Eu sou um outro: a alteridade como paradigma da identidade

Dissertação de Mestrado apresentada no ISPA – Instituto Universitário para obtenção de grau de Mestre na especialidade de Psicologia ClínicaMuitos foram até hoje os autores que dentro e fora da área da psicologia se debruçaram sobre o tema da identidade. No presente trabalho pretende-se chamar a atenção para o carácter eminentemente relacional deste termo que nos é tão caro a todos. Nunca como hoje se viveram e observaram tantas possibilidades de ser e estar no mundo, o que aparentemente poderia contribuir para uma mais fácil assunção daquilo que o sujeito sente que é. Contudo, não é isso que se verifica. As dificuldades sentidas pelas pessoas, mais ou menos conscientes, perante um contexto cada vez mais desumanizado, fazem com que a vida em comunidade se desintegre lentamente perdendo-se assim uma qualidade fundamental do que é ser-se humano. Somos divíduos, e não indivíduos como costuma postular-se. O desejo, palavra-chave no discurso da psicanálise, será alvo de análise como aquilo que está no cerne no sujeito, não definindo, porém, a sua identidade. A necessidade de integração do estrangeiro revela-se cada vez mais como um movimento essencial para que nos possamos mover neste contexto assoberbado de estímulos e reivindicações, que parecem concorrer mais para o afastamento do que para a individualização dos sujeitos. Não pode haver forma de olhar e tentar perceber o sujeito que não contemple o contexto no qual ele se insere.Many have been the authors from within and without the field of psychology that have posed questions about identity. In the current work we try to appeal to the eminently relational feature of this concept we all care so much about. Never as nowadays has there been lived and seen these many possibilities of being in the world, which apparently could contribute to an easier assumption of what the subject feels he or she is. However, this it not the case. People are having trouble, consciously or unconsciously, living in this more and more dehumanized environment as ours seems to be. The fact is that community type living has been slowly degrading and this means a profound loss in the quality of being human. We are dividuals, not individuals as we usually see ourselves. Desire, the keyword in the psychoanalytic speech, will be taken into account as what most defines the subject despite being not an identity experience. Integrating the foreigner has never been so important as it is in today's world, in order to be able to live in this overwhelming context of permanent stimulus and claims that seem to promote withdrawal rather than subject's individualization. There cannot be a way of looking upon and understanding the subject that do not contemplate the environment in which he or she takes par

Eu sou um outro: a alteridade como paradigma da identidade

Dissertação de Mestrado apresentada no ISPA Instituto Universitário para obtenção de grau de Mestre na especialidade de Psicologia ClínicaMuitos foram até hoje os autores que dentro e fora da área da psicologia se debruçaram sobre o tema da identidade. No presente trabalho pretende se chamar a atenção para o carácter eminentemente relacional deste termo que nos é tão caro a todos. Nunca como hoje se viveram e observaram tantas possibilidades de ser e estar no mundo, o que aparentemente poderia contribuir para uma mais fácil assunção daquilo que o sujeito sente que é. Contudo, não é isso que se verifica. As dificuldades sentidas pelas pessoas, mais ou menos conscientes , perante um contexto cada vez mais desumanizado, fazem com que a vida em comunidade se desintegre lentamente perdendo se assim uma qualidade fundamental do que é ser se humano. Somos divíduos, e não indivíduos como costuma postul ar se. O desejo, palavra chave no discurso da psicanálise, será alvo de análise como aquilo que es tá no cerne no sujeito, não defi nindo porém a sua identidade. A necessidade de integração do estrangeiro revela se cada vez mais como um movimento essencial para que nos possamos mover neste contexto assoberbado de estímulos e reivindicações, que parecem concorrer mais para o afastamento do que para a individualização dos sujeitos. Não pode haver forma de olhar e tentar perceber o sujeito que não contemple o contexto no qual ele se insere.Many have been the authors from within and without the field of psychology that have posed questions about identity. In the current work we try to appeal to the eminently relational feature of this concept we all care so mu ch about. Never as nowadays has there been lived and seen these many possibilities of being in the world, which apparently could contribute to an easier assumption of what the s ubject feels he or she is. However, this it not the case. People are having trouble, consciously or unconsciously, living in this more and more dehumanized environment as ours seems to be. The fact is that community type living has been slowly degrading an d this me a ns a profound loss in the quality of being human. We are dividuals, not individuals as we usually see ourselves. Desire, the keyword in the psychoanalytic speech, will be taken into ac c ount as what most defines the subject despite being not an id entity experience. Integrating the foreigner has never been so important as it is in today's world, in order to be able to live in this overwhelming context of permanent stimulus and claims that seem to promote withdrawal rather than subject 's individualiz ation. There can not be a way of looking upon and understanding the subject that do not contemplate the environment in which he or she takes part

