Research suggests that the rotational dynamics of an object underpins our perception of its weight. We examine the generalisability of that account using a more ecologically valid way of manipulating an object’s mass distribution , shape (cube or sphere), and lifting approach (lifting directly by the hand or indirectly using a handle or string). The results were in line with our predictions. An interaction effect was found where the mass distribution and lifting approach both associated with the lowest rotational dynamics made the stimulus appear lighter compared to other combinations. These findings demonstrate rotational dynamic effects in a more run-of-the-mill experience of weight perception than what has been demonstrated before using cumbersome stimuli. In the early days of experimental psychology, Weber  describeThe rotational dynamics account proposes that our perception of an object’s weight can be explained by the resistance to rotational forces that we experience in our limbs when we pick it up  mass distribution variations could influence the perceived weight of objects, (2) more rotationally symmetrical spheres could be perceived as lighter than cubes, and (3) the influence of an object’s mass distribution could diminish with non-direct  compared to direct  approaches of lifting. In addition to determining if rotational dynamics has an influence on weight perception, we also sought in a separate experiment to evaluate if the experimental changes in mass distributions were noticeable to the participants.A sample of 21 participants was collected; however, one was removed during the pre-processing process, as their scores in multiple conditions were 4 standard deviations (SDs) greater than our sample’s mean after normalising their data to the same scale as the other participants. Hence, the final sample was 20 participants . All participants were compensated with gift vouchers for their time. Participants reported being free of psychiatric, psychological and neurological disorders, as well as not currently taking medications that could make them drowsy. These exclusion criteria were in place so our sample reflected healthy brain functioning. All participants were also right-handed, as confirmed by the Flinders Handedness Survey . Within each set, one cube had its mass positioned at the “top” and another had its mass positioned at the “bottom”. There was also a cube with the mass distributed along its six faces (“outside”), one with the mass positioned internally in the geometric centre (“inside”), and finally, one with an “even” mass distribution  printed hollow cubes that were painted black and were 6 × 6 × 6 cm with a volume of 216 cm3) and mass (245.5 g), there were again minute differences in construction. The spheres had a circumference of 23.5 cm and a volume of 219 cm3, representing 3 cm3 more volume than the cubes, or approximately a 1% difference. Their actual weight after construction ranged from 247.1 g to 248 g . The spheres were filled in an identical manner to the cubes. The same sphere was used in both the “top” and “bottom” mass distribution trials, it was just rotated. Hence four spheres were used  and would have had a lower rotational inertia compared to the “bottom” objects. Finally, as compared to their cube counter parts, the spheres were more rotationally symmetrical given their shape, and were therefore predicted to be perceived as lighter.The manner with which participants lifted the objects was also manipulated. In one, the cubes were lifted with a handle with a pinching motion between the index finger and thumb. In another, the cubes were lifted from a ring on a 14-cm long string that was attached to the cubes. The last two lifting conditions allowed participants to use their entire hand to lift the spheres and clipless cubes directly. The above lifting conditions are referred to as Handle, String, Sphere and Cube, respectively. The objects lifted directly – the clipless cubes and spheres – allowed participants the best opportunity to detect differences in rotational dynamics as compared to the handles, which themselves conveyed more rotational information than the strings.The height of the surface on which the objects was placed was controlled for such that lifting occurred from the same height. In the direct lifting condition, the cubes were placed on a slight platform so they were at the same height as when the cubes had a handle attached to them . For the string condition, the cubes were placed on a lower surface, such that when the string had no slack, it too was at the same height as the top of the handle. In doing this, we ensured that there would be no differences in the joint along which rotation occurred and that rotational dynamics would not differ due to the starting location of the joints and consequently the axis of rotation.To help eliminate response biases  or incorrect (0).Statistical analyses were done using JASP  and GraphPad Prism . Where appropriate, Greenhouse-Geisser corrections were made for violations of sphericity, as determined by Mauchly’s test of sphericity. Mean %-scores were analysed with a 4  × 5  repeated-measures ANOVA to examine how the participant’s weight perception of the stimuli was influenced by their lifting approach and the object’s mass distribution. Tukey’s Honest Significant Difference (HSD) post hoc comparison tests were performed to further examine significant interactions and main effects Tukey, . SubjectTo summarise, in line with predictions, the first experiment found a significant interaction, indicating that the Sphere with the “inside” mass distribution was felt to be particularly light compared to the other stimuli and other significant comparisons. There was also a significant main effect of Lifting Approach where stimuli lifted by the Strings were perceived to be heavier than each of the other lifting approaches. A significant main effect of Mass Distribution was also found. This revealed that objects with the “inside” mass distribution were perceived to be lighter than those with the “bottom” and “even” distributions, and those with the “outside” distribution were also felt to be lighter than those with the “bottom” distribution. Experiment 2 revealed that participants were significantly more likely than chance at correctly identifying only the Sphere with the “bottom” mass distribution. Next, we provide more detailed statistics supporting these findings.p = .02, η2p = .12 .There was a significant Lifting Approach × Mass Distribution interaction, F = 2.6, see Fig. . Post hop = .006, η2p = .2 , 11.8 for those lifted directly with the Hand , and 13 as compared to the Sphere . In other words, objects lifted by the string were perceived as being uniquely heavy as compared to the lifting methods. All other comparisons were non-significant (p > .05).ANOVA revealed a significant main effect of Lifting Approach, F = 4.6, p = .004, η2p = .22 , and 1.9 , respectively. Objects with the “outside” mass distribution (mean = -0.6) were also found to be lighter than those with the “bottom” mass distribution (mean = 0.9), with a %-score mean difference of -1.4 . All other mass distribution differences were non-significant .ANOVA also revealed a significant main effect of Mass Distribution, F = 5.5, t(19) = 5, p < .001, d = 1.1, for a test value of > .25), having been identified by 79% of participants. As for the cubes, none of the mass distributions were correctly identified by participants at above chance levels .Regarding participants’ reports of perceived mass distribution see Fig. , out of We aimed to determine if the predictions of the rotational dynamics account of weight perception are evident with more naturalistic objects lifted in a more ecological manner than those used in earlier studies. In doing so, we manipulated the rotational dynamics and rotational symmetry of cubes and spheres, as well as our ability to detect them. Overall, the effects we found were in line with those predictions.Introduction, the rotational dynamics account of weight perception (Amazeen & Turvey, As highlighted in the Out of all possible factor combinations, the lightest perceived object was the one constructed with the mass distribution associated with the lowest rotational inertia – in the geometric centre of the object – in a shape that was the most symmetrical, being a sphere. Indeed, the sphere with the “inside” mass distribution accounted for over half of all the significant interaction comparisons. Additionally, it was significantly lighter than all the objects lifted with the strings, meaning that when the rotational dynamics of the objects were removed, their perceived weight increased. This was further supported by the main effect we found for the lifting approach: those objects lifted with strings were uniquely heavy as compared to those other approaches.Even though rotational dynamics affected weight perception, there was limited evidence to suggest that its awareness had an impact. In Experiment 2, participants could only discern the mass distribution of the sphere with its mass distributed on one side. This is interesting as how the mass was distributed in the object did influence how heavy it was perceived to be, as demonstrated by the main effect of mass distribution. This would suggest that awareness of subtle differences in rotational dynamics is not required for rotational dynamics to impact weight perception. The effects of rotational dynamics seem to occur outside of conscious awareness.Importantly for the rotational dynamics theory, our results confirm that weight perception can also change in a manner predicted by this theory when objects are more naturalistic and when rotational dynamics are not uncannily exaggerated. This lends support to the notion that rotational inertia is a broadly applicable physical influence contributing to the perception of object weights, rather than being relegated to an effect that only occurs under specific, artificial and favourable conditions.For example, as compared to differences in tensor objects, the differences in rotational dynamics between the stimuli we used would have been more subtle given that our stimuli were lighter and had less volume, which was reflected in their differences in mass distribution. Additionally, while there would have been some bodily rotation during the participants’ lifts, for example, in the wrist, elbow and shoulder, the natural lifting behaviour would have caused less bodily rotation as compared to previous studies using tensor objects, conceivably reducing the participant’s ability to feel it. Indeed, Experiment 2 reveals that participants were unable to judge the correct mass distributions for most stimuli. Yet, the interaction we found still had a medium effect size, speaking to the influence of rotational dynamics even outside of conscious awareness, most likely mediated by some sort of bottom-up mechanism.This suggestion highlights an interesting question for future research. Could a conscious awareness of differences in mass distribution amplify differences in weight perception, possibly in a top-down manner? While a matter more so for future research, this suggested difference has the potential to yield stronger effects. It is also worth noting that we used one consistent mass for all stimuli. Generalising our conclusions to objects with other masses requires further research.Related to the above, previous research using non-tensor objects also examined the influence of modifying the mass distribution of objects on their perceived weight. For example, Koseleff  shifted There are other interesting lessons to be had from our study. Within the size-weight illusion literature, for example, there is inconsistency in the method used to weight objects. Some authors indicate that they placed their weights in the geometric centre of the stimuli (Buckingham, Our results are difficult to reconcile with the mass-density account of weight perception (Wolf et al., In closing, our study provides evidence for the rotational dynamics explanation of weight perception in the ecological handling of naturalistic objects. This allows for a more generalised application of the theory than what was demonstrated before. Our results also highlight that explanations of weight perception and weight illusions should account for rotational dynamics. The underpinning of weight perception and weight illusions is likely multifactorial, and we posit that rotational dynamics is as an important factor to consider as mass, volume, density and expectations.


