaté - SP, in order to verify the compliance imposed by RDC No. 23, published in April 2013. Methods ­ Iodine content was analyzed in five (5) samples collected from different types and brands of salt sold in Taubaté - SP, one sample from Atacama salt, two from Himalayan salt sold sealed with iodation information, one ground and one coarse type. and two samples of Himalayan salt sold in bulk, the analysis was made using the method proposed by the manual of the Adolfo Lutz Institute (2008). Results ­ Of the 5 samples analyzed, the following results were obtained, 40% of the samples are in accordance with legislation and 60% do not meet the requirements. Samples A, B and E, being from Atacama salt, ground Himalayan salt and bulk Himalayan salt II, respectively, presented values outside the required by the legislation, and their results exceeded the maximum limit of 45 milligrams and only 2 samples, C and D are within what is required by RDC No. 23 of April 24, 2013. Conclusion ­ With the results obtained in this work showed the existence of problems regarding the concentration of iodine in samples sold in the city of Taubaté - The 60% of the samples have higher than recommended iodine content, so they do not meet and may cause health problems to consumers, since their excess is associated with diseases such as hyperthyroidism, high blood pressure and Hashimoto disease for the population general.

An ecological study on health inequalities in the city of Bologna (Emilia-Romagna Region, Northern Italy): bridging knowledge and action.

BACKGROUND: since January 2017, a multidisciplinary research group, involving the Local Health Authority, the Municipality, and the University of Bologna, carried out a city-wide action-research project on health inequalities consisting of an ecological study over the years 2011-2015 based on indicators that are routinely available within health and social services. OBJECTIVES: to document existing geographical inequalities in health outcomes and use of healthcare services in the city of Bologna (Emilia-Romagna Region, Northern Italy), with the aim to suggest policy action to tackle them. DESIGN: the results of the first phase of the above-mentioned project were reported: five related to the social determinants of health (exposure) and five related to the social determinants of ill-health (outcomes). For each municipal statistical area, the distribution of the exposures as well as rates and Bayesian Relative Risks of the outcomes were plotted on the city map. To evaluate the association between social determinants and health outcomes, Spearman correlation coefficients were estimated. SETTING AND PARTICIPANTS: residents in the city of Bologna aged >=18 years in the period 2011-2015, grouped into 90 statistical areas. RESULTS: a North-South divide was apparent for most of the socioeconomic and ill-health indicators, with a high concentration of adverse outcomes in the North-Western part of the city. Adherence to cancer screening represented an exception, being greater in the areas with higher proportion of unfavourable health outcomes. An inverse association between education level and health outcomes was found. Low family income was weakly to moderately correlated with health outcomes. Proportion of residents in council houses and of the teenage foreign population showed a moderate to strong association with all outcomes, but mortality and screening adherence. CONCLUSIONS: an ecological analysis based on data that are routinely collected by local health and social institutions can be effective in revealing the geographical patterns of health inequalities. When accompanied by strategic choices aimed at bridging knowledge and action, this approach may facilitate the direct engagement of local actors towards health equity.

Acceptance and utilization of HIV testing among the youth: a cross-sectional study in Techiman, Ghana.

BACKGROUND: In Ghana, efforts including 'Know Your Status' campaign have been made to increase awareness and improve the uptake of HIV screening. OBJECTIVE: This study examined the acceptance and utilization of the HIV/AIDS 'Know Your Status' campaign and determine dthe differences in HIV testing by demographic characteristics among the youth in Techiman, Ghana. METHOD: This study was a cross-sectional study conducted among the youth aged 15-24 years. A structured questionnaire was used to collect data from 200 purposively selected respondents. RESULTS: The mean age of the respondents was 19.6±2.72 years. There was a universal awareness (100%) of HIV/AIDs, and were knowledgeable about the mode of transmission, symptoms and the prevention of HIV. A high proportion of the respondents (n=161, 80.5%) had heard about the 'Know Your Status' (KYS) campaign. Less than half of respondents (n=91, 45.5%) had tested for HIV, and only 16.5% (n=15/91) of respondents tested through the KYS campaign. Testing for HIV was associated with age (p<0.001) and marital status (p<0.001). CONCLUSION: The youth should therefore be targeted in the awareness and the 'Know Your Status campaigns', and in an effortsto promote screening for HIV.

