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Injury in the superior mesenteric vein (SMV) is notably rare among abdominal visceral vascular lesions and has high morbidity and mortality. A case of a young patient victim of abdominal stab wound (ASW) with an injury to the SMV and infrarenal aorta was reported. Several factors contributed to the favorable outcome of the patient including rapid response to trauma, hemodynamic stability, and the absence of patient comorbidities. The operative method initially includes rapid abdominal bleeding control and great saphenous patch preparation for the treatment of venous injury associated with damage control surgery and hemodynamic resuscitation at the intensive care unit. The patient was admitted to the surgical emergency room and, despite the severity of the injuries, presented a favorable result after operative treatment.

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Enhancements in the structural and operational aspects of transportation are important for achieving high-quality mobility. Toll plazas are commonly known as a potential bottleneck stretch, as they tend to interfere with the normality of the flow due to the charging points. Focusing on the automation of toll plazas, this research presents the development of an axle counter to compose a free-flow toll collection system. The axle counter is responsible for the interpretation of images through algorithms based on computer vision to determine the number of axles of vehicles crossing in front of a camera. The You Only Look Once (YOLO) model was employed in the first step to identify vehicle wheels. Considering that several versions of this model are available, to select the best model, YOLOv5, YOLOv6, YOLOv7, and YOLOv8 were compared. The YOLOv5m achieved the best result with precision and recall of 99.40% and 98.20%, respectively. A passage manager was developed thereafter to verify when a vehicle passes in front of the camera and store the corresponding frames. These frames are then used by the image reconstruction module which creates an image of the complete vehicle containing all axles. From the sequence of frames, the proposed method is able to identify when a vehicle was passing through the scene, count the number of axles, and automatically generate the appropriate charge to be applied to the vehicle.

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This paper examines the characteristics and clinical utility of the psychoanalytic field theory proposed by M. and W. Baranger, with particular emphasis on the issues of the transferential-counter transferential relationship and the 'second look'. The role of central key metaphors embodied in the experience of both patient and analyst is illustrated through the author's personal experience and participation in Three Level Model (3LM) work groups. The risk of moments of intense communication between patient and analyst has the possibility for the analyst to lose distance, making it necessary to go beyond moments of emotional resonance and reverie and to take a "second look" to understand the analyst's involvement in the interactional process in order to prevent the constitution of bastions of the field. The 3LM work groups extend the temporal context to include longer periods of time and a "third group look" that triangulates perspectives through group discussions, allowing for the exploration of transformations that have occurred in the analysis. The field perspective contributes to a deeper understanding of the transference-countertransference relationship. The "second" and the "third look" broadens the analyst's insights and enriches the understanding of the psychoanalytic process and its multifaceted dynamics.

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This article describes and substantiates some of the requirements for how a psychoanalyst should respond to the demands of an educational institution in order to constitute best practices. It considers the following requirements: the need to renounce the position of assigned expert (paradox of an expert/ignorant), the position of outsider that must be held, the specificity of the principle of abstention, and the benefits of appealing to a second look. This second look includes an analysis of the analyst's involvement, while the analyst is inserted in a society whose discourses could parasitise their thinking. These four requirements are illustrated in an experience carried out in public schools in a context of social vulnerability. The clinical device created and applied in these settings is a narrative workshop that uses children's literature as linking objects. The example described here is limited to one instance of the use of the device and, in particular, to the process and the difficulties of working with a six-year-old girl who participated in one of the workshops. The changes she experienced are revealed through an analysis of an observed phoric function and its vicissitudes. This case allows us to note the complexity of the transference dynamics that must be sustained.

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Vida e trabalho no percurso de refugiado estão entre os mais recentes desafios contemporâneos que instigam o olhar e o pesquisar. A fim de potencializar a discussão, julgou-se pertinente atentar para a experiência do olhar frente à imagem. Tomou-se a xilogravura Dia e Noite, arte de Maurits Cornelius Escher, que alude ao movimento migratório de pássaros, por também ela provocar o olhar dadas as características que o artista lhe imprime. Como base teórica condutora da discussão, tomaram-se os conceitos de espaço liso e estriado, de Deleuze e Guattari, imbricados em referencial relativo à situação de refugiado. A conversa entre imagem e teoria ampliou o olhar para além das questões burocráticas, jurídicas e estatísticas, frequentemente associadas aos estudos acerca de refugiado, e permitiu apontar relações de continuidade e coexistência em seus modos de viver e trabalhar. Entende-se que, ao provocar a experiência do olhar, a imagem pode ser capturada, recortada, reduzida, ampliada, torcida, num esforço de sentido não necessariamente óbvio.(AU)

