With the rapid and widespread uptake of physical literacy (PL), there is potential for instructors to devalue participation of children who experience disability. The aim of the investigation was to understand how instructors who facilitate physical activity for children experiencing disability make sense of PL, and more specifically, how these instructors bring meaning to PL. Using interpretive phenomenological analysis, six instructors engaged in individual, semi-structured interviews. The study rationale was underpinned by the conceptual framework of ecological systems theory, which provided a foundation for the research, guided the structure of the interview guide, and facilitated a reflexive interpretation of the findings. Four themes were generated: Recognizing unique embodiments, The importance of context, Beyond physical competence, and Navigating PL’s dominant discourse. The instructors’ meaning of PL, impacted by relational and environmental influences, reflected the importance of movement skill development, while also embracing diverse embodiment and pedagogical flexibility by giving value to exploratory play, partial participation, family involvement, and willingness to abandon rigid lessons plans. Since its inception in the late 1800s . Most unWhitehead defined PL as “the motivation, confidence, physical competence, knowledge and understanding to value and take responsibility for engagement in physical activities for life” , p. 8). . 8]. PL With the declaration that PL is inclusive of all ,6, organAs individuals experiencing disability possess a wide range of personal interests and capabilities , we can Yi et al.  suggesteJurbala  proposedEST is a view of human development based upon the dynamic interplay between the organism and the environment, organized into five environmental levels: microsystem, mesosystem, exosystem, macrosystem, and ,32. EachWith the aim of the research being subjective understanding of how instructors make sense of PL, an interpretivist paradigm, founded on the assumptions that reality is socially constructed and fluid, was required . An inteConsistent with an interpretivist research paradigm and its assumptions, an interpretative phenomenological analysis (IPA) research approach was applied . IPA proAfter obtaining approval from the University’s Institutional Ethics Review Board, recruitment letters were sent to community PL leaders  outlining the specifics of the research investigation. Organizational leaders then distributed the recruitment letters to their organization’s APA instructors, who if interested, contacted the first author to become involved in the study. The first author invited those who met the eligibility requirements to participate in the research. Before data collection, participants were provided with study information, inclusive of the benefits, risks, time commitment, and study withdrawal procedures. All participants provided written informed consent prior to their involvement. To safeguard anonymity, all identifying information was carefully eliminated from the research materials, and pseudonyms were assigned to each participant.In accordance with IPA, a small, homogeneous, purposeful, criterion-referenced sample provided in-depth exploration of the phenomenon ,45,46. TDespite efforts to recruit APA instructors from multiple programs within a large Canadian city, all participants  were from a single program at a single location. Their average age was 27 years (range: 22 to 35 years), while the average number of years instructing in the organization was 3.9 years (range: 0.5 to 6.5 years). Four participants had previous professional experience working with children experiencing disability as a respite care worker, educational assistant, or Special Olympics coach. All participants had a background in APA having taken one or more undergraduate classes in APA.The participants were instructors at a not-for-profit, disability-specific, community-based physical activity and fitness centre in a large Canadian city. Several programs are offered at this centre, including one designed for children aged 4 to 19 years with the designated label of developmental disabilities. Within this program, the children received one-on-one and group instruction 30 min twice per week over a period of 8 weeks. Focusing on the development of movement skills and knowledge towards health and wellness while facilitating autonomy and independence in a fun and social environment , the program is facilitated by instructors educated and trained on PL development according to the various stages of the LTAD . A typicThe participants engaged in one-on-one face-to-face, audio-recorded, semi-structured interviews. All interviews were conducted by the first author at a time and place convenient to all of the participants. The interviews followed an interview guide that was developed based on the research focus and conceptual framework, thereby ensuring consistency of inquiry across participants . As recoInitial interviews with participants lasted an average of 59 min (50 to 75 min). Follow-up interviews, used to clarify information from the initial discussions, occurred with four of the six participants and lasted an average of 20 min (10 to 45 min). After each interview, the first author recorded his thoughts in the form of a reflexive journal. This action of journaling included thoughts about the conversation, the interviewer’s reflections on the participants’ discussions, and considerations for potential emerging themes. The journal notes enabled a reflexive return to the interview setting during analysis . The proThe first author completed an initial