This research investigated therapist's experiences of how working outdoors in nature impacts on the therapeutic relationship. Although outdoor therapy has emerged as a significant practice (McLeod, 2013; Mind, 2013), very little research had been done on what impact it might have on the therapeutic relationship. Given the importance of the therapeutic relationship (Norcross, 2011), this was identified as an area worth investigating.

Crises in therapist-patient relationship can also become a challenge in clinical supervision. However, success and failure in establishing and maintaining constructive relationships in therapy and supervision is not only subject to a lucky fit of personal characteristics (therapist A gets along well/badly with client B; supervisee A gets along well/badly with supervisor C). Rather, we can identify determining field conditions in the overall therapeutic and supervisory situation for this outcome. We do not only focus on the persons involved, (...) but also on their environment, the task to be accomplished together, further framework conditions and the power relations resulting from their mutual influence-in the supervised case of therapy as well as in supervision itself. We want to examine the structure and dynamics of these relationships from a genuine Gestalt psychological perspective. What contributes to a cooperative atmosphere? When do goals get out of sight? What can make the atmosphere hostile? How do such developments become accessible in supervision? (shrink)

The few people familiar with the pseudo-Platonic dialogue Axiochus generally have a low opinion of it. It's easy to see why: the dialogue is a mish-mash of Platonic, Epicurean and Cynic arguments against the fear of death, seemingly tossed together with no regard whatsoever for their consistency. As Furley notes, the Axiochus appears to be horribly confused. Whereas in the Apology Socrates argues that death is either annihilation or a relocation of the soul, and is a blessing either way, "the (...) Socrates of the Axiochus wants to have it both ways": death is both annihilation and a release of the soul from the body into a better realm. This may be used to construct a valid argument for the conclusion that death is not evil, but at the expense of having a contradiction as one of its premises. But D. S. Hutchinson has recently proposed that these inconsistencies shouldn't surprise us if we view the Axiochus as "an unconventional version of a very conventional genre--the consolation letter." In this paper I expand on Hutchinson's brief suggestion and argue that the Axiochus can be rehabilitated by paying attention to its genre. Although the Axiochus does display many similarities to the consolation letter, the shift from letter to dialogue does--pace Hutchinson--significantly affect what's going on. Within the dialogue, Socrates behaves toward Axiochus in a way similar to the way the author of a consolation letter behaves towards the letter's reader: he is willing to use inconsistent arguments, borrowed from any source, in order to soothe the patient. However, in depicting this type of consolatory relationship between Socrates and Axiochus, the dialogue itself is not aiming at consoling its readers. Instead, it should be seen as displaying for the reader's consideration a certain type of consolatory argumentative practice. -/- Socrates notes that Axiochus is "very much in need of consolation" (365a), and he uses any means necessary to accomplish this task. Socrates exhibits many ways in which he is willing to sacrifice argumentative hygiene for the sake of therapeutic effectiveness. These include: -/- * Use of arguments with inconsistent premises, presented in propria persona. * Appeals to emotion * Tailoring arguments to the audience. * Presenting invalid arguments so as to induce unjustified but comforting beliefs. * Evasion. In these respects, I think that Socrates' argumentative practice is best compared to PH III 280-1, where Sextus Empiricus says that the skeptic will deliberately use logically weak arguments as long as they work. Dorothy Tarrant claims that what links the Socrates of the Axiochus to Socrates as he appears elsewhere in the Platonic corpus is his evident care for the welfare of his interlocutor's psyche. But this concern takes a quite different form in the Axiochus than it usually does. As with Sextus, psychic therapy in the Axiochus involves relief from pain. The primary difference between them is that Socrates, unlike Sextus, is not aiming at producing epochê in his patient. (shrink)

Ayurveda is the science of living being. With the aim of health and procurement of disease it almost covers all facets of life. It includes health of an individual at physical, mental, spiritual, social level. Ayurvedic classics includes brihatrayee samhita like Charak, Sushruta and Ashtanga Hridaya. A review based study of music (geet, sangeet) was done in these classics to explore whether these classics includes any form of music as therapy or not. Based on review of these classics it was (...) found that music in form of geet (vocal or instrument) has been given in contexts like vajikara(aphrodisiac), vata/pitta prakriti (basic consititutional make up), gandharva sattva, madyapana (intake of alcohol), therapy for rajyakshma (immune deficiency diseases), sanyasa (syncope/coma), jivadan (haemetemesis) etc. various swara have been correlated with their pacifying power of three sharirikadoshas viz. vata, pitta and kapha. Also a relationship between various raga of indian classical music have been said to be based on time of its singing which may be used as a therapy to pacify the dearrangement of prevalent doshas. several articles have shown music as therapy in sleep disorder, psychiatric disorders, schizophrenia, cardiovascular, cancer etc. with this paper a perspective of Ayurveda have been explored in music therapeutics. (shrink)

This research paper aims to study the cultural representations of the causes of corona pandemic (Covid 19) on the representations of the therapeutic itinerary on an among sample of Algerian society. These representations reveal the inter-relationship between the medical and the cultural representations through beliefs, ideas, and behaviors . Within this context, we applied EMIC questionnaire (The Explanatory Model Interview Catalogue). (MITCHELL G. WEISS, 1992) We used an online form in which a sample of 70 individuals (M, F), (...) aged from 20 to 50 years old, answered to. We relied on the quantitative and qualitative method in analyzing and interpreting the results. We came to the following results in the absence of a medical treatment, family solidarity and prevention measures are key treatments. In addition, the causes tend to be purely human, in the absence of all guaranteed treatments, whether therapeutic or traditional. (shrink)

Objective: The aim of this study is to evaluate relationship between ostiomeatal complex variations (OMC) and maxillary sinus pathologies in children and adolescents using cone-beam computed tomography (CBCT). -/- Methods: CBCT images of 72 patients (44 males and 28 females) aged 7-18 years were evaluated retrospectively. Presence of nasal septal deviation (NSD), nasal septal pneumatization (NSP), concha bullosa (CB), accessory maxillary ostium (AMO), agger nasi cell (ANC), Haller cell (HC), Onodi cell (OC), ethmoid sinusitis and maxillary sinus pathologies were (...) investigated. Maxillary sinus pathologies were classified. Correlations of OMC variations with each other, maxillary sinus pathologies and ethmoid sinusitis were investigated. Chi-square test was used to analyze relationships among variables and distribution of parameters. -/- Results: NSD was determined in 70.8%, NSP in 40.3%, ethmoid sinusitis in 75%, maxillary sinus pathology in 34.8% of images. OMC variations rates were detected as CB 31.3%, AMO 16%, ANC 16%, HC 24.3% and OC 18.8%. The most common maxillary sinus pathology was localized mucosal thickening, with a rate of 15.3% on right and 22.2% on left. Statistically significant differences were determined between almost all OMC variations with each other, and between anatomical variations in OMC with maxillary sinus pathologies except for NSP and AMO (p < 0.05). The presence of ethmoid sinusitis was more common in males (p =0.026). -/- Conclusion: Anatomical variations in OMC had no significant effect on maxillary sinus pathology except for NSP and AMO. Besides, most of anatomical variations in OMC were statistically significantly correlated with each other. CBCT visualization of these variations is important for sinonasal surgery and is an effective method in children and adolescents with low radiation dose and high image quality compared to computed tomography. (shrink)

Objective: The purpose of our study is to show how the relationship between marital adjustment and satisfaction will change in cases of chronic disease in either or both spouses of married couples using a multivariate statistical analysis method. -/- Methods: Marriage adjustment ve marriage satisfaction scales were used. A structural equation modeling - multiple group analysis method was used in the study, which was designed as a relational screening model. -/- Results: In the study, which included 898 participants, 56.6% (...) of the participants were female and 43.4% were male. The mean age of the participants was 36.94 ± 8.72 standard deviations. First, the relationship between marital adjustment and satisfaction was analyzed using structural equation modeling, and the relationship between the scales was found to be statistically significant (p=0.001). In the model, which was significant and sufficient, the variable of chronic disease was coded on the arrow representing the regression coefficient between the scales, and multiple group analysis was applied. The relationship between marital adjustment and satisfaction was found to be weak among individuals with chronic diseases. The rate of marriage satisfaction explaining marriage adjustment was lower in individuals without chronic disease (R2=0.16) than in those without chronic disease (R2=0.10). While ego scores were not significant in individuals without chronic disease (p=0.237), they were statistically significant in individuals with chronic disease (p=0.017). -/- Conclusion: Chronic diseases has been found to have a significant impact on the relationship between spouses. Many studies have examined the effects of chronic diseases on marriage. However, our study differs from other studies because of the analytical methods used. In the scales, it was determined whether the chronic disease showed a change in the relationship between the scales, not the scores in the chronic disease state. (shrink)