Life and work on the refugee journey are among the latest contemporary challenges that instigate to look and to research. In order to enhance the discussion, it was considered pertinent to pay attention to the experience of looking at the image. We took the woodcut Day and Night, art by Maurits Cornelius Escher, which alludes to the migratory movement of birds, because it also provokes the look, given the characteristics that the artist imprints on it. The concepts of smooth and striated space, by Deleuze and Guattari, imbricated in a reference regarding the refugee situation, were taken as the theoretical basis for the discussion. The conversation between image and theory broadened the look beyond bureaucratic, legal and statistical issues, often associated with studies about refugees and allowed pointing out relationships of continuity and coexistence in their ways of living and working. It is understood that, by provoking the experience of the look, the image can be captured, cut, reduced, enlarged, twisted, in an effort of meaning not necessarily obvious.(AU)

La vida y el trabajo en el curso de la vida de los refugiados son algunos de los retos contemporáneos más recientes que instigan la mirada y la investigación. Para mejorar el debate, se consideró pertinente centrarse en la experiencia de mirar la imagen. Se tomó la xilografía Día y Noche, obra de Maurits Cornelius Escher, que alude al movimiento migratorio de las aves, ya que también provoca la mirada dadas las características que el artista le imprime. Los conceptos de espacio liso y estriado, de Deleuze y Guattari, se utilizaron como base teórica para la discusión. La conversación entre la imagen y la teoría amplió la mirada más allá de las cuestiones burocráticas, legales y estadísticas que suelen asociarse a los estudios sobre los refugiados, y nos permitió señalar relaciones de continuidad y convivencia en sus formas de vivir y trabajar. Se entiende que al provocar la experiencia de la mirada, la imagen puede ser capturada, recortada, reducida, ampliada, retorcida, en un esfuerzo por dar un sentido que no es necesariamente obvio.(AU)

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ABSTRACT Objective: Identify the incidence and factors associated with reoperation due to bleeding in the postoperative of a cardiac surgery, in addition to the clinical outcomes of patients. Method: Prospective cohort study, conducted in an Intensive Care Unit (ICU), with adult patients undergoing cardiac surgery. Patients diagnosed with coagulopathies were excluded. The patients were followed up from hospitalization to hospital discharge. Results: A total of 682 patients were included, and the incidence of reoperation was 3.4%. The factors associated with reoperation were history of renal failure (p = 0.005), previous use of anticoagulant (p = 0.036), higher intraoperative heart rate (p = 0.015), need for transfusion of blood component during intraoperative (p = 0.040), and higher SAPS 3 score (p < 0.001). The outcomes associated with reoperation were stroke and cardiac arrest. Conclusão: Reoperation was an event associated with greater severity, organic dysfunction, and worse clinical outcomes, but there was no difference in mortality between the groups.

RESUMEN Objetivo: Identificar la incidencia y los factores asociados con la reintervención por sangrado en el postoperatorio de cirugía cardiaca, además de los resultados clínicos de los pacientes. Método: Estudio de cohorte prospectivo, realizado en una Unidad de Cuidados Intensivos, con pacientes adultos sometidos a cirugía cardiaca. Se excluyeron a los pacientes con diagnóstico de coagulopatías. Los pacientes tuvieron un seguimiento efectuado desde el ingreso hasta el alta hospitalaria. Resultados: Se incluyeron a 682 pacientes, y la incidencia de reintervención fue del 3,4%. Los factores asociados a la reintervención fueron antecedentes de insuficiencia renal (p = 0,005), uso previo de anticoagulante (p = 0,036), mayor frecuencia cardiaca intraoperatoria (p = 0,015), necesidad de transfusión de hemocomponentes en el intraoperatorio (p = 0,040) y mayor puntaje en SAPS 3 (p < 0,001). Los desenlaces asociados con la reintervención fueron accidente cerebrovascular y paro cardiorrespiratorio. Conclusión: La reintervención fue un evento asociado con mayor gravedad, disfunción orgánica y peores desenlaces clínicos, pero no hubo diferencia en la mortalidad entre los grupos.