In this paper, I focus on teachers’ lived experiences during the COVID-19 outbreak. Specifically, I explore the emotional impact the abrupt shift to online teaching had on teachers’ work and life throughout the various phases of the lockdown. I develop my argument by analyzing teachers’ everyday work, using a qualitative approach, and constructing a small-scale empirical study. Philosophically, my attempt is phenomenologically developed and is framed by Heidegger’s and Arendt’s thoughts. Methodologically, my attempt falls within an emerging research horizon that combines educational philosophy with empirical research. Drawing from research data, I argue that teachers’ experience bears witness to a deep modification of the schooling space-time, namely, the horizon in which the very perception of students, themselves, and teaching arise. In the case of teachers experiencing discomfort, fear, and even angst, the totality of their gestures and emotions was, as it were, swallowed by this unknown and disquieting horizon; teachers in distress were experiencing the collapse of any projecting without being freed by projecting itself. In the case of teachers experiencing feelings of fulfillment and even joy, a different horizon was allowed to emerge. Such a different space-time, rather than producing a sense of distance and alienation, created a new intimacy and nearness, which allows for a different attitude toward the topics and the educational community. Students became more sensitive, susceptible to transformation, and open to what was being said. At the same time, relationships were caught in a new web of meanings that transcended them, thus giving birth to an educational experience in its own right. I conclude with some remarks about the building of the educational community. This study focuses on teachers’ experiences during the coronavirus disease (COVID-19) pandemic. Specifically, I explore the emotional impact the abrupt shift to online teaching had on teachers’ work and life throughout the various phases of the lockdown. I develop my argument by analyzing teachers’ everyday work, using a qualitative approach, and constructing a small-scale empirical study. This research stems from an in-service course I conducted and involves 13 secondary-school teachers (with students aged from 13 to 18) from different disciplines. The study is based on a combination of in-depth interviews, dialogues, and email conversations. Specifically, I collected teachers’ observations and insights when they originated—that is, during the course. Thereby, I reserved myself the opportunity to deepen the most interesting aspects in a manner and at a time that suited the teachers: via email, interviews via Google meet, WhatsApp messages and conversations. Methodologically, my endeavor falls within an emerging research horizon combining educational philosophy with empirical research d’Agnese .praesens,” as the condition upon which the continuity between past, present, and future arises  Heideggerian understanding of “The paper is organized in three parts and a conclusion. First, I expose the research’s context and methods grounding my study. Second, I aim to decipher teachers’ sensations of discomfort and anguish through Heidegger’s thought. Third, I analyze feelings of joy and fulfillment via the work of Arendt. In the conclusions, I summarize my attempt and draw further implications for teaching and education.In December 2019, Wuhan Municipal Health Commission in Wuhan City, Hubei province, China, reported “a cluster of pneumonia cases of unknown etiology, with a commonly reported link to Wuhan’s Huanan Seafood Wholesale Market ” ,” better known as “Coronavirus disease” or “Covid-19” , everything had to be done while children were struggling with online teaching and relatives were sick, without having the opportunity to see or touch them.In this context, a principal I knew, called me to a training session for teachers. Knowing the school and the dedicated teachers that work there, I accepted their invitation. Working with teachers is one of my favorite things and, at that moment, it seemed like a way to help.The subject of the course was really broad, namely, “Democracy, Technology, and Inclusion.” The group consisted of 30 secondary school teachers (with students aged 13 to 18) from different disciplines, and the course was based on voluntary participation.I began my course—one three-hour session per week for two months—and, as I typically do, I gave teachers time and space during the online class to share their questions, perspectives, experiences, and counterarguments. Right from the start, I could perceive a desire, even an urgency, to speak up and share doubts, observations, and experiences. Very soon, in the space devoted to discussion, such observations and experiences began to revolve around the situation they were facing: being online before their students with no training, while the world around us seemed to collapse. In the beginning, while acknowledging the urgency they felt—more or less, I was facing the same situation—I attempted to bring the discussion back to the subject of the course. Sometimes teachers, when discussing an issue, slowly slide onto other topics. Therefore, I am prepared to bring the discussion back to the core arguments, avoiding that the course may turn into a support group–as valuable as support groups can be. However, the more I tried to discuss the course topic, the more I scrolled through the slides, and the more I felt how futile and even phony my effort was. The teachers’ minds and hearts were elsewhere, and rightly so. My task at that moment was not so much to present Dewey’s view of democracy in terms of instruction and technology, but rather to give voice and legitimacy to their feelings and experiences, creating a space for the restoration of unity that many of them were demanding. This is what I tried to do.I abandoned my program and centered my course on “Engaging with the unexpected.” Meaningful experiences emerged, and the sharing of perspectives created a space for teachers to deal with the situation they were facing. Of course, I do not want to overstate my attempt, either in terms of helping teachers or in terms of revealing my research. In other words, the chaos, discomfort, powerlessness, and anxiety were not resolved. We merely created a space where feelings and fears were translated into language. As for my study, as Laura Duhan-Kaplan  has adeqBefore addressing methodological questions, a clarification about the research background is needed. Throughout my years of experience as a teachers’ educator, I have often encountered groups of teachers who are passionate about their profession. Often, these teachers—given their deep commitment—were radically exposed to difficulties, frustrations, and failures; however, they could also feel deeply the joy, passion, and possibilities stemming from working in the education field, even more than others. During the discussions presented during the courses I conducted, these teachers would often share insightful considerations and reveal personal feelings related to different aspects of teaching; these included teacher–student relationships, curriculum, professional judgment, and the consequences of their passion and commitment. I would always take note of their interventions, and sometimes, at the end of the course, given the quality of interactions, I would stage research settings to gather such insights systematically. However, at times, when comparing gatherings from experimental settings with the rough material that emerged during the courses, I felt that something was lost. On those occasions, I was left with a subtle sadness and desire to recover the lost insights.I cannot, of course, ignore the possibility that such a difference was due to a failure on my part to create an adequate experimental setting. However, I do believe that something more was at stake. Simply put, the matter teachers shared during the open discussions during the course was something too elusive and difficult to handle to reproduce in a dry experimental setting; the urgency they felt to communicate their deep feelings and insights as part of the matter they were sharing, something that is hardly replicable on demand. Indeed, deep insights and emerging feelings are not at our disposal. Therefore, if we wish to shed light on the actual lived educational experiences, we must carefully listen to when and where such experience arises.Considering the above, for this study, I decided to proceed in a different manner: I would collect teachers’ observations and insights the moment they originated, reserving myself the opportunity to deepen my investigation of the most interesting aspects of their statement in a manner and at a time teachers preferred, via email, interviews via Google meet WhatsApp messages, and in-person conversations. I, of course, informed the teachers of my research purposes and experimental setting from the very beginning.Therefore, when something revealing came to light, I invited the teacher involved to deepen their experience, focusing on their impressions and feelings while exploring the possibility of further expanding their insights. In some cases, I also asked the teachers about an image or metaphor that could better convey the sense of the experience being shared.From the group of 30 teachers involved in the course, I first chose 13 teachers for my research purposes. Such a selection was based on the meaningfulness of their insights related to my study and their willingness to share and inquire about their experiences further. A second selection was made in the reports of their findings; here, I selected reports from 5 teachers: Silvia, Luigi, Gennaro, Davide, and Giovanna. By prior agreement, the interviews were anonymized, and teachers’ names are pseudonyms.From the outset, it was clear that difficulties, discomfort, and even suffering were important aspects of teachers’ emotional state. “Helplessness,” a “permanent sense of warning,” “loss of oneself,” and even “anguish”—as two teachers described their emotions—were the prevalent mood related to the online teaching experience. However, these were not the only feelings experienced by the teachers I met. Along with these feelings—and to my surprise, admittedly—some teachers also spoke of a “wholeness,” a “fulfillment never experienced,” and even “a deep sense of joy” and an “unknown freedom” in encountering their students online.How should one make sense of such a diversity of emotions? Of course, one might argue that this question makes little sense, as the diversity of sensations relies on the diversity of individuals and approaches—and, in a basic sense, this is true. One might even argue that teachers who experienced fear and angst when going online could not teach, for teaching also involves facing unexpected situations. However, I contend that much more was happening within teachers’ emotional horizons and lived experiences. When I listened to teachers and attempted to understand and unravel their emotions, I felt a common root: all those diverse and even opposite feelings were connected to a deep ethical engagement with students and the profession and the struggle to face an unknown situation in an unknown manner. Otherwise stated, it was the entanglement of the unknown space in which teachers were thrown with their commitment and responsiveness to students that caused such a deep and diverse bunch of emotions.Methodologically, given the nature of this work, I can place this study within an emerging research framework combining educational philosophy with empirical research, where empirical should better be understood as “bearing witness” Hansen . The phrSuch a step back means to be faithful to matter, which I would say is both heavy and ephemeral. Thus, “engaging firsthand what is happening in an educational setting [and…] reflecting upon it through a philosophical lens” serves to illuminate “aspects of current policy, practice, and research that might otherwise remain in the shadows” Hansen , p. 9. SIn educational research–or any other research, for that matter–certain aspects may be silenced, and others may not gain “theoretical” or “methodological dignity.” Transparency, warrantability, external validity, and reliability do not always work in a benign way. Of course, this is not a call to obscurity, which would be senseless, if not ridiculous. This is a call to live, educate, and inquire with and by the “mystery, doubt, and half-knowledge” of the world in which human beings live Dewey , p. 34 fPhilosophical reflection may thus work as a companion while “qualitative research and philosophy are treated as similar intellectual undertakings and can therefore be thoroughly integrated.” .