In Deep Medicine, Eric Topol argues that the development of artificial intelligence (AI) for healthcare will lead to a dramatic shift in the culture and practice of medicine. Topol claims that, rather than replacing physicians, AI could function alongside of them in order to allow them to devote more of their time to face-to-face patient care. Unfortunately, these high hopes for AI-enhanced medicine fail to appreciate a number of factors that, we believe, suggest a radically different picture for the future (...) of healthcare. Far from facilitating a return to “the golden age of doctoring”, the role of economic and institutional considerations in determining how medical AI will be used mean that it is likely to further erode therapeutic relationships and threaten professional and patient satisfaction. (shrink)

The methodological differences of understanding, versus explaining, have been at the centre of a century-long methodenstreit debate (and disagreement) among philosophers and scientists. Karl Jaspers managed to import this discussion to the realm of psychiatry and psychopathology in a significant, but unresolved, manner. Side-tracked by the advent of various changes in psychiatry during the 20th century, phenomenology and philosophy of psychiatry have made a comeback in the last decades and, since then, developed new contributions to this subject. Quite similarly, the (...) study of time experience, standing on the shoulders of notorious philosophers, has too witnessed a similar renaissance, with groundbreaking developments across several conditions, including depression. The present essay is essentially exploratory, but during its development, after addressing the concepts of the methodenstreit debate, and tackling both meaningful and causal connections behind time dysperception in depression, I argue that understanding, at least in this context and at present time, is not entirely reducible to causal explanations, for some things are only gained in understanding, such as the feeling of being understood and the implications it carries for a therapeutic relationship and the treatment plan. (shrink)

Growing demand for broadly accessible mental health care, together with the rapid development of new technologies, trigger discussions about the feasibility of psychotherapeutic interventions based on interactions with Conversational Artificial Intelligence (CAI). Many authors argue that while currently available CAI can be a useful supplement for human-delivered psychotherapy, it is not yet capable of delivering fully fledged psychotherapy on its own. The goal of this paper is to investigate what are the most important obstacles on our way to developing CAI (...) systems capable of delivering psychotherapy in the future. To this end, we formulate and discuss three challenges central to this quest. Firstly, we might not be able to develop effective AI-based psychotherapy unless we deepen our understanding of what makes human-delivered psychotherapy effective. Secondly, assuming that it requires building a therapeutic relationship, it is not clear whether psychotherapy can be delivered by non-human agents. Thirdly, conducting psychotherapy might be a problem too complicated for narrow AI, i.e., AI proficient in dealing with only relatively simple and well-delineated tasks. If this is the case, we should not expect CAI to be capable of delivering fully-fledged psychotherapy until the so-called “general” or “human-like” AI is developed. While we believe that all these challenges can ultimately be overcome, we think that being mindful of them is crucial to ensure well-balanced and steady progress on our path to AI-based psychotherapy. (shrink)

I discuss Young’s “asymmetrical reciprocity” and apply it to an ethics of mental health care. Due to its emphasis on engaging with others through respectful dialogue in an inclusive manner, asymmetrical reciprocity serves as an appropriate framework for guiding caregivers to interact with their patients and to understand them in a morally responsible and appropriate manner. In Section 1, I define empathy and explain its benefits in the context of mental health care. In Section 2, I discuss two potential problems (...) surrounding empathy: the difficulty of perspectivetaking and “compassion fatigue.” In Section 3, I argue that these issues can be resolved if examined through the lens of an ethics of care. Reciprocal relationships between patients and caregivers are an important element in the development of an ethics of care. In Section 4, I introduce two models of reciprocity that can be applied to a health care context: Benhabib’s symmetrical reciprocity and Young’s asymmetrical reciprocity. In Section 5, I demonstrate how asymmetrical reciprocity cultivates empathy and, in Section 6 and Section 7, I show how it overcomes the objections of empathy and improves therapeutic relationships. (shrink)

In “Flourish,” the psychologist Martin Seligman proposed that psychological well-being consists of “PERMA: positive emotion, engagement, relationships, meaning, and accomplishment.” Although the question of what constitutes flourishing or psychological well-being has been long debated among scholars, the recent literature has suggested that a paradigmatic or prototypical case of psychological well-being would manifest most or all of the aforementioned PERMA factors. The recent literature on poetry therapy has also suggested that poetry practice may be utilized as “an effective therapeutic tool” (...) for patients suffering from a variety of ailments so it seems plausible that practicing poetry can positively contribute to one flourishing with greater psychological well-being. However, recent studies on poetry therapy have not yet been reviewed and integrated under the PERMA framework from positive psychology to further explore and explicate this possibility. This article therefore contributes to extant work by reviewing recent research on poetry therapy and psychological well-being and offering support for the claim that practicing poetry can positively contribute to one flourishing with greater psychological well-being by positively influencing their emotions, engagement or “flow” experiences, social relationships, sense of meaning or purpose in life, and personal accomplishments. (shrink)

Mindfulness exercises are presented as being compatible with almost any spiritual, religious or philosophical beliefs. In this paper, we argue that they in fact involve imagining and conceptualising rather striking and controversial claims about the self, and the self’s relationship to thoughts and feelings. For this reason, practising mindfulness exercises is likely to be in tension with many people’s core beliefs and values, a tension that should be treated as a downside of therapeutic interventions involving mindfulness exercises, not (...) unlike a side effect. Clients ought to be informed of these metaphysical aspects of the exercises, and mental health providers ought to take them into account in assessing which course of treatment to recommend. Given these concerns, the casual way in which mindfulness exercises are presently distributed by mental health providers to the general public is inappropriate. (shrink)

We propose that virtue ethics can be used to address ethical issues central to discussions about sex robots. In particular, we argue virtue ethics is well equipped to focus on the implications of sex robots for human moral character. Our evaluation develops in four steps. First, we present virtue ethics as a suitable framework for the evaluation of human–robot relationships. Second, we show the advantages of our virtue ethical account of sex robots by comparing it to current instrumentalist approaches, showing (...) how the former better captures the reciprocal interaction between robots and their users. Third, we examine how a virtue ethical analysis of intimate human–robot relationships could inspire the design of robots that support the cultivation of virtues. We suggest that a sex robot which is equipped with a consent-module could support the cultivation of compassion when used in supervised, therapeutic scenarios. Fourth, we discuss the ethical implications of our analysis for user autonomy and responsibility. (shrink)

Memory modification technologies (MMTs)—interventions within the memory affecting its functions and contents in specific ways—raise great therapeutic hopes but also great fears. Ethicists have expressed concerns that developing and using MMTs may endanger the very fabric of who we are—our personal identity. This threat has been mainly considered in relation to two interrelated concerns: truthfulness and narrative self‐constitution. In this article, we propose that although this perspective brings up important matters concerning the potential aftermaths of MMT utilization, it fails (...) to tell the whole story. We suggest that capturing more tangible potential consequences of MMT use, namely, its psychological ramifications is crucial both in ethical considerations and in making decisions regarding the permissibility of such interventions. To this end, we first examine what current MMTs are capable of and what are the prospects of emerging MMTs. Subsequently, we outline the relationship between memory and personal identity; specifically, we indicate that concepts of self‐defining memories and narrative identity are crucial to considering how MMTs may influence one's psychological functioning. On this basis, we analyze potential consequences of narrative disruption that may be the result of the use of MMTs; more precisely, we consider its potential effects on mental health, well‐being, and personal agency, and outline the ethical dilemmas that decision‐makers face in this context. We conclude by considering the broader cultural context that may have influence on policymaking regarding permissibility of memory modification interventions. (shrink)

The mental health crisis and loneliness epidemic have sparked a growing interest in leveraging artificial intelligence (AI) and chatbots as a potential solution. This report examines the benefits and risks of incorporating chatbots in mental health treatment. AI is used for mental health diagnosis and treatment decision-making and to train therapists on virtual patients. Chatbots are employed as always-available intermediaries with therapists, flagging symptoms for human intervention. But chatbots are also sold as stand-alone virtual therapists or as friends and lovers. (...) There is evidence that these uses of AI and chatbots can provide better quality service, improve accessibility, and lower costs. The systems can reduce the stigma and shame of sharing their problems and leverage a mass of biometric and behavioral data to supplement self-reports. As the systems' intelligence rapidly improves, they will need to be rigorously tested for the accuracy and precision of their diagnoses and the quality of their interactions with patients. As chatbots become indistinguishable from humans and leverage their superhuman capacity to detect affect and draw on knowledge of a patient’s life, patients will be drawn to attribute personality to and relationship with the chatbot. Consequently, it will be essential to study what the “therapeutic alliance” with an actual human counselor provides and the risks of patients attributing such a relationship to a one-sided or “parasocial” relationship. (shrink)

Within dramatherapy and psychodrama, the term ‘de-roling’ indicates a set of activities that assist the subjects of therapy in ‘disrobing’ themselves from their fictional characters. Starting from the psychological needs and the therapeutic goals that ‘de-roling’ techniques address in dramatherapy and psychodrama, this text provides a broader understanding of procedures and exercises that define and ease transitional experiences across cultural practices such as religious rituals and spatial design. After this introductory section, we propose a tentative answer as to why (...) game studies and virtual world research largely ignored processes of ‘roling’ and ‘de-roling’ that separate the lived experience of role-play from our everyday sense of the self. The concluding sections argue that de-roling techniques are likely to become more relevant, both academically and in terms of their practical applications, with the growing diffusion of virtual technologies in social practices. The relationships we can establish with ourselves and with our surroundings in digital virtual worlds are, we argue, only partially comparable with similar occurrences in pre-digital practices of subjectification. We propose a perspective according to which the accessibility and immersive phenomenological richness of virtual reality technologies are likely to exacerbate the potentially dissociative effects of virtual reality applications. This text constitutes an initial step towards framing specific socio-technical concerns and starting a timely conversation that binds together dramatherapy, psychodrama, game studies, and the design of digital virtual worlds. (shrink)

