Nurses’ Attitudes Towards Ambiguity in Communication with Patients and Families, Emotional Coping Strategies and Attitudes Towards End-Of-Life Care in General Wards

Purpose: We clarified the relationship between attitudes towards ambiguity in nurses’ communication with patients and families, emotional coping strategies and attitudes towards end-of-life care among nurses in general wards. Methods: Requests for participation in a survey were sent to nurses working in general wards with 3 or more years of work experience. The survey was in the form of an online self-administered questionnaire. Results: The responses of the 239 nurses who answered the survey were subject to analysis. Among nurses’ attitudes towards ambiguity, the highest scores were for “control of ambiguity” followed by “enjoyment of ambiguity.” Among emotional coping strategies, the highest scores were for “regulating both patients’ and one’s own emotions.” “Positive attitudes toward caring for dying persons” was most significantly associated with “enjoyment of ambiguity.” “Recognition of caring for the pivot dying persons and his families” was most significantly associated with “regulating both patients’ and one’s own emotions.” Conclusion: The results suggest that nurses working in general wards may need to foster attitudes towards “enjoyment of ambiguity” in communication with patients and families, and also coping abilities “regulating both patients’ and one’s own emotions”, so that they can enhance the attitude toward end-of-life care.

Are prosodic effects on sentence comprehension dependent on age? / Os efeitos prosódicos na compreensão de frases variam de acordo com a idade?

ABSTRACT Purpose to investigate prosodic boundary effects on the comprehension of attachment ambiguities in Brazilian Portuguese and to test two hypotheses relying on the notion of boundary strength: the absolute boundary hypothesis (ABH) and the relative boundary hypothesis (RBH). Manipulations of prosodic structure influence how listeners interpret syntactically ambiguous sentences. However, the role of prosody in spoken language comprehension of sentences has received limited attention in languages other than English, particularly from a developmental perspective. Methods Twenty-three adults and 15 children participated in a computerized sentence comprehension task involving syntactically ambiguous sentences. Each sentence was recorded in eight different prosodic forms with acoustic manipulations of F0, duration and pause varying the boundary size to reflect predictions of the ABH and RBH. Results Children and adults differed in how prosody influenced their syntactic processing and children were significantly slower than adults. Results indicated that interpretation of sentences varied according to their prosodic forms. Conclusion Neither the ABH or the RBH explained how children and adults who speak Brazilian Portuguese use prosodic boundaries to disambiguate sentences. There is evidence that the way prosodic boundaries influence disambiguation varies cross-linguistically.

RESUMO Objetivo investigar os efeitos de fronteiras prosódicas na compreensão de ambiguidades sintáticas no português brasileiro além de testar duas hipóteses baseadas na noção de intensidade de fronteira: a hipótese de fronteira absoluta (ABH) e a hipótese de fronteira relativa (RBH). Manipulações da estrutura prosódica influenciam como os ouvintes interpretam frases sintaticamente ambíguas. No entanto, o papel da prosódia na compreensão da linguagem oral tem recebido atenção limitada em línguas além do inglês, particularmente do ponto de vista do desenvolvimento. Método Vinte e três adultos e 15 crianças participaram de uma tarefa computadorizada de compreensão de frases envolvendo frases sintaticamente ambíguas. Cada frase foi gravada em oito formas prosódicas diferentes com manipulações acústicas de F0, duração, e pausa, variando o tamanho da fronteira prosódica de modo a transparecer as previsões da ABH e RBH. Resultados Crianças e adultos diferiram em como a prosódia influenciou o processamento sintático; as crianças foram significativamente mais lentas que os adultos. Os resultados indicaram que a interpretação das frases variou de acordo com suas formas prosódicas. Conclusão Nenhuma das hipóteses (ABH ou RBH) explica como crianças e adultos falantes do Português brasileiro utilizam as fronteiras prosódicas para desambiguar frases. Há evidências de que a maneira com a qual os limites prosódicos influenciam a desambiguação de frases varia entre os idiomas.

Cytogenetic and molecular characterization of an SRY-negative 46, XX ovotesticular DSD: a case report / Caracterização citogenética e molecular de um DDS ovotesticular 46, XX SRY-negativo: relato de caso

Introduction: Ovotesticular disorder of sex development is a rare condition characterized by the concomitant presence of testicular and ovarian tissue, and usually presents genital ambiguity. They are chromosomally heterogeneous, and cytogenetic analyses is relevant. Objective: to report a patient from Manaus, Amazonas state, Brazil, with ovotesticular disorder of sex differentiation 46,XX and SRY-negative. Case report: patient aged 19 years, first child of non-consanguineous parents, diagnosed at birth with genital ambiguity and, without correct diagnosis, was registered a male sex. The patient underwent surgery to correct bilateral cryptorchidism, orchiopexy and colpectomy. During puberty, he developed female and male sexual characteristics. Investigation at this time revealed: laboratory (normal total testosterone and estradiol as high follicle-stimulating hormone and luteinizing hormone, histopathological (right gonad, ovarian follicles and left gonad, atrophic testicles), karyotype (46, XX) and molecular (SRY-negative). Diagnosis of ovotesticular disorder of sex development was established. The patient chose to remain male and underwent bilateral mastectomy, vaginal colpectomy and bilateral gonadectomy. Currently, the patient receives hormonal replacement therapy, followup with a multi-professional approach and awaits masculinizing genitoplasty. Discussion: For OT-DSD individuals with 46, XX, the female sex is suggested as the best sex of rearing option. Unlike the reported cases, the patient chose the male sex, since the sex at registration of birth was important in his choice. Conclusion: Cytogenetic and molecular analyses allowed us to assist in the etiological diagnosis of the patient with OT-DSD. However, molecular analyses are necessary to elucidate the genes involved in the sexual determination of this patient.

