We argue that the universal recommendations against “off-label” pediatric use of approved COVID-19 issued by the FDA, CDC, and AAP are overbroad. Especially for higher-risk children, vaccination can be ethically justified even before FDA authorization or approval – and similar reasoning is relevant for even younger patients. Legal risks can also be managed, although the FDA, CDC, and Department of Health and Human Services (HHS) should move quickly to provide clarity.

BACKGROUND Patients with chronic pain face significant barriers in finding clinicians to manage long-term opioid therapy (LTOT). For patients on LTOT, it is increasingly common to have them sign opioid treatment agreements (OTAs). OTAs enumerate the risks of opioids, as informed consent documents would, but also the requirements that patients must meet to receive LTOT. While there has been an ongoing scholarly discussion about the practical and ethical implications of OTA use in the abstract, little is known about how clinicians (...) use them and if OTAs themselves modify clinician prescribing practices. OBJECTIVE To determine how clinicians use OTAs and the potential impacts of OTAs on opioid prescribing. DESIGN We conducted qualitative analysis of four focus groups of clinicians from a large Midwestern academic medical center. Groups were organized according to self-identified prescribing patterns: two groups for clinicians who identified as prescribers of LTOT, and two who did not. PARTICIPANTS 17 clinicians from General Internal Medicine, Family Medicine, and Palliative Care were recruited using purposive, convenience sampling. APPROACH Discussions were recorded, transcribed, and analyzed for themes using reflexive thematic analysis by a multidisciplinary team. KEY RESULTS Our analysis identified three main themes: (1) OTAs did not influence clinicians’ decisions whether to use LTOT generally but did shape clinical decision-making for individual patients; (2) clinicians feel OTAs intensify the power they have over patients, though this was not uniformly judged as harmful; (3) there is a potential misalignment between the intended purposes of OTAs and their implementation. CONCLUSION This study reveals a complicated relationship between OTAs and access to pain management. While OTAs seem not to impact the clinicians’ decisions about whether to use LTOT generally, they do sometimes influence prescribing decisions for individual patients. Clinicians shared complex views about OTAs’ purposes, which shows the need for more clarity about how OTAs could be used to promote shared decision-making, joint accountability, informed consent, and patient education. (shrink)

The 21st century is undergoing an unprecedented productivity shift due to the use of disruptive technologies, including artificial intelligence, cloud computing, blockchain, big data, robotics, and augmented reality, among others. The use of these technologies is expanding across all sectors of the economy, blurring the boundaries between different activities, and digital systems are permeating them, leading to a reevaluation of knowledge and techniques in various fields of study. Accounting is not exempt from this reality, and blockchain technology is emerging as (...) a methodology that brings about substantial changes in topics that have been the conceptual and technical foundation of the discipline, such as double-entry bookkeeping. -/- This essay aims to approach blockchain from two objectives. The first is to present blockchain technology as a tool for accounting. This technology enables a paradigm shift in accounting by providing more transparent, secure, and reliable information. This leads to a review and reconsideration of certain roles of professionals in the field of economics, such as the external auditor as a guarantor of the reasonableness of accounting information. The conceptual frameworks related to the topic and how blockchain enables the incorporation of a third distributed ledger are presented. -/- The second approach of the essay seeks to analyze the responses of accounting regulations to a new type of assets that arise with the advent of blockchain, such as cryptocurrencies in general. The position adopted by the IASB is shown, which fails to provide a convincing response and has led to different regulatory bodies in various countries adopting their own positions. The result of the analysis is presented in a comparative table. -/- The essay concludes by reflecting on the changes brought about by this new technology and the role that academia should play. (shrink)

Relative Energy Deficiency in Sport (RED-S) is a syndrome of impaired health and performance that occurs as a result of low energy availability (LEA). Whilst many health effects associated with RED-S have been widely studied from a physiological perspective, further research exploring the psychological antecedents and consequences of the syndrome is required. Therefore, the aim of this study was to qualitatively explore athlete experiences of RED-S. Twelve endurance athletes (female n= 10, male n= 2; M age = 28.33 years) reporting (...) past or current experiences of RED-S, associated with periods of LEA, took part in semi-structured interviews designed to explore: contexts and mechanisms underpinning the onset of RED-S; the subjective experience of RED-S; and contexts and mechanisms influencing “recovery” from RED-S. Regardless of how RED-S was initiated, all athletes experienced a multitude of physiological impairments, accompanied by significant psychological distress. This paper contributes novel understanding of the complex interplay between physiological and psychological components of RED-S from the perspective of information-rich cases. The findings suggest that system-wide educational prevention and awareness interventions are vital for athletes and support personnel, such as coaches, parents, dieticians, psychologists, and sports medicine staff. (shrink)

According to Fernández, we self-attribute beliefs on the basis of their grounds, “bypassing” the beliefs to be attributed. My paper argues that this procedure runs into normative and metaphysical problems if certain changes in the subject’s ways of forming beliefs occur. If the change is accidental, the problem is normative: self-attributing the resulting belief by way of Bypass cannot be justified. The metaphysical problem is that it is unclear how the procedure can reflect any change in belief-formation at all, (...) given that it is not supposed to take into account anything but the (changing) grounds of the beliefs, not the beliefs themselves. (shrink)

Martin Heidegger (1889–1976) is one of the most influential philosophers of the twentieth century. His influence, however, extends beyond philosophy. His account of Dasein, or human existence, permeates the human and social sciences, including nursing, psychiatry, psychology, sociology, anthropology, and artificial intelligence. In this chapter, I outline Heidegger’s influence on psychiatry and psychology, focusing especially on his relationships with the Swiss psychiatrists Ludwig Binswanger and Medard Boss. The first section outlines Heidegger’s early life and work, up to and including the (...) publication of Being and Time, in which he develops his famous concept of being-in-the-world. The second section focuses on Heidegger’s initial influence on psychiatry via Binswanger’s founding of Daseinsanalysis, a Heideggerian approach to psychopathology and psychotherapy. The third section turns to Heidegger’s relationship with Boss, including Heidegger’s rejection of Binswanger’s Daseinsanalysis and his lectures at Boss’s home in Zollikon, Switzerland. (shrink)

This chapter provides an overview of how existential phenomenology has influenced qualitative research methods across a range of disciplines across the social, health, educational, and psychological sciences. It focuses specifically on how the concepts of “existential structures,” or “existentials”—such as selfhood, temporality, spatiality, affectivity, and embodiment—have been used in qualitative research. After providing a brief introduction to what qualitative research is and why philosophers should be interested in it, the chapter provides clear, straightforward examples of how qualitative researchers have used (...) existentials to analyze qualitative data and design qualitative studies. The chapter is intended to introduce philosophers to existential approaches to phenomenological qualitative research, with the aim of facilitating interdisciplinary dialogue and collaboration. (shrink)

“On the Subject Matter of Phenomenological Psychopathology” provides a framework for the phenomenological study of mental disorders. The framework relies on a distinction between (ontological) existentials and (ontic) modes. Existentials are the categorial structures of human existence, such as intentionality, temporality, selfhood, and affective situatedness. Modes are the particular, concrete phenomena that belong to these categorial structures, with each existential having its own set of modes. In the first section, we articulate this distinction by drawing primarily on the work of (...) Martin Heidegger—especially his study of the ontological structure of affective situatedness (Befindlichkeit) and its particular, ontic modes, which he calls moods (Stimmungen). In the second section, we draw on a study of grief to demonstrate how this framework can be used when conducting phenomenological interviews and analyses. In the concluding section, we explain how this framework can be guide phenomenological studies across a broad range of existential structures. (shrink)

In this paper I offer an alternative phenomenological account of depression as consisting of a degradation of the degree to which one is situated in and attuned to the world. This account contrasts with recent accounts of depression offered by Matthew Ratcliffe and others. Ratcliffe develops an account in which depression is understood in terms of deep moods, or existential feelings, such as guilt or hopelessness. Such moods are capable of limiting the kinds of significance and meaning that one can (...) come across in the world. I argue that Ratcliffe’s account is unnecessarily constrained, making sense of the experience of depression by appealing only to changes in the mode of human existence. Drawing on Merleau-Ponty’s critique of traditional transcendental phenomenology, I show that many cases of severe psychiatric disorders are best understood as changes in the very structure of human existence, rather than changes in the mode of human existence. Working in this vein, I argue that we can make better sense of many first-person reports of the experience of depression by appealing to a loss or degradation of the degree to which one is situated in and attuned to the world, rather than attempting to make sense of depression as a particular mode of being situated and attuned. Finally, I argue that drawing distinctions between disorders of structure and mode will allow us to improve upon the currently heterogeneous categories of disorder offered in the DSM-5. (shrink)