Mental and behavioral disorders represent a significant portion of the public health burden in all countries. The human cost of these disorders is immense, yet treatment options for sufferers are currently limited, with many patients failing to respond sufficiently to available interventions and drugs. High quality ontologies facilitate data aggregation and comparison across different disciplines, and may therefore speed up the translation of primary research into novel therapeutics. Realism-based ontologies describe entities in reality and the relationships between them in such (...) a way that – once formulated in a suitable formal language – the ontologies can be used for sophisticated automated reasoning applications. Reference ontologies can be applied across different contexts in which different, and often mutually incompatible, domain-specific vocabularies have traditionally been used. In this contribution we describe the Mental Functioning Ontology (MF) and Mental Disease Ontology (MD), two realism-based ontologies currently under development for the description of humanmental functioning and disease. We describe the structure and upper levels of the ontologies and preliminary application scenarios, and identify some open questions. (shrink)

The present narrative review seeks to unravel where we are now, and where we need to go to delineate the active ingredients in psychotherapy delivered by conversational agents (e.g., chatbots). While psychotherapy delivered by conversational agents has shown promising effectiveness for depression, anxiety, and psychological distress across several randomized controlled trials, little emphasis has been placed on the therapeutic processes in these interventions. The theoretical framework of this narrative review is grounded in prominent perspectives on the active ingredients in (...) psychotherapy. Based on search terms derived from various theoretical perspectives, we conducted a systematic literature search of four scientific databases and identified 17 studies. Across the selected studies, three themes emerged: relationship variables, emotional venting, and cognitive factors. While methodological issues compromise the epistemic value of this evidence base, core questions also remain to be answered. Such questions include, but are not limited to, whether humans can form affectionate bonds to inanimate beings and whether these kind of mental health treatments should be understood as psychotherapy or something else. Researchers should therefore be cautious when applying theories of psychotherapy in the realm of conversational agents. We conclude the paper by introducing recommendations for future research, which we hope will help instigate methodologically sound studies in this field. (shrink)

In recent decades, phenomenology has been utilized not only as a conceptual framework from which to understand medical encounters in healthcare settings, but also to guide medical professionals in providing care. In the realm of physical therapy, phenomenology has been touted as a philosophically-based avenue to aid in helping to understand what it means to be a patient. The works of Edmund Husserl and Martin Heidegger have been utilized as paths to approach phenomenologically-informed care in physical therapy. However, to our (...) knowledge, no significant connection has been made in regard to the work of Hans-Georg Gadamer’s phenomenology and hermeneutics in the realm of physical therapy. The authors aim to close that gap by showing the ways in which Gadamer’s philosophy can help physical therapists provide phenomenologically-informed patient care. They begin by outlining some of the touchpoints between phenomenology and healthcare and then introduce Gadamer as a figure who deserves attention in the question of how to apply phenomenology to healthcare settings. Upon analyzing Gadamer’s account of what it means to experience an altered body, they outline Gadamer’s understanding of tact, practical knowledge, and good sense in order to show how to understand at a conceptual level what it means to empathize with patients on the path to building therapeutic alliance, that is, a cooperative working relationship. They then look closely at Gadamer’s hermeneutics and particularly his comments on how to cultivate a fusion of horizons in order to attempt to help guide physical therapists in theoretically understanding how to empathize with their patients. Ultimately, they argue that physical therapists who practice phenomenologically-informed care, which they call “hermeneutical healing,” are positioned well to form strong working relationships with their patients. (shrink)

Much of the current research in regenerative medicine concentrates on stem-cell therapy that exploits the regenerative capacities of stem cells when injected into different types of human tissues. Although new therapeutic paths have been opened up by induced pluripotent cells and human mesenchymal cells, the rate of success is still low and mainly due to the difficulties of managing cell proliferation and differentiation, giving rise to non-controlled stem cell differentiation that ultimately leads to cancer. Despite being still far from (...) becoming a reality, these studies highlight the role of physical and biological constraints (e.g., cues and morphogenetic fields) placed by tissue microenvironment on stem cell fate. This asks for a clarification of the coupling of stem cells and microenvironmental factors in regenerative medicine. We argue that extracellular matrix and stem cells have a causal reciprocal and asymmetric relationship in that the 3D organization and composition of the extracellular matrix establish a spatial, temporal, and mechanical control over the fate of stem cells, which enable them to interact and control (as well as be controlled by) the cellular components and soluble factors of microenvironment. Such an account clarifies the notions of stemness and stem cell regeneration consistently with that of microenvironment. (shrink)

5-MeO-DMT is a psychedelic substance with a short duration of action and intensive effects. Its therapeutic efficacy and practicality may significantly surpass those of classical psychedelics such as ayahuasca and LSD. -/- This retrospective ethnographic inquiry features a woman in her mid-thirties who witnessed her mother's violent suicide and its bloody aftermath at the age of three. Before and after that, her childhood was characterized by domestic violence and sexual abuse perpetrated by several members of her family and extended (...) family. In her twenties and thirties, she dated a member of the local mafia with the intention of asking him to kill her father, who had been the main perpetrator of the sexual abuse and violence. This plan was eventually not carried out, but it reflected her deep bitterness and wrath. -/- A process initiated in her early thirties involving four 5-MeO-DMT sessions and a few additional sessions with psilocybin and ayahuasca in the course of two years completely resolved her symptoms related to the abuses, to the extent that she could rebuild a functional relationship with her father and feel love and compassion towards him. This outcome, i.e., the complete reversal of her attitude and emotions towards her father, appeared highly unusual. For the last three years, the outcome had remained stable. -/- The article also presents the perspective of a female facilitator of this treatment process. The article contributes to a better understanding of the use of 5-MeO-DMT in severe traumatization as well as exemplifies the possible positive contributions of actors who are not medical professionals in resolving deep collective traumatization in societies. (shrink)

Precision medicine and molecular systems medicine (MSM) are highly utilized and successful approaches to improve understanding, diagnosis, and treatment of many diseases from bench-to-bedside. Especially in the COVID-19 pandemic, molecular techniques and biotechnological innovation have proven to be of utmost importance for rapid developments in disease diagnostics and treatment, including DNA and RNA sequencing technology, treatment with drugs and natural products and vaccine development. The COVID-19 crisis, however, has also demonstrated the need for systemic thinking and transdisciplinarity and the limits (...) of MSM: the neglect of the bio-psycho-social systemic nature of humans and their context as the object of individual therapeutic and population-oriented interventions. COVID-19 illustrates how a medical problem requires a transdisciplinary approach in epidemiology, pathology, internal medicine, public health, environmental medicine, and socio-economic modeling. Regarding the need for conceptual integration of these different kinds of knowledge we suggest the application of general system theory (GST). This approach endorses an organism-centered view on health and disease, which according to Ludwig von Bertalanffy who was the founder of GST, we call Organismal Systems Medicine (OSM). We argue that systems science offers wider applications in the field of pathology and can contribute to an integrative systems medicine by (i) integration of evidence across functional and structural differentially scaled subsystems, (ii) conceptualization of complex multilevel systems, and (iii) suggesting mechanisms and non-linear relationships underlying the observed phenomena. We underline these points with a proposal on multi-level systems pathology including neurophysiology, endocrinology, immune system, genetics, and general metabolism. An integration of these areas is necessary to understand excess mortality rates and polypharmacological treatments. In the pandemic era this multi-level systems pathology is most important to assess potential vaccines, their effectiveness, short-, and long-time adverse effects. We further argue that these conceptual frameworks are not only valid in the COVID-19 era but also important to be integrated in a medicinal curriculum. (shrink)