Introdução: distúrbio da diferenciação do sexo ovotesticular é uma condição rara com presença concomitante de tecido testicular e ovariano, geralmente com ambiguidade genital. Os pacientes são cromossomicamente heterogêneos e a análise citogenética é fundamental. Objetivo: relatar o caso de um paciente do município de Manaus, Amazonas, portador de distúrbio da diferenciação do sexo ovotesticular 46, XX e SRY-negativo. Caso clínico: paciente de 19 anos, primeiro filho de pais não consanguíneos, que ao nascimento foi diagnosticado com ambiguidade genital, contudo, sem diagnóstico correto, foi registrado como sendo do sexo masculino. Foi submetido a cirurgias para correção da criptoquirdia bilateral, orquidopexia e colpectomia vaginal. Na puberdade, desenvolveu características sexuais feminina e masculina. Investigação diagnóstica mostrou: exames hormonais (testosterona total e estradiol normais enquanto hormônio folículo-estimulante e hormônio luteinizante elevados), histopatológicos (gônada direita, folículos ovarianos e gônadas esquerda, testículos atróficos), cariótipo (46, XX) e molecular (SRY-negativo). O diagnóstico de distúrbio da diferenciação do sexo ovotesticular foi estabelecido. O paciente optou por permanecer no sexo masculino e submeteuse à mastectomia bilateral, colpectomia vaginal e gonadectomia bilateral. Atualmente faz reposição hormonal, acompanhamento com abordagem multiprofissional e aguarda pela genitoplastia masculinizante. Discussão: aos indivíduos DDS-OT com 46, XX é sugerido como a melhor opção de sexo, o feminino. Diferentemente dos casos relatados, o paciente optou por permanecer no sexo masculino, visto que o registro de nascimento foi importante para a sua escolha. Conclusão: análises citogenéticas e moleculares permitiu auxiliar no diagnóstico etiológico do paciente com DDS-OT, contudo, análises moleculares são necessárias para elucidação de genes envolvidos na determinação sexual desse paciente.

Estranhezas no campo analítico / Strange things in the field of analysis / Extrañezas en el campo analítico / Étrangeté dans le champ analytique

O autor discute fatos clínicos que se manifestam como estranhos "acidentes" no campo analítico. O analista se assusta com o surgimento abrupto de descargas, atos, sintomas, imagens e situações que o deixam perplexo e estranho. Tem a impressão de que está participando de situações que correspondem ao estranho inquietante descrito por Freud. Através de material clínico, o autor propõe que esses acidentes indicam a substituição do conhecido, do familiar, pelo não familiar. Mas o desconhecido não é inteiramente desconhecido, porque se refere a experiências primitivas que não foram suficientemente simbolizadas. Essa ambiguidade se manifesta na desorientação do analista, que não sabe se sua função analítica está intacta ou perturbada. É demonstrado que ambas as situações estão de fato presentes. Aspectos teóricos são discutidos.

The author writes about clinical facts that happen as strange "incidents" in the field of analysis. The analyst is astonished by the abrupt rise of release, actions, symptoms, images and situations that made him feel perplexed and strange. He has that impression he is part of situations related to Freud's uncanny theory. Through clinical material, the author proposes these incidents are about replacing the familiar for the unfamiliar. What is not familiar is not completely unknown, though. It is related to primitive experiences that haven't been signified enough. This ambiguity manifests in making the analyst disoriented, not sure if his analytical role is intact or disturbed. It is shown that both situations are actually present. Theoretical aspects are discussed.

El autor discute datos clínicos que se manifiestan como extraños "accidentes" en el campo analítico. El analista se asusta con el surgimiento abrupto de descargas, actos, síntomas, imágenes y situaciones que le dejan perplejo. Tiene la impresión de que está participando de situaciones que corresponden al extraño inquietante descrito por Freud. A través de material clínico, el autor propone que esos accidentes indican la sustitución del conocido, del familiar, por el no familiar. Pero lo desconocido no es totalmente desconocido, porque se refiere a experiencias primitivas que no fueron simbolizadas lo suficiente. Esa ambigüedad se manifiesta en la desorientación del analista, que no sabe si su función analítica está intacta o alterada. Está demostrado que ambas situaciones de hecho están presentes. Aspectos teóricos son discutidos.

L'auteur discute des faits cliniques qui se manifestent comme des « accidents ¼ étranges dans le champ analytique. L'analyste s'étonne du surgissement abrupt de décharges, d'actes, de symptômes, d'images et de situations qui le laissent perplexe et étrange. Il a la sensation qu'il participe à des situations qui correspondent à l'étrange inquiétant décrit par Freud. Au moyen d'un matériel clinique, l'auteur propose que ces accidents indiquent le remplacement du connu, du familier, par le non familier. Mais l'inconnu n'est pas tout à fait inconnu, car il fait référence à des expériences primitives qui n'ont pas été suffisamment symbolisées. Cette ambiguïté se manifeste dans la désorientation de l'analyste qui ne sait pas si sa fonction analytique était intacte ou perturbée. On démontre que les deux situations sont vraiment présentes. On discute des aspects théoriques.