In this paper I examine the ways in which our language and terminology predetermine how we approach, investigate and conceptualise mental illness. I address this issue from the standpoint of hermeneutic phenomenology, and my primary object of investigation is the phenomenon referred to as “mania”. Drawing on resources from classical phenomenology, I show how phenomenologists attempt to overcome their latent presuppositions and prejudices in order to approach “the matters themselves”. In other words, phenomenologists are committed to the idea that in (...) our everyday, natural attitude, we take for granted a number of prejudices and presuppositions that predetermine how we conceive of and understand what we experience. In order to properly approach the phenomena themselves, we need to find ways of neutralising our presuppositions and prejudices in order to develop new (and hopefully more accurate) accounts of the phenomena under investigation. One of the most popular examples of such an attempt at neutralisation is what Edmund Husserl calls the epoché, which is the practice of bracketing out or suspending presuppositions. However, later phenomenologists developed alternative approaches. Martin Heidegger, for instance, engaged in etymological analyses to discover latent meanings in our language and terminology. Hans-Georg Gadamer also engaged in historical analyses of how our traditions sediment into latent prejudices. After discussing the various ways in which phenomenologists have attempted to neutralise presuppositions and prejudices prior to engaging in their investigations, I apply some of these principles and methods to the domain of psychopathology, and discuss some of the prejudices inherent in contemporary discussions of the phenomenon of mania. I examine recent attempts to link the phenomenon that we today refer to as “mania” with the ancient Greek concept of “μανία” (mania), and argue that the practice of linking contemporary and historical concepts can be detrimental to attempts at reclassifying disorders. In addition, I consider the implications of the shift in terminology from “manic depressive illness” to “bipolar disorder” – especially how conceiving of mania as one of two “poles” predetermines its description by both clinicians and patients. Finally, I address the implications of the headings under which mania and bipolar disorder are discussed within diagnostic manuals. For example, I discuss the removal of the headings of affective and mood disorders in the DSM-5, and the explicit decision by the authors to place bipolar disorder between depressive disorders and schizophrenia. What I aim to accomplish in this paper is not so much a phenomenological investigation of mania as it is a pre-phenomenological investigation. In other words, I offer a preparatory investigation of the phenomenon (or phenomena) referred to as “mania” in contemporary discourse, with the intention of laying the groundwork for further phenomenological and psychological research. (shrink)

Alex Byrne and Jordi Fernández propose two different versions of a transparency theory of self-knowledge. According to Byrne, we self-attribute beliefs by an inference from what we take to be facts about the world (following a rule he calls BEL). According to Fernández, we self-attribute the belief that p on the basis of a prior mental state, a state which constitutes our grounds for the belief that p (thereby realizing a procedure he calls Bypass). In this paper, I (...) present the two theories in outline and discuss various objections concerning their normative (Can the procedure give us knowledge?) and metaphysical aspects (Is the procedure functional?). I conclude that especially the metaphysical objections against Bypass are somewhat more difficult to counter than those against BEL and that the modifications required of Fernández’s theory make it very similar to Byrne’s. -/- Alex Byrne y Jordi Fernández proponen dos diferentes versiones de la teoría de la transparencia del autoconocimiento. Según Byrne, para autoatribuir creencias inferimos qué es lo que creemos a partir lo que tomamos como hechos sobre el mundo (siguiendo una regla que Byrne llama BEL). Según Fernández, autoatribuimos la creencia de que p con base en un estado anterior a esta creencia, un estado que fundamenta la creencia de que p (realizando un procedimiento que él llama Bypass). En este artículo expongo las dos teorías y discuto objeciones que conciernen su aspecto normativo (¿puede el procedimiento darnos conocimiento?) y metafísico (¿es funcional el procedimiento?). Concluyo que en especial las objeciones metafísicas son más graves en el caso de Bypass que en el de BEL y que las modificaciones requeridas de la teoría de Fernández la asemejan mucho a la de Byrne. (shrink)

Gianni Vattimo's Non-religious Christianity. Weakening of being, secularization and divine kenosis.

This chapter provides an overview of how existential phenomenology has influenced qualitative research methods across a range of disciplines across the social, health, educational, and psychological sciences. It focuses specifically on how the concepts of “existential structures,” or “existentials”—such as selfhood, temporality, spatiality, affectivity, and embodiment—have been used in qualitative research. After providing a brief introduction to what qualitative research is and why philosophers should be interested in it, the chapter provides clear, straightforward examples of how qualitative researchers have used (...) existentials to analyze qualitative data and design qualitative studies. The chapter is intended to introduce philosophers to existential approaches to phenomenological qualitative research, with the aim of facilitating interdisciplinary dialogue and collaboration. (shrink)

El propósito del trabajo consistirá en explicar las relaciones del pensamiento de Nietzsche con la metafísica occidental, así como las razones por las que éste podría ser considerado como “el último metafísico”, según la interpretación de Heidegger, de acuerdo con su idea de la Voluntad de poder (Wille zur Macht). Se explicará cómo su pensamiento implicaría un acabamiento o culminación, en tanto llevaría hasta el extremo el pensamiento del ente en cuanto tal, pero, a la vez, se mantendría aún dentro (...) de los confines de la metafísica, de acuerdo con la tesis heideggeriana. Esta tesis será examinada a la luz del pensar de otro intérprete de Nietzsche y Heidegger: el filósofo italiano Gianni Vattimo, a fin de ver lo cierto en ella, y si acaso Heidegger hizo una justa valoración del pensamiento nietzscheano. En relación con esto, profundizaremos en la oposición, en particular, de Vattimo a la interpretación heideggeriana de Nietzsche, quien argumenta que en la filosofía de Nietzsche es posible hallar elementos de real superación de la metafísica, y que incluso ésta podría augurar un pensar post-metafísico. Finalmente, me centraré en la respuesta que presenta Heidegger frente al problema, la cual propone “un nuevo inicio” del pensar, para el cual habrían de confluir el “evento apropiador” o Ereignis con las determinaciones de erigir fundamento sobre el abismo [Ab-grund]. (shrink)

Authors from all over the world unite in an effort to cultivate dialogue between Asian and Western philosophy. The papers forge a new, East-West comparative path on the whole range of issues in Kant studies. The concept of personhood, crucial for both traditions, serves as a springboard to address issues such as knowledge acquisition and education, ethics and self-identity, religious/political community building, and cross-cultural understanding. Edited by Stephen Palmquist, founder of the Hong Kong Philosophy Café and well known for both (...) his Kant expertise and his devotion to fostering philosophical dialogue, the book presents selected and reworked papers from the Kant in Asia conference, held in Hong Kong in May 2009. In addition to keynote essays by Patricia Kitcher (Columbia), Günter Wohlfart (Wuppertal), and Cheng Chung-ying (Hawaii), the book contains 64 contributed essays. The latter include contributions from Andrew Brook, David Cummiskey, Rainer Enskat, Wolfgang Ertl, Hans Feger, Klaus-Gerd Giesen, Ronald Green, Martin Moors, Ulrich Seeberg, Susan Shell, Rein Vos, Günter Zoeller, and numerous Asian philosophers. (shrink)