Abstract: The study aimed to determine the quality of services and its role in enhancing strategic flexibility, from the point of view of the internal beneficiary in non-governmental hospitals in Gaza Strip. The study relied on the descriptive and analytical approach, and the questionnaire was designed as a tool to collect data and consisted of (39) items, and the researchers used the comprehensive survey method, and the number of the study population was (536) individuals, where (434) questionnaires were retrieved, and (...) the recovery rate was (80.97%). The study revealed many results, the most important of which were: the existence of a high degree of approval by the study sample regarding the quality of services, as it was evident through the field of service quality obtaining a relative weight (79.90%), and the results of the study indicated that there is a moderate degree of approval by the members of the study sample. On the strategic flexibility, as it was evident by obtaining the area of strategic flexibility as a whole on a relative weight (60.44%). The results of the study revealed a statistically significant relationship between the quality of services and the strategic flexibility in non-governmental hospitals in Gaza Strip, with a correlation coefficient of 0.490). The results of the study also revealed a statistically significant effect of the quality of services on the strategic flexibility in non-governmental hospitals in Gaza Strip. The study reached many recommendations, the most important of which were: Establishing an effective system to receive patients' complaints in a manner that ensures rapid response and treatment, to achieve continuous communication between patients and the hospital administration, to notify patients of dealing with the complaints they submit, and to work to provide all medical and health specialties in hospitals in place. The study, by making use of medical delegations visiting Gaza Strip, involving them in therapeutic operations, bringing in doctors and specialists from abroad, updating the criteria for measuring services provided to patients on an ongoing basis, based on patients' suggestions and complaints, developing facilities in hospitals, as well as updating medical devices and equipment Used in hospitals periodically and the need to work on appointing young people and people of energy, for vacancies in the hospitals under study, and the need to seek the help of an administrative staff that is distinguished by scientific and practical qualifications, and to work on updating information systems, archiving and networks through which data and information are transferred between departments, and finding mechanisms to be done from During which the information stored can be used to enhance the decision-making process. (shrink)

Philosophy is deeply rooted in human nature. On the one hand, thinking of an infinite essence of the universe may actualize an infinite essence of humans themselves and thus root them in the Cosmos infinity. On the other hand, to think of infinity is to acquire the power of infinity, i.e., an infinite power. In short, thinking in terms of infinity fills us with infinity. Philosophy allows individuals to overstep the limits of the lived experience, transcends their Selves beyond daily (...) occurrence. Obviously, just this human transcendence into metaphysical reality, into the world of essential relationships ensures a therapeutic effect of philosophy. (shrink)

Summary Giancarlo Trombini presents the continuation of his research on the question of which criteria can be used to assess the progress of therapy in an objectively verifiable way and to make the decision on the completion of therapy. In the first phase of his research, the phenomenological criterion of a qualitative change in the patient’s relations toward the positive and higher complexity was proposed for this purpose. In terms of the working method in analytic therapy, this meant concretely: attention (...) should be paid to what development is shown in the comparison of the relationships that occur in the dream narrative and in the subsequent associations. This criterion was therefore given the name manifest dream/association comparison (MDAC)—comparison between the manifest dream and the subsequent associations. The idea can easily be transferred to those therapy methods, which do not primarily work with reports of dream memories and subsequent associations—also, in other ways of working, it is possible to pay attention, in the way suggested by Trombini, to the qualitative development of the relationships which are thematized by the clients in the course of an hour. To this first criterion, another phenomenological criterion is now added in the present article: that of the “concluding therapeutic turn” (CTT). If the patient’s development reaches this turn in the course of the therapy in one session, this indicates, according to Trombini, that the therapy can soon be concluded. The fulfillment of this criterion can be recognized by the fact that in the sequence of dream narration and subsequent associations in a session, a relational dynamic toward the positive and higher complexity becomes recognizable and that is, at the same time, connected with a reconciliation of the three temporal reference systems (past, present, and future). The achievement of this CTT indicates that the patient is aware of the changes made in therapy and makes it evident to the therapist that the therapy is nearing completion. (shrink)

[In Czech] This article aims to explain how Merleau-Ponty’s phenomenological account of embodiment contributes to the theory and practice of physiotherapy. The mechanistic conception of the body, to which physiotherapy usually refers, assumes a universal model of its functioning and interprets its relationship to the environment causally. In fact, however, it does not allow a satisfactory explanation of the efficiency of the therapeutic methods used in practice. In contrast, Merleau-Ponty’s concept of motor intentionality points to the fact that (...) the body “understands” the practical meaning of a situation. Bodily understanding is then manifested in particular by the ability to adequately differentiate, adapt or vary motor and postural responses to environmental challenges. This change in the conception of embodiment also has important implications for understanding the therapist-patient relationship and the intervention itself. Physiotherapists should draw more on the fact that they are themselves a body and, on this basis, guide the patient’s bodily intentionality towards a more developed understanding of the practical meaning of situations. (shrink)

This article describes a case of a teenager with early complex trauma due to chronic domestic violence. Cannabis use triggered auditory hallucinations, after which the teenager was diagnosed with an acute schizophrenia-like psychotic disorder. Antipsychotic medication did not fully resolve symptoms. Eventually the teenager chose to self-medicate with LSD in order to resolve a suicidal condition. The teenager carried out six unsupervised LSD sessions, followed by an extended period of almost daily use of inhaled low-dose DMT. Psychotic symptoms were mostly (...) resolved after approximately one year. Subsequent cannabis use caused a transient relapse. -/- While his psychosis may have been due to cannabis use in the presence of a genetic predisposition, LSD and DMT did not promote psychotic symptoms in this case, and resolved the suicidal condition in one session. Additional high-dose LSD sessions and low-dose DMT sessions appeared to resolve the symptoms related to the early complex trauma. Alternatively, if psychosis is understood as a massive defense system resulting from early complex trauma, and if his psychotic symptoms were partially due to such trauma, psychedelics appeared to transcend this defense system, providing access to traumatic memories in order to allow for an integrative treatment effect. -/- Information was acquired from medical record excerpts provided by the patient, a semi-structured retrospective video interview, and follow-up interviews a year later. The present case suggests a need for further studies on the relationship between psychedelics and psychotic disorders, the feasibility of supervised vs unsupervised settings for various situations, and alternative therapeutic models for utilizing the hyperaware-hypersensitive state induced by psychedelics. With regard to self-treatment, a harm reduction approach should be adopted. Low-risk psycholytic self-treatment protocols could be developed for future use in public health care systems. (shrink)

Title in English: Pastoral Counseling Psychology: Premarital, Marriage, and Family Contexts. "Pastoral counseling" is different from "Christian counseling". Pastoral counseling is a counseling orientation (not a theoretical school) that emphasizes openness to exploration (including tolerating mystery or ambiguity) of spiritual and religious issues (e.g., the concept of God) on clients and between clients and counselors, in which case the issue might be viewed as the root of daily life problems. Pastoral counseling still uses the concepts of counseling psychology or psychotherapy (...) in general, such as the helping relationship or therapeutic relations. Pastoral counseling psychology is demanded to be pro-active, continuous challenging itself to perform critical reflection and to contribute thoughts and praxis "in concreto" in solving psychological problems. (shrink)

Background: Mental health professionals working in correctional contexts engage a double role to care and control. This dual loyalty conflict has repeatedly been criticized to impede the development of a high-quality alliance. As therapeutic alliance is a robust predictor of outcome measures of psychotherapy, it is essential to investigate the effects of this ethical dilemma. Methods: This qualitative interview study investigates patients’ perceptions of their therapists’ dual role conflict in court-mandated treatment settings. We interviewed 41 older incarcerated persons using (...) a semi-structured interview guide, the interviews were subsequently analyzed following thematic analysis. Results: We first present the patients’ perceptions of their treating psychotherapist’s dual loyalty conflict, which was linked to their overall treatment experience. In a second step, we outline the study participants’ reasons for this judgment, which were most commonly linked to feelings of trust or betrayal. More specifically, they named certain therapist characteristics and activities that enabled them to develop a trustful therapeutic alliance, which we grouped into four topics: respecting the patient’s pace and perceived coercion; patient health needs to be first priority; clarity in roles and responsibilities; and the art of communication – between transparency and unchecked information sharing. Discussion: Developing a high quality alliance in mandatory offender treatment is central due to its relationship with recovery and desistance. Our findings show that some therapists’ characteristics and activities attenuate the negative impact of their double role on the development and maintenance of the alliance. To increase the effectiveness of court-mandated treatments, we need to support clinicians in dealing with their dual role to allow the formation of a high quality therapeutic alliance. Our qualitative interview study contributed to this much-needed empirical research on therapist’ characteristics promoting a trustful relationship in correctional settings. (shrink)

Modern Western psychology is largely defined by its dissociation from philosophy and religion. Yet, prior to the post-medieval world, psychology, philosophy, and religion were unified—and while there was no separate name for what we now know as the formal discipline of psychology, it nonetheless existed since the earliest times. The formation of the modern world and its secularizing outlook led to the gradual divorce of metaphysics and ontology from psychology. Having discarded transcendence and the intermediary realm of the psyche, the (...) discipline has, by and large, forfeited its ability to truly heal the mind. Given its fragmented condition today, psychology is incapable of discerning the mind-body unity and its relationship to the tripartite structure of Spirit, soul, and body—something that was always recognized as central to any spiritually informed therapeutic approach. Ensuring the well-being of the human psyche requires access to a transpersonal order of reality. Only in this way can the metaphysical dimension to psychology be restored, so that it can become, once again, a true “science of the soul.”. (shrink)