RESUMO Objetivo: Identificar a incidência e os fatores associados à reoperação devido sangramento no pós-operatório de cirurgia cardíaca, além dos desfechos clínicos dos pacientes. Método: Estudo de coorte prospectivo, realizado em Unidade de Terapia Intensiva (UTI), com pacientes adultos submetidos à cirurgia cardíaca. Foram excluídos pacientes com diagnóstico de coagulopatias. Os pacientes foram acompanhados desde a internação até a saída hospitalar. Resultados: Foram incluídos 682 pacientes e a incidência de reoperação foi 3,4 %. Os fatores associados à reoperação foram: histórico de insuficiência renal (p = 0,005), uso prévio de anticoagulante (p = 0,036), maior frequência cardíaca intraoperatória (p = 0,015), necessidade de transfusão de hemocomponentes no intraoperatório (p = 0,040) e maior pontuação no SAPS 3 (p < 0,001). Os desfechos associados a reoperação foram: acidente vascular encefálico e parada cardiorrespiratória. Conclusão: A reoperação foi um evento associado a maior gravidade, disfunção orgânica, e piores desfechos clínicos, porém não houve diferença de mortalidade entre os grupos.

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Introducción: El problema de la infertilidad cobra mayor dimensión y trascendencia a nivel mundial, soncada vez más frecuentes las consultas de parejas infértiles en la atención primaria de salud.Objetivo: Caracterizar el comportamiento de la infertilidad, desde la Atención Primaria de Salud.Métodos: Se realizó un estudio observacional, descriptivo, longitudinal retrospectivo, en parejas infértiles, pertenecientes a la consulta municipal de infertilidad del Policlínico Docente Noelio Capote del municipio Jaruco, provincia Mayabeque, desde el mes de septiembre delaño 2017 hasta septiembre del 2019. El universo de estudio estuvo constituido por 113 parejas infértiles. Las variables estudiadas fueron: la edad, la tenencia de hijos anteriores; eltipo de infertilidad, el tiempo de infertilidad previa a la consulta y los factores de riesgos asociados.Resultados: Predominaron en las parejas infértiles las edades entre 30 a 39 años con un 37.2 por ciento, las mujeres tenían en mayor número de hijos anteriores 39.82 por ciento, la infertilidad primaria fue la más frecuente con un 60.17 por ciento, de 2 a 5 años fue el tiempo de infertilidad de las parejas previa a la consulta con un 37.17 por ciento, el tabaquismo y la obesidad eran los factores de riesgos que prevalecieron con 53.98 por ciento y 42.48 por ciento.Conclusiones: La infertilidad se reconoce como un problema de salud, con un importante impacto médicosocial de la pareja, existe un elevada resolutividad en la Atención Primaria de Salud.(AU)

Introduction: The problem of infertility takes a higher dimension and transcendence at world level, every time the consultations of infertile couples are more frequent in Primary Health Care.Objective: To characterize the behavior of infertility since Primary Health Care.Methods: An observational, descriptive, longitudinal retrospective study was carried out, in infertile couples, from the municipal infertility consultation at ¨Noelio Capote¨ teaching Policlinic in Jaruco, Mayabeque, from September, 2017 to September, 2019. The study universe wasformed by 113 infertile couples. The studied variables were: age, the tenancy of previous children; type of infertility, previous time of infertility of the consultation associated risk factors.Results: The infertile couples from 30 to 39 years old prevailed with a 37.2 per cent, women with previouschildren 39.82 per cent, primary infertility was the most frequent with a 60.17 per cent, from 2 to 5 yearswas the infertility time of the couples previous the consultaion with a 37.17 per cent, smoking habitand obesity were the risk factors that prevailed with a 98 % 42.48 per cent.Conclusions: Infertility is recognized as a health problem, with an important medical-social impact of thecouple, there is a high possibility of solution Primary Health Care.(AU)

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Introduction Transoral laser microsurgery (TLM) is the treatment of choice for Tis-T2 squamous cell glottic carcinomas due to its advantages compared with open surgery and radiotherapy. However, the CO 2 laser beam causes changes and damage on the specimens, making the histological assessment of resection margins, the gold standard for confirming radical tumor resection, sometimes difficult. Objective To assess the different ways to manage patients depending on the status of the histopathological margin according to recent studies to detect the most commonly shared therapeutic strategy. Data Synthesis We analyzed the literature available on the PubMed and Web of Science databases, including only articles published since 2005, using specific keywords to retrieve articles whose titles and abstracts were read and analyzed independently by two authors to detect relevant studies. Therefore, we focused on disease-free survival, overall survival, local control, laryngeal preservation, and disease-specific survival. Thus, 17 studies were included in the present review; they were grouped according to the status of the histological margin, and we analyzed the different management policies described in them. This analysis showed that there is not a shared strategy, though in most studies the authors performed a second-look surgery in the cases of positive margins and a close follow-up in cases of negative ones. The main disagreement is regarding the management of close or non-valuable resection margins, since some some authors performed a second-look surgery, and others, a close follow-up. Conclusions Definitely, the most shared policy is the second-look surgery in case of positive surgical margins, and a close follow-up in case of close or non-valuable resection margins. Key Points To date, TLM is the treatment of choice for Tis-T2 squamous cell glottic carcinomas. The CO 2 laser beam could impair the histological assessment of the resection margins, which is the gold standard to confirm radical tumor resection. Second-look TLM is the most performed strategy in case of positive surgical margins.Close follow-up is the most shared policy in case of close or non-valuable resection margins.In cases of negative resection margins, follow-up represents the best approach.