Angiografia Pulmonar por Ressonância Magnética Tridimensional Optimizada por Contraste no Estudo da Patologia Vascular Pulmonar

OBJECTIVES: To assess the feasibility of performing pulmonary angiography using MRI with contrast enhancement in patients with pulmonary vascular disease. METHODS: We present our experience in ten individuals, two controls and eight patients who underwent the exam after injection of a gadolinium-based contrast agent on a 1 Tesla MR scanner using a time-of-flight sequence and breath-holding during injection of contrast. RESULTS: Pathology in the main pulmonary artery and its major branches was detected easily while resolution at the segmental and subsegmental levels was inadequate. CONCLUSION: Contrast-enhanced magnetic resonance pulmonary angiography is feasible on a 1 Tesla MR scanner for the study of pathology of the main pulmonary artery and its major branches, like massive pulmonary embolism. However its ability to detect and define distal vessel pathology as found in chronic thromboembolic pulmonary hypertension and small pulmonary emboli is limited

Adoption and patterns of use of invasive physiological assessment of coronary artery disease in a large cohort of 40 821 real-world procedures over a 12-year period

Funding Information: The authors wish to acknowledge the invaluable contributions of Paulo Leal regarding data acquisition and management, and John Henderson for statistical consultancy. Publisher Copyright: © 2021 Sociedade Portuguesa de CardiologiaIntroduction and Objectives: Use of invasive physiological assessment in patients with coronary artery disease varies widely and is perceived to be low. We aimed to examine adoption rates as well as patterns and determinants of use in an unselected population undergoing invasive coronary angiography over a long time frame. Methods: We retrospectively determined the per-procedure prevalence of physiological assessment in 40 821 coronary cases performed between 2007 and 2018 in two large-volume centers. Adoption was examined according to procedure type and patient- and operator-related variables. Its association with relevant scientific landmarks, such as the release of clinical trial results and practice guidelines, was also assessed. Results: Overall adoption was low, ranging from 0.6% in patients undergoing invasive coronary angiography due to underlying valve disease, to 6% in the setting of stable coronary artery disease (CAD); it was 3.1% in patients sustaining an acute coronary syndrome. Of scientific landmarks, FAME 1, the long-term results of FAME 2 and the 2014 European myocardial revascularization guidelines were associated with changes in practice. Publication of instantaneous wave-free ratio (iFR) trials had no influence on adoption rates, except for a higher proportion of iFR use. In 42.9% of stable CAD patients undergoing percutaneous coronary intervention there was no objective non-invasive evidence of ischemia, nor was physiological assessment performed. Younger operator age (4.5% vs. 4.0% vs. 0.9% for ages 55 years, respectively; p<0.001) and later time of procedure during the day (2.9% between 6 and 8 p.m. vs. 4.4% at other times) were independent correlates of use of invasive physiology. Conclusions: Our study confirms the low use of invasive physiology in routine practice. The availability of resting indices did not increase adoption. Strategies are warranted to promote guideline implementation and to improve patient care and clinical outcomes.publishersversionpublishe

Thrombus aspiration in patients with ST-elevation myocardial infarction: results of a national registry of interventional cardiology

