Adjusting the distance.

This paper describes the anxiety evoked in a patient threatened by invasion or engulfment by his object on the one hand, and the fears of isolation and abandonment on the other. The author illustrates the patient's strugles to find a distance between himself and his object he can tolerate. The analyst has also to cope with the anxieties evoked by the patient's projections, and find a distance between himself and his patient that enables him to think and work.

A 3D lung lesion variational autoencoder.

In this study, we develop a 3D beta variational autoencoder (beta-VAE) to advance lung cancer imaging analysis, countering the constraints of conventional radiomics methods. The autoencoder extracts information from public lung computed tomography (CT) datasets without additional labels. It reconstructs 3D lung nodule images with high quality (structural similarity: 0.774, peak signal-to-noise ratio: 26.1, and mean-squared error: 0.0008). The model effectively encodes lesion sizes in its latent embeddings, with a significant correlation with lesion size found after applying uniform manifold approximation and projection (UMAP) for dimensionality reduction. Additionally, the beta-VAE can synthesize new lesions of varying sizes by manipulating the latent features. The model can predict multiple clinical endpoints, including pathological N stage or KRAS mutation status, on the Stanford radiogenomics lung cancer dataset. Comparisons with other methods show that the beta-VAE performs equally well in these tasks, suggesting its potential as a pretrained model for predicting patient outcomes in medical imaging.

A Kleinian appreciation of the Ego and the Id (1923-2023).

I divide this paper into three parts. First, I discuss Freud's ideas about repression and the unconscious sense of guilt in order to compare them with Klein's view that we disown uncomfortable facts through a process of splitting and projection, leading to a paranoid defence against guilt. Second, I describe Klein's struggle to understand the origin and the severity of the primitive super-ego which was so prominent in her child patients. She considered that an important aim of analysis was to moderate the severity of the super-ego to create a more humane inner world. Finally, I will elaborate on her view, as well as Freud's, that some of the primitive terrifying objects that lie buried deep in the unconscious are fixed and unmodifiable. I will use some ideas from Ron Britton to suggest that instead of trying to modify or get rid of these persecuting figures, it might be possible to stand up to them and to emancipate the ego from the tyranny of the super-ego.

The Musical Semiotics of Voice in Distance: Some Reflections on the Question of Teleanalysis.

Within the context of the debate over teleanalysis, I wish to reintroduce the discussion of voice as the primary link between analyst and patient, a link present in analysis on the phone. Far from questioning the importance of the in-person analysis, I aim to emphasize the voice, the musical semiotics of emotions, as a critical, if not the most vital, aspect of psychoanalysis as a "talking cure" and an art of listening. Insofar as the speaking is instituted in the body, the body is present through voice, even in the virtual analytic room in teleanalysis. I argue that the need for the presence of the material bodies in the session is one aspect of the analytic rituals that, along with the room, the couch, and other power objects, set the stage for the continuous projection of the role identities of the analytic couple. In teleanalysis, the seductive nature of the analytic situation and the status differential are more salient in the analyst's office turf than in the patient's room.

Karl Abraham, The Origins of Projective Identification and The Day of Atonement.

Karl Abraham, one of Melanie Klein's analysts, undoubtedly influenced Klein in her clinical and theoretical thinking. Abraham was arguably the first analyst to focus on character, as well as the relationship between bodily experience and object relationships-central to the concept of projective identification. His writing on mourning (like Klein's, intensely personal) described identificatory processes with the lost object. In a lesser known essay, Abraham applied some of these ideas to the Jewish Day of Atonement, Yom Kippur. Through examination of this lesser known paper, this article describes how Abraham initiated ideas around the concept of projective identification, and then extends Abraham's early ideas to a more contemporary understanding of the concept. This extension represents a contemporary elaboration of a psychoanalytic contribution to a study of ritual, which was of great interest to many early psychoanalysts-among them, Abraham.

Receptivity is not passivity: A comparison between psychoanalysis and phenomenology concerning experience, judgement and the analytic attitude.