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Abstract Introduction Transoral laser microsurgery (TLM) is the treatment of choice for Tis-T2 squamous cell glottic carcinomas due to its advantages compared with open surgery and radiotherapy. However, the CO2 laser beam causes changes and damage on the specimens, making the histological assessment of resection margins, the gold standard for confirming radical tumor resection, sometimes difficult. Objective To assess the different ways to manage patients depending on the status of the histopathological margin according to recent studies to detect the most commonly shared therapeutic strategy. Data Synthesis We analyzed the literature available on the PubMed and Web of Science databases, including only articles published since 2005, using specific keywords to retrieve articles whose titles and abstracts were read and analyzed independently by two authors to detect relevant studies. Therefore, we focused on disease-free survival, overall survival, local control, laryngeal preservation, and disease-specific survival. Thus, 17 studies were included in the present review; they were grouped according to the status of the histological margin, and we analyzed the different management policies described in them. This analysis showed that there is not a shared strategy, though in most studies the authors performed a second-look surgery in the cases of positive margins and a close follow-up in cases of negative ones. The main disagreement is regarding the management of close or non-valuable resection margins, since some some authors performed a second-look surgery, and others, a close follow-up. Conclusions Definitely, the most shared policy is the second-look surgery in case of positive surgical margins, and a close follow-up in case of close or non-valuable resection margins. Key Points To date, TLM is the treatment of choice for Tis-T2 squamous cell glottic carcinomas. The CO2 laser beam could impair the histological assessment of the resection margins, which is the gold standard to confirm radical tumor resection. Second-look TLM is the most performed strategy in case of positive surgical margins. Close follow-up is the most shared policy in case of close or non-valuable resection margins. In cases of negative resection margins, follow-up represents the best approach.

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Este trabalho se originou no atendimento psicanalítico de crianças com surdez e seus familiares. Considerou-se, na singularidade do encontro entre o analista e o sujeito, a língua de sinais como nó inquietante ao redor da qual o Real da transferência era percebido em seus efeitos e a posição ocupada pela criança no discurso materno evidenciava-se. Os efeitos da língua de sinais transitavam entre o incômodo, com tentativas de impedir sua circulação no discurso, e o apaziguamento, em momentos em que trazia sentido e fazia movimentar a cadeia de significantes. Para além da especificidade dos conteúdos analisados, pretende-se expor considerações quanto à língua materna dos sujeitos com surdez, articulando-a com conceitos referentes à dinâmica pulsional dos objetos a - voz e olhar. Tais objetos se apresentaram de modo singular e suas particularidades estiveram relacionadas à língua materna e ao modo como ela se colocou para os sujeitos quando ocorreu o diagnóstico da surdez. Para atingir os objetivos propostos, foram utilizados trechos dos casos clínicos analisados a fim de contribuir para o desenvolvimento das proposições e articulações teóricas.

Este trabajo se originó a partir del cuidado psicoanalítico de los niños sordos y sus familias, teniendo, en la singularidad del encuentro entre el analista y el sujeto, el lenguaje de señas como un nudo que trajo reflexiones, alrededor del cual se percibía lo Real de la transferencia en sus efectos y la posición ocupada por el niño en el discurso de la madre era evidente. Los efectos del lenguaje de señas pasaron entre la inquietud, con intentos de evitar su circulación en el discurso, y apaciguamiento, en momentos que dieron sentido y movieron la cadena de significantes. Además de la especificidad de los contenidos analizados, se presentan consideraciones con respecto a la lengua materna de los sujetos sordos, articulando conceptos relacionados con la dinámica de conducción de los objetos voz y mirada, que se presentaron de una manera única. Sus características se relacionaron con la lengua materna y con la forma cómo la lengua materna se presentó para los sujetos cuando recibieron el diagnóstico de la sordera. Para lograr los objetivos, se emplearon extractos de los casos clínicos analizados para contribuir al desarrollo de las proposiciones y articulaciones teóricas.