“[t]o think ‘Being’ means: to respond to the appeal of its presencing… This thinking… is only a possible occasion to follow the path of responding, and indeed to follow it in the complete concentration of care and caution toward Being that language has Perhaps one of the most beautiful expressions of this stance lies in the Heideggerian work,  Student . HeideggResponding to “the appeal of… presencing” places human beings into a situation of radical dependency: neither in acting nor in thinking we are ever at our disposal. We must attend to such a matter with “care and caution” , recovering a stance toward the world which allows for new meanings to emerge.To begin my analysis of teachers’ emotions and experiences, a few words about my choice to read such emotions and experiences through Heidegger and Arendt are necessary. My choice for Heidegger lies in a quality of his thought well-described by Magrini: “Rather than philosophizing, Heidegger is concerned with embracing poetic, ‘meditative’ thought” , p. 502.bios-graphie…Thus, the possibility of representing birth and death, to conceive of them in time and to explain them to others – that is, the possibility of narrating – grounds human life in what is specific to it, in what is non-animal about it, non-physiological… Arendt rehabilitates the praxis of the narrative. Challenging the remoteness of the poetic work, only action as narration, and narration as action, can fulfil life in terms of what is ‘specifically’ human about it. This concept… links the destinies of life, narrative and politics”  conception of identity we may find in her work. Rather than relying on thought or some other theoretical virtue, Arendt saw identity as something that arises from one’s actions and speech. For Arendt, public space constitutes the private, or rather there is no private space disjointed by the public - I shallApart from that, I would highlight how the study of philosophy and philosophizing is always a very personal matter. While Arendt’s insight that our identity is revealed not in our thoughts but in our actions and speech has enlightened me, I cannot help but believe that as researchers we live with what we read, think, and study, and that our experiences frame such a studying and are shaped by it. Setting aside any theoretical correspondence or similarity between the material analyzed and the means of analysis, I fear that my choice is based fundamentally on my engagement with philosophy. In addition, I cannot exclude any other interpretation, and accordingly one could choose any other eminent philosopher to shed light on the words and experiences. Moreover, it is in the nature of the study that the use of other thinkers would have changed the interpretation of the teachers’ experiences and perhaps even the selection of statements, emotions, and experiences worth analyzing. Thus, my hope is just that the comparison with Heidegger and Arendt will be considered useful. In what follows, I will try to convey this choice as plausible. This means, I believe, bearings witness through philosophy.praesens,  reporting certain significant excerpts of teachers’ conversations and interviews; (b) analyzing the question of Introduction, the former group of 30 teachers participating in the course has been restricted to 13 teachers due to both teachers’ willingness and the meaningfulness of their experiences given my aims. The section is divided into three parts. In the first part, I report statements from three teachers regarding anxiety, fear, anguish and a deep sense of helplessness arising from their experiences. In the second part, I analyze Heideggerian understanding of praesens, attempting to relate my analysis to teachers’ experiences. In the third part, I focus on fear and angst. I begin with Silvia’s, Luigi’s and Gennaro’s reports.The material I collected during my research is more extensive than what can be reported. As stated in the “During the lockdown, I woke up with a weight on my chest, and a sense of permanent warning … When my class was about to start, I would reach for my computer, go online, and begin the lecture. Sometimes it was not that bad. I could see their faces and I could imagine what was going on in their minds… But there always was a gap I couldn’t fill. It was something like a permanent lack I was unable to compensate for, and I felt guilty for that, although I knew it was not my fault. This awareness didn’t help me make sense of my work.”“The Third B  had always been a hard one. But online, it was even worse. When you see them and can interact face to face, you can engage their attention, present examples, use irony, and reproach effectively. When you are on Meet, none of these things makes any sense. Any reproach becomes comical…Within two weeks, I found myself in a spiral…It was a total nightmare. Sometimes I was so panicked that I had to break up my lesson. I felt like I was going crazy…I had to call my wife just to speak with her and break that sense of anguish.” When asked about an image conveying such a sense of angst, Luigi reported about “an empty room, all dark, with my voice banging around… A total collapse”“When going online, my prevailing feeling was that the class didn’t follow me… I was speaking in front of that screen with no evidence that someone would listen… I feel the right word for my experience is fear… It’s difficult to explain, but I felt as if the whole situation was an actual threat, and I couldn’t do anything to stop it ... At times, I couldn’t think, for if I did, I would have been paralyzed, in panic. I would just go on with my lesson, trying to not think.”The Basic Problems of Phenomenology, when explaining the “temporal interpretation of being as being handy,” Heidegger introduces the question of praesens as the “horizonal schema of the ecstasis of enpresenting” . As for other questions–time, for example–Heidegger is concerned with delving into the very fabric of one’s being-in-the world. Thus, how is it that Dasein can perceive something as present or absent? Heidegger makes clear that before perceiving something as present or absent, human beings—Dasein, in his understanding—are entangled in the world in such a way as to be able to deal with a more fundamental structure. This ability is the original structure of praesens. Otherwise stated, praesens is the very texture upon which the world, others, and things—including emotions—may be encountered, and the condition of the possibility of any understanding.Heidegger furnishes the first indication of the meaning and function of praesens.” .Importantly, in being the condition upon which we may encounter and perceive what is present and what is not, it also is the condition of possibility of both the “beyond itself”  and the present, the very now. Even enpresenting, in Heidegger’s words, “understands itself as such upon praesens. In other words, the horizon in which the perception of the students, themselves, and the teaching takes place changes dramatically. Any word or silence, any gesture or act, stands on the basis of such a modification. Even one’s commitment and projecting come to be felt upon such a different horizon, by means of which “anything like existent commerce with entities handy and extant becomes possible” . This is also due to the relationship between praesens and temporality: given that Heidegger states that praesens is “already unveiled in the self-projection of temporality” , such a deep structure goes hand in hand with temporality itself. The way in which temporality is given to teachers—or, in a Heideggerian vein, how temporality temporalizes itself in teaching—relies on praesens, too. The temporality of the teachers, based on the accounts of Silvia, Gennaro and Luigi, becomes unbearably dense, but not in the sense that it is full of events. Quite the opposite: their teaching routine involved the same feeling every time. Remembering Heidegger’s understanding of attunement as “not some being that appears in the soul as an experience, but the way of our being there with one another”  What if one is “so panicked… to break up” the lesson (Luigi’s report)? What if teachers in distress were to experience, using Luigi’s powerful words, “a total collapse of time?” In such a condition, one cannot think and act—to say nothing of projecting. Relationships are blocked, as they are perceived as threatening. The totality of gestures and emotions teachers feel and enact is under the shadow of this curtain. Hoping, listening, projecting, awaiting, looking at, talking, hanging back, caring—the whole patrimony of comportments teachers enact in daily classroom activity—is, as it were, swallowed by this unknown and disquieting kind of praesens. What Heidegger calls the “intentional comportments toward the futural” .“That about which one has Approximately forty pages on, in Chapter VI, Heidegger describes angst as “[t]he fundamental attunement” and the “[e]minent disclosedness of Da-sein felt down. Otherwise stated, both acting and thinking collapsed, and the world itself pulled back. Yet, much like fear, such angst comes from a well-defined region: being online with his students.When comparing Heidegger’s analysis with the teachers’ experience, we note that the teachers’ words and emotional qualities bear witness to both fear and angst. Gennaro, Silvia, and Luigi all encountered the fearsome within the world in a definite context; moreover, it is also true that a “harmfulness radiates and thus has the characteristic of being threatening.” What is problematic in defining their experience as just one of fear is that harmfulness—rather than aiming “at a definite range of what can be affected by it”—extends to the whole professional and even personal experience. Even Gennaro’s and Silvia’s sense of self when being in education was jeopardized by the profound change. Furthermore, while Gennaro, Silvia, and Luigi encountered fear in the realm of “innerworldly beings,” they clearly experienced a sinking away of the world: Gennaro’s inability to think, his paralysis and panic, bear witness to the fact that being in teaching, as such, was the source of his angst. What Gennaro experienced while being online was a total breakdown of intelligibility; in his experience, the ecstatic projection of praesens and the irruption of a new kind of praesens; as Heidegger writes, we cannot lose praesens, for praesens is simply what enables the possibility of experiencing something . His project, namely teaching, was impossible to pursue in the situation he found himself in; yet, the project was there, hideously disfigured and causing him to sink in angst. By drawing from Thomson’s interpretation of Heidegger, Luigi was experiencing “a global collapse of […his] identity-defining life project.”  However, what rendered Luigi’s experience so peculiar was that Luigi was experiencing the collapse of any projecting, without being freed by projecting itself. At this point, the analysis of the question of projecting may be helpful.Being and Time, reminiscent of Kierkegaard, Heidegger speaks of Dasein regarding projects and possibilities:be. As projecting, understanding is the mode of being of Dasein in which it is its possibilities as possibilities.”  