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)

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.

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)

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)

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)

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)

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)

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)

“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)

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)

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)

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)

The application of Artificial Intelligence (AI) in healthcare and epidemiology undoubtedly has many benefits for the population. However, due to its environmental impact, the use of AI can produce social inequalities and long-term environmental damages that may not be thoroughly contemplated. In this paper, we propose to consider the impacts of AI applications in medical care from the One Health paradigm and long-term global health. From health and environmental justice, rather than settling for a short and fleeting green honeymoon between (...) health and sustainability caused by AI, it should aim for a lasting marriage. To this end, we conclude by proposing that, in the upcoming years, it could be valuable and necessary to promote more interconnected health, call for environmental cost transparency, and increase green responsibility. (shrink)

The relationship between “Towards a Critique of Violence” (1921) and the work of Franz Kafka has been well established by several critical studies devoted to Walter Benjamin. However, it is striking that Benjamin himself, already well acquainted with the work of the Czech writer in 1921, never made any comment to Kafka’s work in this essay, and, more broadly, in any of the related texts that make up the project on the ‘Critique of Violence’. In this article, we analyze a (...) set of notions (Entstellung, Entsühnung, Zurechstellen) that allow us to establish a mediated relationship between this essay and the articles and letters that Benjamin devoted to Kafka in the 1930s. This relationship takes us back to the only piece in which Benjamin carries out an autonomous treatment of the “category of justice” (1916) in which he identifies -as it will happen eighteen years later, in the essay on Kafka (1934)- the locus of justice in the “non-violence”, thus untying the knot that binds in a perhaps indiscernible way in the Jewish tradition the notions of “messianism” and “violence”. (shrink)

In this chapter, we explain how Karl Jaspers’ concept of empathy can be expanded by drawing upon the tradition of philosophical phenomenology. In the first section, we offer an account of Jaspers' concepts of empathy and incomprehensibility as he develops them in General Psychopathology and “The Phenomenological Approach in Psychopathology.” In the second section, we survey the recent literature on overcoming Jaspers' notion of incomprehensibility and expanding his concept of empathy. In the third section, we outline the levels of investigation (...) at which phenomenological inquiries into psychopathology may proceed. These levels of human existence are, in descending order of depth, (1) phenomenal experiences, (2) interpretive frameworks, (3) modes of existence, and (4) existentials. In the fourth and final section, we argue that to fully empathically comprehend patients with schizophrenia and other mental disorders, the possibility of alterations at all four levels of existence must be acknowledged. (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)

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)

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.

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)

Despite considerable growth in understanding of various aspects of sporting and exercise embodiment over the last decade, in-depth investigations of embodied affectual experiences in running remain limited. Furthermore, within the corpus of literature investigating pleasure and the hedonic dimension in running, much of this research has focused on experiences of pleasure in relation to performance and achievement, or on specific affective states, such as enjoyment, derived after completing a run. We directly address this gap in the qualitative literature on sporting (...) and exercise embodiment by contributing novel insights on the mind-body pleasures of running via focusing analytic attention towards the pleasures recalled by runners as experienced during positive, rewarding running experiences. Applying conceptual insights drawn from sociological phenomenology, we analyse data from an in-depth, event-focused interview study with distance runners who reported positive, rewarding experiences in recent recreational runs. Through reflexive thematic analysis, we present findings in relation to three themes: (1) ‘running feels like it should’; (2) sensory engagements; and (3) time out. The study contributes fresh perspectives, both conceptually and in relation to data-collection approach, to a small literature on the lived experience of pleasure in sport, exercise and physical cultures. (shrink)

Quentin Skinner’s dedication to investigating Hobbes’s concept of liberty in a number of essays and books has born some unusual fruit. Not only do we see the enormous problems that Hobbes set himself by proceeding as he did, but Skinner’s careful analysis allows us to chart Hobbes’ ingenuity as he tried to steer a path between the Charybdis of determinism and the Scylla of voluntarism – not very successfully, as we shall see. The upshot is a theory of individual freedom (...) and civil liberty to challenge the classical republican traditionThis Article does not have an abstract. (shrink)

