La Mano de Dios. Identidad y autoría en el campo de indeterminación

Can psychoanalysis be anything else than an institutionalised discourse? This question will lead us through the present work, looking foward to think psychoanalitical discourse from other coordinates, escaping from cristalization and determination of a practice that seems to be dead. The attempt is to profane: profane the origin as a myth, profane the figure of The Creator, profane the figure of the father-author. In order to achieve this, a constellation of concepts will be deployed to skirt the enigma of the alive: rethink the figure of author, authority, identity and selfhood, faith and property. This deployment will be done seeking to encounter lifeness in the praxis’ playing dimension. Letting analytical discourse play, returning it to it’s potential depth, to it’s indetermination field. Hold the undetermined to enable the virtuality of a potential field, alive, creator, aware of the needs of the event, willing to reinvent itself each time.  ¿Puede el psicoanálisis ser algo más que un discurso instituido? A la luz de este interrogante, el presente trabajo intenta repensar la discursividad psicoanalítica desde coordenadas que escapen a la cristalización y determinación de una práctica que por momentos no pareciera ser más que letra muerta. La apuesta es a la profanación: profanar el origen como mito, profanar la figura de El Creador, del padre-autor. Para realizar este movimiento, en el texto se desplegará una constelación de conceptos que permita bordear el enigma de lo vivo: repensar la figura de autor, de autoridad, de identidad y mismidad, de fé y de propiedad para así encontrarnos con lo vital en la dimensión lúdica de la práxis. Poner a jugar la discursividad analítica, devolviéndola a su fondo de potencia, a su campo de indeterminación. Sostener lo indeterminado para habilitar la virtualidad de un espacio potencial, vivo, creador, atento a las necesidades cambiantes de lo que acontece, dispuesto a reinventarse cada vez

Aplicacions de Realitat Augmentada utilitzant el dispositiu Kinect

El món de la tecnologia i, més concretament, el de la realitat virtual és un sector que actualment no para de créixer i cada cop es desenvolupen més aplicatius que anys enrere semblaven inabastables. Tanmateix, dins d’aquesta gran expansió ens centrarem en la part més visual. Aquest projecte consisteix en fer participar a l’usuari dins d’una escena virtual basada en realitat augmentada on serà capaç de tocar un piano virtual amb els seus peus. Per aconseguir-ho treballarem amb un software especialitzat en el desenvolupament d’escenes virtuals anomenat Unity. Al mateix temps, serà bàsic el rol d’un dispositiu anomenat Kinect ja que ens permetrà posicionar l’usuari dins de l’escena virtual. A la memòria començarem explicant com funciona aquesta plataforma de desenvolupament que es diu Unity, tot posant èmfasis amb les dificultats que s’han hagut d’afrontar ja que era un camp totalment desconegut abans de dur a terme aquest projecte. Posteriorment en el capítol 6 parlarem del dispositiu Kinect tot explicant com funciona la seva càmera RGB i com aquesta recull la informació per a utilizar-la després. Al mateix temps, en el capítol 7 s’explicarà com aquesta eina de treball s’implementa amb Unity per tal d’aconseguir escenes virtuals. Seguidament en el capítol 8 ja ens centrarem en descriure pas per pas l’aplicatiu final que consisteix en una escena virtual a partir de la qual l’usuari podrà tocar un piano amb els seus peus, tot activant unes tecles virtuals que apareixen en pantalla. I finalment, es realitzarà un pressupost del que suposa dur a terme aquest projecte juntament amb les conclusions

Medical management of patients after atypical femur fractures: a systematic review and recommendations from the European Calcified Tissue Society

Context Atypical femur fractures (AFFs) are serious adverse events associated with bisphosphonates and often show poor healing. Evidence acquisition We performed a systematic review to evaluate effects of teriparatide, raloxifene, and denosumab on healing and occurrence of AFF. Evidence synthesis We retrieved 910 references and reviewed 67 papers, including 31 case reports, 9 retrospective and 3 prospective studies on teriparatide. There were no RCTs. We pooled data on fracture union (n = 98 AFFs on teriparatide) and found that radiological healing occurred within 6 months of teriparatide in 13 of 30 (43%) conservatively managed incomplete AFFs, 9 of 10 (90%) incomplete AFFs with surgical intervention, and 44 of 58 (75%) complete AFFs. In 9 of 30 (30%) nonoperated incomplete AFFs, no union was achieved after 12 months and 4 (13%) fractures became complete on teriparatide. Eight patients had new AFFs during or after teriparatide. AFF on denosumab was reported in 22 patients, including 11 patients treated for bone metastases and 8 without bisphosphonate exposure. Denosumab after AFF was associated with recurrent incomplete AFFs in 1 patient and 2 patients of contralateral complete AFF. Eight patients had used raloxifene before AFF occurred, including 1 bisphosphonate-naïve patient. Conclusions There is no evidence-based indication in patients with AFF for teriparatide apart from reducing the risk of typical fragility fractures, although observational data suggest that teriparatide might result in faster healing of surgically treated AFFs. Awaiting further evidence, we formulate recommendations for treatment after an AFF based on expert opinion