reporting significant excerpts of teachers’ interviews; (b) analyzing Arendt’s questions of action, beginning, and “startling unexpectedness”; and (c) analyzing teachers’ emotional experience while elucidating the building of the educational community. I begin with teachers’ experiences.“During the lockdown, I had to leave my study to make room for my son; thus, I worked in my bedroom. In the beginning it was kind of awkward: in the background you could see the bed and clothes lying all over the room… I managed to put up a background from Google tools, but for some reason it didn’t always work. After a while, I resolved to accept the situation, and began to joke about my mess… I began to feel a kind of coziness in that situation. I mean, not just my own coziness in being in my bedroom with a cup of coffee… I felt a kind of shared, common coziness… everyone in their bedroom or living room, with their cup of coffee, chocolate, juice or whatever… So, we decided to have coffee-break together. Some students would prepare toast, others would even cook… It was strange, for we were separated, far from each other, and yet we were closer than ever. At some point, I thought it would have been nice playing some music in the background when teaching. Classical music, rock, pop… we all felt a kind of togetherness in that strange situation… New connections began to emerge… I mean, connections among topics, among students, between me and them, between them and such new topics… At last, I felt students speaking with their voice. I mean, they began reading poetry, making personal comments on authors they studied… Everything was new in those months.”“At the beginning it was bewildering… before the screen, speaking to everyone as always, but in a very different way… You couldn’t know whether your students understood the topics… it was even difficult to understand whether they were there to listen. In some way, it was embarrassing. So, as a way out, I began to concentrate on the topic being explained.” When asked about her focus, Giovanna said: “I intentionally decided to exclude any thought about whether students were there and what they understood about the lesson. I began to delve into my topic. Should I find an image, I felt as a researcher at a microscope...” At this point I asked if one could label her lesson as a kind of study. Giovanna told, “yes, I was studying, but I was studying in front of my class!” When asked about the outcomes of her gesture, Giovanna said: “Unexpectedly, students were interested in such a strange lecture… They were following me… They began to interact and delve into the topics… I discovered a new way to teach… I experienced an unknown freedom by teaching online, from my bedroom.”The questions of action, beginning, and “startling unexpectedness” Arendt  are centThe Human Condition, when discussing the common ground upon which action and speech should be understood, Arendt states that through action, human beingsqua men. This appearance… rests on initiative, but it is an initiative from which no human being can refrain and still be human.” .“…distinguish themselves instead of being merely distinct.” Action is the way “in which human beings appear to each other, not indeed as physical objects, but In and human beings come into the world by means of action. From an Arendtian perspective, in fact, action takes place “between men,” and only through action may human beings’ “specific, objective, worldly interests” arise. These interests, in Arendt’s words, “constitute, in the word’s most literal significance, something which inter-est, which lies between people and therefore can relate and bind them together.”  For Arendt, action is strictly related to the ability human beings have to take upon themselves the responsibility, burden, and bearings of their distinctness. Without denying the well-known Arendtian concern about any attempt to find the essence “of human existence,” , we may infer that, in Arendtian terms, action is essential to being human, and that taking “initiative” is, for Arendt, something that characterizes human beings. By means of action, human beings come into the world and accomplish the newness to which they are destined. How and when such an initiative should be taken and enacted is left open and undetermined by Arendt. However, enacting our own initiative is what makes us human. As Birmingham aptly noted, according to Arendt, action is grounded in the “archaic and unpredictable event of natality.” .initium, newcomers, and beginners” . As Arendt states in The Crisis in Education, acting “for the sake of what is new and revolutionary”  is not something added to human beings, or something we as humans may or may not accomplish. As humans, we come into the world as “” Arendt , p. 189 when acting and speaking, not before. Human beings thus come to know who they are through their ongoing engagement with others—in endless and ever-changing processes—of which the structure and aims come to the fore in concrete situations of life.Such an understanding comes to reframe the interpretation and construction of one’s identity. Here, we should bear in mind that, according to Arendt, the public and political space precedes and grounds individuality: as stated above, for Arendt the subject reveals itself through its actions and speech, activities one may pursue only when one is connected to other human beings in the public arena. It is then not just that we cannot know how our actions will be taken and understood by others, but rather that—more radically—through action, one discloses oneself to oneself. One comes to know who one is To clarify, the central point of Arendt’s understanding is that human beings’ uniqueness emerges from them revealing to others who they are through their actions and speech, while at the very same time revealing to themselves who they are. Therefore, we cannot know who we are before such a revelation occurs. The dimension of the educational community is thus the root from which both one’s being and one’s becoming can grow, changing in unpredictable ways, and accomplishing the “miracle” of natality.praesens, if you wish—thus producing the conditions by which a different praesens was allowed to emerge. Such a different praesens—with everyone in their own room with their belongings—rather than creating a sense of distance and alienation, created a new intimacy and nearness, in which private and public were not just mixed: private and public were unrecognizable by their own features. Moreover, in a sense, their very division was useless for understanding the context, because a whole new environment emerged. As Davide effectively said, “everything was new.” In such a new environment, connections themselves were caught in a new web of meanings which transcended them, thus creating a new community.At this point, we ask the question as to what kind of teaching and educational community emerges from Giovanna’s and Davide’s words. In their cases, too, the lockdown interrupted the space-time of normal schooling—the former This newness was also a defining feature of Giovanna’s teaching. Although Giovanna’s response to the embarrassment and discomfort experienced was quite different from Davide’s, the outcome was similar. The intentional neglect of students that she enacted resulted in a new, engaging manner of teaching rather than a kind of solipsistic teaching. Students were more involved than ever; from their exclusion from the community and even of communication came the discovery of a new behavior toward both the topics being explained and the educational community. Giovanna, in a sense, was teaching in a gap. We then ask: what kind of terrain may come out from a gap, and what meaning may be built or found, given that, when teaching, we are always already in the presence of some meaning? To propose a tentative answer, I wish to focus on the pronouns used by Giovanna in her report. At the beginning of the interview, she reported: “I began to concentrate… I began to delve.” It is as if they had to exclude students to teach them at all. At the end of their interview they stated, with a smile of surprise, “we discovered a new way to teach.” Students, unintentionally imitating her actions, built a new community while building new actions for themselves; through online teaching emerged an environment of intimacy, which deeply transformed students’ receptivity to both teacher’s words and the emerging community. Davide’s sense of joy and discovery while teaching shows how teaching is an ongoing indication to that region in which education and community joyfully emerge, while Giovanna’s experience speaks of a sense of collective, ongoing delving into the topics being discussed. Their words bear witness to an educational experience in its own right, one in which a realm of joy, freedom, fulfillment, and learning may emerge. “The fact of natality” Arendt , 246 andIn this paper, I have examined the lived experiences of teachers during COVID-19 using philosophical thought and scientific literature, thus combining educational philosophy with empirical research. I have analyzed the emotional impact that the abrupt shift to online teaching had on teachers’ work and lives during the various stages of the lockdown. Heidegger’s and Arendt’s thoughts, with their commitment to living, “being-with-others,” and being “for the sake of others”  makes teachers unprotected and vulnerable from the very beginning. This vulnerability does not stem primarily from the fact that we do not control the results of our actions and speech; rather, it stems from the uncertainty about how those actions and speech will be interpreted by others. I reveal myself to myself and come to know myself only when I reveal myself to others. “Although nobody knows whom he reveals when he discloses himself in deed or word, he must be willing to risk the disclosure” Arendt , p. 180.What Giovanna’s and Davide’s words bear witness to is exactly such a primacy of the public dimension, which comes to frame the private: by forcefully sharing their private space, they gained a deeper meaning of and commitment toward their profession. Conversely, Gennaro’s, Silvia’s and Luigi’s experiences of fear, distress, and anguish seem to derive from a lack of relatedness. Luigi “had to call his wife just to speak with her and break that sense of anguish,” while Gennaro was “paralyzed, in panic” and could not “think at all.” Also, Giovanna and Davide learned to change their teaching practices during the pandemic; initially they were neither calm nor happy with online teaching. However, during the pandemic, they managed to rethink their gestures, giving a new, unexpected meaning to their professional life, while building a new educational community with and for their students. Gennaro, Silvia and Luigi, on the other hand, remained trapped in the spiral of their fears.Thus, the experiences of joy and fear seem to point in different but consistent ways to two essential educational dimensions: change and relationship. Without these dimensions, education, as human living, is simply impossible. The teachers’ experiences also reveal that they, to use Heidegger’s account, were simultaneously thrown into change and connectedness as they co-created with students the change and connectedness they experienced during teaching. Teaching as a physical, vulnerable, yet powerful experience is what is revealed by observing and learning from teachers’ words and gestures. Teachers changed themselves as they offered the opportunity for change to their students; this is the meaning of an ever-changing educational community.per-plexus: per, which means with, through, throughout, during, by means of, around, and plexus, which means woven, intricate, obscure, even. Thus, when teaching we may be perplexed, namely, we are going through and by means of what is woven, dwelling in and around what is intricate , attending to such a meaningful messiness, even when such a task is risky, uncertain and frustrating. This seems to be the ethical core of inquiring through philosophy, and this is especially necessary, I would say, in times of fear, insecurity, and constant restriction of free educational spaces. Therefore, the attempt I present, is also a political act.As a concluding remark, I would like to return to the question of what the combination of philosophical thought and ethnographic research can yield. Such an intertwining can led us to think beyond and outside our thinking and engage with the messiness of experience, with what may generate perplexity. The etymology of the word “perplexity” indicates much more than just something to be resolved or put in order. Perplexity is from the Latin