inductive, line-by-line thematic analysis of the interview transcripts using Smith et al.’s  six-stepThe second and third authors acted as “critical companions” In addition to the participants receiving via email, a copy of their transcript(s) for review , a summaFour criteria were used to convey the quality of the research thereby fulfilling a commitment to “integrity, competence, and legitimacy of the research process and findings” Commitment and rigour were established through use of multiple data sources , comprehensive data collection (multiple interview opportunities), and systematic analysis strategies (six-step process). Further, the participants were provided with opportunities to reflect on their interview transcripts and thematized data, adding a supplemental degree of credibility . TranspaImpact and importance are contingent upon the reader’s subjective evaluation and the subsequent actions they take based on the study findings. By providing a meticulous account of the research processes, research context, and richly descriptive participant experiences supported by direct quotations, readers can assess the relevance of the findings to their own context, and make informed decisions about how to apply them ,60.Four themes generated from the analysis reflected relational and environmental influences on the meaning of PL held by the instructors. These influences occurred at the intersection of individuals (microsystem) with their environment (mesosystem), the cultural (sport) context of PL (exosystem), and the larger interaction of social and cultural values embedded in (normatively referenced) active lifestyle development (macrosystem). The instructors understood PL through an ongoing negotiation between best pedagogical practices emphasized within the field of APA and the playground to podium sport foundation of PL . The themes were: (a) Recognizing unique embodiments, (b) The importance of context, (c) Beyond physical competence, and (d) Navigating PL’s dominant narrative.Although adhering to a movement competency understanding of PL, the instructors collectively understood that each child expressed unique embodiments, abilities, interests, and needs and that their (microsystem related) relationships with the children were immediate and impactful. Rachel highlighted the need to step away from the macrosystem influences of PL , that being norm referenced movement development with the aim of sport focused goals, to encourage participation of children with diverse embodiment. “I think that physical competency looks so different for everyone”. Patrick also noted that competency depended on one’s embodied capability: “It [motor ability] is unique to everyone, 100%. Everyone is going to have a different ability level when it comes to a certain movement or skill when using their body in time and space”. Beth further added: To one person, it [PL] might mean that they can complete a triathlon. To another person, it might be that they can get by in gym class and not feel like they are being pointed out or singled out for not being good at that particular game or something.Instructors highlighted important aspects of adaptations they make that may not be present in non-APA or inclusive settings . Samantha expressed the need to adjust for differences in movement ability and overall physical proficiency; however, acknowledged that there is “no definitive recipe that can be followed”. Beth underscored the need to deviate from planned activities to prevent or alleviate expectation frustrations that can impact children’s motivation to continue engaging with planned activities. “… if I see a kid getting really frustrated with a skill or something, I’ll just say, ‘you know what, let’s just play a game, and then we’ll go back to it’”. Incorporating interests were deemed important by the instructors to enhance children’s enjoyment, ultimately increasing the meaningfulness attached to a PL experiences. Beth recalled, It is one thing to just hit a ball and then run around the bases, but that’s pretty boring for a kid who’s not really interested in sports. But if you make it exciting for them by bringing in extra visuals and noises and things that they enjoy, just making any game more enjoyable and more individualistic, that’s going to make them want to come back.Further, they valued partial participation above overwhelming a child by forcing engagement in a non-preferred activity. Andrea emphasized meeting the children where they were at by honouring what they would be willing to do rather than imposing what instructors may have felt they needed to do . I had a kid who was really dysregulated all day, and I was getting to the point where I thought, ‘I’ve tried all of my measures,’ but we just sat there and passed the ball back and forth. He did nothing of what I planned to do, but at least he was still doing some type of physical, you know, activity. Martin noted that flexibility in the presentation of information was important, highlighting that for some children, simplifying activities was necessary to help them remain engaged and “not being overwhelmed with information”. Instructors also discussed the need to know how participants felt physically as they entered the physical activity environment. Patrick highlighted how a child’s physiological state when entering the physical activity environment is a pedagogical strategy that gives value to partial participation and establishes a positive, participatory context. “There are days when kids come in exhausted, and you know what? You just slow things down. You do what you can”.Instructors emphasized the importance of constructing environments