This work originated from the psychoanalytical care of deaf children and their families, having, in the singularity of the encounter between the analyst and the subject, the sign language as a disturbing knot, around which the Real of the transfer was perceived in its effects and the position occupied by the child in the mother's speech was evident. The effects of sign language passed between the nuisance, with attempts to prevent its circulation in the speech; and appeasement, in moments that brought meaning and moved the chain of signifiers. In addition to the specificity of the analyzed contents we intend to expose considerations regarding the mother tongue of deaf subjects, articulating concepts related to the drive dynamics of objects voice and gaze. These happened in a unique way and the particularities were related to the mother tongue and how it was placed for these subjects when deafness was diagnosed. To achieve the proposed objectives we will use some excerpts of the clinical cases analyzed, in the format of vignettes, in order to contribute to the development of the propositions and theoretical articulations.

Ce travail est né de la prise en charge psychanalytique des enfants sourds et de leurs familles. Dans la singularité de la rencontre entre l'analyste et le sujet, la langue des signes était vue comme un nœud inquiétant autour duquel le Réel du transfert était perçu dans ses effets et la place occupée par l'enfant dans le discours de la mère était évidente. Les effets du langage des signes évoluent entre l'inconfort, avec des tentatives d'empêcher sa circulation dans le discours, et l'apaisement, dans des moments où il apportait du sens et faisait bouger la chaîne des signifiants. En plus de la spécificité du contenu analysé, nous avons l'intention d'exposer des considérations concernant la langue maternelle des sujets atteints de surdité, en l'articulant avec des concepts liés à la dynamique pulsionnelle des objets à - voix et regard. Ces objets étaient présentés de manière unique et leurs particularités étaient liées à la langue maternelle et à la manière dont elle était présentée aux sujets lors du diagnostic de surdité. Pour atteindre les objectifs proposés, des extraits des cas cliniques analysés ont été utilisés afin de contribuer au développement de propositions et d'articulations théoriques.

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Este artigo é sobre uma experiência de estágio realizada na Escola Experimental de Bonneuil-sur-Marne, fundada pela psicanalista Maud Mannoni e que acolhe crianças psicóticas, autistas ou com neuroses graves. Trata-se do relato de uma viajante sobre o seu encontro com o estrangeiro, com o estranho familiar, com a loucura e de suas tentativas de fazer laço com o outro. Foi no encontro com algumas crianças que as pontes e os pontos de contato foram criados pelo território dos orifícios pulsionais, sendo o olhar o enlaçamento primordial.

Este artículo versa sobre una experiencia de prácticas realizada en la Escuela Experimental de Bonneuil-sur-Marne, fundada por la psicoanalista Maud Mannoni y que acoge a niños psicóticos, a autistas o con neurosis graves. Se trata del relato de una viajera sobre su encuentro con el extranjero, con el extraño familiar, con la locura y sus intentos de hacer el lazo con el otro. En el encuentro con algunos niños, los puentes y los puntos de contacto fueron creados por el territorio de los orificios pulsionales, siendo la mirada el enlazado primordial.

This article is about an internship experience held at the Bonneuil-sur-Marne Experimental School, founded by the psychoanalyst Maud Mannoni and which welcomes psychotic, autistic or severely neurotic children. It is about a traveler's story and her encounter with the foreign, with the familiar stranger, with the madness and her attempts to tie in with the other. It was in the meeting with some children that the bridges and the points of contact were created by the territory of the driving holes, being the look the primordial entanglement.

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Resumen El presente artículo reflexivo pretende, desde una perspectiva interpretativa y crítica, realizar un acercamiento al concepto de imagen del mundo en la Posmodernidad y sus vínculos con la virtualidad y la mirada para advertir el tipo de subjetividad que se genera de estas intersecciones a partir del psicoanálisis. El texto presenta una introducción y reflexión inicial, un acápite sobre conceptos psicoanalíticos vinculados a la Posmodernidad y un acápite final sobre discusiones posibles.

Abstract From an interpretative and critical perspective, this paper seeks to make possible an approach to the image of the world concept in Postmodernism and its links with virtuality, as well as a view to warn the kind of subjectivity generated by these intersections from psychoanalysis. The text provides an introduction and an initial reflection, a section on psychoanalytic concepts related to postmodernism and a final subheading on possible discussions.

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Sostener la clínica psicoanalítica de la "llamada esquizofrenia" es apostar fuertemente a la posibilidad de escucha del "dicho esquizofrénico". Se trata de una apuesta que busca ir más allá de lo deficitario que muchas veces sella el campo de las psicosis. Además de eso, también se trata de ir más allá de lo postulado en relación a la paranoia, delimitando un posible territorio de intervención clínica en la psicosis esquizofrénica. Es en este sentido que lo restitutivo en la "llamada esquizofrenia" será identificado y discutido. Lo que se articula a la relación del sujeto con su Otro y al desarrollo propuesto con respecto al Otro del "dicho esquizofrénico". Tales elementos, preliminares de una posible "dirección de la cura", apuntan a una particular práctica de la escucha del analista, donde la mirada y el cuerpo asumen su máxima expresión, abriendo el campo a consideraciones a respecto de la finalidad y la conclusión o término del tratamiento psicoanalítico de la "llamada esquizofrenia".