This paper provides an overview of current linguistic and ontological challenges which have to be met in order to provide full support to the transformation of health ecosystems in order to meet precision medicine (5 PM) standards. It highlights both standardization and interoperability aspects regarding formal, controlled representations of clinical and research data, requirements for smart support to produce and encode content in a way that humans and machines can understand and process it. Starting from the current text-centered communication practices in healthcare and biomedical research, it addresses the state of the art in information extraction using natural language processing (NLP). An important aspect of the language-centered perspective of managing health data is the integration of heterogeneous data sources, employing different natural languages and different terminologies. This is where biomedical ontologies, in the sense of formal, interchangeable representations of types of domain entities come into play. The paper discusses the state of the art of biomedical ontologies, addresses their importance for standardization and interoperability and sheds light to current misconceptions and shortcomings. Finally, the paper points out next steps and possible synergies of both the field of NLP and the area of Applied Ontology and Semantic Web to foster data interoperability for 5 PM. The goal is to transform health and social care by fully understanding disease mechanisms and by turning health and social care from reactive to proactive. The current healthcare system transformations aiming at 5 PM medicine are supported by a broad range of technologies, with data-centered approaches playing a crucial role. Other than with clinical trials, quality data are intended not only to be collected and analyzed for a specific purpose but during the whole care process within a health ecosystem, i.e., a network of all relevant interconnected entities ranging from patients and carers to diagnostic and care processes targeting clinical conditions, pathogens, devices and being reflected by an ever-increasing amount of data.The implementation of 5 PM involves multiple domains and disciplines with their specific objectives and perspectives, using a broad range of methodologies, educational backgrounds, skills and experiences as well as a broad range of resources. The technologies to be deployed range from wearable and implantable micro- and nanotechnologies, biomolecular analytical techniques such as the family of OMICS technologies, up to super- and quantum-computing and big data analytics. Many of these technologies only unfold their potential if rooted in semantic resources like terminologies, ontologies and information models as core requirements for data standardization and interoperability.The challenge is not only to understand the world of sciences and practices contributing to 5 PM, but also to formally and consistently represent it, i.e., of multidisciplinary and dynamic systems in variable context. Thus, mapping and harmonization data and processes among the different disciplines, methodologies, perspectives, intentions, languages, etc. must be supported. This is bound to the advancement of communication and cooperation between the business actors from data to concept and knowledge levels, in order to provide high-quality integration and interoperability between and within health ecosystems. Consequently, knowledge representation (KR) and knowledge management (KM) are crucial for the transformation of health and social care.KR and KM happen at three levels: (a) the epistemological level of domain-specific modeling; (b) the notation level of formalization and domain representation; (c) the processing level of implementations. The different levels are represented by languages of different abstraction and processability.Like specialized dictionaries provide words that constitute textual expressions in a certain field of interest, domain ontologies provide the building blocks for the construction of knowledge in that domain, in order to support representation and communication. For enabling interoperability between different stakeholder perspectives as well as logical deduction and machine processing, we have to advance ontologies to become a repository of representational units for precise descriptions of classes of domain entities in logic-based languages . In ordeInteroperability and Integration Reference Architecture – Model and Framework (viz. (a) domains representing specific aspects and perspectives of the system, forming domain-specific sub-systems; (b) generic granularity levels of the system’s elements enabling the composition/decomposition of the system; (c) the viewpoints within its development process. The latter one extends the views defined in ISO/IEC 10746 Open Distributed Processing – Reference Model  for the Enterprise View through the Universal Modeling Language (UML) for the Information View and the Computational View up to programming languages for the Engineering View. As described before, the languages thereby move towards higher expressivity, but more constrained grammars. Capturing knowledge in ontologies enables the understanding of facts and relations by both humans and machines. Thereby, structured and semi-structured knowledge can be represented in different styles at different levels of formalization  the need to constitute clinical cohorts that are large enough for high evidence on the effectiveness of interventions and (ii) the need to account for the individual character of health and disease, which demands personalized decisions for those patients that cannot be considered instances of well-studied large cohorts.The key to address this problem is data. The more reliable health data are available, the better personalized decisions can be responsibly made on a scientific basis, and the better are data from routine care suited for retrospective investigations. This requires a thorough understanding of (i) what biomedical data are, (ii) which different kinds of data need to be distinguished, and (iii) how data relate to the reality of facts and hypotheses in the domains of biomedical research and personalized healthcare.We understand by biomedical data all those signals used to support human and machine communication and reasoning about entities (including actors and processes) in the biomedical domain, and which are processed using modeling and programming languages. We have to consider the whole range between structured data , primarily for machine processing and unstructured data , mainly for processing by humans.The way computers deal with data is different from how people do. This raises issues regarding data quality, completeness, processing workflows and interoperability. Data quality is affected not only by measurement inaccuracies, but also by human errors in data handling. Humans also account for the completeness of data collection and registration, but also of the outcome of data retrieval. The fact that the growing amount of biomedical data has far exceeded the limits of human cognition makes automatic data processing indispensable for responsible medical practice. Additionally, different professionals in health care encode data in different ways, using different structures and different languages. This makes data interoperability a major goal which has been largely unfulfilled to date.Clinical data requires some language to be encoded, with a given vocabulary, syntax, a more or less apparent semantics, embedded into overly diverse and often only implicit pragmatic contexts. This is true for languages used by machines as well as for natural  languages. The following example will demonstrate this.A hospital laboratory machine plots a set of attributes, values and unit triples  into a tabular structure. Similarly, a clinician inserts codes from a coding system  into an electronic health record (EHR) together with textual descriptions into a predefined table. In another setting, the clinicians write free-text reports, using the local natural language with its rules and domain-specific terms. In all these cases, not all semantics and contexts are obvious. E.g., the lab machine output does not explain the sampling and analysis techniques. The table with the ICD-10 codes, even correctly filled, may leave open whether the codes refer to diagnostic hypotheses at admission or to clinical evidence at the discharge of a patient. And in the doctor’s report, crucial background information about the patient may be missing because the writer assumes it as known to the reader.via forms and tables suited to machine processing, e.g., for billing, disease reporting and quality assurance, often redundantly and therefore unwillingly, which explains biases and errors  data stewardship desiderata . We reinTo this end, we discuss different formalisms to encode data and knowledge in biomedicine. We hypothesize that precision medicine, requires precision formalisms, such as KR languages with mathematical precision and computable semantics. This desideratum is challenged by a clinical documentation culture, in which narratives are the main carrier of information.3.3.1.The crafting of a human language expression regarding its representation of reality principally depends on our innate capability to use a set of symbols and rules. It adjusts to the degree of precision needed by the data exchange use case as well as the background knowledge and thematic scope of the communication partners.E.g., the expression [i] “MCP, pale, cld, 90/45, 130/min” is precise enough to describe a life-threatening shock situation when uttered by a clinician in an emergency scenario. Clinicians prefer brevity of information-rich messages over redundancy (cf. the following expression [ii]), as long as the recipient of the message can be expected to fill the gaps, here added in italics:Minimallyconsciouspatient with apaleface, coldskin, and an arterial blood pressure measured with a sphygmomanometer on the upper arm resulting in a systolic value of90mmHg and a diastolic value of45mmHg, with a pulse rate, measured digitally over a peripheral artery , of130 beats per minuteon average.”