In this article, we develop a new approach to integrating philosophical phenomenology with qualitative research. The approach uses phenomenology’s concepts, namely existentials, rather than methods such as the epoché or reductions. We here introduce the approach to both philosophers and qualitative researchers, as we believe that these studies are best conducted through interdisciplinary collaboration. In section 1, we review the debate over phenomenology’s role in qualitative research and argue that qualitative theorists have not taken full advantage of what philosophical phenomenology (...) has to offer, thus motivating the need for new approaches. In section 2, we introduce our alternative approach, which we call Phenomenologically Grounded Qualitative Research (PGQR). Drawing parallels with phenomenology’s applications in the cognitive sciences, we explain how phenomenological grounding can be used to conceptually front-load a qualitative study, establishing an explicit focus on one or more structures of human existence, or of our being in the world. In section 3, we illustrate this approach with an example of a qualitative study carried out by one of the authors: a study of the existential impact of early parental bereavement. In section 4, we clarify the kind of knowledge that phenomenologically grounded studies generate and how it may be integrated with existing approaches. (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)

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)

Philosophers of logic are particularly interested in understanding the aims, epistemology, and methodology of logic. This raises the question of how the philosophy of logic should go about these enquires. According to the practice-based approach, the most reliable method we have to investigate the methodology and epistemology of a research field is by considering in detail the activities of its practitioners. This holds just as true for logic as it does for the recognised empirical and abstract sciences. If we wish (...) to systematically understand the aims and epistemology of logic, we are best placed achieving this by looking at what logicians do, rather than reflecting upon the nature of logic itself. In this entry, we outline the motivations for a practice-based approach towards the philosophy of logic and highlight its advantages over more “top-down” approaches, which attempt to infer conclusions about the nature of logic and its methodology on the basis of traditional assumptions about knowledge, metaphysics, or logic itself. We end by addressing several prominent concerns raised against the practice-based approach. (shrink)

Hobbes in Leviathan, chapter xv, 4, makes the startling claim: “The fool hath said in his heart, ‘there is no such thing as justice,’” paraphrasing Psalm 52:1: “The fool hath said in his heart there is no God.” These are charges of which Hobbes himself could stand accused. His parable of the fool is about the exchange of obedience for protection, the backslider, regime change, and the tyrant; but given that Hobbes was himself likely an oath-breaker, it is also self-reflexive (...) and self-justificatory. For, Hobbes’s fool is not a windbag, or one of the dumb mob, led astray by priests. He is, in the terminology of Psalm 52, an insipiens, a madman or raving lunatic, whose rebellion against God the King is his own destruction and that of his people. A long iconographic tradition portraying the fool as insipiens, Antichrist, heretical impostor and tyrant king, was at Hobbes’s disposal. (shrink)

Las máquinas aceleradas de Turing (ATMs) son dispositivos capaces de ejecutar súper-tareas. Sin embargo, el simple ejercicio de definirlas ha generado varias paradojas. En el presente artículo se definirán las nociones de súper-tarea y ATM de manera exhaustiva y se aclarará qué debe entenderse en un contexto lógico-formal cuando se pregunta por la existencia de un objeto. A partir de la distinción entre posibilidades lógicas y físicas se disolverán las paradojas y se concluirá que las ATMs son posibles y existen (...) como objetos abstractos. (shrink)

Recent archaeological discoveries show ancient, and particularly Near Eastern society to have been supremely contractual, while Mediterranean society was historically characterized by strong family structures, challenging the 19th century evolutionary Status-to-Contract canon.

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)

En el marco de los estándares profesionalizantes de la academia, con sus “rankings” y productividad científica, las humanidades subsisten. Una explicación de este fenómeno es que, según la ontología social, las razones para la acción independiente de deseos son piezas clave en la educación. Por ello, dichas razones, que constituyen obligaciones, también serían claves para el desarrollo de las humanidades. Aquí examino de qué forma el individualismo y la competencia tensionan la dinámica entre deseos y obligaciones. Ciertamente, el mercado valora (...) más la satisfacción de deseos que la teorización sobre la intencionalidad colectiva y su producto: la civilización humana. (shrink)