Mística, yerbas santas y solidaridad: memoria del cuidado no médico de la lepra en Agua de Dios / Mystique, Holy Herbs and Solidarity: Memory of Non-Medical Care of Leprosy in Agua de Dios / Mística, ervas santas e solidariedade: memória do cuidado no médico da lepra em Agua de Dios

Resumen Introducción: La representación social de la lepra como una enfermedad del pasado, el carácter local que la circunscribe a los sanatorios y el escaso contacto de trabajadores de la salud foráneos con la enfermedad hace pensar que el conocimiento sobre su cuidado ha circulado entre generaciones de una manera más o menos confinada. Ese saber que incorpora no solo conocimiento biomédico, sino expresiones en saberes, creencias, prácticas, relatos, los actores que las construyen y recrean y su relación compleja con las dinámicas de inserción en el territorio, se constituye hoy, en sí mismo, en un patrimonio vivo, que merece ser narrado. Desarrollo: Se parte de comprender la memoria de los cuidados no médicos de la lepra en Agua de Dios, por medio de un estudio etnográfico, cuyos resultados permiten proponer dos expresiones. La primera involucra a agentes de salud no médicos y su relación con los sujetos de cuidado; que muestra que el cuidado demanda no solo conocimiento científico, sino también disposiciones particulares de los sujetos, como capacidad de escucha, observación, paciencia y trascendencia, acompañadas de un posicionamiento y negociación cotidianos en el territorio. La segunda está compuesta por las alternativas de cuidado intermediadas por otros agentes con saberes autorizados, que agrupan una amplia farmacopea relacionada con el uso de plantas medicinales, referencias a curanderos y prácticas solidarias de tutoría entre pacientes y relaciones de su bienestar con el medio ambiente. Conclusiones: Todas estas expresiones de cuidado desafían los discursos y prácticas canónicas de la biomedicina alrededor de esta enfermedad.

Abstract Introduction: The social representation of leprosy as a disease from the past, its local character that circumscribes it to the sanatoria, and the scarce contact of health workers with it suggest that the knowledge about its care has circulated between generations more or less confined. This confined knowledge, which incorporates not only biomedical knowledge but also expressions in knowledge, beliefs, practices, stories, the actors that construct and recreate them and their complex relationship with the dynamics of insertion in the territory in a living heritage, deserves to be narrated. Development: We begin by understanding the memory of the non-medical care of leprosy in Agua de Dios, through an ethnographic study, whose results allow us to propose two expressions of these. The first one, involving the non-medical health agents (especially nurses) and its relationship with care subjects, showed that this demands particular dispositions from the subjects as listening ability, observation, patience, and transcendence, accompanied by daily positioning and negotiation in the territory. The second is the care alternatives mediated by other agents with authorized knowledge that group a wide pharmacopeia related to the use of medicinal plants; references to healers and solidarity practices of mentoring between patients and relationships of their well-being with the environment. Conclusions: All these expressions of care challenge the discourses and canonical practices of biomedicine around this disease.

Resumo Introdução: A representação social da lepra como uma doença do passado, seu carácter local que a circunscreve aos sanatórios, e o escasso contato de trabalhadores da saúde estrangeiros com a doença, faz pensar que o conhecimento sobre seu cuidado, tem circulado entre gerações de uma maneira mais ou menos confinada. Esse saber "confinado", que incorpora não só conhecimento biomédico, senão expressões em saberes, crenças, práticas, relatos, os atores que as constroem e recriam e sua relação complexa com as dinâmicas de inserção no território, constitui-se hoje em si mesmo, em um patrimônio vivo, que merece ser narrado. Desenvolvimento: Partimos de compreender a memória dos cuidados não médicos da lepra em Agua de Dios, através de um estudo etnográfico, cujos resultados nos permitem propor duas expressões destes. A primeira que envolve agentes de saúde não médicos e sua relação com os sujeitos de cuidado, mostrou que esta demanda não só conhecimento "científico", mas também disposições particulares dos sujeitos como capacidade de escuta, observação, paciência e transcendência, acompanhadas de um posicionamento e negociação cotidianos no território. A segunda a constituem as alternativas de cuidado intermediadas por outros agentes com saberes "autorizados" que agrupam uma ampla farmacopeia relacionada com o uso de plantas medicinais; referências a curandeiros e práticas solidárias de tutoria entre pacientes e relações de seu bem-estar com o meio ambiente. Conclusões: Todas estas expressões de cuidado, desafiam os discursos e práticas canónicas da biomedicina ao redor desta doença.