“sic!).The message would even be understood when introducing some noise, such as typing errors and other mistakes like in expression [iii]: “MCP, palle, cld, 90/455, 130/s”  recipient of this information, as perceived wordy and redundant. Similarly, a structured representation  would taIn contrast, an automated decision support system would not tolerate any missing parameter, and a wrong unit of measurement could cause considerable harm. The tendency to brevity, the acceptance of noise and the reliance on contextual information to fill gaps and correct errors is characteristic for oral communication, as well as in SMS or social networks posts. Clinical language, equally produced in a hurry, prioritizing content over form, resembles more to the language of WhatsApp messages and tweets than to scholarly publications . Table 2Published texts, in contrast, are carefully copy-edited and follow guidelines, which, e.g., prevent the use of unorthodox spelling or undefined acronyms. The reader of a scientific paper would not be left in the dark, whether “MCP” means “Monocalcium Phosphate”, “Metacarpophalangeal,” “Medical College of Pennsylvania” or, like in our example, “Minimally conscious patient”.The observation that clinical narratives are often characterized by complete freedom in text design, forms a contrast with the enormous amount of effort invested in vocabulary normalization over decades . To nameAlthough clinical terminology systems are often referred to by the term “controlled vocabulary” (CV), this does not imply that they play a significant role for controlling the terms used when producing clinical or scholarly narratives. Their main purposes are the support of structured data entry into forms such as for health statistics, quality assurance, reporting, and billing, the semantic annotation of article content in literature databases and the standardization of clinical data sets for research, e.g., within the Medical Outcomes Partnership (OMOP) Common Data Model .Most terminology systems are primarily models of human language. They organize words and cohesive multiword sequences, normally referred to as “domain terms” or “terminological units.” These units are connected by semantic relations such as synonymy and hyponymy. From a class of domain terms, normally one, typically self-explaining term is flagged as the preferred term. Its meaning is further explained by textual elucidations. Semantic relations in informal terminology systems, however, rely more on context-dependent human judgment than on crisp, objective criteria. E.g., the fact that “Animal” is a hypernym of “Human” may be trivial for a biologist, but debatable for a jurist. For a chemist “alcohol” is clearly a hypernym of “ethanol,” whereas a general practitioner uses them as synonyms. The meaning of “fear,” “anxiety” and “worry” has no clear boundaries, so that whether they are considered synonyms is much dependent on individual judgment and situational context.3.2.For decades, natural language processing (NLP) has been seen as an important and relevant application area of artificial intelligence, particularly because it bears the promise to bridge between humans and machines. Only in the last decade, however, NLP technology has reached enough maturity to play an ever-increasing role in application software, which determines ever larger parts of our everyday life, particularly in mobile applications.When applying NLP technology to clinical narratives or scholarly publications, the main focus is on text mining, by use of different information extraction (IE) methods . IE systSmoker (yes/no), to parameters with numerical values for a parameter like Oxygen Saturation  to codes from a terminology system with up to hundreds of thousands of possible values. Their standardized meaning, is then often further contextualized by information models such as HL7-FHIR , but also complex, such as “non-intensive COVID-19 infection with positive vaccination status.” At this level, two NLP tasks must be distinguished. First, the identification and delineation of a text passage to which a specific semantic type like Disease, Symptom, Medication, Proper Name, Institution can be ascribed. This is known as Named Entity Recognition. Second, the mapping of the identified candidate to the target vocabulary, which is known as Named Entity Normalization, Entity Linking or Concept Mapping  as well as subdivided into sections. Sections can also be assigned a type, e.g., hors see  or seman Mapping . Pioneer Mapping , MetaMap Mapping  and MedK Mapping . In thesMany use cases require connecting text passages, after normalization, to a temporal context. Clinical texts often do not report on facts chronologically, and time differences between important events of a patient history, e.g., between the first diagnosis of a tumor and its recurrence after therapy, are of prime interest. Standards like TimeML  have beeThe described analysis steps are implemented in classical text mining systems as software known as automated annotators or taggers. A common framework is Apache UIMA . IndividA major paradigm shift has occurred in NLP during the last decade, driven by the unprecedented rise of artificial neural networks (ANNs) for machine learning, known as Deep Learning. Although the principles of ANNs have been formulated about 80 years ago, only now their combination with powerful computer architectures, big amounts of data, and innovative algorithms has unveiled their potential. Their popularity has been supported by practical program libraries such as KERAS, TensorFlow, PyTorch, and HuggingFace .Deep learning approaches have largely replaced “shallow” machine learning methods in recent years, especially because features that are productive for learning success no longer require time-consuming feature engineering . RevolutTraining neural networks with sufficiently large amounts of data is “expensive” in terms of hardware requirements and processing time. This is specifically true when it comes to the generation of language models, which are usually downstreamed in a second step to a specific problem domain like named entity recognition or document classification, often referred to as transfer learning . Just soNevertheless, traditional, “low-tech” rule-based approaches still find their application, particularly where scarceness of training data meets in-depth expert knowledge about the domain. Training models only on publicly available data is by far not enough to reach a good quality, particularly when it comes to entity normalization and disambiguation, and even more for languages other than English . This isIt should not be forgotten that speech recognition technology, nowadays mostly implemented as recurrent neural networks like LSTMs  is becom4.4.1.For the most part, medical research and medical standards of care are driven by international scientific and professional communities. Researchers and practitioners with different linguistic and cultural backgrounds have little problems when discussing medical issues, as long as a certain level of command of English and the knowledge of English medical terminology is guaranteed. Thus, experts from Baltimore, Bamako, Beijing, Berlin, Bogotá and Brisbane can get together to discuss issues of state-of-the-art clinical diagnosis and therapy. The picture changes already when we want to automatically integrate data from two hospitals in the same city: All kinds of major problems will arise, and harmonization of data from their respective EHRs requires human labor to an often-prohibitive extent. Similar challenges arise whenever we attempt to bridge between EHR data and content of scholarly publications and databases.The main desideratum is semantic interoperability. The role ontologies and other semantic standards can play in fostering or creating semantic interoperability of heterogeneous clinical and scholarly data to fulfill the pHealth requirements will be discussed in the following section.4.2.Ontologies have been important resources in computer science for decades, accompanied by a variety of tools and representational languages. Unfortunately, the way how they were conceived and defined, as well as the purposes for which they have been built, has shown great variation. We have introduced the notion of a terminology system in the previous section, and often the term “ontology” is also used to refer to them. We consider this view to be of little use. Instead, we introduce the clear bipartition, highlighting “ontologies” as “formal ontologies” , contrasFormal ontologies are “precise mathematical formulations” , or moreThe fact that natural language plays only a secondary role in formal ontologies is not a contradiction to what we wrote in the previous sections. The main difference is that the types of entities characteristic for a domain is the starting point when building an ontology, and not the meaning of domain terms in a particular natural language in the first place. In no way this should detract from the importance of domain language dictionaries. But the concerns are strictly divided: the ontological standardization of domain entities on the one hand, and on the other hand the anchoring of domain terminologies in several natural languages and dialects. This means, in practice, that synonyms and term variants in different languages are then linked to ontology IDs. At least one preferred term, often referred to as “label” is needed in order to make the ontology understandable by humans. Enriching it by additional terms is often done by the ontology builders themselves. Here, the ontology also fulfills the role of a dictionary.Standardization has been an important issue regarding the formal languages employed by ontologies. Based on description logics , promoteEqually, by the W3C, the Simple Knowledge Organization System SKOS  has beenThe following example may illustrate the difference between the two languages. In SKOS, the triple < “Homo sapiens”; skos:broader; “Living organism” > expresses that the meaning of the expression “Living organism” is conceived as broader than the expression “Homo sapiens.” In OWL, the triple < “Homo sapiens”; owl:subclassOf; “Living organism” > has the status of an axiom. It means that the class of all individuals of the type “Homo sapiens” is included in the class of all individuals of the type “Living organism.” Whereas in SKOS, the relata are human language expressions like words and terms, in OWL “Homo sapiens” and “Living organism” are no more than human-readable class labels that make the ontology human-readable. The exact meaning of the classes requires further definitions of these types. According to these definitions, the axiom could be questioned by the fact that the class labeled as “Homo sapiens,” according to how it is defined, may also include dead persons. As SKOS has no formal semantics, it is at the discretion of the users to approve the statement < “Homo sapiens”; skos:broader; “Living organism” > as largely appropriate, despite boundary cases like the abovementioned one.Thus, RDF-based Semantic Web standards constitute a framework that equally accounts for ontologies as carefully constructed cornerstones, for informal knowledge organization systems as bridges to human language, and the breadth of knowledge representation built upon it.4.3.Whereas computer science has always had a functional look on ontologies – an ontology is as good as it supports a given use case and its particular world view, life sciences have put much more emphasis on the interoperability aspect of ontologies. For instance, the Open Biological and Biomedical (OBO) Foundry  establisOrthogonality means that each ontology has its scope limited to entities of clearly defined types and scopes. It points to a framework of shared fundamental categories: chemical entities and roles such as in ChEBI, anatomical entities in the FMA, cell components, biological processes in the biological process and molecular “function” (activity) in the Gene ontology. Other examples are qualities in the human phenotype ontologies, locations in the environment ontology. All this points to high-level types of a common “upper level” , which iIn the domain of life science, BFO , 82, theThe fact that BFO 2020 has become an ISO standard  sheds liApart from BFO, standardization has also been an issue in biomedical terminologies, particular in the case of SNOMED CT , which s4.4.via BioPortal . Even good ontologies often do not have a good labeling discipline, because the language expressions used as labels have different meanings in different communities. In other cases, ontologies like the Gene Ontology (GO) do not have more than one label per class, which leads to the practice to refer to GO classes as “GO terms,” which is confusing for anybody with a terminology of a linguistics background.Finally, a complicating factor when constructing ontologies is the continuous nature of many natural kinds . Instanc5.We now move to discuss the interface between ontologies and natural language technologies, with the goal to support formal, unambiguous and canonical representations of structured and unstructured data in the field of 5 PM, encompassing