DESENVOLVIMENTO EMBRIONÁRIO E DIFERENCIAÇÃO SEXUAL -/- E. I. C. da Silva Departamento de Agropecuária – IFPE Campus Belo Jardim Departamento de Zootecnia – UFRPE sede -/- 1.1 INTRODUÇÃO O sexo foi definido como a soma das diferenças morfológicas, fisiológicas e psicológicas que distinguem o macho da fêmea permitindo a reprodução sexual e assegurando a continuidade das espécies. Os processos de diferenciação sexual são realizados durante o desenvolvimento embrionário, onde ocorre a proliferação, diferenciação e maturação das células germinativas e primordiais, precursoras (...) de ovócitos e espermatozoides em fêmeas e machos, respectivamente. Assim, os embriões machos e fêmeas iniciam o seu desenvolvimento de forma semelhante, de modo que em ambos os sexos se estabelecem em estruturas idênticas a partir das quais se formarão os órgãos reprodutores correspondentes a cada sexo. O conhecimento da origem e do desenvolvimento do aparelho genital é indispensável para entender sua função e as alterações que produzem infertilidade ou esterilidade. 1.2 DETERMINAÇÃO DO SEXO CROMOSSÔMICO Nos mamíferos, o sexo cromossômico é determinado no momento da fertilização, quando um óvulo, que contém um cromossomo X, é fecundado por um espermatozoide portador de um cromossomo X ou um cromossomo Y. No primeiro caso, o complemento cromossômico seria XX, o que originaria uma fêmea (sexo homogamético), e no segundo daria como resultado um macho com a fórmula cromossômica XY (sexo heterogâmico). 1.3 A GÔNADA INDIFERENCIADA A primeira manifestação das gônadas se aprecia no embrião em forma de um par de eminências longitudinais chamadas cristas ou dobras gonodais, situadas em ambos os lados da linha média entre os mesonefros (rins em desenvolvimento) e do mesentério dorsal. Nos embriões dos mamíferos, as células germinativas primordiais (CGP) manifestam-se em estágios precoces do desenvolvimento, podendo ser detectadas pela primeira vez na metade da gastrulação. As CGP são células grandes, de citoplasma claro e núcleo grande e redondo, localizadas na parede do saco vitelino, perto do alantoide. Essas células possuem grande capacidade de proliferação e vão migrar desde o endoderma do intestino e o epitélio do saco vitelino, através do mesentério, até as cristas gonodais. Isso ocorre por volta do 26° dia da gestação no bovino. Sua migração realiza-se graças aos movimentos de translocação passiva e deslocamento ameboide ativo. Desconhece-se o mecanismo pelo qual estas células são dirigidas para as cristas gonodais, porém foram estudadas algumas moléculas que se expressam durante sua migração e que poderiam desempenhar um papel importante na diferenciação deste tipo celular. A fosfatase alcalina é uma enzima que tem sido usada como marcador de CGP para determinar a sua origem e migração. Num estudo recente, foi inserido um marcador fluorescente que se exprime unicamente nas células germinativas primordiais de embriões transgênicos, e utilizando este marcador e a fosfatase alcalina determinou-se a origem e o padrão de migração destas células. O primeiro sinal de diferenciação das células germinativas primordiais é a expressão de fosfatase alcalina, e esta apareceu pela primeira vez na parte mais posterior da linha primitiva. No sétimo dia de desenvolvimento no embrião do camundongo, o endoderma visceral (AF+) é substituído pelo endoderma definitivo (AF-) originado na parte anterior da linha primitiva. O fator de transcrição Oct-4 é expresso nas CGP de ambos os sexos, pelo que acredita-se estar envolvido na mantença a totipotêncialidade das células. O receptor tirosina quinase, cujo ligante é o fator de Steel, é outra das moléculas que expressam as CGP. Tem sido demonstrado que este receptor possui um papel muito importante na sobrevivência deste tipo celular. Existem outros fatores que promovem a sobrevivência e/ou proliferação de CGP in vitro. Em experiências realizadas com o fator de transformação beta I (TGFβ-I), observou-se que este tem um efeito negativo sobre a proliferação das CGP. Outra atividade que tem sido postulada a este fator é o de um agente quimioatraente que possivelmente possa direcionar a migração destas células para a gônada. a) Um formado pelas células germinativas primordiais (precursoras dos gametas masculinos ou femininos), rodeadas de células somáticas das quais posteriormente se derivarão as células de Sertoli no macho e as células da granulosa na fêmea. b) O tecido que formará o estroma da gônada: tecido conjuntivo, vasos sanguíneos e as células intersticiais com atividade esteroidogênica (células de Leydig no testículo e a teca interna do ovário). As células somáticas do primórdio gonodal originam-se do mesoderma. Inicialmente são de três tipos: mesenquimáticas, mesoteliais e endoteliais. As células mesenquimáticas e mesoteliais iniciam grande atividade proliferativa ao chegar as CGP. Observa-se então uma condensação de células de origem mesotelial e mesenquimatoso que forma um agregado compacto denominado "blastema gonodal". A partir deste primórdio embrionário, diferenciam-se dois tecidos gonodais: os cordões sexuais e o estroma. Os cordões sexuais são arranjos epiteliais que se encontram delimitados por uma folha basal, e dentro deles encontramos as CGP. Por sua vez, no estroma encontram-se células do tipo mesenquimático e vasos sanguíneos. Neste momento, as gônadas são indiferenciadas e bipotencialmente sexuais, sendo impossível diferenciar, morfologicamente, uma gônada masculina de uma feminina, mas no caso dos machos genéticos já existe uma diferenciação da gônada a nível molecular. Nesta fase já se encontram presentes as estruturas das quais se desenvolvem os dutos mesonéfricos ou de Wolff precursores do aparelho genital masculino e os dutos paramesonéfricos ou de Müller que darão origem ao aparelho reprodutor feminino. Há uma série de fatores envolvidos no desenvolvimento precoce da gônada, entre os quais o fator esteroidogênico I (SFI: Steroidogenic fator l), que é um membro da subfamília de receptores nucleares, receptores órfãos. Este fator de transcrição tem um local de ligação ao DNA composto por dois dedos-de-Zinc. O SFI foi identificado como um ativador de genes envolvidos na biossíntese de esteroides em diferentes células. O SFI está presente durante o desenvolvimento embrionário em regiões associadas com funções endócrinas como gônadas, adrenais, pituitárias e hipotálamos. Os animais homozigotos para o gene SFI defeituoso, necessitam de gônadas e adrenais e têm a função gonadotrófica alterada. Os ratos sem SFI carecem de gonadotrofos e têm um desenvolvimento anormal do núcleo ventro-medial do hipotálamo; em particular as gônadas deixam de se desenvolver entre os dias 11 a 15 e degeneram-se por apoptose. No entanto, a crista genital forma-se e é colonizada pelas células germinativas, o que indica que estas continuam a receber o sinal adequado para a sua migração. Portanto, o SFI não está envolvido no desenvolvimento precoce da gônada e do sistema urogenital, mas parece estar envolvido na manutenção do crescimento das células somáticas presentes na gônada indiferenciada. O gene associado ao tumor de Wilms (WTI: Wilm's tumor Associated) está envolvido no desenvolvimento da gônada e do rim. Durante o desenvolvimento embrionário, WTI se expressa em todo o mesoderma intermediário e posteriormente na gônada indiferenciada, bem como no rim em formação. WTI regula o sinal indutivo do mesênquima para o epitélio celômico dos mesonefros. Se este for o caso, então WTI é responsável pelo crescimento da crista genital ao dirigir a entrada do epitélio celômico. Dado que estas células darão origem às células de Sertoli, a carência de WTI pode causar o desenvolvimento de embriões XY como fêmeas simplesmente porque não se formam as células de Sertoli. Em geral, todos os genes importantes na diferenciação do mesoderma intermediário e do sistema urogenital intervêm no desenvolvimento da gônada precoce. 1.4 DIFERENCIAÇÃO GONODAL O desenvolvimento das gônadas e ductos genitais descritos até o momento, é o mesmo para ambos os sexos. Igualmente, os genes descritos, que estão envolvidos no desenvolvimento das gônadas, ductos genitais e migração das células germinativas, afetam igualmente os embriões com genótipo XX ou XY. A gônada primitiva consiste anatomicamente de uma medula (interna) e uma crosta (externa), e de acordo com o local onde ocorre a colonização das células germinativas, diferenciara em testículo ou um ovário, respectivamente. Nos mamíferos, a primeira manifestação estrutural de diferenciação sexual é detectada na gônada dos machos, onde as células germinativas estão localizadas na medula. A diferenciação do testículo inicia-se quando os cordões sexuais se separam do epitélio celômico como consequência dos arranjos produzidos por uma invasão do mesênquima e vasos sanguíneos que provoca a compactação dos cordões, agora denominados cordões testiculares. As células que rodeiam os cordões se achatam e formam as células mioides, que são responsáveis pela formação das membranas basais. As células do epitélio interno, ou seja, as células de Sertoli, têm duas funções principais: o suporte das CGP e a síntese da hormona antimulleriana, responsável pela regressão dos ductos de Müller e secretada durante o período de diferenciação sexual. As células do estroma que rodeiam os cordões testiculares diferenciam-se para formar vários tipos de células: células mioides, fibroblastos, endotélio e células de Leydig, que são as mais importantes pela sua atividade endócrina. Posteriormente, os cordões testiculares dão origem aos túbulos seminíferos, que contêm o epitélio que produzirá os espermatozoides ao chegar à puberdade. Na fêmea, durante os estágios iniciais de diferenciação gonodal, não se observam mudanças em relação à gônada indiferenciada, só pode-se observar um certo crescimento devido à proliferação de células somáticas e germinativas. As células germinativas iniciam um período de proliferação, que termina com o início da meiose. Iniciada a meiose, dá-se o processo de foliculogênese; neste momento os cordões epiteliais se fragmentam, de tal maneira que cada ovócito fica rodeado de células epiteliais cobertas por uma folha basal fina (figura 1). Para que a gônada primitiva se desenvolva em testículo é indispensável a presença do cromossoma Y, independentemente do número de cromossomas X que contenha o genoma de um indivíduo. O gene determinante do testículo encontra-se localizado no cromossoma Y, denominado sry em ratos e SRY em humanos. O gene sry se expressa durante o desenvolvimento embrionário na crista genital de embriões de camundongos. A expressão é detectável no dia 10,5, pouco depois do aparecimento das cristas genitais, atinge o seu máximo durante o dia 11,5 e mantém-se até pouco depois de ocorrerem os primeiros sinais morfológicos de diferenciação testicular no dia 12,5. Este padrão de expressão é compatível com a teoria de que sry atua induzindo a ativação dos genes (figura 2) que conduzem ao desenvolvimento testicular, sem que exista a necessidade da expressão contínua de sry para manter a diferenciação do testículo após o dia 12,5. Como mencionado anteriormente, a gônada primitiva é composta por vários tipos de células. No entanto, as células germinativas primordiais não são o local de expressão do sry, já que os embriões que necessitam de células germinativas mantêm a expressão de sry e desenvolvem o sexo gonodal normalmente. As células somáticas na gônada em desenvolvimento incluem também as células de suporte. Sabe-se que é nestas células que o sry é expresso para que se diferenciem em células de Sertoli, e a expressão transitória de sry indica que deve ativar a outros genes para a manutenção das células de Sertoli. Uma vez diferenciadas as células de Sertoli, elas se encarregarão da diferenciação do resto das células na gônada. -/- Figura 1: Representação da diferenciação dos órgãos genitais internos. Adaptado de BRONSON, 1989. Figura 2: Cascada de genes envolvidos na diferenciação sexual, adaptado de KOOPMAN, 1999. O fator sry é necessário para a diferenciação do testículo. Embora não se conheçam os genes que provavelmente regulam esse gene, estudos realizados em camundongos demonstram que este gene parece coordenar-se com certos genes autossômicos. Entre estes genes autossômicos, o sox9, que é produzido pelas células de Sertoli uma vez que são estimuladas por sry, de modo que sox9 é um dos genes relacionados estruturalmente com sry. O Sox9 funciona como um fator de transcrição, mas não se sabe se a proteína tem qualquer outra função estrutural; este gene exprime-se abundantemente nos condrócitos e está relacionado com defeitos do aparelho ósseo chamados displasia campomélica. Curiosamente, os pacientes XY com esta condição sofrem frequentemente de reversão do sexo. O Sox9 é um dos poucos genes, além do SRY, do qual as mutações demonstraram interferir com a determinação sexual masculina. No entanto, apenas 75% dos pacientes com anomalias esqueléticas de tipo displasia campomélica têm reversão sexual e não foram encontrados casos de reversão sexual devido a um defeito de Sox9 que não seja acompanhado de defeitos esqueléticos. Isso indica que o Sox9 é apenas um membro da rede de genes que são ativados para determinar a diferenciação sexual, enquanto a rota que rege a condrogênese é mais sensível a perturbações deste. O momento em que se detecta a expressão do gene Sox9 (11dpc em ratos) coincide com a máxima expressão de sry, o que poderia indicar a possibilidade de que sry regule positivamente a Sox9. De fato, na região do promotor de Sox9 há um local de união ao que potencialmente se pode unir o sry. A expressão de Sox9 durante a diferenciação sexual sugere um papel abaixo de sry na diferenciação das células de Sertoli. O cromossoma X também é importante na diferenciação gonodal. O gene DAX-I foi isolado do lócus DSS (Dosage sensitive sex reversal) do cromossoma X. DAX-I é parte da cascata de determinação sexual, mas não é necessário para a formação do testículo. DAX-I é um membro dos receptores nucleares conhecidos como receptores órfãos. Este gene demonstrou ser um poderoso repressor da transcrição de SFI e de vários genes. Os padrões de expressão de DAX-I são complementares daqueles de SFI, ambos expressos nas cristas genitais. Em resumo, dada a evidência exposta, desenvolveu-se a hipótese de que DAX-I é um antagonista de sry; esse antagonismo é dependente dos níveis relativos de DAX-I e sry e de um limiar que varia de espécie para espécie. A DAX-I foi classificada como o gene antitestículo. Na fêmea (cariótipo XX) é importante que ocorra a inativação de um dos cromossomas sexuais X para que se mantenha o equilíbrio genético ao igualar o conteúdo de DNA dos cromossomas. Esse cromossoma inativado constitui o chamado corpúsculo de Barr. No entanto, para que a meiose se realize, é necessário dos dois cromossomas X ativos nos ovócitos para assegurar a diferenciação ovárica e a fertilidade. 