Um pensamento em torno do setting / Thinking about setting / Un pensamiento sobre el encuadre / Une réflexion à propos du cadre

Neste trabalho o autor aproxima-se de um discurso sobre o setting que não dissesse respeito tanto às suas características e funções, mas ao seu significado conceitual. O setting pode ser considerado a parte "material" ou "factual" da relação analítica, mas a redução dele aos seus elementos externos deve ser entendida como intolerância à verdade, como relação primária entre elementos irredutíveis, que sempre têm algo de material e de mental. Por relação primária quer dizer a relação bebê-seio (mãe), entendida como precondição de qualquer experiência possível, que surge, como Bion indicou, como preconcepção - as preconcepções do seio e edípicas. O setting é um espaço real em que os sonhos podem se desenvolver, um espaço em que o ser e o sonhar são dois momentos inseparáveis. Portanto, para indicar um elemento fundamental, pode-se dizer que o setting tem a ver com a ambiguidade paradoxal do ser.

In this paper the author approaches a discourse on the setting that does not concern as much its characteristics and functions as its conceptual meaning. The setting can be considered the "material" or "factual" part of the analytical relationship, but the reduction of the setting to its external elements must be understood as an intolerance of the truth, as a primary relationship between irreducible elements. The setting is a real space in which dreams can create a space in which being and dreaming are two inseparable moments. Therefore, to indicate a fundamental element, it can be said that the setting has to do with the paradoxical ambiguity of being.

En este artículo el autor acercarse de un discurso sobre el encuadre que no se refiera tanto a sus características y funciones sino a su significado conceptual. Se puede considerar el encuadre la parte "material" u "objetiva" de la relación analítica, pero la reducción de él a sus elementos externos debe entenderse como una intolerancia a la verdad, como una relación primaria entre elementos irreductibles. El encuadre es un espacio real en el que los sueños pueden desarrollarse, un espacio en el que ser y soñar son dos momentos inseparables. Por lo tanto, para indicar un elemento fundamental, se puede decir que el encuadre tiene que ver con la ambigüedad paradójica del ser.

Dans cet article, l'auteur aborde un discours concernant le cadre qui ne touche pas tellement ses caractéristiques et ses fonctions mais sa signification conceptuelle. Le cadre peut donc être considéré comme la partie « matérielle ¼ ou « factuelle ¼ de la relation analytique, mais le réduire à ses éléments extérieurs doit être compris comme une intolérance à la vérité, comme une relation primaire entre des éléments irréductibles qui ont toujours quelque chose de matériel et de mentale. Par relation primaire il veux dire le rapport nouveau-né/sein (la mère), prise comme une précondition de toute expérience possible qui surgit, telle que l'a signalé Bion, des préconceptions du sein et œdipiennes. Le cadre est un espace réel dans lequel les rêves peuvent se développer, un espace dans lequel l'être et le rêve sont deux moments indissociables. Par conséquent, pour indiquer un élément fondamental, on peut dire que le cadre a une relation avec l'ambiguïté paradoxale de l'être.

Que dúvida pode haver? / What doubt can there be? / ¿Qué duda puede haber? / Quel doute peut-il y avoir?

Consciente das complexidades que a sexualidade humana implica, Virginia Woolf desconstrói, em Orlando: uma biografia, os binarismos redutores que tolhem o desejo e a liberdade. No corpo de seu protagonista (corpo feito de linguagem), ela tece uma crítica irônica aos estereótipos formados a partir dos conceitos que categorizam os seres humanos em dois gêneros sexuais distintos na sociedade patriarcal ocidental.

In her novel Orlando: a biography, Virginia Woolf deconstructs the sexual dichotomies that restrict human desire and freedom. Knowing how complex sexuality is, she produces the body of her protagonist by the means of an ironical language that criticizes the stereotypes formed by the concepts that categorize the human beings into two distinct genders in the patriarchal occidental society.

En su novela Orlando: a biography, Virginia Woolf desconstruye las dicotomias sexuales que refrenan el deseo y la libertad de las personas. Consciente de las complejidades de la sexualidad humana, ella produce el cuerpo de su protagonista por medio de um lenguaje irónico que critica los estereotipos formados por los conceptos que categorizan los seres en dos géneros distintos en la sociedad patriarcal occidental.

Dans son roman Orlando : une biographie, Virginia Woolf déconstruit les binarismes qui restreignent le désir et la liberté humains. Consciente qu'elle est des complexités la sexualité, elle produit le corps de son/sa protagoniste par le moyen dun langage critique qu'ironise les stéréotypes formés par les deux genres sexuels distincts dans la société patriarcale occidentale.

El tercer espacio: propiedades de desplazamiento de la experiencia psicocultural / The Third Space: Displacement Properties of the Psycho-Cultural Experience

Resumen El propósito de este artículo consiste en presentar el tema El tercer espacio: propiedades de desplazamiento de la experiencia psicocultural. Se refiere al espacio potencial del desarrollo temprano humano,que hace contrapunto en su devenir histórico con el mundo sociocultural. Surge mayormente de la reflexión concienzuda obtenida de la clínica psicoanalítica con consultantes niños y adultos, así como de la investigación sobre la relación entre psicoanálisis y literatura. La psicoterapia con niños sucede en un espacio de juego, en un taller de trabajo psicológico donde se explicitan los síntomas perturbadores y se vehiculiza el conflicto, en una zona intermedia, así llamada por D.W. Winnicott, no tan lejana del tratamiento con consultantes adultos donde al transcurrir el proceso de análisis del inconsciente se produce un tiempo-espacio de ambigüedad y extrañamiento. Tales procesos de naturaleza clínica permiten observar que en el devenir y la producción cultural humana se hace notar un espacio que se abre hasta que se define el traslado experiencial. Ese es el tercer espacio. Otro modo de observar ese tercer espacio se encuentra en el lenguaje; ese componente ambiguo, incierto, se efectúa mediante el desplazamiento semántico en el texto literario. Así, ese tiempo-espacio de ambigüedad, propicio para el desplazamiento de procesos de lenguaje, convertido en hechos culturales como obra artística o fenómeno psicosocial, tiene como basamento procesos transicionales intrapsíquicos advertidos desde el desarrollo precoz. De manera amplia, el tercer espacio se propone como ámbito teórico e investigativo dado que constituye un aporte a la lectura y a la investigación textual psicoanalítica.