research data as well as real-world data from EHRs.5.1.It is unrealistic that non-standardized and low-structured narrative data, currently prevailing in EHRs , 88 will5.2.The performance of NLP systems depends crucially on the available resources. These include terminology systems and corpora, as well as language models derived from the latter. For the clinical language, there is a great need to catch up here, due to the lack of models tailored to clinical language, as well as natural languages other than English . So doesClinical researchers can only dream of this. Clinical content is highly confidential, so that only reliably anonymized data can be considered for the training of NLP systems. Anonymization means marking names of persons and institutions  in order5.3.Annotated corpora, i.e., text collections that were manually enriched by labels that describe the text according to its syntactic and semantic features, is not only an enormously resource-intensive effort, but also of utmost importance for entity normalization and semantic relation detection, but also text classification, sentiment analysis, question-answering and other tasks. Models trained with annotated corpora enable machines to understand the meaning of language in clinical narratives, and allow for more accurate analysis of medical data, particularly in P5 medicine settings.Body Part), which requires a deep knowledge of the underlying ontology as well as familiarity with the domain, particularly in the case of ambiguous text passages such as acronyms. Entity normalization, i.e., the linkage of words and text passages to ontology identifiers such as SNOMED CT or LOINC codes is only the first step. Equally important is their linkage to contextual or temporal modifiers, in order to represent the entirety of a statement, e.g., whether a diagnosis is confirmed, suspected or negated, when an examination was done or when a recurrence of a disease occurred. Finally, annotations often need to be linked by relations, such as procedures or observations with the related anatomical sites, operations with devices or infections with pathogens, but also sequences of events by their temporal order and possibly causation. The relations used for annotation should be consistent with the underlying standards, such as Finding site in SNOMED CT or verificationStatus in FHIR. For assessing the quality of the manual annotations, the inter-rater agreement between annotators is very often measured via Cohen’s kappa, Fleiss kappa or F1 value  in one or multiple queries. The fact that the cerebellum is part of the brain is explicitly stated as part of the knowledge system and not externalized in the mind of some database employees. An example for a new data point created based on automatic inference is if a study has the information that the pediatric patient Jane Doe lives with their parent John Doe and the system also has the information that John Doe is a smoker, a knowledge management system containing a computer-interpretable definition of a smoking household as a household that has at least one smoker as a member, the system automatically infer that Jane Doe is living in a smoking household. Beyond these use cases, the use of ontologies and other SWTs also allows automatic sorting of individual entities in categories that have computer-interpretable definitions, as  demonstrOne application of SWT is Knowledge Representation and Reasoning (KRR) , a core In 2018, Brochhausen et al. pointed out, that there might be a disconnect regarding the use of the terms “semantic” or “semantics” in biomedical informatics: terminology systems, often in combination with Common Data Models (CDMs) are implemented to provide semantics and foster semantic integration and researchers using those resources and claim their data is semantically integrated and computer-interpretable . None ofBut if this communicative gap exists, what is meant when biomedical informatics papers talk about semantics or semantic interoperability. The multitude of interpretations of the terms “semantic,” “semantics,” or “semantic interoperability” warrants a systematic review, which is out of scope for this paper. However, we want to highlight some possible interpretations and how they compare or relate to the SWT approach using ontologies.One traditional perspective is that achieving semantic interoperability relies on and can be achieved by the use of standardized terminologies or controlled vocabularies. In 2016, Seerainer and Sabutsch affirm: “Semantic interoperability within a nationwide electronic patient record, entailing the interconnection of highly diverse organizations with various IT systems, can only be achieved by providing standardized terminologies”  . Their We have mentioned above the role that the interplay between informal terminology systems and ontologies plays for semantic integration in conjecture with ontologies . In crea6.6.1.The use of NLP for processing clinical routine data has long been seen as a rather academic topic, which may be useful to solve well-delineated problems, but whose implementation within robust IT environments was still a long way away and not safe enough for clinical decision support. Whereas in the 20th century AI and NLP was characterized by unrealistic promises and several drawbacks, the universal AI boom of the last 10 years has brought intelligent applications including “understanding” of human language within user reach.But the question of how these developments can be translated into real improvements of health care and health management is not ultimately answered, in particular, how can they be harnessed for events with high and urgent information and action needs, such as pandemics? A recent review  of approvia open interfaces, and enable high quality text recognition, thus creating trust in their use and enabling automation of medical documentation processes. The performance of clinical NLP systems should be easily proven via benchmarks and shared tasks within the process of the adaptation to the application domain. This has to be done with a consistent and continuous application-oriented development of semantic standards, in particular ontologies such as SNOMED CT and information models such as HL7-FHIR, with specific consideration of the output of clinical NLP systems. This goes along with easy access to terminology resources, corpora and language models optimized for the clinical language. Modern hospital IT should therefore support computationally intensive AI processes, such as with GPU computers, and therefore enables easy integration and adaptation of NLP systems specifically but support multimodal approaches in general by combining, e.g., OMICS, image and textual resources widening the patient’s digital pheno- and genotype scope. Qualitatively adapted NLP systems, at its best, adapted to an entire target domain  per patient. The business case of integrating data from multiple healthcare providers requires transition to allowing multiple patient IDs per patient to accommodate sampling regarding tumor progression happening in multiple providers (Enterprise View, allowing multiple IDs into the Business View (ad hoc decision, but the principled approach, if used consistently, will allow increased rigor on ontology design decisions.However, increasing unification of the existing ontologies in the OBO Foundry and principled expansion of its coverage might require further development and assessment of methodologies to guide ontology design decisions and representational strategies. The publication of ISO 23903  Interopeuma care . Viewingroviders , 122 . Tess View , which pThey showed that the reference architecture assisted in the resolution of representational design decisions and provided a rigorous way of managing such representation questions. Additional research is needed to test the usefulness of ISO 23903 for this purpose and alternative methods for rigorous methods of ontology design need to be developed and evaluated.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.Future opportunities. All authors contributed to the article and approved the submitted version.MK and SS wrote the sections on NLP. MB and CZ contributed to the section on ontologies, supported by SS. BB wrote the background section and contributed to the overall design of the article, as well as to Section 6 The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Pain is both one of the oldest complaints known to medicine and a field for some of medicine’s latest breakthroughs and innovations. Pharmacologic treatment of pain is one of the oldest remedies, and opioids have been used since ancient times as an effective pain reliever but with certain specific risks for abuse. Greater knowledge of opioids led to a more thorough understanding of the complexities of pain, which may have any number of mechanisms. A greater understanding of nerve fibers and pain signaling led to the development of more drugs and the more targeted delivery of analgesics using the hollow needle. The hollow needle changed pain treatment and led to percutaneous injections and what would later become interventional pain medicine with regional anesthesia and nerve blocks. Today, imaging can be combined with interventional techniques for more precise localization of nerves for diagnosis and treatment. The role of artificial intelligence in interventional pain medicine, especially in imaging for interventional procedures, remains unknown but will likely become extremely beneficial. Pain is one of the oldest medical complaints and one about which many questions remain unanswered. While physicians have struggled to understand and manage pain for centuries, the past 40 years have seen a dramatic increase in pain studies, scientific breakthroughs in analgesia, new techniques, and a broad acceptance of the multidisciplinary nature of complete pain therapy . InterveThe purpose of this article is to provide a summary of the historical milestones in pain medicine, from the original use of opioids as an analgesic to modern uses of ultrasound-guided advanced techniques and possible future directions. This is a historical review based on the authors’ viewpoints as to the most salient developments and key milestones.When pain medicine was synonymous with opioidsThe “milk of the poppy” was known as an analgesic as far back as 4000 B.C. by the Sumerians in Mesopotamia . While tMeanwhile, in 1806, German pharmacist, Friedrich Sertürner, isolated a compound in opium, which he named “principum somniferum,” and was marketed in Germany and the United States under the trade name Morphine. Morphine was a name derived from Morpheus, the god of sleep . SertürnIn 1856, the introduction of the hypodermic syringe accelerated the use of morphine, which was not regulated and could be purchased in drug stores without a prescription. In 1888, about 15% of all prescriptions dispensed in the city of Boston were for opioids, which were recommended for everything from menstrual cramps to “nervous diseases” and as an antitussive. With this general enthusiasm for the miracle drug morphine quickly came case reports of rampant addiction .In 1883, Heinrich Dreser was working for Bayer, and by acetylating morphine, he created diacetylmorphine. Using the trade name Heroin, this agent was marketed as a “non-addicting formulation of morphine,” a marketing claim that was quickly debunked . Heroin Opioids quickly became drugs of choice to manage pain, induce sleep, improve mood, and manage mental health conditions. This led to their widespread use, proliferation of side effects, morbidity, and potentially life-threatening respiratory depression. As a backlash against the disordered and dangerous use of opioids, a fear and stigmatization of opioids, or “opiophobia,” developed . The HarA physician named John Joseph Bonica 1914-1994) had been a wrestler as a young man, and in adulthood, he suffered from debilitating chronic pain that was not associated with a specific injury or localized tissue damage but rather arose without peripheral associations. Bonica was describing something quite