24 research outputs found
Do desamparo à dor de existir na poesia de Flobela Espanca: alguns apontamentos
No full textDissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Filosofia e Ciências Humanas, Programa de Pós-Graduação em Psicologia, Florianópolis, 2014.A questão central dessa pesquisa é se a dor que Florbela descreve em seus versos poéticos tem como motivo o que Freud denominava desamparo. Trabalhamos aqui as relações do desamparo freudiano com a dor de existir na perspectiva teórica psicanalítica. A poesia de Florbela Espanca apresentada ilustra as relações do desamparo com a dor de existir. Utilizou-se do método de análise discursiva de base psicanalítica, extraindo dos trechos poéticos sentidos coerentes com essa perspectiva de análise. Realizamos uma revisão bibliográfica do tema do desamparo na teoria freudiana. Examinando os poemas escritos de 1903 a 1917, constatamos que o desamparo e a dor de existir apresentam-se na posição melancólica nas personagens da poesia de Florbela Espanca.Abstract : This text aims to discuss some effects of "Helplessness" (the Freudian idea of "Hilflosigkeit") in Florbela Espanca's poetry. Examining the author's discourse from a psychoanalytic point of view, the work tries to make the pain that the Portuguese author often describes in her verses understandable. The main conclusion is that Florbela's characters show helplessness and existential pain in a way that is typical of the melancholic position
Predictors of insufficient peak amikacin concentration in critically ill patients on extracorporeal membrane oxygenation
No full textInternational audienceBackground: Amikacin infusion requires targeting a peak serum concentration (Cmax) 8–10 times the minimal inhibitory concentration, corresponding to a Cmax of 60–80 mg/L for the least susceptible bacteria to theoretically prevent therapeutic failure. Because drug pharmacokinetics on extracorporeal membrane oxygenation (ECMO) are challenging, we undertook this study to assess the frequency of insufficient amikacin Cmax in critically ill patients on ECMO and to identify relative risk factors.Methods: This was a prospective, observational, monocentric study in a university hospital. Patients on ECMO who received an amikacin loading dose for suspected Gram-negative infections were included. The amikacin loading dose of 25 mg/kg total body weight was administered intravenously and Cmax was measured 30 min after the end of the infusion. Independent predicators of Cmax < 60 mg/L after the first amikacin infusion were identified with mixed-model multivariable analyses. Various dosing simulations were performed to assess the probability of reaching 60 mg/L < Cmax < 80 mg/L.Results: A total of 106 patients on venoarterial ECMO (VA-ECMO) (68%) or venovenous-ECMO (32%) were included. At inclusion, their median (1st; 3rd quartile) Sequential Organ-Failure Assessment score was 15 (12; 18) and 54 patients (51%) were on renal replacement therapy. Overall ICU mortality was 54%. Cmax was < 60 mg/L in 41 patients (39%). Independent risk factors for amikacin under-dosing were body mass index (BMI) < 22 kg/m2 and a positive 24-h fluid balance. Using dosing simulation, increasing the amikacin dosing regimen to 30 mg/kg and 35 mg/kg of body weight when the 24-h fluid balance is positive and the BMI is ≥ 22 kg/m2 or < 22 kg/m2 (Table 3), respectively, would have potentially led to the therapeutic target being reached in 42% of patients while reducing under-dosing to 23% of patients.Conclusions: ECMO-treated patients were under-dosed for amikacin in one third of cases. Increasing the dose to 35 mg/kg of body weight in low-BMI patients and those with positive 24-h fluid balance on ECMO to reach adequate targeted concentrations should be investigated
Additional file 1: of Predictors of insufficient peak amikacin concentration in critically ill patients on extracorporeal membrane oxygenation
No full textTable S1. List of the data included into the multivariable mixed models. Table S2. Infection sites, pathogens identified and their ECOFF for Amikacin in 88 patients with documented infections. Figure S1. Distribution of amikacin Cmax concentrations in ECMO-treated patients. Table S3. Total population characteristics and univariable analyses of factors predictive of amikacin Cmax > 80 mg/L. Figure S2. Amikacin Cmax distribution within our population on ECMO with 25 mg/kg for all patients or with using potentially adapted dosing regimens based on 24-h fluid balance and BMI, as described in Table 3. (DOCX 273 kb