Abstract: The purpose of this article is to present the topic: The Third Space: Displacement Properties of the Psycho-Cultural Experience, referring to the potential space in early human development, which interacts with its historic occurrence in the socio-cultural world. It arises mostly from thoughtful consideration obtained from psychoanalytic consultation with children and adults, as well as investigation of the relationship between psychoanalysis and literatura Psychotherapy with children takes place in a play space, in a psychological workshop where the symptoms causing a disturbance are identified and the conflict is focused in an intermediate zone, thus named by D.W. Winnicott; it is not that far from the treatment of adult patients, wherein the analysis process of the subconscious takes place and creates a time and space of ambiguity and estrangement. Such processes of a clinical nature allow observing that throughout these and human cultural production there is a space which is opened until the transfer of the experience takes place, that is the: third space. Another way to observe this third space is through language; the ambiguous and uncertain component, which takes place in semantic displacement in the literary text. Therefore that temporal and spatial ambiguity, which encourages the displacement of language processes, into cultural expression and artistic productions or psychosocial phenomena, has as its foundation those intra-psychic transitional processes, noticed since early development. Taken amply, the third space is proposed as a theoretical and investigative field becauseit contributes to the reading and investigation of psychoanalytic texts

The comparison of risky and ambiguity decision making and cool executive functions between patients with obsessive compulsive disorder and healthy controls

Abstract Background: Executive functioning has been evaluated in obsessive compulsive disorder (OCD). Cool and hot executive functioning discrimination provided a different way of conceptualising executive functions. Objectives: The aim of this study was to compare ambiguity and risky decision-making and cool executive functions in an OCD and a healthy control group. The relationship between decision-making and cool executive functioning was investigated. Methods: Sixty-two OCD patients and 48 healthy control participants were compared. Decision-making was measured using the Iowa Gambling Task. The cool executive functioning was assessed using the Stroop Test and the Wisconsin Card Sorting Task (WCST). Results: The OCD group completed the WCST and the Stroop Test statistically significantly with a lower score than that of the control group. The OCD group had impaired response inhibition and set-shifting that indicate impaired cool executive functioning. In contrast to a lack of a statistically significant difference, the risky decision-making performance was worse in the OCD group than in the healthy control group and in the unmedicated OCD patients than in the medicated OCD patients. Discussion: The OCD patients had a poorer performance in risky decision-making and cool executive functioning. There was a link between risky decision-making performance and impaired cool executive functions.

O segredo na clínica da ambiguidade genital: Um estudo de caso / The secret in the clinic of genital ambiguity: A case study / El secreto en la clínica de ambigüedad genital: Un estudio de caso

O artigo apresenta o estatuto do segredo familiar como forma de enfrentamento ao diagnóstico de ambiguidade genital de uma criança. O estudo de caso, realizado a partir da escuta clínica de base psicanalítica, evidenciou a experiência destes pais frente à condição da ambiguidade genital, de forma particular e única. Destaca-se o modo como cada um tenta assimilar o real desta condição genética a partir de um segredo familiar estabelecido entre os pais e o irmão mais velho do paciente.

This article presents the statute of the family secret as a way of confronting the diagnosis of genital ambiguity in a child. The case study, conducted through a psychoanalytic clinical listening, disclosed a unique and particular parental experience in facing their child's genital ambiguity. We highlight individuals' particular attempts to assimilate the reality of this genetic condition through a family secret established between the patient's parents and older brother.

El artículo presenta el estatuto del secreto de familia como forma de enfrentar el diagnóstico de ambigüedad genital del niño. Un estudio de caso desde la escucha clínica psicoanalítica pone de relieve la experiencia de los padres frente a la condición de ambigüedad genital de manera particular y única. Se destaca la forma como cada cual intenta asimilar el real de esta condición genética a partir de un secreto de familia que se establece entre los padres y el hermano mayor del paciente.

Aplicación de un árbol de decisión difusa con clasificación de ambigüedad para determinar el exceso de peso en escolares / Application of a fuzzy decision tree with ambiguity classification to determine excess weight in schoolchildren

RESUMEN La técnica del árbol de decisiones en las ciencias de la salud sirve para comprender las correlaciones entre las descripciones de los pacientes y para clasificar de forma precisa en diversas categorías. El objetivo del estudio fue analizar la exactitud de la clasificación del exceso de peso de escolares mediante la aplicación de un árbol de decisión difusa, utilizando una base de datos de Itaupú, Paraná (Brasil). Se utilizó la base de datos de una muestra conformada por 5962 estudiantes (3024 del sexo femenino y 2938 del sexo masculino), con un rango de edad entre los 6 a 17 años de edad. Las variables consideradas fueron peso, estatura y el Índice de Masa Corporal (IMC). Para clasificar los datos antropométricos de los escolares se utilizó un árbol de decisión difusa. Los resultados del aprendizaje mostraron una clasificación correcta en el sexo femenino de 2688 y en el sexo masculino de 2471 registros respectivamente. En relación a la exactitud, se determinó 84% en el sexo masculino y 89% en el sexo femenino. El Área Bajo la curva mostró valores más altos en el método Difuso y en ambos sexos (0.965-0.983), mientras que en el método clásico, fueron inferiores (0.804-0.895). De acuerdo a los resultados calculados es posible aplicar el árbol de decisión difusa para la clasificación de escolares con exceso de peso con una exactitud aceptable, además se presenta como una técnica alternativa que puede ahorrar tiempo a la hora de analizar el estado nutricional, sin embargo, no se realizó otros cálculos estadísticos que tengan que ver con la precisión y exactitud a través de métodos estadísticos convencionales y comparar con la técnica de árboles difusos.