apart from the nociceptive pain triggered by tissue damage or injury with which physicians of that era were familiar. Bonica went on to describe an emotional component to pain and added a psychological dimension that went beyond the physical aspects of pain and pain intensity. Bonica founded the International Association for the Study of Pain (IASP) , which r14-1994 hPain clinics emerged around this time, bringing a multidisciplinary approach to pain management. This merges psychology, physiotherapy, pharmacology, and other disciplines to better manage pain. It also emerged that, in addition to medical science, drugs, or treatments, it was vital that clinicians have empathy with the patient and provide emotional support in the proper context of that patient’s religious and cultural beliefs. Pain is contextualized within the culture and can color how individuals respond. For example, in some cultures, pain is accepted as a normal part of everyday life; others think it is a sign of good character to bear pain without complaining, while other cultures may encourage people to seek immediate relief from even mild pain. Furthermore, healthcare professionals may also apply their own cultural attitudes and biases toward how they treat patients experiencing pain .The emerging understanding of painIn 1644, René Descartes discussed phantom pain, which he considered real rather than imaginary, and postulated that pain was experienced in the brain, not in the periphery . UnderstOver a quarter century ago, the World Health Organization (WHO) introduced its now well-known “pain ladder” for the treatment of cancer pain in adults. The concept was that pain should be addressed based solely on its intensity, and treatment should ramp up from weakest to strongest therapeutic options in a stepwise progression . At stepPain physiology requires consideration of the types of nerve fibers that carry pain to the brain. The primary afferent axons were defined by diameter in µm and velocity in meters per second. The A fibers could be divided into α, β, and δ fibers. The α fibers were involved in somatic motor and proprio-nociception; β fibers in touch and pressure; and δ in “fast” pain signaling, the sense of cold, and touch. B fibers, on the other hand, were preganglionic sympathetic in nature. The C fibers are very small-diameter fibers. When found in the dorsal root, C fibers were associated with slow pain transmission and a sense of heat. Sympathetic system C fibers were postgangliotic. A and B fibers are myelinated, but C fibers are not. The fastest and largest-diameter fibers are A, while the slowest and smallest-diameter fibers are C, with B in the middle. The body has its own system to modulate pain, but these mechanisms are not fully elucidated. The Gate Control Theory maintains that there can be segmental inhibition of pain in that only a certain number of pain signals can be carried at one time before they block each other out . The bodIn 1965, Ronald Melzack and Patrick D. Wales proposed the Gate Control Theory of Pain, which theorized that within the spinal cord there was a mechanism that determined which pain signals from the periphery could be transmitted to the brain for processing; in other words, there was a “gate” that allowed certain signals to come through while blocking others . The GatProstanoids are involved in the inflammatory response, chronic inflammation, and painful symptoms, and the inhibition of the cyclo-oxygenase (COX) enzymes can reduce prostanoid and prostaglandin production, reducing both pain and inflammation . Among tPain may also be treated using adjuvant agents, such as the anticonvulsants carbamazepine, gabapentin, and pregabalin, or sodium-channel blockers, such as ketamine or calcium-channel blockers, such as ziconotide. These are not opioids but may be used as monotherapy or combined with other analgesics Table .While one might think that problems related to opioid dependence and opioid use disorder are problems relegated to the developed world, it is important to note that tramadol use disorder has emerged as a serious problem in sub-Saharan Africa . TramadoIn Mexico, President Andres Manuel Lopez Obrador proposed a ban that would prohibit the use of fentanyl even in surgical or medical settings . While nOpioids are underutilized in Latin America, although scientific evidence supports that opioids are medically necessary, safe, and effective analgesics when used in appropriate patients under clinical supervision ,39. InapHow the hollow needle changed pain treatmentIn 1844, Francis Rynd, an Irish physician (1811-1861), developed a hollow needle without a sharp point that could be used for subdermal fluid infusions. In 1853, a physician in Scotland seeking to treat his wife for pain as she was dying of terminal cancer used this hollow needle and a syringe to create the first hypodermic needle with which he could inject her with morphine for analgesia. Alexander Wood was the first physician to treat pain in that manner, and his dying wife was the first person to be administered morphine injections for pain control. Wood used the device to deliver medicine subcutaneously rather than intravenously. Charles Pravaz in France developed the first practical metal syringe for use with a fine-tipped, sharp hollow needle. The first use of these syringes was for intra-auricular injections, but they were soon used to inject opioid analgesics as well. This invention, born of necessity, changed clinical practice forever. In fact, Alexander Wood obtained a patent for the use of his syringe to inject morphine for pain and even marketed it as a “narcotic injection syringe” . A surgeFor surgical interventions, non-steroidal anti-inflammatory drugs (NSAIDs) and steroids were needed to blunt the inflammatory response, while opioids were required to increase descending inhibition, and lidocaine blocked sodium channels. This concept of “balanced analgesia,” first introduced into the literature by John S. Lundy in 1926, allowed for different agents with different mechanisms of action to produce the variety of different effects needed for anesthesia . This isThe advent of regional anesthesia and nerve blocks may be traced back to a report from 1884 by a physician named Carl Koller, a colleague of Sigmund Freud, both of whom had an interest in the medical use of cocaine. Koller found that cocaine was an excellent local anesthetic, and it was used in a variety of procedures, including ophthalmologic procedures, urological operations, and general surgery . In the These techniques gave rise to what has become known as interventional pain management, a specialty field that has had numerous innovations in pain care . IntervePercutaneous injections were made possible by the hollow needle, expanding the role of regional anesthesia in surgical procedures as well as for pain management . For exaIn fact, it is the combination of the hollow needle for delivery of drugs or tools with imaging, such as fluoroscopy, that has opened even more opportunities by allowing the physicians to view in real time the precise location and appropriate angling of the needle and to monitor the delivery of medication or energy.In terms of the future, interventional medicine may be able to help solve the problem of osteogenic pain by giving physicians better tools to study unique bone structures and to deploy substances such as cement for repair, agents for neurolysis, and radiofrequency energy. Under fluoroscopic guidance, the hollow needle in the hands of skilled interventional pain physicians can use multiple devices and techniques to conquer pain. More and more interventional procedures are carried out every year because they are safe and effective. But as interventional procedures become more familiar and widespread, they may be used indiscriminately, leading to inappropriate patient selection, disregard of evidence-based findings in the literature, and poor adherence to guidelines. Optimal results with interventional pain medicine require not only innovation and research but also investment in the training and education of physicians and the health literacy of our patients .From blind techniques to ultrasound and beyondToday, ultrasound (US) imaging is widely recognized for its ability to help guide interventional procedures, offering real-time images in multiple planes using a relatively simple technique with no radiation. The use of the US can benefit static or dynamic examinations. The three main fields for US guidance in interventional medicine are neuraxial injections (such as lumbar spine injections), nerve management , and musculoskeletal pain management .However, until the turn of the millennium, the benefits of ultrasound imaging were not well recognized. In 1953, Daniel Charles Moore (1918-2015) wrote about a variety of regional anesthetic techniques with the slogan, “no paresthesia, no anesthesia!” The idea was that paresthesia served to confirm the placement of the needle’s tip at the epineurium of the nerve, which, in turn, offered a strong probability of adequate analgesia .Raj P. Prithvi (1932-2016) was a pioneer of regional anesthesia who used a blind technique with nerve stimulation to identify and localize various nerves . He was Moore argued that his model of seeking paresthesias applied to certain specific types of peripheral nerve blocks, such as the brachial plexus or sciatic nerves, among others . The queIn 1994, Jerry Vloka and Admir Hadzic, two physicians from the New York School of Anesthesia, founded NYSORA, an organization dedicated to the promotion of regional anesthesia, pain management, and perioperative medicine by means of education initiatives . It was US guidance offers numerous advantages to the interventional pain physician. It is a safe, low-cost, readily accessible, and noninvasive system that is widely used and understood. US machinery is portable, and cost-effective, and generally available in most institutions and clinics. A major advantage of US guidance is that it can be used in real time to guide procedures. Perhaps most importantly, there are no radiation risks at all with this imaging technique, meaning it can be used as needed without concerns about exposing the patient to unsafe levels of radiation. There are certain limitations with US systems in that their use can be dependent on the operator’s expertise, and there is a steep learning curve to learn how to use them for the best results. US devices may produce artifacts that can impede easy interpretation. There is also a problem with resolution X-depth, meaning that at deep tissue levels, images can lose resolution. For interventionalists, this can make spinal imaging particularly challenging. A novel approach to managing this imaging problem is to fuse magnetic resonance imaging (MRI) and/or computed tomography (CT) scans with US images. Technology exists to create fused images that allow for easy interpretation as anatomic structures such as bones become readily recognizable .While still in its infancy, artificial intelligence (AI) may greatly improve our imaging abilities and our ability to use US images. For example, AI is already used with some breast US images to recognize and mark specific anatomical structures . No doubPain diagnosis and treatment must be one of the oldest fields of medicine, but it is continually improving and advancing. The hollow needle, percutaneous drug delivery, regional anesthesia, and nerve blocks offer safe and effective forms of anesthesia and analgesia for patients. The use of US imaging techniques offers more precise control for nerve localization, and future fused images can provide good insight into the difficult-to-image structures of the spine. Osteogenic pain is an important new area for interventional techniques since there are few other options for patients with bone disorders. The future of pain medicine is still being written, with the next chapter likely to be how artificial intelligence is incorporated into interventional pain medicine, particularly in terms of its role in imaging and identification of particular bony structures.