We make choices about our own appearance and evaluate others' choices – every day. These choices are meaningful for us as individuals and as members of communities. But many features of personal appearance are due to luck, and many cultural beauty standards make some groups and individuals worse off (this is called “lookism”). So, how are we to square these two facets of personal appearance? And how are we to evaluate agency in the context of personal beauty? I identify three (...) ways of responding to these questions: beauty advo- cacy, beauty skepticism, and beauty revisionism. Advocates connect an honorific sense of beauty with personal charac- ter. Skeptics focus on beauty standards, and primarily offer a social critique of beauty standards. Some skeptics suggest embracing other aesthetic ideals – even ugliness. Revision- ists critique beauty standards, but retain an honorific sense of beauty. Each position offers tools to evaluate personal agency as aesthetic agency, whether first-personally or through our appreciation of others' appearance. (shrink)

Buddhist philosophy asserts that human suffering is caused by ignorance regarding the true nature of reality. According to this, perceptions and thoughts are largely fabrications of our own minds, based on conditioned tendencies which often involve problematic fears, aversions, compulsions, etc. In Buddhist psychology, these tendencies reside in a portion of mind known as Store consciousness. Here, I suggest a correspondence between this Buddhist Store consciousness and the neuroscientific idea of stored synaptic weights. These weights are strong synaptic connections built (...) in through experience. Buddhist philosophy claims that humans can find relief from suffering through a process in which the Store consciousness is transformed. Here, I argue that this Buddhist 'transformation at the base' corresponds to a loosening of the learned synaptic connections. I will argue that Buddhist meditation practices create conditions in the brain which are optimal for diminishing the strength of our conditioned perceptual and behavioural tendencies. (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 ancient and modern worlds, although there are fundamental differences between these two worlds for Hegel. Through an immanent critique of (...) both the Phenomenology and the Philosophy of Right which focuses on the role of woman as presented by Hegel in the figure of Antigone, my analysis reveals the limitations of Hegel’s dialectical theory. (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)

Hobbes's interest in the power of the Image was programmatic, as suggested by his shifts from optics, to sensationalist psychology, to the strategic use of classical history, exemplified by Thucydides and Homer. It put a great resource at the disposal of the state-propaganda machine, with application to the question of state-management and crowd control.

Schwarz pursues a primordial theme by Freudian means, extrapolating from the psychogenesis of a person to the psychogenesis of a nation. He thus associates monarchy with culture in its infancy, displaying infantile narcisism and meglomania. But as perhaps the best worst case, Pharaonic Egypt, demonstrates, meglomania and narcissism expresssed in colossi, grandiose claims of the king that would shame even the gods, are more likely a sign of weakness than strength. And classical republicanism continues to maintain a monarchical element, now (...) transferred to presidents. (shrink)

This essay advances the following set of arguments: First, that we must take seriously Hobbes's claim in Behemoth that "the science of just & unjust" is a demonstrable science, accessible to those of even the meanest capacity. Second, that Leviathan is the work in which this science, intended as a serious project in civic education, is set out. Third, that Hobbes is prepared to accept, like Plato & Aristotle, "giving to each his own," as a preliminary definition of justice, from (...) which however, he draws some very un-Aristotelian conclusions. Fourth, that though in Hobbes's theory "just & unjust" are equivalent of "lawful & unlawful," this is far from being a simple statement of legal positivism, but rather the conclusion of a practical syllogism. Fifth, that the impediments to this demonstrable science of justice being universally accepted, on Hobbes's account, are twofold, explained in terms of religion & the role of preachers & educators produced by the universities, on the one hand, & by the activity of "democratical gentlemen" & classical republicans dominating parliament, on the other. Sixth, that Hobbes's account of the transition from jus to lex, specified in terms of a transition from the state of nature to that of civil society, although Epicurean in origin, is much closer to a conventional civil law position. Adapted from the source document. (shrink)

It is my thesis that Renaissance classical translations and imitations were often works of political surrogacy in a literary environment characterized by harsh censorship. So, for instance, the works of Homer, Virgil, and Lucan were read as coded texts, that ranged across the political spectrum.

