O ato no texto analítico: siginificação e autorização

The article examines the difference between the discourse held by the university and that held by the analyst, as comprised in a text. It establishes the difference between a work in accordance to the prescriptions of the academic procedures and the findings brought about by an analytic text. It concludes that while the further is addressed to knowledge, guided by intention and reason, the last is proffered by a subject who occupies a place where he is not only precluded by reason but abolished by the laws of language. This subject can only leave that place by making an act.El artículo pretende examinar la diferencia entre el discurso universitario y el discurso analítico, tal como ésta puede ser aprehendida en la articulación de un texto. Asimismo, establece la diferencia entre un trabajo realizado de acuerdo con las formulaciones prescritas por el procedimiento universitario y el hallazgo que un texto analítico introduce. Se concluye que, mientras que en el primero se trata de un conocimiento regido por la intención y la razón, el segundo es proferido desde un lugar en el cual el sujeto se encuentra no sólo excluido por la razón, sino, también, abolido por las leyes del lenguaje –lugar de exilio del cual sólo puede salir mediante su acto.O artigo procura examinar a diferença entre o discurso universitário e o discurso analítico tal como ela pode ser apreendida na articulação de um texto. Estabelece a diferença entre um trabalho realizado tendo em vista as formulações prescritas pelo procedimento universitário e o achado trazido por um texto analítico. Conclui que enquanto o primeiro se dirige ao conhecimento regido pela intenção e pela razão, o segundo é proferido de um lugar em que o sujeito se encontra não só excluído pela razão mas abolido pelas leis da linguagem - lugar de exílio de onde só pode sai

The construction of the real scene in Freud's The Wolf Man

O trabalho acompanha a apresentação que Freud faz da cena primordial que seu famoso paciente - conhecido como o Homem dos Lobos - relata durante o tratamento. Ressalta, no percurso, todo o cuidado que o autor tem em precisar os dados que circundavam a apresentação da cena, para garantir a sua materialidade. Da mesma forma, ele conta com a convicção do paciente em encontrar na cena os significantes que o representam. É sobre tal materialidade que vemos Freud, passo a passo, paradoxalmente, construindo a referida cena. Essa alusão ao que denominava a realidade material é apontada como o traço mais marcante do edifício teórico freudiano.The present work follows Freud's presentation of the primal scene reported by his famous patient, known as The Wolf Man, during his treatment. Highlights the author's care in being very exact about the data that surrounded the presentation of the scene, in order to garantee its materiality. In the same way, he counts on the patient's conviction in finding in the reported scene those signitiers that represent him. It then argues that upon such material one can observe Freud, step by step, paradoxically, constructing the scene. This reference to what he called material reality is considered the most distinguished trait of Freudian theorethical construction

Da cena da impossibilidade à imagem do impossível: o risco como prática da letra em Marguerite Duras

Resumo: Com a afirmação de Lacan (1965) que faz convergir a prática da letra e o uso do inconsciente, propomos uma reflexão em torno da noção de imagem em O amante (1984), de Marguerite Duras. Nos dois campos, literário e psicanalítico, preservando as diferenças, identificamos uma especificidade das noções de escrita e de leitura, que trarão consequências para o que entendemos como representação. A escrita de Duras evidencia uma perda no lugar do saber. Com isso, podemos identificar um fazer com a letra muito singular – em que se transpõe o limite da impossibilidade para fazer imagem com esse mesmo impossível. Abstract: With Lacan’s (1965) affirmation that converges the practice of the letter and the use of the unconscious, we propose a reflection on the notion of image in The Lover (1984), by Marguerite Duras. In both fields, literature and psychoanalysis, beyond the differences, we identify a specificity of the notions of writing and lecture, that will have consequences for what we understand by representation. The writing of Duras shows us a loss in the place of knowledge. Thereby we can identify some very unique treatment with the letter – in which we transpass barriers of the impossibility to be able to make out an image of this same impossible

Internationalization: Towards New Horizons

AbstractThis article aims to examine the internationalization actions of Brazilian Postgraduate Programs. Data were used from the Coordination for the Improvement of Higher Education Personnel (CAPES) and the Ministry of Education (MEC), which perform an evaluation of postgraduate courses every three years. Recently, the period was changed to four years. The data reported in the Indicators Booklet of productions of each program, selected according to 8 criteria, allowed the grouping of activities. The comments made on the Evaluation Form were then examined. This showed that internationalization actions are varied and are overwhelmingly present in the Brazilian programs (n= 49). It was verified that the evaluation valorizes production in international publications, often to the detriment of the various actions that effectively contribute to internationalization. It was concluded that, despite publication in international media being a relevant indicator, it does not definitively indicate participation in international knowledge production. The demand, on behalf of students and researchers, for the qualification that is provided in the country would be the most accurate indicator of internationalization. No courses, in the period examined, accommodated non-Portuguese speakers. Despite the efforts already made toward effective internationalization, there remains the important and urgent step: to make the National Postgraduate System a reference point in the international community