Supporting psychonalytical clinical treatment of "so-called schizophrenia" means betting strongly on the possibility of listening to "schizophrenic speech". This is a bet which seeks to reach beyond the deficit that many times seals the field of psychoses. In addition to that, it seeks to go beyond the given tenets as regards paranoia, by outlining a possible territory for clinical intervention in schizophrenic psychosis. In that sense, the restorative aspect in "so-called schizophrenia" will be identified and discussed. What is articulated concerning the subject\\\'s relationship with his or her Other and the development proposed regarding the Other in "schizophrenic speech". Such preliminary elements for a possible "direction of treatment" point towards a specific approach in the analyst\\\'s listening practice, where the look and the body adopt the height of their expression, opening the field to considerations regarding the purpose and conclusion or end point of psychoanalytical treatment of "so-called schizophrenia".

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O presente artigo é uma decorrência das pesquisas que venho desenvolvendo, ao longo de quase duas décadas, sobre o uso da imagem técnica em pesquisa acadêmica. O ponto de partida é a afirmação de que a utilização da câmera como mediação provoca uma intervenção singular na relação que se estabelece entre o pesquisador e os sujeitos da pesquisa. O objetivo é apresentar os princípios metodológicos que têm orientado o uso de câmera de vídeo em pesquisa acadêmica, oferecendo subsídios para a definição do ato de pesquisar como construção de uma ética e de uma estética do olhar. A filosofia da linguagem de Mikhail Bakhtin, o debate pioneiro instaurado por Walter Benjamin sobre as transformações da arte na época da reprodução técnica, o cinema documentário de Eduardo Coutinho e a obra teórica e cinematográfica de Pasolini são as principais referências.

This article is a result of the researches that I have developed over nearly two decades on the use of audiovisual camera in academic research. The starting point is the claim that the use of the camera as mediation causes an unique intervention in the relationship that is established between the researcher and the research subjects. The goal is to present the methodological principles that have guided the use of audiovisual in academic research, offering support for the definition of the act of researching as building an ethical and aesthetical look. The philosophy of Bakhtin´s language, the pioneer debate initiated by Walter Benjamin on the transformation of the art at the time of mechanical reproduction, Coutinho´s documentary film and the theoretical and cinematographic work of Pasolini are the main references.

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Os cilindromas são tumores de apêndices cutâneos. Apresentamse normalmente na área da cabeça e pescoço. Muitas modalidades foram descritas para seu tratamento. Apresentamos aqui o caso de uma idosa que se apresentou com lesões recorrentes e que recebeu a opção de fazer uma excisão radical de todas as lesões versus a excisão das lesões sintomáticas. Ela optou por remover as lesões sintomáticas. A excisão cirúrgica das lesões sintomáticas é uma alternativa razoável para pacientes idosos.

Cylindromas are tumors of skin appendages. They present most commonly in the head and neck area. Many modalities have been described to treat them. We present a case of an elderly female who presented to us with recurrent lesions and was offered radical excision of all lesions versus excision of symptomatic lesions. She opted for the removal of symptomatic lesions. Surgical excision of symptomatic lesions is a reasonable alternative in elderly patients.

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Este trabalho aborda os efeitos da cirurgia de mastectomia sobre as mulheres em atendimento ambulatorial em um hospital geral. Analisa, em especial, os efeitos dessa intervenção médica sobre a imagem corporal. Destaca um fato comum a todas as pacientes atendidas no ambulatório, que é a ausência do tema da morte em suas falas, mesmo nos casos mais avançados da doença. Elas abordam principalmente o tema da beleza, associando-a à feminilidade. Para essas mulheres, a mutilação do seio tem o efeito de um confronto com o real, despertando a angústia. A partir das contribuições de Lacan, o artigo discute a função do belo de fazer uma barreira protetiva em relação à Coisa, permitindo suportar o trágico.(AU)

This work addresses the effects of mastectomy surgery on women in outpatient care at hospitals. It particularly analyzes the effects of such a medical intervention in body image. It highlights a common fact to all patients that were seen in the ambulatory care facility, which is the absence of death as a subject in their speech, even in more advanced cases of the disease. They approach mainly the topic of beauty, associating it with femininity. For those women, breast mutilation caused a confrontation with reality, arousing the feeling of anguish. Drawing from the contribution of Lacan, this article discusses the function of the beautiful in building a protective barrier in relation to the Thing, allowing the bearing of the tragic.(AU)