Political fact-checkers evaluate the truthfulness of politicians’ claims. This paper contributes to an emerging scholarly debate on whether fact-checkers treat political parties differently in a systematic manner depending on their ideology (bias). We first examine the available approaches to analyze bias and then present a new approach in two steps. First, we propose a logistic regression model to analyze the outcomes of fact-checks and calculate how likely each political party will obtain a truth score. We test our model with a (...) sample of fact-checks from Newtral, a major Spanish fact-checker. Our model would signal bias under two assumptions: a) all political parties are on average equally accurate in their statements; b) the verification method gives precise instructions and is implemented systematically. We investigate this second assumption with a series of interviews with Newtral fact-checkers. We show that standard verification protocols are so loosely implemented that fact-checks reflect a set of journalistic decisions, rather than a bias in the statistical sense. We call for a more rigorous definition of verification methods as a pre-requisite for an unbiased assessment of politician’s claims. (shrink)

BioPortal is a Web portal that provides access to a library of biomedical ontologies and terminologies developed in OWL, RDF(S), OBO format, Protégé frames, and Rich Release Format. BioPortal functionality, driven by a service-oriented architecture, includes the ability to browse, search and visualize ontologies (Figure 1). The Web interface also facilitates community-based participation in the evaluation and evolution of ontology content.

The COVID-19 pandemic put immense pressure on healthcare systems globally, including those of highly developed countries like the United States and United Kingdom. During the pandemic, professional nursing organizations were the first to call attention to the disproportionate pandemic-related deaths among Filipino nurses. These organizations played a central role in addressing the various crises Filipino nurses faced due to their vulnerabilities as frontliners, ethnic minorities, and migrants in their host countries. Using the Volatile, Uncertain, Complexity, and Ambiguous (VUCA) framework, this (...) monograph assesses the pandemic-response actions and strategies of PNAA and PNAUK, two Filipino nursing associations in the US and UK. The major themes suggest that the two organizations are multifunctional entities with the capacity to act as lobbyists, research organizations, and decision-makers when adapting, strategizing, and coping with VUCA conditions. These findings corroborate previous findings on the potentiality of diasporic nursing organizations in addressing the gaps in government support for migrant workers in the healthcare industry. (shrink)

This essay, published in Political Theory in 1975, was one of the first to address the subject of the last two long books of Hobbes's Leviathan on religion. It addresses the purpose of these books and the relation between Hobbes's philosophy, ecclesiology and theology and the problems they raise.

This paper provides a semantic analysis of the particles afinal (European Portuguese) and alla fine (Italian) in terms of the notion of truth unpersistence, which can be situated at the intersection of epistemic modality and discourse structure. In the analysis proposed, the particles are propositional operators and require that the truth of a proposition p* fail to persist through a temporal succession of epistemic states, this proposition being incompatible with the prejacent, and that the interlocutors share knowledge of a previous (...) epistemic attitude toward p*. We analyze two main cases (plan-related and non plan-related propositions) and also show that these particles are indexical to one (or more) epistemic agent(s) and allow for shifts in perspective. (shrink)

As a representative of the papacy Bellarmine was an extremely moderate one. In fact Sixtus V in 1590 had the first volume of his Disputations placed on the Index because it contained so cautious a theory of papal power, denying the Pope temporal hegemony. Bellarmine did not represent all that Hobbes required of him either. On the contrary, he proved the argument of those who championed the temporal powers of the Pope faulty. As a Jesuit he tended to maintain the (...) relative autonomy of the state, denying the temporal powers ascribed by radical papalists and Augustinians. Their argument was generally framed as a syllogism: Christ, who possessed direct temporal power as both God and man, exercised it on earth; the Pope is the vicar of Christ; therefore the Pope possesses and may exercise direct temporal jurisdiction. Bellarmine simply denied that Christ had exercised the temporal power, which as God, it is true, he possessed. Moreover, he drew up and circulated a list of patristic passages collected under the title De Regno Christi quale sit, to prove to the Pope the orthodoxy of his position. (shrink)

This is part 1 of 6 of the dossier What Do We Talk about when We Talk about Queer Death?, edited by M. Petricola. The contributions collected in this article sit at the crossroads between thanatology and queer theory and tackle questions such as: how can we define queer death studies as a research field? How can queer death studies problematize and rethink the life-death binary? Which notions and hermeneutic tools could be borrowed from other disciplines in order to better (...) define queer death studies? The present article includes the following contributions: – MacCormack P., What does queer death studies mean?; – Radomska M., On queering death studies; – Lykke N., Death as vibrancy; – Hillerup Hansen I., What concreteness will do to resolve the uncertain; – Olson P., Queer objectivity as a response to denials of death; – Manganas N., The queer lack of a chthonic instinct. (shrink)