ABSTRACT The decision tree technique in the health sciences serves to understand the correlations between the descriptions of patients and to classify accurately in various categories. The aim of the study was to analyze the accuracy of the classification of excess weight of schoolchildren through the application of a fuzzy decision tree, using a database of Itaupú, Paraná (Brazil). We used the database of a sample consisting of 5962 students (3024 female and 2938 male), with an age range between 6 to 17 years of age. The variables considered were weight, height and the Body Mass Index (BMI). To classify the anthropometric data of the students, a diffuse decision tree was used. The learning results showed a correct classification in the female sex of 2688 and in the male sex of 2471 records respectively. In relation to accuracy, 84% was determined in the male sex and 89% in the female sex. The Area under the curve showed higher values in the Fuzzy method and in both sexes (0.965-0.983), while in the classical method, they were lower (0.804-0.895). According to the calculated results it is possible to apply the fuzzy decision tree for the classification of overweight students with an acceptable accuracy, and it is presented as an alternative technique that can save time when analyzing the nutritional status, however, no other statistical calculations were made that have to do with the precision and accuracy through conventional statistical methods and compare with the technique of fuzzy trees.

Effects of Role Conflict and Ambiguity, and Fatigue on Self-Resilience in Clinical Nurses: After the MERS outbreak / 산업간호학회지

PURPOSE: This study aimed to investigate the degree of role conflict and its ambiguity, and fatigue in clinical nurses and to analyze the effect of these on their self-resilience in order to provide fundamental data for improving their working environment after the Middle East Respiratory Syndrome outbreak. METHODS: After the collection of data from 258 clinical nurses in five general hospitals, t-test, ANOVA, Pearson's correlation coefficient, and multiple regression were performed using IBM SPSS Statistics 20.0. RESULTS: A significant positive correlation was found between nurses' role conflict and ambiguity and fatigue; while a negative correlation was found between nurses' role conflict and ambiguity and self-resilience. A significant negative correlation was found between fatigue and self-resilience. According to the study results, the factor that affected clinical nurses' self-resilience the most was role conflict and its ambiguity, followed by marital status, fatigue, educational level, religion, and related tasks, which together accounted for 38% of self-resilience in clinical nurses. CONCLUSION: To improve weaknesses in nursing care after the Middle East Respiratory Syndrome outbreak, the scope of nursing care was changed upon the expansion of integrated nursing and care-giving services. Therefore, in the rapidly changing environment of nursing, policies to improve nursing performance, as well as successful reaction capability, are suggested.

Psicoterapia de casal: ambiguidade na demanda de tratamento e manejo clínico / Couple's psychotherapy: ambiguity in treatment and clinical management / Psicoterapia de pareja: ambigüedad en la demanda del tratamento y manejo clínico

O presente trabalho tem como objetivo investigar a demanda de tratamento em psicoterapia de casal, buscando compreender as repercussões das contradições entre a queixa inicial e as questões latentes na condução do encaminhamento, bem como o manejo clínico necessário diante da ambiguidade do pedido de ajuda. Desenvolvemos uma investigação clínico-qualitativa, a partir de um estudo de caso. O atendimento ocorreu em uma clínica-escola de uma universidade privada da cidade do Rio de Janeiro. A psicoterapia de casal transcorreu em coterapia, durante três meses, com frequência de uma vez por semana, estando em supervisão semanalmente. Verificamos que, muitas vezes, a demanda do casal por tratamento é fortemente ambígua, podendo desencadear impasses para o psicoterapeuta, como intensas inquietações na condução das intervenções terapêuticas e dúvidas na indicação adequada de tratamento.

This study aims to investigate the demand for treatment in couples psychotherapy. It seeks to understand the repercussions of contradicting initial complaints and latent issues in the conduct requiring referral, as well as the necessary clinical management due to the ambiguity in the request for help. We developed a clinical-qualitative investigation, based on a case study. The treatment took place at a private university school-clinic in the city of Rio de Janeiro. The couples psychotherapy occurred in co-therapy, once a week for three months with weekly supervisions. We verified that the couples' demand for treatment is often very ambiguous, which can lead to deadlocks for the psychotherapist, such as intense concerns about the conduct of therapeutic interventions and doubts regarding the recommendations for the adequate treatment.

El presente trabajo tiene como objetivo investigar la demanda de tratamiento en psicoterapia de parejas. Busca comprender las repercusiones de las contradicciones entre la queja inicial y las cuestiones latentes en la orientación del tratamiento, como el manejo clínico necesario ante la ambigüedad de la solicitud de ayuda. Desarrollamos una investigación clínico-cualitativa, basada en un estudio de caso. El caso tuvo lugar en una clínica-escuela de una universidad privada en la ciudad de Rio de Janeiro. La psicoterapia de pareja transcurrió en coterapia, una vez por semana durante tres meses con supervisión semanal. Verificamos que, a menudo, la demanda de la pareja por el tratamiento es fuertemente ambigua, pudiendo desencadenar dificultad al psicoterapeuta, como las preocupaciones intensas sobre la realización de intervenciones terapéuticas y las dudas con respecto a las recomendaciones de tratamiento adecuadas.

Can a lexical decision task predict efficiency in the judgment of ambiguous sentences?