Starting from Edmund Husserl's last book Experience and Judgement, this paper explores the notions of "passivity" and "receptivity" in phenomenology and psychoanalysis. Both sciences agree that receptivity differs from passivity, but they have developed different conceptualizations about the very nature of the rudimentary "ego-activity" which is the source of receptivity. In phenomenological terms, "pre-predicative" experience roots in a primary presence and openness of the ego towards the world, whilst psychoanalysis has emphasized the role of projective and introjective processes which are close to bodily experiences and unconscious phantasy. The second part of the paper draws some conclusions concerning the analytic situation, in particular the shift among receptivity, empathy, curiosity and creative imagination as central features of the analytic attitude from a mainly Kleinian point of view. The paper argues that receptivity is a field where phenomenological and psychoanalytic approaches can mutually enrich and learn from each other.

The enigma of transference. Freud's discovery and its repercussions.

This brief introduction gives an historical outline of the development of the concept of transference in the different psychoanalytic traditions. It goes back to the various meanings of the German term "Übertragung" - transference, transcription, transmission, transposition and assignment - and how they were accentuated by the different psychoanalytic schools. The paper depicts the transition from a mainly intrapsychic understanding of transference as repetition to a more bipersonal and intersubjective approach exploring the different meanings of "intersubjectivity" and the forces that operate within the analytic field. Major developments arose from a new understanding of the role of the analyst's countertransference and the detection of transference mechanisms in narcissistic, borderline and psychotic states. The exploration of different forms of splitting and projective and introjective identification deepened the understanding of the analytic communication and led to concepts like "acting in", role-responsiveness, "actualization" and "enactment". As the author tries to show, all these approaches can find a legitimization in Freud's original writings, but the main differences concern technical issues, i.e. the interpretation of transference.

Risk of incident cardiovascular diseases at national and subnational levels in Iran from 2000 to 2016 and projection through 2030: Insights from Iran STEPS surveys.

BACKGROUND: Cardiovascular Disease (CVD) is the leading cause of death in developing countries. CVD risk stratification guides the health policy to make evidence-based decisions. AIM: To provide current picture and future trend of CVD risk in the adult Iranian population. METHODS: Nationally representative datasets of 2005, 2006, 2007, 2008, 2009, 2011, and 2016 STEPwise approach to non-communicable diseases risk factor surveillance (STEPS) studies were used to generate the 10-year and 30-year risks of CVD based on Framingham, Globorisk, and World Health Organization (WHO) risk estimation models. Trend of CVD risk was calculated from 2000 until 2016 and projected to 2030. RESULTS: In 2016, based on Framingham model, 14.0% of the Iranian, aged 30 to 74, were at great risk (≥20%) of CVD in the next 10 years (8.0% among females, 20.7% among males). Among those aged 25 to 59, 12.7% had ≥45% risk of CVD in the coming 30 years (9.2% among females, 16.6 among males). In 2016, CVD risk was higher among urban area inhabitants. Age-standardized Framingham 10-year CVD risk will increase 32.2% and 19%, from 2000 to 2030, in females and males, respectively. Eastern provinces had the lowest and northern provinces had the greatest risk. CONCLUSIONS: This study projected that CVD risk has increased from 2000 to 2016 in Iran. Without further risk factor modification, this trend will continue until 2030. We have identified populations at higher risks of CVD to guide future intervention.

Half-duplex and full-duplex interference mitigation in relays assisted heterogeneous network.

In a multicell environment, the half-duplex (HD) relaying is prone to inter-relay interference (IRI) and the full-duplex (FD) relaying is prone to relay residual-interference (RSI) and relay-to-destination interference (RDI) due to Next Generation Node B (gNB) traffic adaptation to different backhaul subframe configurations. IRI and RDI occur in the downlink when a relay is transmitting on its access link and interfering with the reception of a backhaul link of another victim relay. While the simultaneous transmission and reception of the FD relay creates the RSI. IRI, RDI, and RSI have detrimental effects on the system performance, leading to lower ergodic capacity and higher outage probability. Some previous contributions only briefly analysed the IRI, RSI, and RDI in a single cell scenario and some assumed that the backhaul and access subframes among the adjacent cells are perfectly aligned for different relays without counting for IRI, RSI and RDI. However, in practise the subframes are not perfectly aligned. In this paper, we eliminate the IRI, RSI, and RDI by using the hybrid zeroforcing and singular value decomposition (ZF-SVD) beamforming technique based on nullspace projection. Furthermore, joint power allocation (joint PA) for the relays and destinations is performed to optimize the capacity. The ergodic capacity and outage probability comparisons of the proposed scheme with comparable baseline schemes corroborate the effectiveness of the proposed scheme.