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Este trabalho aborda os efeitos da cirurgia de mastectomia sobre as mulheres em atendimento ambulatorial em um hospital geral. Analisa, em especial, os efeitos dessa intervenção médica sobre a imagem corporal. Destaca um fato comum a todas as pacientes atendidas no ambulatório, que é a ausência do tema da morte em suas falas, mesmo nos casos mais avançados da doença. Elas abordam principalmente o tema da beleza, associando-a à feminilidade. Para essas mulheres, a mutilação do seio tem o efeito de um confronto com o real, despertando a angústia. A partir das contribuições de Lacan, o artigo discute a função do belo de fazer uma barreira protetiva em relação à Coisa, permitindo suportar o trágico

This work addresses the effects of mastectomy surgery on women in outpatient care at hospitals. It particularly analyzes the effects of such a medical intervention in body image. It highlights a common fact to all patients that were seen in the ambulatory care facility, which is the absence of death as a subject in their speech, even in more advanced cases of the disease. They approach mainly the topic of beauty, associating it with femininity. For those women, breast mutilation caused a confrontation with reality, arousing the feeling of anguish. Drawing from the contribution of Lacan, this article discusses the function of the beautiful in building a protective barrier in relation to the Thing, allowing the bearing of the tragic

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RESUMO

Practices of other-initiated repair deal with problems of hearing or understanding what another person has said in the fast-moving turn-by-turn flow of conversation. As such, other-initiated repair plays a fundamental role in the maintenance of intersubjectivity in social interaction. This study finds and analyses a special type of other-initiated repair that is used in turn-by-turn conversation in a sign language: Argentine Sign Language (Lengua de Señas Argentina or LSA). We describe a type of response termed a "freeze-look," which occurs when a person has just been asked a direct question: instead of answering the question in the next turn position, the person holds still while looking directly at the questioner. In these cases it is clear that the person is aware of having just been addressed and is not otherwise accounting for their delay in responding (e.g., by displaying a "thinking" face or hesitation, etc.). We find that this behavior functions as a way for an addressee to initiate repair by the person who asked the question. The "freeze-look" results in the questioner "re-doing" their action of asking a question, for example by repeating or rephrasing it. Thus, we argue that the "freeze-look" is a practice for other-initiation of repair. In addition, we argue that it is an "off-record" practice, thus contrasting with known on-record practices such as saying "Huh?" or equivalents. The findings aim to contribute to research on human understanding in everyday turn-by-turn conversation by looking at an understudied sign language, with possible implications for our understanding of visual bodily communication in spoken languages as well.

RESUMO

Este ensaio procura mostrar de que maneira a modernidade tecnológica produz em permanência comportamentos arcaicos, preservados no interior da civilização que se pretende lógica e científica. Da pseudoformação escolar aos particularismos políticos, do fim do espaço público às legislações submetidas a lobbies, passa-se da ideia de polis - a cidade como destino comum de uma coletividade que partilha os mesmos valores - à thyase - organização de grupos na forma de seitas - religiosas ou políticas. Mostra-se, assim, o modo de produção do mal-estar e da violência no mundo contemporâneo, só podendo ser superados rompendo-se com os particularismos ressentidos e com a política que opõe amigo e inimigo. Neste sentido, assim como o futuro é contingente, o passado também o é, podendo ser reaberto em suas esperanças de paz e felicidade não cumpridas e que podem fazer advir o presente...

This essay shows how the technological modernity continues to produce archaic behavior, preserved inside a civilization that intends to be logical and scientific. From school pseudoformation to political particularism, from the end of the public space to the legislation subjected to lobbying, we passed from the idea of polis - the city as common fate of a community that shares the same values - to the idea of thyase - groups organized as religious or political sects.The mode of production of the malaise and the violence in today's world is thus shown. It is argued that they can only be overcome by breaking up with the resentful particularism and with the policy that opposes friends and enemies. In this sense, the future and the past are equally contingent. The latter can be reopened in its unfulfilled hopes of peace and happiness and may lead us to reopen the present...