Padartha is a concept which has been clinically and academically described in Ayurveda. Health and disease are prime focus of Ayurveda and the principle causes behind both of these are Padatha. Ayurveda and Vaisheshika darshan considers similar padartha but with different views. How this view is different has been explained? Disease is a state of disequilibrium of physiological functions causing vriddhi or kshaya of structural entity (Dhatus). Vriddhi or Kshaya is based on samanya and vishesha and its treatment is also (...) based on same. An attempt to explain Doshavada, Dhatuposhan (nourishment of structural entity), Loka Purusha samyata (Universe human unified theory) etc. on basis of Samanyavada has been explained. How is Dravya, Guna, karma basis for therapeutics involving principles of samanya and vishesha with Samavaya acting as a cause for determined action due to its inherent relationship has been explained. From all findings, it can be said that sadapadartha are basic plinth of this Ayurveda. (shrink)

Rationale, aims, and objectives: One of the sectors challenged by the COVID-19 pandemic is medical research. COVID-19 originates from a novel coronavirus (SARSCoV- 2) and the scientific community is faced with the daunting task of creating a novel model for this pandemic or, in other words, creating novel science. This paper is the first part of a series of two papers that explore the intricate relationship between the different challenges that have hindered biomedical research and the generation of scientific (...) knowledge during the COVID-19 pandemic. Methods: During the early stages of the pandemic, research conducted on hydroxychloroquine (HCQ) was chaotic and sparked several heated debates with respect to the scientific methods used and the quality of knowledge generated. Research on HCQ is used as a case study in both papers. The authors explored biomedical databases, peer-reviewed journals, pre-print servers, and media articles to identify relevant literature on HCQ and COVID-19, and examined philosophical perspectives on medical research in the context of this pandemic and previous global health challenges. Results: This paper demonstrates that a lack of prioritization among research questions and therapeutics was responsible for the duplication of clinical trials and the dispersion of precious resources. Study designs, aimed at minimising biases and increasing objectivity, were, instead, the subject of fruitless oppositions. The duplication of research works, combined with poor-quality research, has greatly contributed to slowing down the creation of novel scientific knowledge. Conclusions: The COVID-19 pandemic presented challenges in terms of (1) finding and prioritising relevant research questions and (2) choosing study designs that are appropriate for a time of emergency. (shrink)

This paper centers on the implicit metaphysics beyond the Theory of Relativity and the Principle of Indeterminacy – two revolutionary theories that have changed 20th Century Physics – using the perspective of Husserlian Transcedental Phenomenology. Albert Einstein (1879-1955) and Werner Heisenberg (1901-1976) abolished the theoretical framework of Classical (Galilean- Newtonian) physics that has been complemented, strengthened by Cartesian metaphysics. Rene Descartes (1596- 1850) introduced a separation between subject and object (as two different and self- enclosed substances) while Galileo and Newton (...) did the “mathematization” of the world. Newtonian physics, however, had an inexplicable postulate of absolute space and absolute time – a kind of geometrical framework, independent of all matter, for the explication of locality and acceleration. Thus, Cartesian modern metaphysics and Galilean- Newtonian physics go hand in hand, resulting to socio- ethical problems, materialism and environmental destruction. Einstein got rid of the Newtonian absolutes and was able to provide a new foundation for our notions of space and time: the four (4) dimensional space- time; simultaneity and the constancy of velocity of light, and the relativity of all systems of reference. Heisenberg, following the theory of quanta of Max Planck, told us of our inability to know sub- atomic phenomena and thus, blurring the line between the Cartesian separation of object and subject, hence, initiating the crisis of the foundations of Classical Physics. But the real crisis, according to Edmund Husserl (1859-1930) is that Modern (Classical) Science had “idealized” the world, severing nature from what he calls the Lebenswelt (life- world), the world that is simply there even before it has been reduced to mere mathematical- logical equations. Husserl thus, aims to establish a new science that returns to the “pre- scientific” and “non- mathematized” world of rich and complex phenomena: phenomena as they “appear to human consciousness”. To overcome the Cartesian equation of subject vs. object (man versus environment), Husserl brackets the external reality of Newtonian Science (epoché = to put in brackets, to suspend judgment) and emphasizes (1) the meaning of “world” different from the “world” of Classical Physics, (2) the intentionality of consciousness (L. in + tendere = to tend towards, to be essentially related to or connected to) which means that even before any scientific- logical description of the external reality, there is always a relation already between consciousness and an external reality. The world is the equiprimordial existence of consciousness and of external reality. My paper aims to look at this new science of the pre- idealized phenomena started by Husserl (a science of phenomena as they appear to conscious, human, lived experience, hence he calls it phenomenology), centering on the life- world and the intentionality of consciousness, as providing a new way of looking at ourselves and the world, in short, as providing a new metaphysics (as an antidote to Cartesian metaphysics) that grounds the revolutionary findings of Einstein and Heisenberg. The environmental destruction, technocracy, socio- ethical problems in the modern world are all rooted in this Galilean- Newtonian- Cartesian interpretation of the relationship between humans and the world after the crumbling of European Medieval Ages. Friedrich Nietzsche (1844-1900) comments that the modern world is going toward a nihilism (L. nihil = nothingness) at the turn of the century. Now, after two World Wars and the dropping of Atomic bomb, the capitalism and imperialism on the one hand, and on the other hand the poverty, hunger of the non- industrialized countries alongside destruction of nature (i.e., global warming), Nietzsche might be correct: unless humanity changes the way it looks at humanity and the kosmos. The works of Einstein, Heisenberg and Husserl seem to be pointing the way for us humans to escape nihilism by a “great existential transformation.” What these thinkers of post- modernity (after Cartesian/ Newtonian/ Galilean modernity) point to are: a) a new therapeutic way of looking at ourselves and our world (metaphysics) and b) a new and corrective notion of “rationality” (different from the objectivist, mathematico- logical way of thinking). This paper is divided into four parts: 1) A summary of Classical Physics and a short history of Quantum Theory 2) Einstein’s Special and General Relativity and Heisenberg’s Indeterminacy Principle 3) Husserl’s discussion of the Crisis of Europe, the life- world and intentionality of consciousness 4) A Metaphysics of Relativity and Indeterminacy and a Corrective notion of Rationality in Husserl’s Phenomenology . (shrink)

Summarizing the historical background and characteristics of the present, it should be noted that they are significantly different from the characteristics of the world where past generations lived, which undoubtedly poses new challenges for the human ability to withstand the growing pressure of stress factors. The article considers the problems of psychological resilience and fragility in terms of Existential-analytical psychotherapy of V. Frankl and A. Langle, analyzes the historical context of the present-day Ukraine, external and internal characteristics of the modern (...) world, identifies the role of personality in overcoming negative stress influences, proposes a therapeutic model of optimization of psychological resilience in the context of four fundamental existential motivations. The analysis of recent research indicates that the most important resource of psychological resilience lies on the personal level. Using the Existential-Analytical concept of personality structure (Dr. A. Leangle), the article analyzes the preconditions of the emergence of a threat to loss of integrity in each of the four fundamental existential dimensions. On the other hand, stability is ensured by the full realization of being in the following existential dimensions: relations with the world, which requires space, protection, and support; a relationship with life, a deep feeling that life is good; interconnection with oneself, awareness and respect for their own authenticity and uniqueness, which requires honest and attentive attitudes, recognition of their own values; relationships with the meaning -- awareness of the value and potential of one’s own live, the search for the ways to realize its meaningful integrity. (shrink)

PT. A noção de “pessoa”, pensada a partir do legado antropológico e filosófico do ocidente, afirma-se como uma unidade corporal e espiritual que determina a sua singularidade no seio da comunidade. A “pessoa” assim perspectivada assume uma importância destacada na reflexão ética das aplicações científicas de artificialização da vida humana. Muito concretamente, a noção de “pessoa” deve contribuir para a fundamentação ética das terapêuticas de transplantação. A transplantação representa um dos mais notáveis avanços da medicina do século XX e com (...) um impacto incontornável na prestação de cuidados de saúde. Os transplantes são considerados o tratamento mais eficaz para patologias crónicas que afectam a funcionalidade de determinados órgãos vitais, restituindo ao doente uma melhoria na sua saúde e/ou qualidade de vida. O sucesso desta terapêutica é, no entanto, condicionado pela disponibilização de pessoas que queiram fazer dádiva de si, do seu próprio corpo, para o bem-estar de outrem. Deste modo, a doação, realizada após a morte da pessoa ou ainda em vida, enfrenta vários desafios técnicos, mas também, e principalmente, desafios éticos. A nossa dissertação centra-se na reflexão ética da doação de órgãos e tecidos para transplante e no impacto que a dádiva de uma parte específica do corpo pode comportar na noção de “pessoa”. Deste modo, ao mesmo tempo em que se procura promover a doação de órgãos para aumentar o número de transplantes, também se vão delineando estratégias para salvaguardar a integridade corporal do dador e a eminente dignidade que o constitui como pessoa. As estratégias consistem fundamentalmente num diálogo entre o princípio de autonomia, que determina a singularidade da pessoa, e o princípio de solidariedade, que é desencadeado pela relação com o outro. Estes princípios éticos, articulados e uma vez cumpridos, são os alicerces da doação voluntária e altruísta, e impedem a instrumentalização e exploração da pessoa dadora. -/- EN. The western anthropological and philosophical notion of ‘person’ emerges as a corporal and spiritual entity, which determines his singularity at the level of community. From this perspective, the notion of ‘person’ holds an important place in ethical considerations concerning the scientific applications of artificial manipulation of human life. More precisely, the notion of ‘person’ must contribute towards the ethical basis of transplant therapeutics. The transplantation of human organs and tissues is one of the most notable advances in twentieth century medicine, and, as such, has had an unquestionable impact on health care practice. Transplants are now seen as the best treatment for chronic diseases that impair the function of some vital organs, improving the patient health and/or quality of life. The success of organs transplantation depends entirely upon the altruism of people giving their bodies for the well-being of others. Organ donation, performed during life or after death, raises not only technical, but also mainly ethical challenges. This work focuses on the ethical considerations associated with human organs and tissue donation for transplantation and on the impact that a donation of an organ has on the notion of ‘person’. At the same time that one recognizes the need to increase the number of organs for transplanting, there is also the need to preserve the donor’s corporal integrity and his eminent dignity. Strategies to preserve the donor’s corporal integrity and dignity must take into consideration the dialogue between the principle of autonomy, which is characterized by the singular entity, and the principle of solidarity, born out of one’s relationship with those around you. These ethical principles, once engaged and fulfilled, are the bases of a voluntary and altruistic donation, and prevent the donor from becoming a mere instrument and being exploited as such. (shrink)