The climatic risk of Amazonian protected areas is driven by climate velocity until 2050.

Changes in species distribution in response to climate change might challenge the territorial boundaries of protected areas. Amazonia is one of the global regions most at risk of developing long distances between current and future analogous climates and the emergence of climate conditions without analogs in the past. As a result, species present within the network of Protected Areas (PAs) of Amazonia may be threatened throughout the 21st century. In this study, we investigated climate velocity based on future and past climate-analogs using forward and backward directions in the network of PAs of Amazonia, in order to assess the climatic risk of these areas to climate change and verify their effectiveness in maintaining the current climate conditions. Using current (1970-2000) and future (2041-2060) average annual air temperature and precipitation data with a resolution of 10 km, climate velocities across the entire Amazon biome and average climate velocities of PAs and Indigenous Lands (ILs) were evaluated. The results show that the effects of backward velocity will be greater than that of forward velocity in the Amazon biome. However, the PA network will be less exposed to backward velocity impacts than unprotected areas (UAs)-emphasizing the importance of these areas as a conservation tool. In contrast, for the forward velocity impacts, the PA network will be slightly more exposed than UAs-indicating that the current spatial arrangement of the PA network is still not the most suitable to minimize impacts of a possible climate redistribution. In addition, a large extent of no-analog climates for backward velocities was found in central Amazonia, indicating that high temperatures and changes in precipitation patterns in this region will surpass the historical variability of the entire biome, making it a potentially isolated and unsuitable climatic envelope for species in the future. Most of the no-analog climates are in PAs, however the climate risks in ILs should also be highlighted since they presented higher climate velocities than PAs in both metrics. Our projections contrast with the median latitudinal migration rate of 2 km/year observed in most ecosystems and taxonomic groups studied so far and suggest the need for median migration rates of 7.6 km/year. Thus, despite the important role of PAs and ILs as conservation tools, they are not immune to the effects of climate change and new management strategies, specific to each area and that allow adaptation to global changes, will be necessary.

Revision of Potamobates Champion, 1898 (Hemiptera: Heteroptera: Gerridae) and description of a new genus for P. thomasi Hungerford, 1937.

Potamobates Champion, 1898 (Hemiptera: Heteroptera: Gerridae) heretofore included 18 species distributed from southern Mexico to Peru. They display a distinct morphology, especially regarding the projections of abdominal segment VIII. Specific identification and delimitation are difficult, and the genus lacks a thorough revision and evaluation of inter- and intraspecific variation. Here, we revise Potamobates, redescribe and/or illustrate known species, and describe P. molanoi Floriano and Moreira, sp. nov. and Brailovskybates Floriano and Moreira, gen. nov. The new genus is erected for P. thomasi Hungerford, 1937 and is characterized by the following features: (1) abdomen elongated, longer than the mesothorax; (2) abdominal spiracles positioned at the center of the segments; (3) male abdominal segment VIII without projections; (4) male pygophore and proctiger not rotated in relation to the longitudinal axis of the body; (5) female abdominal tergum VIII subequal in length and width; (6) and posterior margin of female abdominal sternum VII not produced medially, with a pair of lateral projections.

The Therapeutic Relationship: Intrapsychic and Behavioral Changes in Both Patient and Analyst.

This article explores how the therapeutic relationship facilitates intrapsychic and behavioral changes in both the patient and the analyst. Key elements of the therapeutic relationship are reviewed, including transference, countertransference, introjective and projective identification, as well as the "real relationship." Special attention is paid to the "transformative relationship," which is a special kind of bond that develops between analyst and patient that is unique and transformative. It consists of mutual respect, emotional intimacy, trust, understanding, and affection. Empathic attunement is a key element in the evolution of a transformative relationship. This attunement optimally promotes intrapsychic and behavioral changes in both the patient and the analyst. This process is illustrated by a case presentation.