El olvido imposible / The impossible oblivion

El presente artículo toma como objeto al olvido y su retorno. Para mayores precisiones: al olvido que fracasa, filtra, deja pasar por alguna hendija un residuo del material que se intenta desterrar. En las siguientes páginas daremos cuenta de esa dialéctica, así como del valor de señuelo de aquel material que insiste sin ser exactamente lo buscado. Se expondrá de qué manera dicha dialéctica, paradójicamente, esconde e indica un texto, y provoca en el soñante una profunda sensación de intriga que da surgimiento al deseo del saber posibilitando, en ocasiones, el inicio del trabajo analítico. Para concluir distinguiremos este deseo nacido bajo transferencia de la manifestación del deseo de saber, que desafía el afecto característico de las neurosis: el horror al saber

The present article takes as an object the oblivion and its return. For more precisions: to the oblivion that fails, the one that filters, the one that lets pass through some cleft a residue of the material that is trying to banish. In the following pages we will talk about that dialectic, as well as the decoy value of that material that insists without being exactly what is searched. It will be explained how that dialectic, paradoxically, hides and indicates a text, and provokes in the dreamer a deep sense of intrigue that gives rise to the desire for knowledge, making possible, at times, the beginning of analytical work. To conclude, we will distinguish this desire born under the transfer of the manifestation of the desire to know, which challenges the characteristic affection of neuroses: the horror of knowledge

Low Health Literacy and Health Information Avoidance but Not Satisficing Help Explain "Don't Know" Responses to Questions Assessing Perceived Risk.

BACKGROUND: People who say they don't know (DK) their disease risk are less likely to engage in protective behavior. PURPOSE: This study examined possible mechanisms underlying not knowing one's risk for common diseases. METHODS: Participants were a nationally representative sample of 1005 members of a standing probability-based survey panel who answered questions about their comparative and absolute perceived risk for diabetes and colon cancer, health literacy, risk factor knowledge and health information avoidance, and beliefs about illness unpredictability. Survey satisficing was a composite assessment of not following survey instructions, nondifferentiation of responses, haphazard responding, and speeding. The primary outcomes were whether a person selected DK when asked absolute and comparative risk perception questions about diabetes or colon cancer. Base structural equation modeling path models with pathways from information avoidance and health literacy/knowledge to DK responding for each DK outcome were compared to models that also included pathways from satisficing or unpredictability beliefs. RESULTS: Base models contained significant indirect effects of health literacy (odds ratios [ORs] = 0.94 to 0.97, all P < 0.02) and avoidance (ORs = 1.05 to 1.15, all P < 0.01) on DK responding through risk factor knowledge and a direct effect of avoidance (ORs = 1.21 to 1.28, all P < 0.02). Adding the direct effect for satisficing to models resulted in poor fit (for all outcomes, residual mean square error estimates >0.17, all weighted root mean square residuals >3.2, all Comparative Fit Index <0.47, all Tucker-Lewis Index <0.49), indicating that satisficing was not associated with DK responding. Unpredictability was associated with not knowing one's diabetes risk (OR = 1.01, P < 0.01). LIMITATIONS: The data were cross-sectional; therefore, directionality of the pathways cannot be assumed. CONCLUSIONS: DK responders may need more health information, but it needs to be delivered differently. Interventions might include targeting messages for lower health literacy audiences and disrupting defensive avoidance of threatening health information.

Computed tomography-based 3-dimensional preoperative planning for unlinked total elbow arthroplasty.

HYPOTHESIS: Three-dimensional (3D) surgical planning for unlinked total elbow arthroplasty (TEA) would be helpful for estimation of the implant size and accurate placement of implants. METHODS: We included 28 patients who underwent TEA with an unlinked total elbow implant in this study. All patients underwent computed tomography scans of the elbow before surgery, and a 3D digital model of the elbow was reconstructed. After the appropriate size and position of the prosthesis were determined, 10 points around the bone tunnel (4 on the humerus and 6 on the ulna) were measured to plan the insertion of the humeral and ulnar stems. Two-dimensional planning was also performed using anteroposterior and lateral radiographs. Intraoperatively, the surgeon measured the planned parameters using a slide gauge to reproduce the 3D planned position of the stem insertion. RESULTS: The stem sizes were accurately estimated in 57% of patients for the humerus and 68% for the ulna with 2-dimensional planning and in 86% for the humerus and 96% for the ulna with 3D planning. The mean differences between the positions of the prostheses after surgery with reference to the planned positions were 0.8° of varus and 1.5° of flexion for the humeral component and 0.7° of varus and 2.9° of flexion for the ulnar component. We did not evaluate rotational positioning in this study. CONCLUSIONS: The 3D surgical planning allowed accurate estimation of the implant size and appropriate placement of implants. This method may contribute to a reduced incidence of complications and improved long-term outcomes from TEA.