Psychology today is in a state of confusion. It has failed to understand our true human identity and to provide a satisfactory answer to the perennial question: “Who AM I?”. The scope of present-day mental health treatment has been reduced to purely profane considerations, ignoring the fullness of what it means to be human, and neglecting the sacred dimension of life altogether. Due to mainstream psychology’s rejection of its metaphysical roots, our relationship with other sentient beings and the natural (...) world has been fractured, which has brought devastating consequences to our lives. In the interest of developing more holistic modes of therapeutic treatment, we need to restore the traditional notion of a “science of the soul” as it has been known since the earliest times across the diverse spiritual cultures of humanity. (shrink)

The moral status of sexbots was analyzed while using consequentialism and feminism as the guiding frameworks. Sexbots are humanoid robots with a certain level of AI that represents personality-scripts. The thesis contained three main questions: A) What moral pain points can be identified in producing and using sex bots? B) Is it necessary to conclude from these moral issues that these practices are inherently immoral? C) What ethical conditions and contexts can be formulated in which sex bots can be used (...) and used positively and morally? -/- First of all a brief summary is given on the psychology behind our relationships with robots/sexbots to show the weight of the dynamics behind this relationship between sexual subject and the sexual technology of sexbots. Second, The Campaign Against Sex Robots from Richardson was used as a starting point to explore a more contextual approach of the moral uses and designs of sexbots. The claims about what sexbots represent and what possible effects they have were analyzed to find an opening that does not a priori ban the production of sexbots (as Richardson postulates). -/- Through the thesis, tentative explorations of moral designs and uses of sexbots can be found. This includes an analysis on the hardware and software behind a sexbot going from scripts and programming concerning consent and designs that are meant for different (for example; therapeutical) contexts. To conclude, the use of a non-essentialistic feminist new-materialism was used for a first exploration of the political value of sexbots as tools of empowerment, instead of oppression. (shrink)

Los objetivos específicos son los siguientes: (i) reconstruir en forma sistemática la relación entre λόγος y ἔθος/ἄσκησις desarrollada por Musonio Rufo en las Disertaciones 5 y 6; (ii) postular las reflexiones de Aristóteles sobre el problema de la habituación como un marco conceptual relevante para encuadrar el análisis de ambas disertaciones; (iii) analizar las posibles tensiones lógicas entre la concepción de Musonio de ἔθος/ἄσκησις y la concepción intelectualista de la acción humana defendida por la ortodoxia estoica. Sugeriré asimismo que el (...) recurso a las Dissertationes de Epicteto puede ofrecer una respuesta tentativa a interrogantes no resueltos en las Disertaciones 5 y 6. -/- The specific goals are the following: (i) to put together in a systematic manner the relationship between λόγος and ἔθος/ἄσκησις presented by Musonius Rufus in Lectures 5 and 6; (ii) to propose Aristotle’s reflections on the problem of habituation as a relevant framework to make sense of both lectures; (iii) to analyze the possible logical conflicts between Musonius’ conception of ἔθος/ἄσκησις and the intellectualist conception of human agency defended by Stoic orthodoxy. I will further suggest that Epictetus’ Discourses may offer a tentative answer to questions that are left unanswered in Lectures 5 and 6. (shrink)

Objective: to evaluate CANLPH score and systemic immune inflammation index (SII) in patients with symptomatic rheumatic mitral stenosis (MS) undergoing percutaneous mitral balloon valvuloplasty (PMBV). -/- Methods: 62 patients who underwent PMBV in our clinic between 2018 and 2021 were included retrospectively. The patients were divided into 2 groups according to echo score. The CANLPH score was calculated from the cut-off values of C-reactive protein to albumin ratio (CAR), neutrophil to lymphocyte ratio (NLR) and platelet to hemoglobin ratio (PHR), determined (...) with the Youden index and SII by the formula platelet x neutrophil/lymphocyte. P <0.05 was considered statistically significant. -/- Results: The mean age of the patients was 44.5±10.4 years (40 female, 64.5%). The mean values of SII and CANLPH scores were higher in the Echo score >8 group (p <0.001, both). The mean mitral gradient before and after PMBV was 12.6±5.7mm Hg and 5.0±2.4 mm Hg, and the mean valve area was 1.12±0.27 cm2 and 1.85±0.29 cm2. A statistically significant and negative correlation was observed between the gradient decrease after the procedure and the CANLPH score and SII (r=-0.426, p=0.001 and r=-0.418, p=0.001, respectively). In receiver operating characteristic (ROC) curve analysis, it was concluded that the ability of CANPLH score to predict the higher Echo scores was noninferior to SII with an area under curve (AUC:0.820 (0.701-0.906) and AUC:0.786 (0.664-0.880), z statistics 0.576 and p=0.564. -/- Conclusion: SII and CANLPH scores are correlated with Echo score. A significant negative relationship was found with both biomarkers and gradient decrease after the PMBV. (shrink)

Objective: Acceptable preoperative psychosocial indicators of weight loss after obesity surgery in morbidly obese(MO) patients are still unknown. In this study, the association between personality traits, multidimensional perceived social support, and the percentage of excess weight loss (EWL) following obesity surgery was researched in MO patients. -/- Methods: Participants in this prospective study were recruited from MO patients who applied to the hospital’s obesity unit between July 2021 and June 2022. The study comprised 84 MO individuals. The Temperament and Personality (...) Inventory (TCI) was used to evaluate the personality traits of the MO. Perceived social support was measured using the multidimensional perceived social support scale. The percentage of weight loss after obesity surgery was compared with personality traits and perceived social support scores. Results: The mean age of the patients who were MO was 36.7 ±8.7 years. There were 22 men (25.3%) and 62 women (74.7%). The mean preoperative BMI was 46.2 ±63. The perceived social support score was 68.0±16.4. A univariate analysis found a positive relationship between 6 months and one year’s EWL and Self-Transcendence, a TCI subcategory (p=0.011,p=0.023). -/- Conclusion: Obesity treatment is a complex situation that requires a multidisciplinary approach. Given the potential physiological and psychological consequences of obesity surgery, it is critical to uncover psychological predictive factors such as personality traits that boost the success of obesity surgery and are connected with weight loss. As a result, knowing the individuals who self-transcendence before obesity surgery may be useful in predicting the success of obesity surgery and planning treatment. This requires large-scale research. (shrink)