with the participant in mind thereby creating positive PL contexts . Beth and Samantha highlighted the need to address certain physical characteristics of the environment such as noise, people, and colour. According to Beth, attending to these features, helps to establish a level of comfort by “reducing the risk of over-stimulating the individual”. In addition to accommodating noise, Andrea offered up suggestions for making the physical environment easier to navigate, highlighting her use of “headphones for the purpose of noise reduction, and the use of visual markers to assist with transitions from one activity to the next”. Finally, Patrick indicated that contexts created according to individualized needs provided “a sense of overall security”, resulting in a learning climate that is welcoming to children. This comfort contributed to an “optimal experience, one that individuals positively associate with, and want to come back to”, thus maximizing the opportunity for further PL engagement. Beyond discussions of the physical environment, instructors also believed that their attitudes profoundly impacted the meaning they gave to PL. Samantha indicated that instructor attitudes of “acceptance of diversity and inclusion, allowing children the opportunity to come into the physical activity setting without judgment”, fostered the best possible learning climate for children, strengthening their overall motivation to engage. Providing opportunities without a rigid movement-skills focus represented a welcoming and supportive physical activity context. As Rachel expressed, physical activity opportunities should occur within a supportive, enjoyable, success-oriented context. Although the instructor may have a PL goal in mind, “if kids feel like it is work, it’s going to be viewed as negative”. She believed that opportunities should allow children to have the freedom to play and have fun without worrying about completing an instructor imposed developmental movement task or accomplishing an instructor driven goal. Reflecting on her experiences, Samantha indicated that using play as a pedagogical strategy allows one to “experiment and try things out without someone telling them what’s right or wrong”, from which further instructional activities and strategies can emerge. Samantha highlighted that eliminating pressures to meet criterion-framed normative movement skill standards nurtured a context of happiness, fun, and success in movement. As Andrea put it, play increases the child’s confidence by developing an “understanding of what it means to be physically active”. There were dynamic interactions among the influences instructors gave to their meanings of PL for children experiencing disability. The instructors gave importance to relationships with the children and the parents in the immediate environment (microsystem influences) as well as the community at large (macrosystem influences). The instructors held a steadfast belief that others’ perspectives were essential in optimizing their understanding of PL as it was applied to children experiencing disability. Parents were a vital component of the program context, providing information on their children’s strengths, interests, and motivations and were considered to be part of the instructional team-approach (interactive mesosystem influence). Thus, a team-based approach consisting of regular parental consultation elevated the quality of PL experiences for the children. An ongoing dialogue allowed instructors and parents to exchange information. In describing her interactions with parents, Beth indicated that parents brought meaning to her understanding of PL by establishing consistency across different environments in the children’s days. A few parents have suggestions like “maybe you can try this; it has worked in the past” and we say, “great!” We will try that, and like visual schedules, sometimes parents really recommend we do that because they rely on one at home. We say, “okay, we will for sure use a visual schedule then”.Similarly, Rachel shared how conversations with parents enhanced the meaning of PL by enhancing important and productive relationships with the child. She embraced the microsystem influences of parent input on learning preferences and ultimately the meaning of PL for specific children. I talked to mom, and she said often her little boy needed  pressure when he was overwhelmed or upset. If we were doing a task that might be more challenging for him, he would just come and sit on my lap which meant he needed a squeeze.In addition to seeking contributions from parents, the instructors shared the importance of children’s contributions. They valued the importance of activity preferences, providing choice in equipment selection, pacing of the activities, and asking for feedback on their experiences. Patrick noted, however, that obtaining the children’s input was challenging, “… it is sometimes very difficult to get feedback from them because of the communication limitations and cognitive abilities”. Beth explained that providing children with choices was an optimal way to work around variations in communicative ability and afforded the children with a sense of direction in creating future opportunities that may increase relevance and importance of active movement participation. Beth recalled:… the parents really wanted him to work on body awareness, and they thought yoga was a great way to do it, but he hated it. So, we just started playing a different game and rolling dice, and whatever number appeared, he had to come up with a movement to do that many times … it was just finding different ways to do the