El Moisés de Freud: saber y transmisión en el psicoanálisis

The article examines Freud's text Moses and Monotheism to circumscribe the relation between the presence of the Great Man and the long lasting tradition of Jewish religion. Refers to the emphasis put by Freud in the murder of Moses, since it shows a point where the transmission chain is interrupted. The subject must come in this place of interruption as responsible to give the chain its continuity. The Freudian construction is then approached from the point of view of the psychoanalytical operation when the patient supposes the analyst has full knowledge of the circumstances. It concludes by saying that only when faced with the lack of total knowledge on the part of the analyst which occupies the place of an object that causes the patient desire will the latter recognize a place of his/her own in a chain of transmission.Empezando por el texto Moisés y el monoteísmo, examina las características de la religión judaica en su relación con el Gran Hombre que la inaugura. Reconoce el énfasis dado por Freud al asesinato de Moisés revelando un punto de discontinuidad en la cadena de transmisión. Lugar donde va a ser novedad ver surgir un sujeto que retome la transmisión, sin embargo bajo su propia responsabilidad. Acerca la construcción freudiana de la operación analítica en la cual también se supone que el analista posee saber completo. Concluye que aquel que hace el análisis sólo va a ocupar su posición en una cadena de transmisión cuando se depara con la falta del saber completo del analista, en este momento él va a surgir en la cadena como el sujeto responsable por su duración.Partindo do texto Moisés e o monoteísmo, o artigo examina as características da religião judaica em sua relação com o Grande Homem que a inaugura. Reconhece a ênfase dada por Freud ao assassinato de Moisés, o qual dá relevo a um ponto de descontinuidade na cadeia de transmissão que, remetendo à falha no saber mosaico, indica também o seu lugar de causa da religião judaica; lugar no qual vemos o aspecto inovador de um sujeito que retoma a transmissão, porém, sob sua própria responsabilidade. Em seguida, mostra que esta formulação pode ser aproximada à da operação analítica, pois localiza nesse mesmo lugar o ponto em que, da queda do sujeito a quem se supõe saber, surge o analista em sua dimensão objetal. O analisante responderá à convocação feita pelo analista como objeto, momento em que advirá na cadeia como sujeito responsável por sua duração

Psychiatry’s clinical tradition, psychoanalysis and current practices in mental health

Este texto trata de la clínica de la psicosis y propone que se retomen, a través del psicoanálisis, las categorías de la psiquiatría clásica, principalmente el automatismo mental. El objetivo es demonstrar la utilidad de este programa de trabajo para el tratamiento de la psicosis en los servicios de salud mental, hoy polarizado entre el reduccionismo biológico y la rehabilitación psicosocial. La riqueza clínica de tales descripciones clásicas, desde la teoría de Lacan, permite reconocer el funcionamiento complejo de la psicosis y el trabajo hecho por el sujeto para enfrentar las dificultades impuestas por esta condición. A modo de conclusión, se analiza el automatismo mental de Clérambault con el fin de demostrar la dependencia estructural de todo sujeto en cuanto al lenguaje y al significante, hecho que produce la subjetividad como efecto.: The paper analyzes the clinic of psychosis in the mental health field by revisiting classical psychiatry categories through psychoanalysis, especially mental automatism. This paper aims to demonstrate the usefulness of what may be considered a working plan for the clinic of psychosis, which is today polarized into biological reductionism and psychosocial care. The accuracy of these classical psychiatric descriptions, revisited through Lacan’s theory, enables the recognition of the complexity of psychosis and especially the subject’s efforts to tackle the difficulties that result from this condition. In the conclusion, we analyze Clérambault’s syndrome called “mental automatism” so as to demonstrate every subject’s structural dependency on language and on the signifier, from which the subjectivity as an effect is derived.L’article discute la clinique de la psychose dans le domaine de la santé mentale proposant un repris par la psychanalyse des catégories de la psychiatrie classique tel que l’automatisme mental. Son objectif est de démontrer l’utilité de ce qu’on peut considérer un programme de travail pour le champ du traitement de la psychose dans la santé mentale, polarisé aujourd’hui entre le réductionnisme biologique et la réhabilitation psychosociale. La richesse clinique de ces descriptions psychiatriques classiques, repris par le biais de la théorie lacanienne, permet de reconnaître la complexité de la psychose et surtout le travail du sujet pour faire face aux difficultés imposées par cette condition. En conclusion, l’automatisme mentale de Clérambault est analysé pour démontrer la dépendance structurelle de tous les sujets par rapport au langage et au signifiant, fait premier duquel la subjectivité dérive comme un effet.Este artigo aborda a clínica da psicose no campo da saúde mental propondo uma retomada de categorias da psiquiatria clássica pela psicanálise, especialmente o automatismo mental. Seu objetivo é demonstrar a utilidade do que pode ser considerado um programa de trabalho para o campo de tratamento da psicose na saúde mental, polarizado hoje entre o reducionismo biológico e a atenção psicossocial. A riqueza clínica dessas descrições psiquiátricas clássicas, em sua releitura pelo viés da teorização lacaniana, possibilita reconhecer o funcionamento complexo da psicose e, em particular, o trabalho do sujeito para fazer face às dificuldades impostas por essa condição. Como conclusão, o automatismo mental de Clérambault é analisado visando a demonstrar a dependência estrutural de todo sujeito em relação à linguagem e ao significante, fato primeiro do qual deriva a subjetividade como efeito

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research