Po?ticas verbais e visuais em Peter Pan e Wendy: o encontro emp?rico entre livro e leitor na cultura das m?dias
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Previous issue date: 2012-01-13This thesis is based on Lucia Rabello de Castro and Vera Lopes Besset s concept of research-intervention and considers the conception of subject understood as subjectivity in process, according to Felix Guattari and Gilles Deleuze. Its inference methods are grounded on Charles Sanders Peirce s epistemological system - inclusive of logical thinking intuitions - represented in Brazil by Lucia Santaella due to its difficult access. This paper was developed from empiric data collected at a Workshop on the reading of the piece Peter Pan and Wendy, by James Barrie, which took place in a public school of Porto Alegre (RS, Brazil) and was attended by children; the paper gathers considerations on the idea of book as a complex medium, whose aesthetical and communicative values affect reading operations. These ideas consider the proposition that the behavior seen in the visual and verbal discourse implied in the illustrated book takes place in a hybrid, interlaced, non-dialogical, nonlinear way, which will ensure a unique and indelible effect over the emotional conscience and memory. This topic was also part of the author s Master s dissertation in the same institution. The collected data were analyzed considering how readers related to an illustrated edition of the piece, both in an aesthetical-cognitive perspective, guided by Pierce s semiotics and children expression and drawing studies (in which Phillipe Grieg outstands), and in a psychosocial, emotional perspective, which was based on Louise Kaplan, Felix Guattari and Gilles Deleuze s ideas. Moreover, the empiric study brought about some follow-ups, which were divided in four essays: on the first, there is a reevaluation of the concept of book as support and medium considering its history, status as a cultural icon and its connection to new reading interfaces; this ideas are supported by a theoretical grade which includes language historians and philosophers such as Roger Chartier, Wilson Martins, Vil?m Flusser, David Olson and Jacques Derrida, communication and graphic design theorists such as Rafael Cardoso, Philip Meggs and Aston Purvis, among other scholars whose attention lies on the topic illustrated book , such as Alan Powers. On the second essay, Peter Pan and Wendy is reviewed based on the author s Master s studies and is represented as part of the Peter Pan Universe in its conjuration in several media, besides being contextualized cultural and historically, aiming to set and contrast reader from that time and place s expectations with contemporary Brazilian reader s expectations. Nestor Garcia Canclini, Henry Jenkins, Nicolas Bourriaud, Roger Chartier, cultural studies theorists Silvia and Guillermo Obiols, Zygmunt Bauman, Michelle Perrot, children literature experts Maria Tatar, Peter Hollindale, Jacqueline Rose and Isabelle Cani s theories outstand. On the third essay, a new concept of reader and reading is emulated, based on the latin definitions leggere and legens, in which reading agents and operations are amplified humanistically in the discussion of categories such as critical reader, competent reader, positive and negative reader and emancipation by reading. This approach discusses Immanuel Kant s illuminist ideas, still influent in Western modern thinking, in contrast to the above mentioned deconstructivists such as Felix Guattari and Gilles Deleuze. At last, the fourth essay assesses cultural, political and market contexts, which are the macro-mediators in the successful encounter of readers, book, literature and art. It defends the idea of a pleasing, emotional space for circulation, access and mediation of the illustrated book, which could encourage a sensitive-critical reading not only related to literary text but also to visual graphic artistic discourses, which then would be integrated to one s subjectivity. This last statement is supported by culture and art scholars such as Marilena Chau? and Gisela Taschner, anthropologist Roy Wagner and historian - anthropologist Michel de Certau; Felipe Lindoso, from publishing market and Fernando Hern?ndez and Humberto Maturana, education theorists.Esta