skill.Finally, instructors highlighted that PL is not isolated to a single context. Input and support from those within the community were necessary to reinforce the overall and holistic meaning of PL (macrosystem levels of influence). Rachel indicated that discussions with community members within various sport, recreation, and physical activity sectors were “interesting” as they opened her eyes to new considerations regarding her instructional approaches. Specifically, these conversations stimulated opportunities on how her current approaches could accommodate a smoother, more continuous transition to other physical activity settings that integrated their own cultural customs and value systems to participation. After all, according to Rachel, “it all comes down to exposure and development, or giving meaningful opportunities to the kids, so they can be active in the future”. Patrick went one step further, articulating that, not just conversations, but the relationships formed by instructors across contexts was essential for fostering consistency and continuous PL development:As far as fostering physical literacy, kids need to be in an appropriate environment, inclusive of those that interact with them. Building strong and long-lasting relationships with other facilitators, those that are willing to share information, will provide better results in developing physical literacy from one place, or program, to the next.Addressing continuity from a slightly different perspective, Samantha articulated that community support was essential for the continuous development of PL. With it, long-term engagement in physical activity is possible. Expressing subtle bitterness, she conveyed that the current system of services for children experiencing disability is inadequate as there is a lack of options once they reach a certain age: “… it’s really difficult once they leave our program. Once they age out, if we don’t have something set up in the community or there are no community-based programs, there is nowhere they can go”. This discontent resonated through Martin’s observation that the amount of time individuals spend with him is limited. For PL development to evolve, “it is something that needs to be constantly and consistently reinforced by individuals beyond the physical activity context”. The instructors reflected the influence of the cultural value (macrosystem level) of normatively based, movement competence as the base of the sport development framework of PL . Participants highlighted that the acquisition of movement skills were foundational for the improvement of overall movement ability and hence PL. For example, Rachel declared that movement skills served as “the basis for informing physical literacy”, suggesting they are imperative for ongoing participation in physical activity. Beth stated that movement skills provided an increased opportunity for children experiencing disability to “know how to move or play almost any game or sport, in any environment”. She further emphasized that by encouraging movement skill development, children were better prepared to participate in physical activity:We want them to be able to more easily know how to run, walk, skip, oh my gosh, all the different physical literacy tools and like especially the fundamental movement skills so that if they, you know, work on stair climbing or running or jumping in our centre then that translates to like the home and the gym.Not unlike Rachel and Beth, Patrick indicated that foundational movement skills are the basis for all types of future engagement in physical activity:Physical literacy is like learning how to read and write where you first learn the alphabet—the A, B and Cs. With physical literacy, your ABCs are learning basic movement skills like running, jumping, hopping and skipping … these skills support a range of physical movements from recreational capabilities to becoming an athlete.Martin further noted that movement skill acquisition fostered a sense of independence and self-sufficiency, improving one’s “ability to self-guide their physical activity engagement, leading to participation in more advanced activities”. The instructors further reaffirmed the dominant narrative associated with PL through the considerable value they placed on movement skill assessment—the social value placed on categorizing competence (exosystem influences imposed on the children experiencing disability through instructor attitude and action). Patrick’s explanation summarizes a shared understanding among the participants that assessment was valuable for providing an initial indication of the movement competence of children experiencing disability. However, rather than seeking to document deficits based on norm-referenced performance standards, assessments were used as a tool for self-referenced instruction. The assessments provided a frame of reference to begin instruction and provided “a measure of progress, or more specifically, a measure of change”. For the participants, movement skill assessments were essential for generating a long-term, customized instruction plan, complete with information on optimizing PL development. The application of EST ,32 reveaDespite noting the importance of the ‘physical’  as being foundational to PL development , proximaSimilarly, instructors acknowledged the variability that occurs with learning. Noting the need for person-centred flexibility and variation in instructional approach , and that participants should be empowered to guide instruction rather than being a pure recipient of it, instructors highlighted a necessary departure from linear, readiness-based styles of PL development . In doiAcknowledging that the meaning attached to the physical activity experiences of children is something organically produced through the relationships with others , instructors appreciated the value associated with a team-based approach to PL development. Collaborating with others and seeking input beyond their own ideas was essential to instructors’ understanding of PL, and ultimately, the creation of positive and customized learning climates that emphasized more than just skill acquisition, but were increasingly sensitive to the needs of each child . FurtheChallenging the dominant PL narrative dictated by the top-down, ableist culture of sport and broader society (exosystem and macrosystem influences), PL held meaning for instructors as a shared pedagogical responsibility . InstrucDespite challenging the dominant PL narrative and expanding the concept’s applicability, instructors recognized that their emphasis on the ‘physical’  reinforced an incomplete understanding of PL as a holistic concept , counterWe acknowledge limitations to the study. Although we presented findings from only one instructional program, the instructors provided a homogeneous sample from which to gain in-depth understanding of PL for children who experience disability ,55. The All in all, the meaning attached to PL, and the understandings that the instructors possessed, were embedded in the upper-level macrosystem and exosystem influences  coupled with lower-level mesosystem and microsystem influences . These understandings reflected competing personal and environmental influences, illuminating the value instructors placed on PL, as well as their commitment to facilitating meaningful PL experiences for children experiencing disability. Using an ecological systems perspective, PL interpreted to be the acquisition of normative movement skill development having the potential to marginalize children with diverse embodiments. The important implications of the study lie with the need for flexible pedagogical strategies as instructors actively moved beyond understanding PL as movement competency. They incorporated motivational aspects of engagement by incorporating play in their instructional approaches, giving value to partial participation, abandoning rigid lesson plans to address children’s daily needs, and family involvement to support sustained engagement in activities of PL. Continued use of ecological frameworks is recommended to garner deepening insight into the nature of individual–environment interactions associated with understanding the meaning of PL in APA and inclusive contexts.


IIT 4.0 openly rejects the mainstream view that consciousness is generated by the brain, positing instead that consciousness is ontologically primary while the physical domain is just “operational”. However, this philosophical position is presently underdeveloped and is not rigorously formulated in IIT, potentially leading to many misinterpretations and undermining its overall explanatory power. In the present paper we aim to address this issue. We argue that IIT’s idealistic ontology should be understood as a specific combination of phenomenal primitivism, reductionism regarding Φ-structures and complexes, and eliminativism about non-conscious physical entities. Having clarified this, we then focus on the problematic tension between IIT’s idealistic ontology and its simultaneous endorsement of realism, according to which there is some kind of external reality independent of our minds. After refuting three potential solutions to this theoretical tension, we propose the most plausible alternative: understanding IIT’s realism as an assertion of the existence of other experiences beyond one’s own, what we call a non-solipsistic idealist realism. We end with concluding remarks and future research avenues.Integrated Information Theory (IIT) is currently one of the most influential scientific theories of consciousness. Here, we focus specifically on a metaphysical aspect of the theory’s most recent version (IIT 4.0), what we may call its  IIT 4.0 openly rejects the mainstream view that consciousness is generated by the brain, positing instead that consciousness is ontologically primary while the physical domain is just an experience-dependent “operational” construct to understand consciousness from the scientific, third-person perspective:Currently, Integrated Information Theory (IIT) is one of the leading scientific theories of consciousness ,2,3,4. I“The primacy of intrinsic existence (of experience) in IIT contrasts with standard attempts at accounting for consciousness as something ‘generated by’ or ‘emerging from’ a substrate constituted of matter and energy and following physical laws.”  (p. 38)phenomenal primitivism ; (ii) reductionism regarding Φ-structures and complexes ; and (iii) eliminativism about non-conscious physical entities such as, presumably, atoms, neurons, bodies and rocks . Then, in realism, namely, the idea that “something exists (and persists) independently of our own experience” , then its Φ-structure corresponds to the quality of the experience of S in state s, while its Φ value corresponds to its quantity”  truly exists because it exists for itself—it exists absolutely” ... In fact, it may be more valid, since to be highly conscious (to have high Φ) implies that there is something it is like to be you… From this standpoint, it would seem that entities with high Φ exist in a stronger sense than entities of high mass”  is what exists in physical terms… [it] truly exists because it exists for itself—it exists absolutely as a conscious being”  does not exist as such but only “unfolded” as a Φ-structure—an intrinsic entity that exists for itself, absolutely” —an intrinsic entity that exists for itself, absolutely, rather than relative to an external observer” [“a substrate is what can be observed and manipulated “operationally” from the extrinsic perspective. From the intrinsic perspective, what truly exists is a complex with all its causal powers unfolded [the bserver”  (p. 28).