Percepções de estudantes dos anos finais do ensino fundamental de escolas públicas sobre o ensino de Ciências durante a pandemia da COVID-19

A pandemia da COVID-19 pode ser apontada como a maior quebra de paradigmas da história da educação no século XXI. Dada a sua gravidade, a melhor alternativa para mitigação de danos na educação segue sendo o ensino remoto emergencial (ERE), que é mediado, em maior ou menor grau, pelas Tecnologias da Comunicação e Informação (TICs). No entanto, aprender Ciências através desta nova abordagem metodológica pode ser desafiador, considerando as desigualdades no acesso e uso das TICs no Brasil. Soma-se a isso a grande capacidade de abstração dos alunos que a disciplina de Ciências por vezes requer, o que causa dúvidas e incertezas no processo de ensino-aprendizagem. Assim, o objetivo do estudo foi questionar e compreender como os alunos dos anos finais do ensino fundamental, de duas cidades de realidades socioeconômicas distintas, estão percebendo o aprendizado na disciplina de Ciências. A metodologia, de cunho quali-quantitativo, utilizou um questionário para a coleta de dados, estatística descritiva e a análise de conteúdo para a discussão. O trabalho identificou diferenças marcantes entre as escolas das duas cidades pesquisadas, no que tange a aspectos socioeconômicos e étnicos e sua relação com o acesso à rede, uso de eletroeletrônicos e os impactos desses fatores na aprendizagem na disciplina de Ciências. A análise permite inferir que são urgentes as medidas de enfrentamento à pandemia dentro do contexto familiar, que refletirá no contexto escolar, de forma a diminuir o impacto dos efeitos negativos na aprendizagem

Overexpression of WNT16 Does Not Prevent Cortical Bone Loss Due to Glucocorticoid Treatment in Mice

Glucocorticoids (GC) are commonly used for the treatment of a wide variety of autoimmune, pulmonary, gastrointestinal, and malignancy conditions. One of the devastating side effects of GC use is osteoporotic fractures, particularly in the spine and hip. Bisphosphonates (BP) are the most commonly prescribed pharmacological agents for the prevention and treatment of GC-induced osteoporosis (GIO). However, GIO is marked by reduced bone formation and BP serves mainly to decrease bone resorption. The WNT signaling pathway plays a major role in bone and mineral homeostasis. Previously, we demonstrated that overexpression of WNT16 in mice led to higher bone mineral density and improved bone microarchitecture and strength. We hypothesized that WNT16 overexpression would prevent bone loss due to glucocorticoid treatment in mice. To test our hypothesis, we treated adult wild-type and WNT16-transgenic mice with vehicle and GC (prednisolone; 2.1 mg/kg body weight) via slow-release pellets for 28 days. We measured bone mass and microarchitecture by dual-energy X-ray absorptiometry (DXA) and micro-CT, and performed gene expression and serum biochemical analysis. We found that GC treatment compared with the vehicle significantly decreased femoral areal bone mineral density (aBMD), bone mineral content (BMC), and cortical bone area and thickness in both wild-type and transgenic female mice. In contrast, the trabecular bone parameters at distal femur were not significantly changed by GC treatment in male and female mice for both genotypes. Further, we observed significantly lower level of serum P1NP and a tendency of higher level of serum TRAP in wild-type and transgenic mice due to GC treatment in both sexes. Gene expression analysis showed lower mRNA levels of Wnt16, Opg, and Opg/Rankl ratio in GC-treated female mice for both genotypes compared with the sex-matched vehicle-treated mice. These data suggest that although WNT16 overexpression resulted in higher baseline bone mineral density and bone volume per trabecular volume (BV/TV) in the transgenic mice, this was insufficient to prevent bone loss in mice due to glucocorticoid treatment

Pain, quality of life and safety outcomes of kyphoplasty for vertebral compression fractures: report of a task force of the American Society for Bone and Mineral Research.