Abstract The lexicon plays a fundamental role in reading, but little is known about how it influences reading efficiency. Thus, this study seeks to identify which lexical factors in a lexical decision task are relevant in a semantic decision test. A total of 33 university students were recruited to perform a lexical decision task and a semantic decision task. The results revealed differences between the three types of words in the lexical decision task for all measures, but only in the regressive saccades for the semantic decision task. Ambiguous sentences triggered fewer regressions than sentences related to objects. The only lexical measure found to predict efficiency was average time on regular words, which predicted 24% of the efficiency. We discuss the implications of the use of a lexical decision task and the use of the inverse efficiency score as a semantic measure, and we discuss how the lexicon can predict semantic comprehension.

Conflitos e ambiguidades de papéis no trabalho de juízes: as percepções de juízes portugueses / Conflictos y ambigüedades entre los papeles de jueces: las percepciónes de jueces de Portugal / Role conflict and role ambiguity in the work of judges: the perceptions of Portuguese judges

Resumo Reformas em judiciários de diversos países criaram um novo papel para os juízes, um papel gerencial, em que juízes assumem novas responsabilidades relacionadas com as atividades administrativas. Esse novo papel é diferente do papel tradicional, focado em tarefas judiciais, e tem gerado conflitos no trabalho de juízes. Com base nesse contexto, o presente estudo tem como objetivo identificar e discutir conflitos e ambiguidades envolvendo os papéis judicial e gerencial, desempenhados por juízes de Portugal. A pesquisa foi realizada em Portugal, entre 2013 e 2014, e os dados foram coletados por meio de entrevistas em profundidade com 12 juízes. Os principais conflitos são: incompatibilidade entre a realização de atividades judiciais e administrativas; carga de trabalho elevada e equipe administrativa insuficiente e desmotivada; produtividade versus qualidade do trabalho judicial; e alta responsabilidade do cargo e baixo salário. As principais ambiguidades identificadas nas entrevistas referem-se a: relação formal entre juízes e pessoal administrativo; função do juiz no processo de planejamento dos tribunais; critério para distribuição de processos judiciais entre juízes; e critério de avaliação do desempenho de juízes. Os resultados são discutidos e são sugeridas pesquisas adicionais.

Resumen Reformas judiciales en varios países han creado un nuevo papel para los jueces, el papel de gestor, en el que los jueces asumen nuevas responsabilidades relacionadas con las actividades administrativas. Esta nueva función es diferente del papel tradicional centrado en tareas judiciales y ha generado conflicto en el trabajo de los jueces. Dentro de este contexto, el presente estudio tiene como objetivo identificar y discutir conflictos y ambigüedades entre los papeles judicial y de gestión desempeñados por jueces de Portugal. El estudio se realizó en Portugal, entre 2013 y 2014, y los datos fueron recolectados a través de entrevistas en profundidad con 12 jueces. Los principales conflictos son: incompatibilidad con el desempeño de las actividades judiciales y administrativos; alta carga de trabajo y el equipo de administración inadecuada y sin motivación; la productividad versus calidad del trabajo judicial; y la posición de alta responsabilidad y de bajos ingresos. Las principales ambigüedades detectadas en las entrevistas se refieren a: relación formal entre los jueces y personal administrativo; papel del juez en el proceso de planificación de los tribunales; o criterio para la distribución de los casos judiciales entre jueces; y o criterio de evaluación para juzgar el desempeño de jueces. Se discuten los resultados y se sugiere una agenda para futuros estudios.

Abstract The reform of the judiciaries of several countries have created a new role for judges, a managerial role, in which judges assume new management responsibilities. This new role is different from the traditional one which focused on judicial tasks, and has generated conflict and ambiguity in the work of judges. This study aims to identify and discuss the conflicts and ambiguities between the judicial and administrative roles performed by Portuguese judges. The research took place in Portugal over the period between 2013 and 2014, and data was collected from in-depth interviews with 12 judges. The research identifies several areas of role conflict and ambiguity in the judges' work. The main conflicts are: incompatibility between the carrying out of judicial and management activities; high workload and insufficient and unmotivated administrative staff; the need to maintain both productivity and judicial quality; and the great responsibility of the position but poor remuneration. The main ambiguities reported are: the formal relationship between judges and administrative officials; the judge's function in the process of court planning; the criteria for the distribution of judicial proceedings among judges; and the criteria to evaluate judges' performance. These results are discussed and a research agenda is suggested.

Role ambiguity, group cohesion and job satisfaction: A Demands-Resources Model (JD-R) Study from Mexico and Spain / Ambigüedad de rol, cohesión grupal y satisfacción laboral: un estudio con el modelo demandas y recursos laborales (JD-R) en México y España

Abstract In line with the Job Demands-Resources (JD-R) theory, this paper studies the rela tionship between role ambiguity (Demand) and group cohesion (Resource) to predict job satisfaction. This study was carried out at the same multinational company in Mexico and Spain (N= 537), where blue-collar workers are organized in work groups. It is hypothesized that high levels of role ambiguity are related to low job satisfaction whereas positive high levels of group cohesion are related to high job satisfaction. In addition, it is posited that group cohesion could buffer the relationship between role ambiguity and job satisfaction. Results confirm the JD-R theory with regard to direct effects. Moderating effects have been found in both countries but, contrary to the hypotheses, since these strengthen the negative effect of role ambiguity on job satisfaction. These results are relevant since nowadays, organizations need to deal with increas ingly higher levels of ambiguity. The results are also being commented from a cross-cultural research perspective.