1.5 DIFERENCIAÇÃO DOS DUCTOS SEXUAIS O embrião possui, além das gônadas indiferenciadas, dois sistemas de ductos: os de potencialidade masculina denominam-se ductos de Wolff ou mesonéfricos, e os de potencialidade feminina se chamam ductos de Müller ou paramesonéfricos (figura 1). Se a diferenciação gonodal levou à formação de um testículo, a partir do ducto mesonéfrico ou de Wolff se desenvolverão os ductos eferentes, o epidídimo, os ductos deferentes e as vesículas seminais. As hormonas importantes no desenvolvimento do aparelho genital masculino são a testosterona, produzida pelas células de Leydig, e sua forma 5α reduzida, a 5α di-hidrotestosterona. Acredita-se que a testosterona é responsável pela virilização dos ductos de Wolff, e a di-hidrotestosterona dos órgãos genitais externos. No macho, os canais de Müller atrofiam-se devido à ação de uma hormona fetal de origem testicular denominada hormona inibidora das estruturas de Müller (HIM) ou hormona antimulleriana. Este processo começa assim que os cordões espermáticos se formam e se diferenciam as células de Sertoli. A existência de HIM foi proposta baseada em estudos realizados em bezerras freemartin, devido à existência de uma hormona responsável pela atresia dos ductos de Müller que na fêmea dá origem ao útero e aos ovidutos. Essa hormona provoca a involução do aparelho genital do bovino nas gestações gemelares nas quais os produtos de diferente sexo têm comunicação sanguínea por ter ocorrido a anastomose dos vasos de ambas as placentas (figura 3). A HIM é uma glicoproteína pertencente à subfamília de TGFβ, é expressa pelas células que darão origem às células de Sertoli e é um dos primeiros marcadores de diferenciação nestas células. A HIM é secretada na vida adulta pelas células de Sertoli no testículo e por células da granulosa no ovário. No rato a HIM é expressa-se no 12° dia em um teste padrão que segue muito de perto o aumento na expressão de sry. No macho, esta secreção de HIM continua durante a vida fetal e adulta, contudo os níveis de HIM declinam na puberdade devido a um aumento na secreção de testosterona. Vários fatores intervêm na regulação do gene de HIM, incluindo os acima descritos SFI e Sox9. O gene HIM contém segmentos de DNA que são conservados em várias espécies de vertebrados. Existe um nexo de ligação para SFI, que ativa a transcrição de HIM. A mutação no local de ligação de SFI resulta em reversão do sexo em indivíduos XY incluindo genitais femininos normais, presença de um útero formado enfatizando a importância de SFI na determinação sexual e na expressão de HIM. Embora SFI seja um bom candidato como regulador de HIM, é expresso em outras células, como as de Leydig e adrenais, que não expressam HIM. Em contrapartida, Sox9 é expresso unicamente nas células de Sertoli que são as produtoras de HIM. O gene HIM também tem um nexo de ligação para Sox9. Além disso, Sox9 pode atuar sinergicamente com SFI para promover a secreção de HIM. Ao contrário destes dois fatores de transcrição, DAX-I antagoniza a ação de Sox9 e provavelmente SFI sobre o promotor de HIM. Assim, para que as células de Sertoli secretem HIM, a transcrição de DAX-I deve diminuir. Figura 3: Representação da diferenciação dos órgãos genitais externos. Adaptado de BRONSON, 1989. Os ductos de Wolff tornam-se o sistema de ejaculação do macho. A porção mais próxima dos testículos dá origem ao epidídimo, a parte central ao ducto deferente e a porção mais distal às vesículas seminais. A próstata e a parte membranosa da uretra do macho desenvolvem-se a partir da porção pélvica do seio urogenital. A virilização e diferenciação dos ductos de Wolff dependem da produção de testosterona pelo testículo. Quanto aos órgãos genitais externos do macho, o tubérculo genital é ampliado e as dobras uretrais se fundem para formar a uretra peniana. A fusão das dobras uretrais aproxima os tubérculos genitais para formar o escroto (figura 4). Figura 4: Diferenciação do aparelho genital da fêmea e do macho. Adaptado de KOOPMAN, 1989. A diferenciação dos órgãos genitais da fêmea ocorre de forma passiva, já que a ausência de testículos e por isso da hormona inibidora dos ductos de Müller (HIM), assim como dos andrógenos virilizantes, favorece o desenvolvimento dos ductos de Müller, enquanto os de Wolff sofrem atrofia. A porção cefálica dos ductos de Müller dá origem aos ovidutos, que na sua terminação caudal se fundem com o útero. O contato dos ductos de Müller com o seio urogenital induz uma intensa proliferação celular que resulta na formação da área uterovaginal localizado entre o seio urogenital e os ductos de Müller. As células do prato uterovaginal proliferam e aumentam a distância entre as duas estruturas criando o espaço que formará a vagina quando o prato é canalizado e forma um lúmen. Em contraste com o que ocorre no macho, na fêmea a maior parte do seio urogenital se mantém exposta na superfície da abertura onde desembocam a vagina e a uretra. O tubérculo urogenital da fêmea tem um crescimento limitado e forma o clitóris. A sequência de passos da diferenciação sexual do aparelho genital é resumida na tabela 1. Tabela 1: Destino em desenvolvimento dos rudimentos sexuais dos fetos macho e fêmea dos mamíferos -/- Rudimento sexual Macho Fêmea Gônada Testículo Ovário Ductos de Müller (Paramesonéfricos) Vestígios Útero, parte da vagina, ovidutos Ductos de Wolff (Mesonéfricos) Ductos eferentes deferentes, epidídimo, vesículas seminais Vestígios Seio urogenital Uretra, próstata, glândulas bulbouretrais Parte da vagina, uretra, vestíbulo, glândulas vestibulares Tubérculo genital Pênis Clitóris Pregas vestibulares Escroto Lábios vulvares Fonte: HAFEZ, 2004. 1.6 DIFERENCIAÇÃO SEXUAL DO HIPOTÁLAMO Os processos de diferenciação sexual não se limitam apenas às células somáticas do organismo do feto, mas incluem também os centros nervosos superiores do cérebro. Assim, da mesma maneira que a gônada e os ductos sexuais se desenvolvem para o tipo feminino ou masculino, propôs-se que o cérebro pode ser "masculinizado" ou permanecer "Feminizado". A diferenciação do hipotálamo vai depender do ambiente esteroidal do neonato e ocorre na fase perinatal. Estes eventos serão de grande transcendência na vida reprodutiva do indivíduo. Tanto a fêmea como o macho nascem com a capacidade de secreção de gonadotropinas de acordo com um padrão cíclico; contudo, no macho, a exposição do hipotálamo à ação dos andrógenos testiculares durante os primeiros dias da vida extrauterina provoca a masculinização, com o qual o hipotálamo do macho é programado para que a secreção de gonadotropinas se realize a um ritmo relativamente constante por parte da hipófise (secreção tônica). Na fêmea, tanto a secreção tônica como a cíclica se conservam. No entanto, observou-se que a injeção de testosterona ou o transplante de testículo na rata fêmea durante os primeiros dias de vida, suprime a sua futura atividade estral (secreção cíclica). Por outro lado, se os ovários forem transplantados para o rato macho normal castrado na idade adulta, o animal não desenvolve qualquer atividade cíclica, mas se os machos transplantados forem castrados ao nascer, o ovário é capaz de efetuar mudanças cíclicas e ovulações. Isto foi demonstrado em roedores, mas não em animais domésticos ou na espécie humana. Portanto, o padrão de secreção de gonadotropinas, seja cíclico ou tônico, não depende da hipófise, mas do hipotálamo e sua correta diferenciação. 1.7 CONCLUSÕES A maioria dos conhecimentos no campo da biologia do desenvolvimento e, muito especificamente, dos processos de diferenciação sexual têm sido originados de estudos relacionados com desordens congênitas, que na sua maioria devem-se a defeitos de genes específicos. A análise detalhada destas desordens permitiu entender alguns mecanismos endócrinos, moleculares e genéticos envolvidos na diferenciação sexual. A identificação do gene sry como determinante do testículo foi uma contribuição crucial e abriu as portas à compreensão dos mecanismos moleculares e celulares relacionados com o desenvolvimento do testículo. Se este gene não estiver presente, é criado um programa genético alternativo para levar a cabo a diferenciação gonodal para o ovário. Finalmente, devemos ter presente que é necessária uma correlação entre mudanças morfológicas e expressão de genes durante o desenvolvimento para entender os mecanismos relacionados com a diferenciação. -/- Apoio -/- Realização -/- REFERÊNCIAS BIBLIOGRÁFICAS ANDERSON, Robert et al. The onset of germ cell migration in the mouse embryo. Mechanisms of development, v. 91, n. 1-2, p. 61-68, 2000. AUSTIN, Colin Russell; SHORT, R. V. Reproduction in Mammals: Volume 1, Germ Cells and Fertilization. Londres: Cambridge University Press, 1972. BRONSON, Franklin H. Mammalian reproductive biology. Chicago: University of Chicago Press, 1989. BUEHR, Mia. The primordial germ cells of mammals: some current perspectives. Experimental cell research, v. 232, n. 2, p. 194-207, 1997. BYSKOV, Anne G. Differentiation of mammalian embryonic gonad. Physiological reviews, v. 66, n. 1, p. 71-117, 1986. CAPEL, Blanche et al. Migration of mesonephric cells into the mammalian gonad depends on Sry. Mechanisms of development, v. 84, n. 1-2, p. 127-131, 1999. CAPEL, Blanche. The battle of the sexes. Mechanisms of development, v. 92, n. 1, p. 89-103, 2000. DERIVAUX, Jules; BARNABÉ, Renato Campanarut. Reprodução dos animais domésticos. Zaragoza: Acribia, 1980. DOMENICE, Sorahia et al. Aspectos moleculares da determinação e diferenciação sexual. Arquivos Brasileiros de Endocrinologia & Metabologia, v. 46, n. 4, p. 433-443, 2002. DONAHOE, Patricia K. et al. Mullerian inhibiting substance activity in bovine fetal, newborn and prepubertal testes. Biology of reproduction, v. 16, n. 2, p. 238-243, 1977. HAFEZ, Elsayed Saad Eldin; HAFEZ, B. Reprodução animal. São Paulo: Manole, 2004. HANLEY, Neil A. et al. Steroidogenic factor 1 (SF-1) is essential for ovarian development and function. Molecular and cellular endocrinology, v. 163, n. 1-2, p. 27-32, 2000. HIORT, Olaf; PAUL-MARTIN, H. The molecular basis of male sexual differentiation. European journal of endocrinology, v. 142, n. 2, p. 101-110, 2000. HOLY, Lubos; MARTÍNEZ JÚSTIZ, G. Colab. Biología de la reproducción bovina. Havana: Revolucionária, 1975. JOSSO, Nathalie et al. The role of anti-Müllerian hormone in gonadal development. Molecular and cellular endocrinology, v. 145, n. 1-2, p. 3-7, 1998. JOST, Alfred et al. Studies on sex differentiation in mammals. In: Proceedings of the 1972 Laurentian Hormone Conference. Londres: Academic Press, 1973. p. 1-41. KNOBIL, Ernst. Knobil and Neill's physiology of reproduction. EUA: Gulf Professional Publishing, 2006. KOFMAN ALFARO, S.; MERCHANT LARIOS, H.; PEREZ PALACIOS, G. Diferenciacion sexual. I. Bases biologicas del dimorfismo sexual. Rev. invest. clín, p. 349-59, 1982. KOOPMAN, Peter. Sry and Sox9: mammalian testis-determining genes. Cellular and Molecular Life Sciences CMLS, v. 55, n. 6-7, p. 839-856, 1999. MCDONALD, L. E. Veterinary endocrinology. Lea & Febiger, Philadelphia, Pa, 1969. MEIZEL, S.; JOHNSON, M. H. Development in mammals. MH Johnson, Ed, v. 3, p. 1-64, 1978. MELLO, Maricilda Palandi de; ASSUMPÇÃO, Juliana de G.; HACKEL, Christine. Genes envolvidos na determinação e diferenciação do sexo. Arquivos Brasileiros de Endocrinologia & Metabologia, v. 49, n. 1, p. 14-25, 2005. -/- REFERÊNCIAS BIBLIOGRÁFICAS MERCHANT-LARIOS, H. Ovarian differentiation. The Vertebrate Ovary, p. 47-81, 1978. MIES FILHO, Antonio. Reprodução dos animais. Porto Alegre: Sulina, 1987. NEF, Serge; PARADA, Luis F. Hormones in male sexual development. Genes & Development, v. 14, n. 24, p. 3075-3086, 2000. PARKER, Keith L.; SCHEDL, Andreas; SCHIMMER, Bernard P. Gene interactions in gonadal development. Annual review of physiology, v. 61, n. 1, p. 417-433, 1999. SWAIN, Amanda; LOVELL-BADGE, Robin. Mammalian sex determination: a molecular drama. Genes & development, v. 13, n. 7, p. 755-767, 1999. WILHELM, Dagmar; PALMER, Stephen; KOOPMAN, Peter. Sex determination and gonadal development in mammals. Physiological reviews, v. 87, n. 1, p. 1-28, 2007. WILSON, Jean D.; GRIFFIN, James E.; GEORGE, Fredrick W. Sexual differentiation: early hormone synthesis and action. Biology of reproduction, v. 22, n. 1, p. 9-17, 1980. -/- Emanuel Isaque Cordeiro da Silva Belo Jardim, 07 de Maio de 2020. (shrink)