tese foi moldada no conceito de pesquisa-interven??o proposto por L?cia Rabello de Castro e Vera Lopes Besset, tendo em vista uma concep??o de sujeito compreendido como subjetividade em-processo (ou vivente) conforme Felix Guattari e Gilles Deleuze. Seus m?todos inferenciais fundamentam-se no sistema epistemol?gico de Charles Sanders Peirce -inclusivo das intui??es no racioc?nio l?gico - representado no Brasil, em virtude do seu dif?cil acesso, por L?cia Santaella. Produzida a partir de dados emp?ricos recolhidos em uma Oficina de Leitura sobre a obra Peter Pan e Wendy, de James Matthew Barrie, realizada com crian?as de uma escola p?blica de Porto Alegre (RS, Brasil), ela re?ne reflex?es em torno da ideia do livro como m?dia complexa, cujos valores est?ticos e comunicativos s?o interferentes nas opera??es leitoras. Tais reflex?es partem da proposi??o de que o comportamento presente nos discursos verbais e visuais impl?citos no livro ilustrado ocorre de modo h?brido, ac?rdico, entrela?ado, e n?o dial?gico e linear, garantindo um efeito ?nico e indel?vel sobre a consci?ncia memorial e afetiva do leitor, j? apresentada em disserta??o de mestrado defendida na mesma institui??o. Os dados recolhidos na Oficina foram analisados considerando a identifica??o dos leitores com uma edi??o ilustrada da obra selecionada, tanto de um ponto de vista est?tico-cognitivo, orientado por uma semi?tica de base peirceneana e estudos sobre o desenho e a express?o infantil - em que se destaca o nome do psic?logo Phillipe Greig -, quanto do ponto de vista psicossocial e emoafetivo, tendo por base a psic?loga Louise Kaplan e os fil?sofos Felix Guattari e Gilles Deleuze. Al?m disso, o estudo emp?rico propulsionou algumas deriva??es, divididas em quatro ensaios: no primeiro, uma reavalia??o do conceito de livro como suporte e m?dia tendo em vista seu hist?rico, seu status como ?cone cultural, e em sua relativiza??o ?s novas interfaces de leitura, apoiada numa grade te?rica que inclui desde historiadores ou fil?sofos da linguagem escrita como Roger Chartier, Wilson Martins, Vil?m Flusser, David Olson e Jacques Derrida, passando por nomes da Comunica??o ou do Design Gr?fico, incluindo Rafael Cardoso, Philip Meggs e Aston Purvis, entre outros mais atentos ? esp?cie livro-ilustrado, como Alan Powers. No segundo, retoma-se o texto liter?rio Peter Pan e Wendy a partir dos estudos de mestrado, reapresentando-o como m?dulo integrante do Universo Peter Pan em sua conjura??o pelas mais diversas m?dias, contextualizando-o hist?rica e culturalmente, no sentido de situar e contrastar as expectativas do leitor do seu tempo e local de origem ?s do leitor contempor?neo brasileiro. Nomes como Nestor Garcia Canclini, Henry Jenkins, Nicolas Bourriaud, Roger Chartier e estudiosos da cultura e do comportamento como Sivia e Guillermo Obiols, Zygmunt Bauman e Michelle Perrot se destacam, al?m de especialistas nesse cl?ssico infantil como Maria Tatar, Peter Hollindale, Jacqueline Rose e Isabelle Cani. No terceiro ensaio, emula-se um novo conceito de leitor e de leitura, a partir das defini??es latina leggere e do legens, em que agentes e opera??es leitoras s?o ampliadas em sentido human?stico, na discuss?o de categorias como leitor cr?tico, leitor competente, leitor negativo/positivo e a emancipa??o atrav?s da leitura liter?ria. Tal abordagem reflete e discute as ideias iluministas de Immanuel Kant, ainda influentes no moderno pensamento ocidental, em contraste aos desconstrutivistas j? citados, como Felix Guattari e Gilles Deleuze. Por fim, um ?ltimo ensaio avalia os contextos culturais, pol?ticos e mercadol?gicos, macromediadores do encontro bem-sucedido entre os leitores, o livro, a literatura e a arte. Atrav?s dele, defende-se a ideia de um espa?o emoafetivo e prazeroso de circula??o, de acesso e de media??o do livro ilustrado, estimulante de uma leitura critico-sens?vel n?o apenas do liter?rio, mas tamb?m dos discursos art?sticos gr?ficovisuais, a serem integrados na subjetividade. Esta ?ltima reflex?o se sustenta em pensadores da cultura e da arte, tais como as soci?logas Marilena Chau? e Gisela Taschner, o antrop?logo Roy Wagner e o historiador, tamb?m antrop?logo Michel de Certeau, personalidades ligadas ao mercado editorial como o editor Felipe Lindoso e te?ricos da educa??o como Fernando Hern?ndez e Humberto Maturana
The role of biological rhythms and blood glucose levels in maintaining a positive mood state.