The relative efficacy and harms of balloon kyphoplasty (BK) for treating vertebral compression fractures (VCF) are uncertain. We searched multiple electronic databases to March 2016 for randomised and quasi-randomised controlled trials comparing BK with control treatment (non-surgical management [NSM], percutaneous vertebroplasty [PV], KIVA®, vertebral body stenting, or other) in adults with VCF. Outcomes included back pain, back disability, quality of life (QoL), new VCF and adverse events (AE). One reviewer extracted data, a second checked accuracy, and two rated risk of bias (ROB). Mean differences and 95% confidence intervals were calculated using inverse-variance models. Risk ratios of new VCF and AE were calculated using Mantel-Haenszel models. Ten unique trials enrolled 1,837 participants (age range: 61-76 years, 74% female), all rated as having high or uncertain ROB. Versus NSM, BK was associated with greater reductions in pain, back-related disability, and better QoL (k = 1 trial) that appeared to lessen over time, but were less than minimally clinically important differences. Risk of new VCF at 3 and 12 months was not significantly different (k = 2 trials). Risk of any AE was increased at 1 month (RR = 1.73 [1.36, 2.21]). There were no significant differences between BK and PV in back pain, back disability, QoL, risk of new VCF or any AE (k = 1 to 3 trials). Limitations included lack of a BK versus sham comparison, availability of only one RCT of BK versus NSM, and lack of study blinding. Individuals with painful VCF experienced symptomatic improvement compared with baseline with all interventions. The clinical importance of the greater improvements with BK versus NSM is unclear, may be due to placebo effect, and may not counterbalance short-term AE risks. Outcomes appeared similar between BK and other surgical interventions. Well-conducted randomized trials comparing BK with sham would help resolve remaining uncertainty about the relative benefits and harms of BK. This article is protected by copyright. All rights reserved

Vertebral fracture risk in glucocorticoid-induced osteoporosis: the role of hypogonadism and corticosteroid boluses

Objective: The aim of this study was to identify the risk factors associated with fragility fracture (FF) development in glucocorticoid (GC)-treated patients. Methods: 127 patients (aged 62±18 years, 63% women) on GC-treatment (mean dose 14.5±14.1 mg/day and duration 47.7±69 months) were included. The clinical data collected included bone metabolism study (including gonadal axis), GC-treatment, disease activity, dual-energy X-ray absorptiometry analysis (evaluating densitometric osteoporosis (OP) and trabecular bone score (TBS) degraded microarchitecture values (DMA)), X-ray (assessing vertebral fractures (VF)), FRAX risk (GC-adjusted) and previous FF. Results: 17% of the patients had VF, 28% FF (VF and/or non-VF), 29% OP and 52% DMA. Patients with VF received more GC boluses (57.1% vs 29.5%, p=0.03), were older (68±13 vs 60±19 years, p=0.02), postmenopausal (100% vs 67%, p=0.02), had low testosterone levels (57% vs 11%, p=0.02), lower TBS values (1.119±0.03 vs 1.237±0.013, p100, p=0.01) and having received GC boluses (OR 3.45; 95% CI 1.04 to 12.15, p=0.01) were the main factors related to VF. Hypogonadism (OR 7.03; 95% CI 1.47 to 38.37, p=0.01) and FRAX >20 (OR 7.08; 95% CI 1.28 to 53.71, p=0.02) were factors related to FF. Conclusion: Hypogonadism is the principal risk factor for developing fractures in GC-treated men and women, whereas receiving GC boluses is a major factor for VF. These results indicate the importance of evaluating the gonadal axis in these patients

Early changes in biochemical markers of bone formation during teriparatide therapy correlate with improvements in vertebral strength in men with glucocorticoid-induced osteoporosis

Summary: Changes of the bone formation marker PINP correlated positively with improvements in vertebral strength in men with glucocorticoid-induced osteoporosis (GIO) who received 18-month treatment with teriparatide, but not with risedronate. These results support the use of PINP as a surrogate marker of bone strength in GIO patients treated with teriparatide. Introduction: To investigate the correlations between biochemical markers of bone turnover and vertebral strength estimated by finite element analysis (FEA) in men with GIO. Methods: A total of 92 men with GIO were included in an 18-month, randomized, open-label trial of teriparatide (20 μg/day, n = 45) and risedronate (35 mg/week, n = 47). High-resolution quantitative computed tomography images of the 12th thoracic vertebra obtained at baseline, 6 and 18 months were converted into digital nonlinear FE models and subjected to anterior bending, axial compression and torsion. Stiffness and strength were computed for each model and loading mode. Serum biochemical markers of bone formation (amino-terminal-propeptide of type I collagen [PINP]) and bone resorption (type I collagen cross-linked C-telopeptide degradation fragments [CTx]) were measured at baseline, 3 months, 6 months and 18 months. A mixed-model of repeated measures analysed changes from baseline and between-group differences. Spearman correlations assessed the relationship between changes from baseline of bone markers with FEA variables. Results: PINP and CTx levels increased in the teriparatide group and decreased in the risedronate group. FEA-derived parameters increased in both groups, but were significantly higher at 18 months in the teriparatide group. Significant positive correlations were found between changes from baseline of PINP at 3, 6 and 18 months with changes in FE strength in the teriparatide-treated group, but not in the risedronate group. Conclusions: Positive correlations between changes in a biochemical marker of bone formation and improvement of biomechanical properties support the use of PINP as a surrogate marker of bone strength in teriparatide-treated GIO patients