In this essay I address the question, “What is the subject matter of phenomenological research?” I argue that in spite of the increasing popularity of phenomenology, the answers to this question have been brief and cursory. As a result, contemporary phenomenologists lack a clear framework within which to articulate the aims and results of their research, and cannot easily engage each other in constructive and critical discourse. Examining the literature on phenomenology’s identity, I show how the question of phenomenology’s subject (...) matter has been systematically neglected. It has been overshadowed by an unending concern with phenomenology’s methodological identity. However, an examination of recent contributions to this literature reveals that a concern with articulating phenomenology’s subject matter has gradually increased, although such articulations remain preliminary. In light of this, I delineate, define, and illustrate three layers of phenomenological research, which I term “existentials,” “modes,” and “prejudices.” While the delineation of these layers is drawn primarily from classical phenomenological texts, they are defined and illustrated through the use of more contemporary literature. Following the articulation of this subject matter, I briefly consider some of the debates—both foundational and applied—that can be facilitated by the adoption of this framework. (shrink)

This book offers a philosophical account of memory. Memory is remarkably interesting from a philosophical point of view. Our memories interact with mental states of other types in a characteristic way. They also have some associated feelings that other mental states lack. Our memories are special in terms of their representational capacity too, since we can have memories of objective events, and we can have memories of our own past experiences. Finally, our memories are epistemically special, in that beliefs formed (...) on the basis of our memories are protected from certain errors of misidentification and justified in a way which does not rely on any cognitive capacity other than memory. The aim of the book is to explain these features of memory. It proposes that memories have a particular functional role which involves past perceptual experiences and beliefs about the past and suggests that memories have a particular content as well; they represent themselves as having a certain causal origin. The book then accounts for the feelings associated with our memories as the experience of some of the things that our memories represent; things such as our own past experiences, or the fact the memories originate in those experiences. It also accounts for the special justification for belief afforded by our memories in terms of the content that memories have. The resulting picture is a unified account of several philosophically interesting aspects of memory. (shrink)