An Accident With the Death Drive and Its Working Through in the Analyst's Countertransference.

Working through the different faces and vicissitudes of the death drive in the countertransference, and especially through projective identification, is a very challenging process. A thorough and versatile process of containment and working through of the manifold threatening expressions and influences of the death drive is required, experienced most specifically and deeply in the arena of projective identification. This paper demonstrates how each aspect that unfolds in the analyst's countertransference sheds light on a particular layer of anxiety and internal object relations related to it. The creation of a new meaning to the differing expressions of the death drive gradually lessens the compulsion to repeat and enables a better integration between the life and death drives. This process will be illustrated by a prolonged clinical case that involved intense internal working through of the death drive in the analyst's countertransference.

Trends in cigarette consumption across the United States, with projections to 2035.

OBJECTIVES: To make projections of cigarette consumption that incorporate state-specific trends in smoking behaviors, assess the potential for states to reach an ideal target, and identify State-specific targets for cigarette consumption. METHODS: We used 70 years (1950-2020) of annual state-specific estimates of per capita cigarette consumption (expressed as packs per capita or "ppc") from the Tax Burden on Tobacco reports (N = 3550). We summarized trends within each state by linear regression models and the variation in rates across states by the Gini coefficient. Autoregressive Integrated Moving Average (ARIMA) models were used to make state-specific forecasts of ppc from 2021 through 2035. RESULTS: Since 1980, the average rate of decline in US per capita cigarette consumption was 3.3% per year, but rates of decline varied considerably across US states (SD = 1.1% per year). The Gini coefficient showed growing inequity in cigarette consumption across US states. After reaching its lowest level in 1984 (Gini = 0.09), the Gini coefficient began increasing by 2.8% (95% CI: 2.5%, 3.1%) per year from 1985 to 2020 and is projected to continue to increase by 48.1% (95% PI = 35.3%, 64.2%) from 2020 to 2035 (Gini = 0.35; 95% PI: 0.32, 0.39). Forecasts from ARIMA models suggested that only 12 states have a realistic chance (≥50%) of reaching very low levels of per capita cigarette consumption (≤13 ppc) by 2035, but that all US states have opportunity to make some progress. CONCLUSION: While ideal targets may be out of reach for most US states within the next decade, every US state has the potential to lower its per capita cigarette consumption, and our identification of more realistic targets may provide a helpful incentive.

Matriz de consistencia I al 28 03 2023. Políticas, planes, discursos, propuestas y avances en salud / Consistency matrix I to 03 28, 2023. Policies, plans, speeches, proposals and advances in health

La matriz de consistencia consigna de forma literal, los textos extraídos de las 07 fuentes oficiales abordadas; corresponde a los Operadores, Decisores y Gestores en Salud, sacar sus propias conclusiones sobre el alineamiento y coherencia de lo propuesto en cada una de ellas, debidamente contrastada con las demás, sobre todo las de plazo mas corto. Las fuentes se consignan en orden de prelación por su nivel jerárquico, por su proyección en el tiempo y por su peso especifico en la elaboración de otros documentos. Cuando en algunos de los nueve ítems de comparación no aparece una fuente, es porque la misma no incluye en su desarrollo texto alguno relacionado con el ítem abordado.

The exploration of maternal representations during a parenthood-centred psychotherapy from pregnancy to one year postpartum.

Maternal representations play a key role in intrapsychic conflicts relating to accession to parenthood and in the formation of the mother-baby bond. Around the birth of the child, the shadows of past objects are cast on the baby and the parent's self-image. Mother-baby psychoanalytic psychotherapy helps us to understand internal conflicts that tend to interfere with the mother's representations of her child or of herself as a mother, as well as aiming to reduce the risk of difficulties for the child. Through a clinical case, this article explores the development of maternal representations in a course of parenthood-centred psychotherapy that begins during pregnancy and ends 11 months after the baby's birth. The psychic change carried out by the mother frees the mother-baby bond from the projections of the past. Excerpts from clinical sessions illustrate mother-baby interactions during the session, the projection of the mother's internal objects on to the baby, and the elaboration and reintrojection of the mother's internal conflicts. Changes in the mother's representations were measured both qualitatively and quantitatively using the 'R' interview, which allows various dimensions of these representations to be measured on a Likert scale.