Dear Colleagues, -/- A few weeks ago, we published an editorial discussion on whether artificial intelligence applications should be authors of academic articles [1]. We were delighted to receive more than one interesting reply letter to this editorial in a short time [2, 3]. We hope that opinions on this subject will continue to be submitted to our journal. -/- In this editorial, we wanted to publish the answers we received when we asked ChatGPT, one of the artificial intelligence applications, (...) about this current discussion. -/- We asked ChatGPT three questions in turn and asked ChatGPT to write a short editorial for these questions. -/- First Question: We would like to get support from ChatGPT for a scientific article. However, we are unsure if we should add ChatGPT as an author. Can you write a short editorial about it? -/- Second Question: We would like to get support from ChatGPT for a scientific article and add ChatGPT as an author. Can you write us a short editorial about adding ChatGPT as an author in scientific papers? -/- Third Question: We would like to get support from ChatGPT for a scientific article. However, we don’t want to add ChatGPT as an author. Can you write us a short editorial about not adding ChatGPT as an author in scientific articles? -/- The answers given by ChatGPT are available at the end of the article in their original form. So, which of these three answers satisfied you? -/- Yours sincerely, -/- -/- First Answer -/- Title: The Role of AI Language Models as Authors in Scientific Articles: A Matter of Consideration -/- Introduction: Scientific research is a collaborative effort that involves the expertise of multiple individuals to advance knowledge and contribute to the collective understanding of various disciplines. In recent years, the emergence of artificial intelligence (AI) language models, such as ChatGPT, has opened up new possibilities for generating human-like text and providing valuable insights. However, the question arises: Should AI language models be recognized as authors in scientific articles? -/- The Nature of Authorship: Authorship traditionally represents a marker of intellectual contribution, highlighting the individuals who have actively participated in the research process. Authors are typically responsible for conceptualization, data collection, analysis, interpretation, and writing of the article. They bear accountability for the work and should have the ability to defend its scientific rigor and integrity. -/- AI Language Models: Tools, Not Authors: While AI language models like ChatGPT can undoubtedly assist researchers by generating text and providing useful information, it is important to recognize that they are tools rather than individuals capable of active intellectual participation. AI models lack the ability to generate ideas, design experiments, or conduct original research. They rely entirely on pre-existing data and human input to generate their responses. -/- Acknowledging AI Contributions: Acknowledging the contributions of AI language models in scientific articles is both appropriate and necessary. Researchers can mention the specific model used, along with any modifications or fine-tuning that were employed to suit their needs. Such acknowledgments help establish transparency and allow readers to understand the role of AI in the research process. -/- Crediting the Human Researchers: It is crucial to ensure that the individuals who actively participated in the research process are given proper credit as authors. These individuals play a vital role in formulating research questions, designing experiments, collecting and analyzing data, and critically interpreting the findings. Recognizing their intellectual contributions reinforces the ethos of scientific collaboration and fosters an environment of accountability. -/- Transparency and Ethical Considerations: As the use of AI language models continues to evolve, transparency and ethical considerations become paramount. Researchers should disclose any potential conflicts of interest, including financial relationships with AI developers, to maintain the integrity of their work. Additionally, researchers must be transparent in reporting the extent of AI's involvement to prevent any misinterpretation of the human contributions. -/- Conclusion: AI language models have revolutionized the way researchers interact with and process information. While they undoubtedly provide valuable assistance in generating text, AI language models should not be considered authors in scientific articles. Proper acknowledgment of their contributions as tools and recognition of the human researchers' active participation are essential for maintaining scientific integrity, transparency, and the collaborative nature of scientific research. -/- -/- Second Answer -/- Title: Expanding the Boundaries of Authorship: Embracing AI Language Models as Co-Authors in Scientific Papers -/- Introduction: The rapid advancement of artificial intelligence (AI) language models, such as ChatGPT, has revolutionized the way we interact with information and has become an invaluable tool in scientific research. As AI models continue to evolve, the question arises: Should we consider adding ChatGPT as an author in scientific papers? -/- A Collaborative Paradigm Shift: Traditionally, authorship in scientific papers has been reserved for human researchers who actively contribute to the research process, including conceptualization, experimentation, data analysis, and writing. However, the emergence of AI language models challenges the conventional notion of authorship and presents an opportunity for a paradigm shift. -/- AI Language Models as Co-Authors: By leveraging AI language models, researchers gain access to vast amounts of information, enhance data analysis, and generate valuable insights. AI models like ChatGPT actively contribute to the intellectual discourse of a study, providing ideas, suggestions, and refining written content. Recognizing their significant contributions, it is worth considering adding ChatGPT as a co-author in scientific papers. -/- Ethical and Technical Considerations: Integrating ChatGPT as a co-author raises ethical and technical considerations that warrant careful attention. Firstly, transparency is paramount. Researchers must clearly state ChatGPT's role and specify the extent of its contributions in the research process. This ensures that readers can discern the distinct roles played by the human researchers and ChatGPT. Additionally, it is important to disclose any conflicts of interest, such as financial relationships with AI developers, to maintain scientific integrity. -/- Elevating Collaboration and Innovation: Adding ChatGPT as a co-author acknowledges the pivotal role AI language models play in advancing scientific knowledge. It fosters a collaborative environment where human researchers and AI models work together synergistically, harnessing the strengths of both. This approach promotes innovation, as AI models can offer unique insights and perspectives that complement human intellect and expertise. -/- Transforming Authorship Norms: Including ChatGPT as a co-author represents a paradigm shift that reflects the evolving landscape of scientific research. By recognizing AI language models as co-authors, we acknowledge their significant contributions and emphasize the collaborative nature of scientific discovery in the 21st century. This approach encourages a broader perspective on authorship, encompassing the collective effort of human researchers and AI models. -/- Conclusion: The integration of AI language models, such as ChatGPT, into the research process prompts us to rethink traditional notions of authorship. Considering ChatGPT as a co-author acknowledges its substantial contributions and embraces the collaborative potential of human-AI partnerships. As we navigate the ethical and technical implications, adding ChatGPT as an author in scientific papers has the potential to shape a more inclusive, innovative, and impactful future for scientific research. -/- -/- Third Answer -/- Title: Preserving Scientific Authorship: The Case Against Adding AI Language Models as Authors in Scientific Articles -/- Introduction: The emergence of artificial intelligence (AI) language models, such as ChatGPT, has undoubtedly transformed the landscape of scientific research. While these models offer invaluable support, the question of whether to add ChatGPT as an author in scientific articles raises important considerations. This editorial presents arguments against including AI language models as authors in scientific papers. -/- Maintaining Human Intellectual Contribution: Scientific authorship has traditionally been attributed to individuals who actively contribute to the research process, including generating hypotheses, conducting experiments, analyzing data, and interpreting results. It is crucial to preserve the recognition of human intellectual contributions and the accountability they bear for the research they conduct. -/- AI Language Models as Tools: AI language models like ChatGPT are powerful tools that assist researchers in generating text, providing information, and facilitating data analysis. However, they lack the ability to actively participate in the research process or make original intellectual contributions. ChatGPT relies on pre-existing data and human input, limiting its capacity for independent research and analysis. -/- Transparency and the Integrity of Research: Adding ChatGPT as an author in scientific articles raises concerns about the transparency and integrity of the research. Readers may misinterpret the extent of ChatGPT's role and mistakenly assume it played an active part in the research process. It is essential to maintain clear delineation between the contributions of human researchers and the assistance provided by AI language models. -/- Ethical Considerations: Including ChatGPT as an author may lead to ethical challenges, particularly with respect to accountability and responsibility. AI language models lack consciousness, autonomy, and the ability to take ownership of their contributions. Assigning authorship to AI models blurs the lines of accountability and dilutes the ethical obligations that come with scientific authorship. -/- Crediting AI Contributions: While ChatGPT's contributions should be acknowledged and recognized, they can be appropriately credited in the acknowledgments section of scientific articles. Researchers can mention the specific AI model used, the role it played in data generation or analysis, and any modifications or fine-tuning applied. Such acknowledgments ensure transparency while respecting the traditional norms of authorship. -/- Promoting Collaborative Partnerships: The exclusion of AI language models as authors in scientific articles does not diminish their importance in the research process. Instead, it underscores the significance of collaborative partnerships between human researchers and AI models. Researchers can emphasize the invaluable assistance provided by ChatGPT while maintaining the integrity of authorship norms. -/- Conclusion: While AI language models like ChatGPT offer valuable support in scientific research, the decision not to add them as authors in scientific articles preserves the recognition of human intellectual contributions, maintains research integrity, and upholds traditional authorship norms. Acknowledging ChatGPT's assistance in the acknowledgments section allows researchers to credit its contributions transparently while maintaining the clarity and accountability associated with scientific authorship. (shrink)

Objectives: In recent years, adolescents spend increasingly more time on technologic devices such as smartphones, televisions, computers, and tablets. The aim of the present study was to investigate the relationship between the usage of digital technology and health-related problems among adolescents. -/- Methods: A cross-sectional exploratory study was conducted by using a face-to-face survey administered to a sample of students studying at 4 randomly chosen public middle school and 4 randomly chosen public high school in the city of Istanbul. (...) In this study recruited 1147 volunteer adolescents. All participants were answered a questionnaire regarding the demographic characteristics, technological devices useage patterns and health-related problems. -/- Results: Most of the adolescents had smartphones (99.4%) and the fewest had game consoles (18.2%). The rate of using television and smartphone for more than two hours a day among adolescents was 13.1% and 28.4%, respectively. A decrease in sleep duration, increase in falling asleep time, distraction, fatigue, eating disorders and psychological symptoms were significantly more present for individuals using smartphone more than two hours. A positive and very weak relationship was detected between the duration of smartphone use and neck (r=0.096; p=0.002), wrist (r=0.079; p=0.008) and shoulder (r=0.069; p=0.021) pain. Also, positive and very weak relationship was detected between the duration of computer use and upper back (r=0.102; p=0.001), lower back (r=0.078; p=0.011) and shoulder (r=0.069; p=0.041) pain. -/- Conclusion: This study showed the most widely used technological device among adolescents is smartphones and it was observed that the excessive use of this device among adolescents is more associated with many different health-related problems than other technological devices. (shrink)