Anydomainofscientificresearchhasitssustainingorthodoxy. Thatis, research on a problem, whether in astronomy, physics, or biology, is con- ducted against a backdrop of broadly shared assumptions. It is these as- sumptionsthatguideinquiryandprovidethecanonofwhatisreasonable-- of what "makes sense." And it is these shared assumptions that constitute a framework for the interpretation of research results. Research on the problem of how we see is likewise sustained by broadly shared assump- tions, where the current orthodoxy embraces the very general idea that the business of the visual system is to (...) create a detailed replica of the visual world, and that it accomplishes its business via hierarchical organization and by operatingessentiallyindependently of other sensorymodalitiesas well as independently of previous learning, goals, motor planning, and motor execution. (shrink)

Se ofrece una interpretación de la filosofía política de María Zambrano desde el sufismo deIbnʿArabī. Primero, explicaremos tres nociones centrales en la obra del Šayḫ, como la doble fidelidad a la dimensión de la «incomparabilidad» (tanzīh) y de la «similaridad» (tašbīh), la «nueva creación» (ḫalq al-ǧadīd) y el «hombre perfecto» (insān al-kāmil). Después, trataremos algunos de los textos más políticos de Zambrano, como Horizonte del liberalismo(1929), Isla de Puerto Rico (1940), «Martí, camino de su muerte» (1953) y Persona y democracia (...) (1958). Según veremos, el marco ontológico, epistemológico y antropológicodel maestro andalusí permite ahondar en el sentido místico del discurso político zambraniano. (shrink)

Today, many philosophers write on topics of contemporary interest, such as emerging technologies, scientific advancements, or major political events. However, many of these reflections, while philosophically valuable, fail to contribute to those who may benefit the most from them. In this article, we discuss our own experience of engaging with nursing researchers and practicing nurses. By drawing on the field of philosophical phenomenology, we intervene in a longstanding debate over the meaning of “empathy” in nursing, which has important implications for (...) nursing research, training, and practice. However, our intention is not only to introduce and discuss this philosophical intervention. Rather, we present this intervention as a model for how philosophers might successfully engage with the field of nursing, and perhaps with other fields as well, with the aim of effecting positive change in research or practice. The article proceeds in five parts. First, we introduce the problem of conceptual clarity in nursing and explain why many nursing concepts are still in need of refinement. Second, we discuss the origins of the concept of empathy in nursing and outline the challenges associated with borrowing theory from other fields. Third, we explain how nurses tend to conceptualize empathy today, drawing upon the psychological distinction between cognitive and emotional empathy. Fourth, we discuss our intervention in this debate and explain how we attempt to resolve existing conceptual confusions by developing the concept of empathy from the ground up. Fifth, we conclude by briefly reflecting upon some of the challenges of interdisciplinary engagement and providing some recommendations based upon our own experience. (shrink)

Empathy is a topic of continuous debate in the nursing literature. Many argue that empathy is indispensable to effective nursing practice. Yet others argue that nurses should rather rely on sympathy, compassion, or consolation. However, a more troubling disagreement underlies these debates: There’s no consensus on how to define empathy. This lack of consensus is the primary obstacle to a constructive debate over the role and import of empathy in nursing practice. The solution to this problem seems obvious: Nurses need (...) to reach a consensus on the meaning and definition of empathy. But this is easier said than done. Concept analyses, for instance, reveal a profound ambiguity and heterogeneity of the concept of empathy across the nursing literature. Since the term “empathy” is used to refer to a range of perceptual, cognitive, emotional, and behavioral phenomena, the presence of a conceptual ambiguity and heterogeneity is hardly surprising. Our proposal is simple. To move forward, we need to return to the basics. We should develop the concept from the ground up. That is, we should begin by identifying and describing the most fundamental form of empathic experience. Once we identify the most fundamental form of empathy, we will be able to distinguish among the more derivative experiences and behaviors that are addressed by the same name and, ideally, determine the place of these phenomena in the field of nursing. The aim of this article is, consequently, to lay the groundwork for a more coherent concept of empathy and thereby for a more fruitful debate over the role of empathy in nursing. In Part 1, we outline the history of the concept of empathy within nursing, explain why nurses are sometimes warry of adapting concepts from other disciplines, and argue that nurses should distinguish between adapting concepts from applied disciplines and from more theoretical disciplines. In Part 2, we show that the distinction between emotional and cognitive empathy—borrowed from theoretical psychology—has been a major factor in nurses’ negative attitudes toward emotional empathy. We argue, however, that both concepts fail to capture the most fundamental form of empathy. In Part 3, we draw on and present some of the seminal studies of empathy that can be found in the work of phenomenological philosophers including Max Scheler, Edmund Husserl, and Edith Stein. In Part 4, we outline how their understanding of empathy may facilitate current debates about empathy’s role in nursing. (shrink)

In this chapter, I introduce phenomenology and phenomenological psychopathology by clarifying the kind of implicit experiences that phenomenologists are concerned with. In section one, I introduce the phenomenological concept of pre-reflective experience, focusing especially on its relation to the concept of implicit experience. In section two, I introduce the structure of pre-reflective self-consciousness, which has been studied extensively by both classical phenomenologists and contemporary phenomenological psychopathologists. In section three, I show how phenomenological psychopathologists rely on an account of pre-reflective self-consciousness (...) to better understand the experience of schizophrenia and I outline some of the methodological challenges that arise in this field of research. This introduction should facilitate critical engagement and collaboration between phenomenologists and researchers working across a variety of disciplines, including psychology, psychiatry, the cognitive sciences, and analytic philosophy of mind. (shrink)

El autor del artículo edita y estudia una inscripción funeraria inédita de época helenística encontrada en Aptera (Creta) por la arqueóloga griega V. Ninioú-Kindelí. El texto de la inscripción dice así: A) Σώσανδρος | Βίτωνος. B) Ἀμφιμήδης | Σωσάνδρω.