Local lowest-rank dynamic mode decomposition for transient feature extraction of rolling bearings.

The fault diagnosis mainly relies on the detection of periodic pulse components caused by the local damage. However, the impulsive component in bearing vibration signals is usually disturbed by noise and some harmonics due to the harsh working environment, which makes great challenge to fault diagnosis. To enhance the performance in fault diagnosis of rolling bearing, a local lowest-rank dynamic mode decomposition (LLRDMD) is proposed in this paper. Firstly, an improved projection operator is proposed to reduce the noise of augmented snapshot matrix and thus eliminating the bias of high-dimension dynamic system matrix. Secondly, by solving a local lowest-rank optimization problem, the impulsive component and interference components in the high-dimension dynamic system matrix are separated. Compared with DMD, the proposed method achieves better performance in the extraction of transient pulse component while avoiding the problems of parameter selection and mode selection. Lastly, the proposed method is applied to three sets of real datasets. Compared with existing methods, LLRDMD achieves a higher accuracy in fault diagnosis.

O florir da violeta: um estudo de caso em avaliação terapêutica / The flowering of violet: a case study in therapeutic assessment / La flor de la violeta: un estudio de caso en evaluación terapéutica

A Avaliação Terapêutica (AT) é um processo avaliativo e interventivo proposto para ser semiestruturado e colaborativo com o objetivo de promover mudanças positivas no cliente, que é convidado a ter uma participação ativa durante o processo. Na AT, os resultados dos testes psicológicos padronizados ganham destaque como facilitadores do processo de autoconhecimento do cliente. Desse modo, usualmente, integram-se os achados de testes psicológicos de autorrelato com os métodos projetivos para gerar informações que possam ampliar a visão que o cliente tem de si. Neste artigo, buscou-se compreender o potencial de uso dos testes psicológicos e da relação colaborativa a partir de um caso atendido na perspectiva da AT. A participante, Violeta (nome fictício), foi atendida em 10 sessões com duração entre 60 e 115 minutos. Foram utilizados os testes psicológicos Escala de Bem-Estar Psicológico (Ebep), Escala de Vulnerabilidade e Estresse no Trabalho (Event), Bateria Fatorial de Personalidade (BFP), Método de Rorschach e Inventários de Habilidades Sociais 2 (IHS-2). Observou-se que, durante o processo, Violeta ampliou sua autopercepção, o que possibilitou mudanças no modo de agir em seus relacionamentos amorosos e na reflexão sobre como sua postura era vista por si e por seus colegas de trabalho. Acredita-se que a AT cumpriu com o objetivo de estabelecer uma experiência terapêutica que possibilitasse mudanças positivas para a cliente. Este estudo de caso contribuiu para ampliar a compreensão sobre a importância e o uso dos testes psicológicos neste modelo de avaliação psicológica.(AU)

The Therapeutic Assessment (TA) is an evaluative and interventional process proposed to be semi-structured and collaborative with the objective of promoting positive changes in the client, who is invited to have an active participation during the process. At the TA, the results of standardized psychological tests are highlighted as facilitators of the client's self-knowledge process. In this way, the findings of psychological self-report tests are usually integrated with projective methods to generate information that can broaden the client's view of themselves. In this article, understanding the potential use of psychological tests and of the collaborative relationship from a case treated from the TA perspective was sought. The participant, Violet (fictitious name), was assisted in 10 sessions lasting between 60 and 115 minutes. The psychological tests Psychological Well-Being Scale (EBEP), Vulnerability and Stress at Work Scale (EVENT), Personality Factorial Battery (BFP), Rorschach Method and Social Skills Inventories 2 (IHS-2) were used. It was observed that, during the process, Violet increased her self-perception, which allowed changes in her way of acting in her love life and in her reflection on how her posture was seen by herself and herco-workers. It is believed that TA fulfilled the objective of establishing a therapeutic experience that would enable positive changes for the client. This case study contributed to broaden the understanding about the importance and use of psychological testing in this psychological assessment model.(AU)