Resumen Siguiendo la teoria de las demandas-recursos laborales, este trabajo estudia las relaciones entre la ambigüedad de rol (demanda), y la cohesión grupal (recurso) para predecir la satisfacciön. El estudio se ha realizado en la misma multinacional en México y en España (N = 537), donde los operarios trabajan en grupos. Las hipötesis plantean que los altos niveles de ambigüedad de rol se relacionarán con una baja satisfacciön laboral, mientras que altos niveles de cohesión grupal estarán relacionados con una elevada satisfacciön laboral en ambos países. Además, se plantea que la cohesión grupal amortiguará la relaciön entre la ambigüedad de rol y la satisfacciön. Los resultados confirman la teoría demandas-recursos en relaciön con los efectos directos. También se han encontrado efectos moduladores en los dos pa ses, aunque en contra de las hipötesis, pues potencian el efecto negativo de la ambigüedad en la satisfacciön. Estos resultados pueden ser relevantes para las organizaciones actuales dado el creciente nivel de ambigüedad. Los resultados tambien se comentan desde la perspectiva de la investigaciön transcultural.

Ambiguity results distribution and its solutions of HLA-A, B and DRB1 sequence-based typing / 重庆医学

Objective To investigate the ambiguity results distribution of HLA-A,B and DRB1 gene sequence-base typing in Guangxi population and to propose the way to resolve.Methods HLA-A,B and DRB1 genes of 1 000 donors in the Guangxi branch bank of China'bone marrow bank were genotyped by PCR-SBT,and then the ambiguity results distribution of the three loci was analyzed.The typing ambiguities resultswere resolved by high-resolution polymerase chain reaction-sequence-specific primers(PCR-SSP) and group specific sequencing primer(GSSP) methods,respectively.Results Among 1 000 samples,at least 1 locus in HLA-A,B and DRB1 genes in 96.7％ samples appeared the ambiguity results,in which the proportions of HLA-A,B and DRB1 loci appearing ambiguity results were 65.7 ％,58.8 ％ and 77.2 ％ respectively.For the samples of detected ambiguity results,single using the GSSP method could resolve the ambiguity typing results of 87.37％ HLA-A,93.54％ HLA-B and 60.49％ HLA-DRB1,using high-resolution PCR-SSP could resolve the ambiguity typing results of 12.63 ％ HLA-A,4.76 ％ HLA-B and 15.29 ％ HLA-DRB1,and the rest 1.70 ％ HLA-B and 24.22 ％ HLA-DRB1 ambiguity results were resolved by both GSSP and high-resolution PCR-SSPs method.Conclusion GSSP and high-resolution PCR-SSPs methods have high abilities to solve HLA ambiguity results both locate inside and outside the sequencing region,respectively.GSSP and high-resolution PCR-SSPs methods are supplement for each other,which can effectively resolve the problem of ambiguity results in high resolution HLA typing.

Hiperplasia adrenal congénita. Presentación de caso / Congenital adrenal hyperplasia. Case presentation

Fundamento: La hiperplasia adrenal congénita es el desorden adrenal más común en niños, causa frecuente de seudohermafroditismo femenino y de ambigüedad sexual. La deficiencia de la enzima 21 hidroxilasa es la causa más común, ocurre entre un 90 y 95 % de los casos. La incidencia de la enfermedad es de 1:14 000 nacimientos. La determinación de hormona 17 hidroxiprogesterona al quinto día de nacido, facilita el diagnóstico y el adecuado tratamiento. Presentación de caso: Se describe el diagnóstico de un recién nacido femenino, de nueve días, con antecedentes prenatales de alto riesgo obstétrico, sin manifestaciones clínicas de pérdida adrenal, al examen físico discreto grado de virilización (moderada hipertrofia del clítoris) y niveles elevados de 17 hidroxiprogesterona, al cual se le realizó confirmatorio de 17 hidroxiprogesterona en suero a los nueve días, resultó positivo y ante los antecedentes prenatales, se decidió su diagnóstico y tratamiento oportuno. Conclusiones: Se realizó el diagnóstico de una hiperplasia adrenal congénita, en recién nacido femenino de nueve días, se brindó asesoría a sus familiares, se indicó tratamiento médico con hidrocortisona y fluorhidrocortizona, se le siguió por consulta del programa de hiperplasia adrenal congénita y se realizó estudio molecular para precisar déficit enzimático.

Background: Adrenal hyperplasia, congenital is the most common adrenal disorder in children, a frequent cause of femenine pseudohermaphroditism and sexual ambiguity. The deficiency of the 21 hydroxylase enzyme is the most common cause, occurs between 90 and 95 % of the cases. The incidence of the disease is at about 1:14 000 births. The determination of hormone 17 hydroxyprogesterone on the fifth day of birth facilitates diagnosis and adequate treatment. Case report: We describe the diagnosis of a 9 days old femenine infant with a prenatal history of high obstetric risk, with no clinical manifestations of adrenal loss, a discrete physical examination of virilization (moderate clitoris hypertrophy) and elevated levels of 17 hydroxyprogesterone, which was confirmed with serum hydroxyprogesterone at 9 days, was positive and before the prenatal history, the diagnosis and timely treatment was decided. Conclusion: Adrenal hyperplasia, congenital was diagnosed in a 9-day-old femenine newborn, counseling was given to her relatives, medical treatment with hydrocortisone and fluorhydrocortisone was indicated, followed by consult with the adrenal hyperplasia, congenital program and molecular study was made to determine enzymatic deficit.