Are philosophy and literature allies or enemies in Jorge Luis Borges's fictions? In this paper, I argue that Borges can satisfy membership in the allies camp because his fictions provide the imaginative scenarios the allies believe are so necessary to this coalition; however, because his stories question philosophy's hold on reality, they can also seem to fall into the enemies camp by countervailing any claim philosophy has on reality and truth; although, ultimately, the manner in which Borges forges an alliance (...) between philosophy and literature will be for reasons not traditionally accepted by those in either the allies or enemies camps. (shrink)

Inspired by the work of Sellars, Cumpa (2014, 2018) and Buonomo (2021) have argued that we can evaluate our metaphysical proposals on fundamental categories in terms of their capacity for reconciling the scientific and the manifest image of the world. This criterion of fundamentality would allow us to settle the question of which categories among those proposed in the debate—e.g., substance, structure or facts—have a better explanatory value. The aim of this essay is to argue against a central assumption of (...) the criterion: semantic descriptivism. Specifically, I aim at showing that the criterion rests on the idea that the manifest picture is mostly a description of the world, and thus, it commits us with certain realism. Instead, I argue that at least some of the vocabulary we use to construct our manifest picture of the world, mental vocabulary, is evaluative rather than descriptive and thus creates problems in reconcile the manifest picture with scientific psychology and neurosciences. I conclude with some remarks on alternatives that could provide a way out of the fundamentality criterion. (shrink)

Contemporary psychiatry finds itself in the midst of a crisis of classification. The developments begun in the 1980s—with the third edition of the Diagnostic and Statistical Manual of Mental Disorders —successfully increased inter-rater reliability. However, these developments have done little to increase the predictive validity of our categories of disorder. A diagnosis based on DSM categories and criteria often fails to accurately anticipate course of illness or treatment response. In addition, there is little evidence that the DSM categories link up (...) with genetic findings, and even less evidence that they... (shrink)

The purpose of this chapter is to determine what is to remember something, as opposed to imagining it, perceiving it, or introspecting it. What does it take for a mental state to qualify as remembering, or having a memory of, something? The main issue to be addressed is therefore a metaphysical one. It is the issue of determining which features those mental states which qualify as memories typically enjoy, and those states which do not qualify as such typically lack. In (...) sections 2 and 3, I will discuss the two main existing conceptions of the conditions that a mental state must satisfy to count as an episode of remembering. The first of these approaches is backward-looking. It puts forward conditions that strictly concern the aetiology of the mental state. I will argue that the conditions offered by the backward-looking approach are both too strong and too weak: They rule out mental states which, intuitively, count as memories while including mental states which, intuitively, do not qualify as memories. The second approach is forward-looking. It puts forward conditions that only concern the use that the subject makes of the mental state while forming beliefs about their own life. I will argue that the conditions proposed by the forward-looking approach are both too weak and too strong as well. However, the discussion of the two approaches will allow us to extract some helpful lessons on the constraints that any proposal about the nature of remembering should respect. An alternative approach aimed at incorporating those lessons will be offered in section 4 by drawing on the literature on functionalism. In section 5, I will argue that this approach can, on the one hand, accommodate as memories those mental states which indicate that the backward-looking approach and the forward-looking approach are too strict while, on the other hand, excluding those mental states which suggest that the two alternative approaches are too permissive. Accordingly, I will conclude that construing memory along functionalist lines is a satisfactory approach to the nature of remembering. (shrink)

Amazon Book Review Series of “Wild Wise Weird”.

Transhumanism is a challenging movement that invites us to rethink what defines humanity, including what we value and regret the most about our existence. Vulnerability is a key concept that require thorough philosophical scrutiny concerning transhumanist proposals. Vulnerability can refer to a universal condition of human life or, rather, to the specific exposure to certain harms due to particular situations. Even if we are all vulnerable in the first sense, there are also different sources and levels of vulnerability depending on (...) concrete social circumstances. Recently, Michael Hauskeller argued about a fundamental incompatibility between transhumanism and vulnerability. He understands vulnerability as an existential category, linked to woundability and mortality. This idea is akin to ontological vulnerability, but it does not notice some important features of social vulnerability. On the other side, transhumanism is a complex and non-homogeneous movement. Here we distinguish between a strong and a weak version of transhumanism. We will propose that the salience of vulnerability is only diminished in the radical one, while a moderate version can reconcile vulnerability with human enhancement. Thus, vulnerability, a concept that has recently gained much importance as an anthropological category in contemporary ethics, is not necessarily at odds with any transhumanist project. (shrink)

Memories are mental states with a number of interesting features. One of those features seems to be their having an intentional object. After all, we commonly say that memories are about things, and that a subject represents the world in a certain way by virtue of remembering something. It is unclear, however, what sorts of entities constitute the intentional objects of memory. In particular, it is not clear whether those are mind-independent entities in the world or whether they are mental (...) entities of some kind. The purpose of this chapter is to map the different positions on this issue, and to highlight the virtues and difficulties for each of the options. In Section 2, I will specify the question of what the intentional objects of memory are by clarifying the relevant notions of memory and intentional object. In Section 3, I will motivate the significance of identifying the intentional objects of memory by exploring the relations between, on the one hand, the intentionality of memory and, on the other hand, the phenomenology and the epistemology of memory. In Section 4, I will consider two natural candidates for being the intentional objects of memory, namely, worldly entities and mental entities, and I will raise some concerns for each of the two candidates. A promising alternative will emerge, in Section 5, as preserving the virtues of the two original candidates while avoiding their difficulties. The alternative will concern a certain combination of worldly and mental entities; a combination that involves both causal and truth-making relations. I will conclude by sketching how the alternative candidate can shed some light on the phenomenological and epistemological issues raised in the third section. (shrink)

Are those judgments that we make on the basis of our memories immune to error through misidentification? In this paper, I discuss a phenomenon which seems to suggest that they are not; the phenomenon of observer memory. I argue that observer memories fail to show that memory judgments are not IEM. However, the discussion of observer memories will reveal an interesting fact about the perspectivity of memory; a fact that puts us on the right path towards explaining why memory judgments (...) are indeed IEM. The main tenet in the account of IEM to be proposed is that this aspect of memory is grounded, on the one hand, on the intentionality of perception and, on the other hand, on the relation between the intentionality of perception and that of memory. (shrink)

Reformation commentators were well aware of the allegorical referents for Leviathan and Behemoth in the book of Job, representing the powerful states of Ancient Egypt and Assyria, but played them down. Hobbes did not.

A widespread view in philosophy claims that inner speech is closely tied to human metacognitive capacities. This so-called format view of inner speech considers that talking to oneself allows humans to gain access to their own mental states by forming metarepresentation states through the rehearsal of inner utterances (section 2). The aim of this paper is to present two problems to this view (section 3) and offer an alternative view to the connection between inner speech and metacognition (section 4). According (...) to this alternative, inner speech (meta)cognitive functions derivate from the set of commitments we mobilize in our communicative exchanges. After presenting this commitment-based approach, I address two possible objections (section 5). (shrink)

Phenomenology has been adapted for use in qualitative health research, where it’s often used as a method for conducting interviews and analyzing interview data. But how can phenomenologists study subjects who cannot accurately reflect upon or report their own experiences, for instance, because of a psychiatric or neurological disorder? For conditions like these, qualitative researchers may gain more insight by conducting observational studies in lieu of, or in conjunction with, interviews. In this article, we introduce a phenomenological approach to conducting (...) this kind of observational research. The approach relies on conceptual grounding to focus a study on specific aspects of the participants’ experiences. Moreover, the approach maintains the openness to novel discoveries that qualitative research requires while also providing a structured framework for data collection and analysis. To illustrate its practical application, we use examples of hemispatial neglect—a neurologic disorder in which patients characteristically lack awareness of their own illness and bodily capacities. However, the approach that we describe can be applied more broadly to the study of complex illness experiences and other experiential alterations. (shrink)

In this paper, I examine recent phenomenological research on both depressive and manic episodes, with the intention of showing how phenomenologically oriented studies can help us overcome the apparently paradoxical nature of mixed states. First, I argue that some of the symptoms included in the diagnostic criteria for depressive and manic episodes in the DSM-5 are not actually essential features of these episodes. Second, I reconsider the category of major depressive disorder (MDD) from the perspective of phenomenological psychopathology, arguing that (...) severe depressive episodes should not be characterized by any particular moods (such as sadness, hopelessness, or guilt), and should instead be characterized by a diminished capacity for finding ourselves situated in and attuned to the world at all. In other words, the affective dimension of depression should be characterized as a change in the way we have moods, not as a change from one kind of mood to another. Third, I turn to mania, arguing that manic episodes, taken as the opposite of depressive episodes, should be characterized not by any particular moods (such as euphoria, grandiosity, or even irritability), but should instead be characterized by an enhanced or heightened capacity for finding ourselves situated in and attuned to the world. In other words, the affective dimension of mania, like the affective dimension of depression, should be understood as a change in the way we have moods, not as a change from one kind of mood to another. Fourth, I return to the phenomenon of mixed states and argue that the affective dimension of depression and mania, when conceived along the phenomenological lines I set forth in the previous sections, dissolves the paradox of mixed states by showing that the essential characteristics of depression and mania cannot and do not coincide. Many cases of mixed states are diagnosed because moods that we take to be essential features of either depression or mania arise within the context of what is considered to be the opposite kind of episode (e.g. dysphoria, typically associated with depression, often arises in what is otherwise considered a manic state). However, if we conceive of the affective dimension of depression as a decrease in the degree to which one is situated in and attune to the world through moods, and the affective dimension of mania as an increase in the degree to which one is situated in and attuned to the world through moods, then the particular mood one finds oneself in is simply irrelevant to the diagnosis of either depression or mania. As a result, the manifestation of any particular moods in what otherwise seems to be a pure manic or depressive episode does not constitute a mixed state. (shrink)