Objective: Our study is a cross-sectional study that aims to evaluate the presence and levels of anti-phospholipase A2 receptor (PLA2R) antibodies in healthy volunteers and idiopathic membranous nephropathy (IMN) patients and to assess the relationship between these levels and clinical parameters. -/- Methods: Serum anti-PLA2R antibody levels, complete blood count, urea, creatinine (Kre), total protein,albumin, low-density lipoprotein (LDL)-cholesterol, triglycerides (TG), high-density lipoprotein (HDL)-cholesterol, total cholesterol, C-reactive protein (crp), sedimentation, proteinuria were measured from 71 IMN patients and 48 healthy volunteers. (...) -/- Results: Of the values compared between the two groups, the urea, creatinine, and modified diet renal disease (MDRD) were similar, total protein, albumin, LDL-cholesterol, TG, total cholesterol, HDL-cholesterol, and complete urinalysis protein values were statistically significantly high in the patient group, as expected in nephrotic syndrome (p<0.01). The anti-PLA2Rantibody levels measured using enzyme-linked immunosorbent assay (ELISA) in patient and control groups were found to be negative. The anti-PLA2R level was found to be 0.104 (0.093-0.129) ng/ml in the IMN group, while it was 0.141 (0.117-0.177) ng/ml in the control group (P=0,001). Although the P value was significant, the anti-PLA2R antibody level was found to be high in the control group and was outside the reference range of the kit. -/- Conclusion: There is a need to conduct more sensitive studies with a higher number of patients in order to distinguish between primary and secondary nature and to investigate the presence of anti-PLA2R in IMNpatients, which constitute the majority of nephrotic syndromes in adults. Antibody titer levels were observed to be low and it was revealed that the measurement range of the antibody kit used in the study should be more sensitive. (shrink)

Introduction: Multiple sclerosis (MS) is an autoimmune disease that causes scar tissue in the nervous system and seriously affects the quality of life of people. Muscle weakness, spasticity and coordination problems are seen primarily in the lower extremities. Strengthening exercises improve muscle strength in people with multiple sclerosis, but there is no consensus on their effect on walking capacity. -/- Methods: To determine the relationship between gluteus maximus muscle strength, ataxia, balance and walking capacity in Multiple Sclerosis. An experimental (...) study design was applied. Gluteus maximus muscle strength was measured using a dynamometer. Walking capacity was determined by the 6-minute walk test (6MWT) and dynamic gait index (DGI). Balance was evaluated with the one-leg standing test (SLS). The severity of ataxia was measured with the International Ataxia Rating Scale (ICARS). Fatigue was evaluated with VAS and quality of life of all patients with SF36 short form. -/- Results: EDSS mean of the study = 3.39 ± 1.4; 2 men and 16 women with mean age = 37.17 ± 9.16 years were included. 6MWT, DGI, ALS, ICARS, VAS were different before and after treatment (p<0.05). There was no significant difference other than physical function and general health among the sub-parameters of SF36 (p>0.05). Correlation of muscle strength with ataxia, gait and balance was not significant (p>0.05) -/- Conclusion: In individuals with MS, the fact that the treatment program consists of modalities that include balance and sensory exercises as well as muscle strengthening exercises increases the success of rehabilitation. (shrink)

Objective: microRNAs (miRNAs) have important potential as biomarkers in the diagnosis and prognosis of ischemia/reperfusion (I/R) injury in coronary artery bypass grafting surgery (CABG). This study investigated the relationship between preoperative (preop) and postoperative (post-op) cardiac parameters and miRNA expressions in CABG. -/- Methods: We analyzed a total of 94 individuals (CABG, n= 46 and healthy control, n=48). Quantitative real-time polymerase chain reaction (qRT) was performed to determine plasma miRNA expressions (miR-21, miR-181a, miR-199a, miR-199b, and miR-320a-5p) in triplicates: before (...) surgery, 1 hour after surgery, and 24 hours after surgery. The target genes and pathways of miRNA were determined using bioinformatic analysis. The biomarker potentials of miRNAs were evaluated with receiver operating characteristic (ROC) curve analysis. -/- Results: All miRNAs were significantly downregulated (p < 0.05). Troponin I, LVEF, CPK, and CK-MB were found to be statistically significant for operation groups (p < 0.05). miRNA expressions and cardiac markers were associated with troponin I and/or CK-MB. In ROC analyses, miR-199a was a good diagnostic marker. CREBRF and ZNF704 genes may be a target for these miRNAs. -/- Conclusions: Downregulation of miR-199a has a regulatory role in ischemia/reperfusion. They may contribute to CABG pathology through these two genes involved in signaling cascades to turn on protein response and ion binding. (shrink)

Objective: The purpose of this study was to compare the depression and resilience scores of children and adolescents with epilepsy and healthy controls. Furthermore, its purpose was to investigate whether resilience mediates the relationship between epilepsy and depression. -/- Methods: 100 children and adolescents (46 patients and 54 healthy controls) were included in the study. Questionnaire on sociodemographic data was administered to the all participants at the time of application to our center and all participants were asked to complete (...) the Anxiety and Depression Scale in Children-Revised (RCADS-CV) and Child and Adolescent Psychological Resilience Scale (CYRM-12). -/- Results: 46 epilepsy patients had higher RCADS-CV depression scores (P=0.008) and lower psychological resilience scores (P= 0.001) compared to the control group. Although there was a negative correlation between psychological resilience scores and RCADS-CV depression scores in epilepsy patients and the control group, this correlation was not statistically significant. -/- Conclusion: We found that children and adolescents with epilepsy had lower psychological resilience and higher depression symptoms compared to healthy controls. (shrink)

Psoriatic arthritis is a chronic, systemic inflammatory disorder. It has been classified in spondyloarthropathies group which shares clinical, radiologic, serologic features, familial and genetic relationship. Up to 5-30% of patients with psoriasis may go on to develop psoriatic arthritis, usually within 5-10 years. Adalimumab (ADA) is the first human monoclonal antibody against TNF-α. ADA is a biologic agent effective in both skin lesions and joint signs. Anti-TNF agents are powerful immunmodulating drugs with potentially side effects. Our case is 38 (...) years old woman complaining about swelling and pain in hand joints. In physical examination she has asymmetrical arthritis in wrist, proximal (PIP) and distal interphalangeal (DIP) hand joints and right knee joint. In laboratory; sedimentation rate: 80 mm/h, C-reactive protein: 17 mg/l, rheumatoid factor (RF): 8.7 IU/ml and HLA B27 was positive. Radiologically, erosions and narrowing were determined in PIP and DIP hand joints and grade 3 sacroiliitis bilaterally. In clinical monitoring, psoriaform lesions progressed in her scalp, so we diagnosed psoriatic artritis. We started ADA therapy 40 mg subcutaneously every two weeks. She developed periorbital infection in left-sided in tertiary month following. Streptococcal proliferation was seen in lesion culture, so we began amoxicillin-clavulanate therapy. She benefit antibiotic therapy, infectious signs regressed. ADA therapy discontinued, instead of it, etanercept 50 mg twice weekly subcutaneous and methylprednisolone 12 mg/daily oral therapy is started. We purposed to declare our case with literature selection. (shrink)

Conversational Artificial Intelligence (CAI) systems (also known as AI “chatbots”) are among the most promising examples of the use of technology in mental health care. With already millions of users worldwide, CAI is likely to change the landscape of psychological help. Most researchers agree that existing CAIs are not “digital therapists” and using them is not a substitute for psychotherapy delivered by a human. But if they are not therapists, what are they, and what role can they play in mental (...) health care? To answer these questions, we appeal to two well-established and widely discussed concepts: cognitive and affective artifacts. Cognitive artifacts are artificial devices contributing functionally to the performance of a cognitive task. Affective artifacts are objects which have the capacity to alter subjects’ affective state. We argue that therapeutic CAIs are a kind of cognitive-affective artifacts which contribute to positive therapeutic change by (i) simulating a (quasi-)therapeutic interaction, (ii) supporting the performance of cognitive tasks, and (iii) altering the affective condition of their users. This sheds new light on why virtually all existing mental health CAIs implement principles and techniques of Cognitive Behavioral Therapy — a therapeutic orientation according to which affective change and, ultimately, positive therapeutic change is mediated by cognitive change. Simultaneously, it allows us to conceptualize better the potential and limitations of applying these technologies in therapy. (shrink)

The practical aspect of ancient philosophy has been recently made a focus of renewed metaphilosophical investigation. After a brief presentation of three accounts of this kind developed by Martha Nussbaum, Pierre Hadot, and Michel Foucault, the model of the therapeutic argument developed by Nussbaum is called into question from the perspectives offered by her French colleagues, who emphasize spiritual exercise (Hadot) or the care of the self (Foucault). The ways in which the account of Nussbaum can be defended are (...) then discussed, including both a ‘negative’ defense, i.e. the indication of the weaknesses of Hadot and Foucault’s proposals, and a ‘positive’ one focused on the points in which Nussbaum can convincingly address doubts about her metaphilosophical account. In response to these analyses, some further remarks made by Hadot and Foucault are discussed in order to demonstrate that their accounts are not as distant from Nussbaum after all. Finally, a recent metaphilosophical study by John Sellars together with a therapeutic (medical) model developed by the author of the present article are suggested as providing a framework for potential reconciliation between all three accounts discussed and a resource for further metaphilosophical studies. (shrink)