No full textA thesis submitted in partial fulfilment of the requirements of the University of
Wolverhampton for the degree of Doctor of PhilosophyAlthough the effects of both the menstrual and circadian cycles on mood have been well documented, the question of whether the two interact to influence mood has not yet been addressed, despite evidence for such an interaction on other variables. Blood sugar level is a major contributor to the mediation of mood and is easily regulated by dietary intervention; there is also evidence that it is influenced by both the menstrual and circadian cycles. The present research takes a positive psychological approach to managing mood; the aims were to identify where natural variations in mood occur in relation to its underlying physiology, taking an applied approach to suggest ways of effectively managing positive mood and maintaining psychological well-being. A series of studies was carried out to measure fluctuations in mood in relation to biological rhythms, and in response to cognitively demanding situations and simple interventions. Mood was measured throughout the research using the UWIST Mood Adjective Checklist. The most consistent results were in relation to the Energetic Arousal dimension. This was shown to be influenced by both the menstrual cycle and the time of day, as well as an interaction between these two factors, and was consistently related to changes in blood glucose levels. Energetic Arousal also appeared to be more sensitive to the effectsof the suggested interventions. Diurnal changes in mood throughout the course of a normal day were more evident among women in their premenstrual to menstrual phases, and also become more apparent in response to cognitive tasks. Trait Anxiety was a mediating factor in how individuals reacted to such tasks. Mood was closely related to blood glucose levels, and raising blood glucose to a robust but safe level effectivelyenhanced positive mood in cognitively demanding situations. Oral contraceptives generally tended to eliminate menstrual cycle-related effects on mood and responses to intervention. It was concluded that mood states among healthy women are influenced by a complex interplay between biological rhythms, physiological states, individual differences and the context in which these moods take place. Simple interventions that can easily be incorporated into one’s daily routine may be efficacious in maintaining a positive mood state, which has beneficial implications for psychological well-being
Lactate is associated with mortality in very old intensive care patients suffering from COVID-19: results from an international observational study of 2860 patients
No full textInternational audiencePurpose: Lactate is an established prognosticator in critical care. However, there still is insufficient evidence about its role in predicting outcome in COVID-19. This is of particular concern in older patients who have been mostly affected during the initial surge in 2020.Methods: This prospective international observation study (The COVIP study) recruited patients aged 70 years or older (ClinicalTrials.gov ID: NCT04321265) admitted to an intensive care unit (ICU) with COVID-19 disease from March 2020 to February 2021. In addition to serial lactate values (arterial blood gas analysis), we recorded several parameters, including SOFA score, ICU procedures, limitation of care, ICU- and 3-month mortality. A lactate concentration ≥ 2.0 mmol/L on the day of ICU admission (baseline) was defined as abnormal. The primary outcome was ICU-mortality. The secondary outcomes 30-day and 3-month mortality.Results: In total, data from 2860 patients were analyzed. In most patients (68%), serum lactate was lower than 2 mmol/L. Elevated baseline serum lactate was associated with significantly higher ICU- and 3-month mortality (53% vs. 43%, and 71% vs. 57%, respectively, p < 0.001). In the multivariable analysis, the maximum lactate concentration on day 1 was independently associated with ICU mortality (aOR 1.06 95% CI 1.02-1.11; p = 0.007), 30-day mortality (aOR 1.07 95% CI 1.02-1.13; p = 0.005) and 3-month mortality (aOR 1.15 95% CI 1.08-1.24; p < 0.001) after adjustment for age, gender, SOFA score, and frailty. In 826 patients with baseline lactate ≥ 2 mmol/L sufficient data to calculate the difference between maximal levels on days 1 and 2 (∆ serum lactate) were available. A decreasing lactate concentration over time was inversely associated with ICU mortality after multivariate adjustment for SOFA score, age, Clinical Frailty Scale, and gender (aOR 0.60 95% CI 0.42-0.85; p = 0.004).Conclusion: In critically ill old intensive care patients suffering from COVID-19, lactate and its kinetics are valuable tools for outcome prediction
Outcomes of Patients Presenting with Mild Acute Respiratory Distress Syndrome: Insights from the LUNG SAFE Study