Episodic memory has a distinctive phenomenology. One way to capture what is distinctive about it is by using the notion of mental time travel: When we remember some fact episodically, we mentally travel to the moment at which we experienced it in the past. This way of distinguishing episodic memory from semantic memory calls for an explanation of what the experience of mental time travel is. In this paper, I suggest that a certain view about the content of memories can (...) shed some light on the experience of mental time travel. This is the view that, when a subject remembers some fact episodically, their memory represents itself as coming from a perception of that fact. I propose that the experience of mental time travel in memory is the experience of representing one of the elements in this complex content, namely, the past perceptual experience of the remembered fact. In defence of this proposal, I offer two considerations. Firstly, the proposal is consistent with the idea that memories enjoy a temporal phenomenology (specifically, a feeling of pastness). Secondly, the proposal is consistent with the possibility that some of our other cognitive capacities might yield an experience of mental time travel which can be oriented towards the future. I argue that the received conception of mental time travel is in tension with those two ideas. (shrink)

Aims and Objectives. This article uses the concept of embodiment to demonstrate a conceptual approach to applied phenomenology. -/- Background. Traditionally, qualitative researchers and healthcare professionals have been taught phenomenological methods, such as the epoché, reduction, or bracketing. These methods are typically construed as a way of avoiding biases so that one may attend to the phenomena in an open and unprejudiced way. However, it has also been argued that qualitative researchers and healthcare professionals can benefit from phenomenology’s well-articulated theoretical (...) framework, which consists of core concepts, such as selfhood, empathy, temporality, spatiality, affectivity, and embodiment. -/- Design. This is a discursive article that demonstrates a conceptual approach to applied phenomenology. -/- Method. To outline and explain this approach to applied phenomenology, the Discussion section walks the reader through four stages of phenomenology, which progress incrementally from the most theoretical to the most practical. -/- Discussion. Part one introduces the philosophical concept of embodiment, which can be applied broadly to any human subject. Part two shows how philosophically trained phenomenologists use the concept of embodiment to describe general features of illness and disability. Part three illustrates how the phenomenological concept of embodiment can inform empirical qualitative studies and reflects on the challenges of integrating philosophy and qualitative research. Part four turns to phenomenology’s application in clinical practice and outlines a workshop model that guides clinicians through the process of using phenomenological concepts to better understand patient experience. -/- Conclusion and Relevance to Clinical Practice. A conceptual approach to applied phenomenology provides a valuable alternative to traditional methodological approaches. Phenomenological concepts provide a foundation for better understanding patient experience in both qualitative health research and clinical practice, and therefore provide resources for enhancing patient care. (shrink)

Hegel’s interpretation of Sophocles’ play Antigone is central to an understanding of woman’s role in the Hegelian system. Hegel is fascinated by this play and uses it in both the Phenomenology and the Philosophy of Right to demonstrate that familial ethical life is woman’s unique responsibility. Antigone is revealed as the paradigmatic figure of womanhood and family life in both the pagan and modern worlds although there are fundamental differences between these two worlds for Hegel. In order to situate the (...) interpretation of this play within its wider context I shall begin with a brief outline of the pagan world described in the Phenomenology. I will then consider the interpretation of this play within the analysis of the modern world in the Philosophy of Right. Throughout, the focus will be on woman’s role in Hegel’s philosophy. (shrink)

The aim of this paper is to offer a version of the so-called conversational hypothesis of the ontogenetic connection between language and mindreading (Harris 1996, 2005; Van Cleave and Gauker 2010; Hughes et al. 2006). After arguing against a particular way of understanding the hypothesis (the communicative view), I will start from the justificatory view in philosophy of social cognition (Andrews 2012; Hutto 2004; Zawidzki 2013) to make the case for the idea that the primary function of belief and desire (...) attributions is to justify and normalize deviant patterns of behaviour. Following this framework, I elaborate upon the idea that development of folk psychological skills requires the subjects to engage in conversationally mediated joint and cooperative activities in order to acquire the conceptual capacity of ascribing propositional attitudes. After presenting the general version of the hypothesis, I present several testable sub-hypotheses and some psychological studies that give empirical plausibility to the hypothesis. (shrink)

Recently, there have been calls to develop a more contextual approach to phenomenological psychopathology—an approach that attends to the socio-cultural as well as personal and biographical factors that shape experiences of mental illness. In this Perspective article, we argue that to develop this contextual approach, phenomenological psychopathology should adopt a new paradigm case. For decades, schizophrenia has served as the paradigmatic example of a condition that can be better understood through phenomenological investigation. And recent calls for a contextual approach continue (...) to use schizophrenia as their primary example. We argue, in contrast, that substance misuse provides a better paradigm case around which to develop a contextually sensitive phenomenological psychopathology. After providing a brief vignette and analysis of a case of substance misuse, we explain why this kind of condition requires considerable sensitivity and attention to context, better motivating the incorporation and development of new contextually sensitive approaches. (shrink)

This paper brings new work to bear on the perennial question about Hobbes's atheism to show that as a debate about scepticism it is falsely framed. Hobbes, like fellow members of the Mersenne circle, Descartes and Gassendi, was no sceptic, but rather concerned to rescue physics and metaphysics from radical scepticism by exploring corporealism. In his early letter of November 1640, Hobbes had issued a provocative challenge to Descartes to abandon metaphysical dualism and subscribe to a ?corporeal God?; a provocation (...) to which the Frenchman angrily responded, but was perhaps importantly influenced. Hobbes's minimal realism was consonant with atheism, to which Descartes felt he was being forced. Moreover, Hobbes was unrelenting in his battle against Cartesian dualism, for which he saw Robert Boyle's experimental science as a surrogate. (shrink)

The objective of this paper is to analyze the theistic and atheistic positions regarding the so-called “Problem of Evil”, highlighting their main arguments in an analysis of the solidity of their assumptions, the inferences they draw from them, the biases of these philosophical positions and the inanity of both positions to deduce from them the existence or non-existence of God. I will argue that the difference between both positions, based on the concept of God, is that the atheistic argument is (...) fallacious, while the theistic one is probabilistic but not necessarily accurate. I will end by proposing a different reading of the problem, arguing that both, the atheistic and theistic arguments, lack solidity to demonstrate the existence or non-existence of God based on the problem of evil, and that the question of the problem of evil is vain and sterile for that purpose. (shrink)

ABSTRACT: Hobbes belonged to philosophical and scientific circles grappling with the big question at the dawn of modern physics: materialism and its consequences for morality. ‘Matter in motion’ may be a core principle of this materialism but it is certainly inadequate to capture the whole project. In wave after wave of this debate the Epicurean view of a fully determined universe governed by natural laws, that nevertheless allows to humans a sphere of libertas, but does not require a creator god (...) or teleology to explain it, comes up against monotheism and its insistence on the incoherence of an ordered world in the absence of a God and his purposes. The following questions were central to this debate: Can we understand the universe as law-governed in the absence of a god? If so, what room is there in a fully determined mechanical universe for human freedom? If humans do enjoy freedom, does the same hold for other animals? Is this freedom compatible with standard views of morality? (shrink)

John Searle’s theory of social ontology posits that there are indispensable normative components in the linguistic apparatuses termed status functions, collective intentionality, and collective recognition, all of which, he argues, make the social world. In this paper, I argue that these building blocks of Searle’s theory are caught in a petitio of constitutive circularity. Moreover, I note how Searle fails to observe language in reciprocal relation to the institutions which not only are shaped by it but also shape language’s practical (...) applications. According to Searle, social theorists that tried to show a connection between society, culture, and language all failed to see the constitutive role of language in the making of social reality. Consequently, I believe that Searle is himself guilty of a certain kind of blind presumption, and argue that Hegel’s philosophy of culture, which Searle dismisses as implausible, offers a more cohesive account of the normative transactions between human beings and their social world. (shrink)

In this article, I argue that phenomenological psychopathologists, despite their critical attitude toward mainstream psychiatry, still hold problematic prejudices about the nature of psychiatric conditions as illness or disorder. I suggest that phenomenological psychopathologists turn to resources in the neurodiversity and mad pride movements to critically reflect upon these prejudices and appreciate the methodological problems that they pose.