Cet essai vise à montrer comment la modernité technologique produit en permanence des comportements archaïques, préservés dans l'intérieur de la civilisation qui se prétend logique et scientifique. De la pseudoformation scolaire aux particularismes politiques, de la fin de l'espace public aux législations soumises aux lobbies, on passe de l'idée de polis - la ville comme destin commun d'une collectivité qui partage les mêmes valeurs - à l'idée de thyase - organisation de groupes sous la forme de sectes religieuses ou politiques. On montre, ainsi, le mode de production du malaise et de la violence dans le monde contemporain, ceux-ci ne pouvant être surmontés qu´en rompant avec les particularismes du ressentiment ainsi qu'avec la politique qui oppose ami et ennemi. En ce sens, tout comme le futur est contingent, le passé l'est aussi, pouvant être réouvert dans ses espoirs de paix et de bonheur non accomplis et qui peuvent faire advenir le présent...

Este ensayo busca mostrar de qué manera la modernidad tecnológica produce en permanencia comportamientos arcaicos, preservados en el interior de la civilización que se pretende lógica y científica. De la pseudoformación escolar a los particularismos políticos, del fin del espacio público a las legislaciones sometidas a lobbies, se pasa de la idea de polis - la ciudad como destino común de una colectividad que divide los mismos valores - a la thyase - organización de grupos en la forma de sectas - religiosas o políticas. Se muestra, así, el modo de producción del malestar y de la violencia en el mundo contemporáneo, sólo pudiendo ser superados, rompiéndose con los particularismos resentidos y con la política que opone amigo y enemigo. En este sentido, así como el futuro es contingente, el pasado también lo es, pudiendo ser reabierto en sus esperanzas de paz y felicidad no cumplidas y que pueden reabrir el presente...

Assuntos

RESUMO

Este ensaio procura mostrar de que maneira a modernidade tecnológica produz em permanência comportamentos arcaicos, preservados no interior da civilização que se pretende lógica e científica. Da pseudoformação escolar aos particularismos políticos, do fim do espaço público às legislações submetidas a lobbies, passa-se da ideia de polis - a cidade como destino comum de uma coletividade que partilha os mesmos valores - à thyase - organização de grupos na forma de seitas - religiosas ou políticas. Mostra-se, assim, o modo de produção do mal-estar e da violência no mundo contemporâneo, só podendo ser superados rompendo-se com os particularismos ressentidos e com a política que opõe amigo e inimigo. Neste sentido, assim como o futuro é contingente, o passado também o é, podendo ser reaberto em suas esperanças de paz e felicidade não cumpridas e que podem fazer advir o presente.(AU)

This essay shows how the technological modernity continues to produce archaic behavior, preserved inside a civilization that intends to be logical and scientific. From school pseudoformation to political particularism, from the end of the public space to the legislation subjected to lobbying, we passed from the idea of polis - the city as common fate of a community that shares the same values - to the idea of thyase - groups organized as religious or political sects.The mode of production of the malaise and the violence in today's world is thus shown. It is argued that they can only be overcome by breaking up with the resentful particularism and with the policy that opposes friends and enemies. In this sense, the future and the past are equally contingent. The latter can be reopened in its unfulfilled hopes of peace and happiness and may lead us to reopen the present.(AU)

Cet essai vise à montrer comment la modernité technologique produit en permanence des comportements archaïques, préservés dans l'intérieur de la civilisation qui se prétend logique et scientifique. De la pseudoformation scolaire aux particularismes politiques, de la fin de l'espace public aux législations soumises aux lobbies, on passe de l'idée de polis - la ville comme destin commun d'une collectivité qui partage les mêmes valeurs - à l'idée de thyase - organisation de groupes sous la forme de sectes religieuses ou politiques. On montre, ainsi, le mode de production du malaise et de la violence dans le monde contemporain, ceux-ci ne pouvant être surmontés qu´en rompant avec les particularismes du ressentiment ainsi qu'avec la politique qui oppose ami et ennemi. En ce sens, tout comme le futur est contingent, le passé l'est aussi, pouvant être réouvert dans ses espoirs de paix et de bonheur non accomplis et qui peuvent faire advenir le présent.(AU)

Este ensayo busca mostrar de qué manera la modernidad tecnológica produce en permanencia comportamientos arcaicos, preservados en el interior de la civilización que se pretende lógica y científica. De la pseudoformación escolar a los particularismos políticos, del fin del espacio público a las legislaciones sometidas a lobbies, se pasa de la idea de polis - la ciudad como destino común de una colectividad que divide los mismos valores - a la thyase - organización de grupos en la forma de sectas - religiosas o políticas. Se muestra, así, el modo de producción del malestar y de la violencia en el mundo contemporáneo, sólo pudiendo ser superados, rompiéndose con los particularismos resentidos y con la política que opone amigo y enemigo. En este sentido, así como el futuro es contingente, el pasado también lo es, pudiendo ser reabierto en sus esperanzas de paz y felicidad no cumplidas y que pueden reabrir el presente.(AU)

Assuntos