BACKGROUND: We aimed to evaluate the impact of thrombus aspiration (TA) during primary percutaneous coronary intervention (P-PCI) in 'real-world' settings. METHODS: We performed a retrospective study, using data from the National Registry of Interventional Cardiology (RNCI 2006-2012, Portugal) with ST-elevation myocardial infarction (STEMI) patients treated with P-PCI. The primary outcome, in-hospital mortality, was analysed through adjusted odds ratio (aOR) and 95% confidence intervals (95%CI). RESULTS: We assessed data for 9458 STEMI patients that undergone P-PCI (35% treated with TA). The risk of in-hospital mortality with TA (aOR 0.93, 95%CI:0.54-1.60) was not significantly decreased. After matching patients through the propensity score, TA reduced significantly the risk of in-hospital mortality (OR 0.58, 95%CI:0.35-0.98; 3500 patients). CONCLUSIONS: The whole cohort data does not support the routine use of TA in P-PCI, but the results of the propensity-score matched cohort suggests that the use of selective TA may improve the short-term risks of STEMI..info:eu-repo/semantics/publishedVersio

Novel insights into an old controversy: Is coronary artery ectasia a variant of coronary atherosclerosis?

Coronary artery ectasia (CAE) is defined as a localized or diffuse non-obstructive lesion of the epicardial coronary arteries with a luminal dilation exceeding 1.5-fold the diameter of the normal adjacent arterial segment. The incidence of CAE has been reported to range between 2% and 4%, which might be an overestimation of the true frequency. The coincidence of CAE with other systemic vascular dilatations has suggested that the mechanism underlying CAE is not only localized to coronary arteries, but also to other vascular compartments such as aorta or peripheral veins. Although the pathophysiology of CAE remains largely unknown, it was supposed to represent a variant of coronary atherosclerosis. This review focuses on this controversy of whether CAE and coronary artery disease (CAD) are two manifestations of the same underlying process. There are clear differences between CAD and CAE with respect to cardiovascular risk factors such as diabetes mellitus, and pathogenic steps in disease progress such as inflammation or extracellular matrix remodeling. As this review will underscore, the current knowledge of the field is insufficient to finally clarify the causative interrelation between CAE and CAD. The clinical course and treatment of CAE mainly depends on its coexistence with CAD. When coexisting with CAD, the prognosis and treatment of CAE are the same as for CAD alone. In isolated CAE, prognosis is better and anti-platelet drugs are the mainstay of treatment. Surgical treatment can be considered in selected patients. For clarifying the mechanism underlying CAE, additional clinical, histopathological and pathophysiological investigations are required. In fact, every patient with CAE should be evaluated systematically for pathological changes in other vascular territories, both in the arterial system as well as in the venous system, which might occur in the disease process

Quinze anos de ecografia intravascular coronária emintervenc ̧ão coronária percutânea em Portugal

INTRODUCTION: Coronary intravascular ultrasound (IVUS) is increasingly important in catheterization laboratories due to its positive prognostic impact. This study aims to characterize the use of IVUS in percutaneous coronary intervention (PCI) in Portugal. METHODS: A retrospective observational study was performed based on the Portuguese Registry on Interventional Cardiology of the Portuguese Society of Cardiology. The clinical and angiographic profiles of patients who underwent PCI between 2002 and 2016, the percentage of IVUS use, and the coronary arteries assessed were characterized. RESULTS: A total of 118 706 PCIs were included, in which IVUS was used in 2266 (1.9%). Over time, use of IVUS changed from none in 2002 to generally increasing use from 2003 (0.1%) to 2016 (2.4%). The age of patients in whom coronary IVUS was used was similar to that of patients in whom IVUS was not used, but in the former group there were fewer male patients, and a higher prevalence of cardiovascular risk factors (hypertension, hypercholesterolemia and diabetes), previous myocardial infarction, previous PCI, multivessel coronary disease, C-type or bifurcated coronary lesions, and in-stent restenosis. IVUS was used in 54.8% of elective PCIs and in 19.15% of PCIs of the left main coronary artery. CONCLUSION: Coronary IVUS has been increasingly used in Portugal since 2003. It is used preferentially in elective PCIs, and in patients with higher cardiovascular risk, with more complex coronary lesions and lesions of the left main coronary artery.info:eu-repo/semantics/publishedVersio