La Evaluación Terapéutica (ET) es un proceso de evaluación e intervención que se propone ser semiestructurado y colaborativo, con el objetivo de lograr cambios positivos en el cliente, quien es invitado a tener participación activa durante el proceso. En la ET se destacan los resultados de las pruebas psicológicas estandarizadas como facilitadoras del proceso de autoconocimiento del cliente. Los hallazgos de las pruebas psicológicas de autoinforme suelen integrarse con métodos proyectivos para generar información que pueda ampliar la visión que el cliente tiene de sí mismo. En este artículo se buscó comprender el uso potencial de las pruebas psicológicas y de la relación colaborativa a partir de un estudio de caso tratado desde la perspectiva de la ET. Atendieron a la participante Violeta (nombre ficticio), en 10 sesiones que duraron entre 60 y 115 minutos. Se utilizaron las pruebas psicológicas Escala de Bienestar Psicológico (EBEP), Escala de Vulnerabilidad y Estrés en el Trabajo (EVENT), Batería de Factorial de la Personalidad (BFP), Método de Rorschach e Inventario de Habilidades Sociales 2 (IHS-dos). Se observó que, durante el proceso, Violeta amplió su autopercepción, lo que permitió cambios en la forma de actuar en sus relaciones amorosas y en el reflejo de como ella y sus compañeros de trabajo veían su postura. Así, se cree que ET ha cumplido el objetivo de establecer una experiencia terapéutica que permitió cambios positivos a la cliente. Este estudio contribuyó a ampliar la comprensión sobre la importancia y el uso de las pruebas psicológicas en este modelo de evaluación psicológica.(AU)

Hot Feelings: Sexual Transference and Countertransference with Male Mid-Adolescents and a Female Psychoanalyst.

The author focuses on the workings of the female analyst-male pair in the consulting room when sexual feelings emerge as part of the adolescent storm. The need for open-bodiedness in relation to the perception of the bodily states of both the analyst and analysand is described and discussed. The author shows how somatic countertransference, reverie, and projective identification are harnessed creatively in the service of transformation. The importance of the third to help provide an analytic space for thought and meaning, rather than enactment and impasse, is discussed. The trajectory from the analyst's wish to silence sexual transference and countertransference in the consulting room, followed by the analyst's initial reluctance to discuss the hot feelings with colleagues, and then the impact of publication anxiety when writing through the experiences and revising this paper is described.

Projections of adult skills and the effect of COVID-19.

In this paper, we project Skills in Literacy Adjusted Mean Years of Schooling (SLAMYS) for the working age population in 45 countries and quinquennial time periods until 2050 according to various population scenarios. Moreover, we integrate the effect of school closures due to the COVID-19 pandemic on these projections. Adult skills are projected using the cohort components method. They can help in assessing the potential consequences of the recent trends for the adult population, particularly the workforce, whose skills are essential for the jobs contributing to economic growth and development outlooks. Our projections are novel as they take into account both the amount of schooling and quality of education and also consider the changes in adult skills through lifetime. Projections show that the adult skills gap between countries in the Global North and countries in the Global South will likely continue to exist by 2050, even under very optimistic assumptions-but may widen or narrow depending on the demographic development trajectories specific to each country. Moreover, the loss of learning due to school closures during the COVID-19 pandemic further exacerbates inequalities between countries. Particularly, in countries where schools have been closed for a prolonged period of time and the infrastructure for effective online schooling is lacking, the skills of cohorts who were in school during the pandemic have been severely affected. The fact that the duration of school closures has been longer in many low- and middle-income countries is a serious concern for achieving global human capital equality. The impact of the COVID-19 pandemic is projected to erase decades-long gains in adult skills for affected cohorts unless policies to mitigate learning loss are implemented immediately.