Enfrentando e celebrando o corpo em suas ambiguidades. Proposta da filosofia madura de Nietzsche / Facing and celebrating the body in its ambiguities. A proposal of the mature philosophy of Nietzsche

O artigo tenta mostrar como Nietzsche em sua filosofia da maturidade ultrapassa a visão tradicional de corpo estabelecida dogmaticamente na história da filosofia ocidental. O corpo é entendido por ele como uma multiplicidade de forças em constante luta por acréscimos de poder. Configura-se como uma unidade de organização e não como uma unidade substancial. Nesse sentido, aquela unidade evidencia uma permanente ambiguidade, pois as configurações de domínio sempre se revezam na ordem do tempo. Não afirmar uma unidade substancial, e sim o movimento contínuo de instâncias de poder, é motivo de intensa celebração.

The article attempts to demonstrate how Nietzsche, in his philosophy of maturity, goes beyond the traditional view of the body dogmatically established in the history of Western philosophy. The body is thus understood as a multiplicity of forces in constant struggle for increases of power. It is an organizational unit rather than a unit of substance. In this sense, the body exhibits permanent ambiguity since the domain settings change throughout time. To profess the body as an organizational unit is, therefore, strong cause for celebration.

Effects of dopaminergic medication on decision-making under ambiguity in patients with early Par-kinson's disease / 中华行为医学与脑科学杂志

Objective To investigate the effects of dopaminergic medication on decision-making un-der ambiguity in patients with early Parkinson's disease( PD) . Methods Using Iowa Gambling Task ( IGT) for 24 early non-medication idiopathic PD patients( Hoehn and Yahr Scale≤Ⅱlevel) ,24 early idiopathic PD patients with regular dopaminergic medication and also for 24 healthy controls( HC) whose age,gender,and education match to PD patients to test their ability of decision-making under ambiguity. Results The results showed non-medication PD group showed impairments on digtal span and verbal fluency and decision-making task. There was significant difference in IGT task scores among the three groups(F=6.024, P=0.004) . The total net scores of advantageous choices in IGT were significantly lower in non-medication PD group( (-4.50 ±22.19) scores) than medication PD group((8.83±23.24)scores) and healthy group((15.92±15.77) scores) . The difference of net scores in block1 to block5 between non-medication PD group and medication PD group was gradually increased,and the difference of net scores in block5 was significant(P0.05) . As the game processing,medication PD group gradually shifted their se-lections toward the advantageous choices. But non-medication group did not exhibit this shift pattern and the performance was much poorer. Meanwhile, the study also indicated the total net scores of advantageous choices for non-medication PD group was positive correlation to the MoCA scores ( r=0.614, P=0.001). Conclusion The present study has shown that non-medication PD group has impairment in decision-making under ambiguity risk condition and prefer to choose risky options. when exogenous complement dopaminergic medication,the risk decision-making ability of medication PD group has been improved.

Disgenesia gonadal mixta / Mixed gonad dysgenesis

La Disgenesia Gonadal Mixta (DGM); es un desorden de la diferenciación sexual (DDS) caracterizado por presencia de tejido testicular inmaduro ò disgenètico de un lado y estría gonadal contralateral, con frecuencia asociado a un mosaico cromosómico tipo 45 X / 46XY. Representa la segunda causa de genitales ambiguos en neonatos después de la hiperplasia suprarrenal congénita y se caracteriza por presentar talla baja y estigmas turnerianos en la infancia y amenorrea primaria en la adolescencia. Se debe diagnosticar tempranamente ya que frecuentemente se asocia a malignización de las gónadas en relación a la presencia de un cromosoma “Y” en alguna de las líneas celulares de la persona afectada. Se reporta el caso de una lactante de 11 meses de edad referida a la consulta de ginecología infanto juvenil del Instituto Docente de Urología en Valencia estado Carabobo por presentar genitales ambiguos desde el nacimiento. Se describen las características al examen físico y el enfoque clínico y terapéutico, haciendo énfasis en los métodos diagnósticos de laboratorio, los hallazgos a la laparoscopia y de la biopsia gonadal. Encontrándose a la evaluación laparoscópica: útero central, testículo derecho y estría gonadal izquierda, la biopsia gonadal reportó presencia de túbulos seminíferos prepuberales y el cariotipo gonadal (método de hibridación fluorescente in situ ò método de FISH) reportó cariotipo 45X/46XY, realizándose posteriormente la gonadectomìa bilateral y la clitoroplastia reductora. Se concluye, la DGM representa una emergencia médica y social debido a la presencia de genitales ambiguos al nacer y el riesgo de malignización futura de las gónadas y su manejo clínico y terapéutico deben ser siempre interdisciplinarios.

The Mixed Gonadal Dysgenesis (MGD) is a disorder of sex development characterized for presence of immature or dysgenetic testicular tissue and contralateral streak gonad frequently associated to chromosome mosaic type 45X/46XY and genital ambiguity. This condition represents the second cause of ambiguous genitalia in neonates after congenital adrenal hyperplasia; characterized by short stature, turner`s stigmata in infancy and primary amenorrhea in adolescence. It should be diagnosed early due to risk of malignant transformation of gonads by the presence of Y chromosome in cell lines of the affected patiens. We report the case of a female infant of 11 motnhs old referred to gynecological pediatric consult of the Instituto Docente de Urologia in Valencia, Carabobo showing genital ambiguity since birth. Characteristics from the physical examination, clinical and therapeutic approach, with emphasis on the laboratory diagnostic methods, laparoscopy finding and gonadal biopsy are described. The laparoscopy evaluation revealed central uterus, right testicle and left gonadal streak. The gonadal biopsy reported the presence of prepuberal seminiferous tubules and the gonadal karyotype (FISH method) reported 45X/46XY; subsequently deciding bilateral gonadectomy and clitoroplasty. In conclusion, MGD represents a social and medical emergency due to the presence of ambiguous genitalia and the risk of future malignant transformation of the gonads. The clinical and therapeutic management should always be interdisciplinary.