Modifying effect of dual antiplatelet therapy on incidence of stent thrombosis according to implanted drug-eluting stent type

Aim To investigate the putative modifying effect of dual antiplatelet therapy (DAPT) use on the incidence of stent thrombosis at 3 years in patients randomized to Endeavor zotarolimus-eluting stent (E-ZES) or Cypher sirolimus-eluting stent (C-SES). Methods and results Of 8709 patients in PROTECT, 4357 were randomized to E-ZES and 4352 to C-SES. Aspirin was to be given indefinitely, and clopidogrel/ticlopidine for ≥3 months or up to 12 months after implantation. Main outcome measures were definite or probable stent thrombosis at 3 years. Multivariable Cox regression analysis was applied, with stent type, DAPT, and their interaction as the main outcome determinants. Dual antiplatelet therapy adherence remained the same in the E-ZES and C-SES groups (79.6% at 1 year, 32.8% at 2 years, and 21.6% at 3 years). We observed a statistically significant (P = 0.0052) heterogeneity in treatment effect of stent type in relation to DAPT. In the absence of DAPT, stent thrombosis was lower with E-ZES vs. C-SES (adjusted hazard ratio 0.38, 95% confidence interval 0.19, 0.75; P = 0.0056). In the presence of DAPT, no difference was found (1.18; 0.79, 1.77; P = 0.43). Conclusion A strong interaction was observed between drug-eluting stent type and DAPT use, most likely prompted by the vascular healing response induced by the implanted DES system. These results suggest that the incidence of stent thrombosis in DES trials should not be evaluated independently of DAPT use, and the optimal duration of DAPT will likely depend upon stent type (Clinicaltrials.gov number NCT00476957

IViHumans Platform The Graphical Processing Layer

Os ambientes virtuais habitados por agentes com uma aparência humanóide têm diversas aplicações práticas nos dias que correm, em áreas como o entretenimento, a educação, a psíco-terapia, o treino industrial ou a reconstituição de ambientes históricos. Estes são exemplos de áreas que podem beneficiar de uma plataforma flexível que suporte a geração e produção de cenas animadas com humanos virtuais inteligentes. A plataforma IViHumans está actualmente a ser construída com esta perspectiva. A plataforma divide-se em duas camadas: uma para o processamento gráfico e outra para a computação de inteligência artificial. A sua concepção pressupõe a inclusão de um conjunto de funcionalidades que cobrem muitos aspectos comuns a aplicações que integram humanos virtuais em ambientes virtuais. Este documento atenta na concepção e no desenvolvimento da camada de processamento gráfico, que constitui a base para a camada de inteligência artificial. A ligação entre as duas camadas e também abordada. As camadas foram projectadas de modo a correr em diferentes processos que comunicam por meio de um protocolo cliente/servidor eficaz e extensível, que idealizamos e implementámos. As tarefas da camada de processamento gráfico baseiam-se, antes de mais, em representações gráficas. Assim sendo, destacamos as técnicas usadas na modelação de objectos tridimensionais. Também nos focamos no desenho e na implementação da plataforma e explicamos como aplicamos os princípios do desenho orientado a objectos para lhe conferir flexibilidade. A concepção de movimento de Reynolds e aplicada de acordo com a nossa interpretação, para que humanos virtuais e outros objectos possam conduzir-se autonomamente pelo mundo, enquanto reproduzem animações coerentes que são automaticamente escolhidas com base em regras especificas para cada personagem. Expomos também a nossa solução para expressões faciais que podem ser misturadas de modo a transmitir emoções complexas e que são objecto de transições suaves e automaticas. Mostramos ainda como os objectos virtuais podem ser caracterizados com propriedades pré-definidas ou atribuídas pelo utilizador e discutimos a integração da percepção através de visão sintética,incluindo como ela e acoplada a diferentes tipos de memória que recordam quaisquer atributos dos objectos que habitam o mundo virtual