No full textHospital mortality in acute respiratory distress syndrome is approximately 40%, but mortality and trajectory in "mild" acute respiratory distress syndrome (classified only since 2012) are unknown, and many cases are not detected WHAT THIS ARTICLE TELLS US THAT IS NEW: Approximately 80% of cases of mild acute respiratory distress syndrome persist or worsen in the first week; in all cases, the mortality is substantial (30%) and is higher (37%) in those in whom the acute respiratory distress syndrome progresses BACKGROUND:: Patients with initial mild acute respiratory distress syndrome are often underrecognized and mistakenly considered to have low disease severity and favorable outcomes. They represent a relatively poorly characterized population that was only classified as having acute respiratory distress syndrome in the most recent definition. Our primary objective was to describe the natural course and the factors associated with worsening and mortality in this population
Correction to: Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome: the LUNG SAFE study (Intensive Care Medicine, (2016), 42, 12, (1865-1876), 10.1007/s00134-016-4571-5)
No full textThe members of the LUNG SAFE Investigators and the ESICM Trials Group were provided in such a way that they could not be indexed as collaborators on PubMed. The publisher apologizes for this error
Intubation Practices and Adverse Peri-intubation Events in Critically Ill Patients from 29 Countries
No full textImportance: Tracheal intubation is one of the most commonly performed and high-risk interventions in critically ill patients. Limited information is available on adverse peri-intubation events. Objective: To evaluate the incidence and nature of adverse peri-intubation events and to assess current practice of intubation in critically ill patients. Design, Setting, and Participants: The International Observational Study to Understand the Impact and Best Practices of Airway Management in Critically Ill Patients (INTUBE) study was an international, multicenter, prospective cohort study involving consecutive critically ill patients undergoing tracheal intubation in the intensive care units (ICUs), emergency departments, and wards, from October 1, 2018, to July 31, 2019 (August 28, 2019, was the final follow-up) in a convenience sample of 197 sites from 29 countries across 5 continents. Exposures: Tracheal intubation. Main Outcomes and Measures: The primary outcome was the incidence of major adverse peri-intubation events defined as at least 1 of the following events occurring within 30 minutes from the start of the intubation procedure: cardiovascular instability (either: systolic pressure <65 mm Hg at least once, <90 mm Hg for >30 minutes, new or increase need of vasopressors or fluid bolus >15 mL/kg), severe hypoxemia (peripheral oxygen saturation <80%) or cardiac arrest. The secondary outcomes included intensive care unit mortality. Results: Of 3659 patients screened, 2964 (median age, 63 years; interquartile range [IQR], 49-74 years; 62.6% men) from 197 sites across 5 continents were included. The main reason for intubation was respiratory failure in 52.3% of patients, followed by neurological impairment in 30.5%, and cardiovascular instability in 9.4%. Primary outcome data were available for all patients. Among the study patients, 45.2% experienced at least 1 major adverse peri-intubation event. The predominant event was cardiovascular instability, observed in 42.6% of all patients undergoing emergency intubation, followed by severe hypoxemia (9.3%) and cardiac arrest (3.1%). Overall ICU mortality was 32.8%. Conclusions and Relevance: In this observational study of intubation practices in critically ill patients from a convenience sample of 197 sites across 29 countries, major adverse peri-intubation events - in particular cardiovascular instability - were observed frequently
The association of the Activities of Daily Living and the outcome of old intensive care patients suffering from COVID-19
No full textPurpose: Critically ill old intensive care unit (ICU) patients suffering from Sars-CoV-2 disease (COVID-19) are at increased risk for adverse outcomes. This post hoc analysis investigates the association of the Activities of Daily Living (ADL) with the outcome in this vulnerable patient group. Methods: The COVIP study is a prospective international observational study that recruited ICU patients ≥ 70 years admitted with COVID-19 (NCT04321265). Several parameters including ADL (ADL; 0 = disability, 6 = no disability), Clinical Frailty Scale (CFS), SOFA score, intensive care treatment, ICU- and 3-month survival were recorded. A mixed-effects Weibull proportional hazard regression analyses for 3-month mortality adjusted for multiple confounders. Results: This pre-specified analysis included 2359 patients with a documented ADL and CFS. Most patients evidenced independence in their daily living before hospital admission (80% with ADL = 6). Patients with no frailty and no disability showed the lowest, patients with frailty (CFS ≥ 5) and disability (ADL < 6) the highest 3-month mortality (52 vs. 78%, p < 0.001). ADL was independently associated with 3-month mortality (ADL as a continuous variable: aHR 0.88 (95% CI 0.82–0.94, p < 0.001). Being “disable” resulted in a significant increased risk for 3-month mortality (aHR 1.53 (95% CI 1.19–1.97, p 0.001) even after adjustment for multiple confounders.
Conclusion: Baseline Activities of Daily Living (ADL) on admission provides additional information for outcome prediction, although most critically ill old intensive care patients suffering from COVID-19 had no restriction in their ADL prior to ICU admission. Combining frailty and disability identifies a subgroup with particularly high mortality