Φ-structure. At the same time, a Φ-structure ontologically reduces to its corresponding conscious experience  exists for itself, in physical terms [Φ-structures, which in turn, reduce to their corresponding consciousnesses. In other words, PSCs are not ontologically eliminated, they really exist. It is just that they are, intrinsically, truly, nothing but phenomenal entities, although described in operational, physical terms.So, according to IIT, a PSC ontologically reduces to the unfolded structure of its specific, maximally integrated, intrinsic causal powers, i.e., its perience . Hence, al terms ,11,12,26idealistic ontology can be defined as follows:(i)Phenomenal primitivism: Conscious experiences are ontologically fundamental or primitive, neither deriving nor reducing their existence from/to anything else.(ii)Eliminativism about non-PSCs: Physical entities that do not specify maximal system integrated information , such as, presumably, electrons, neurons, bodies, rocks and chairs, do not truly exist on their own .(iii)Φ-structuresReductionism about : Cause–effect structures do exist, but they are nothing but conscious experiences, albeit described in physical terms .(iv)Reductionism about physical substrates of consciousness: PSCs do exist, but they are nothing but Φ-structures seen extrinsically, and hence, are ultimately reduced to experiences also .In synthesis, IIT’s monistic, as claimed in [Φ-structures and PSCs), or eliminated from existence .It is important to highlight that the resulting metaphysical picture is wholly aimed in ,19,26. IWith all these distinctions in place, we turn now to the issue of how this radical idealistic ontology may be harmonized with IIT’s simultaneous endorsement of a kind of realism about the external world.In the present section, we will examine in detail the important theoretical tension between IIT’s simultaneous endorsement of what we have called an idealistic ontology, and realism ,12. We brealism, according to whichIntriguingly, although IIT has radical ontological implications regarding the primacy of experience and the secondary, either eliminable or reducible status of physical entities, the theory simultaneously endorses the thesis of “We should assume that something exists (and persists) independently of our own experience… Although IIT starts from our own phenomenology, it aims to account for the many regularities of experience in a way that is fully consistent with realism”  (p. 6).Prima facie, it seems very problematic to hold both that all that exist are ultimately conscious experiences, and that there are things existing independently of our consciousness. Recall that, according to IIT, “bodies and organs, tables and rocks…only exist vicariously… and so they do not truly exist”  (p. 8). A first potential reply could be that, in contrast with IIT’s idealistic ontology, realism is not really an ontological claim, but merely one of its “methodological guidelines”  (p. 6). attitude of the researcher towards the thesis of realism , but not the content of the thesis, which would remain metaphysical all along. Hence, at the metaphysical level of discourse, IIT’s idealistic ontology and realism would remain in a theoretical discrepancy. By entailing that only experiences truly exist, IIT’s account seems fully inconsistent with the metaphysical claim that an external, physical world exists experience-independently.Our objection is that even if realism is meant to be a “methodological guideline”, it would be a metaphysical thesis nonetheless: it claims that we should believe in the existence of an external world beyond our minds. If this is not a paradigmatic example of a metaphysical belief, then we do not know what else could be. So, it can be granted that IIT’s realism could be a heuristic, fundamentally aimed at pragmatically guiding the scientific study of consciousness. However, this qualification would merely affect the existence of the things and properties of a given domain one is realist about, but also the belief in their mind-independence [φs , at best, “only exist relatively, for an observer” [A second potential reply from IIT theorists may be the following. Non-conscious entities such as bodies and chairs do exist, it is just that they exist extrinsically, not for themselves but from the perspective of an intrinsic entity. In other words, extrinsic existence would not be non-existence. Although we see here a promising route to resolve the problem (see ), as stapendence , which ibserver”  (p. 8), noumena, but we will never have direct cognitive or experiential access to them as such. At best, we know them as they appear to us, i.e., as phenomena. A first difficulty with this reply is that it would entail that we cannot have substantive knowledge about the metaphysical nature of extrinsic entities, because the way they are-in-themselves would be forever beyond our grasp, and hence, we would need to remain silent about their true nature. However, IIT does not remain silent about this at all, claiming instead that the divide between intrinsic and extrinsic entities is a divide of being, not of knowing. In other words, there is an epistemic contradiction between the Kantian suspension of judgment about the true noumenal nature of extrinsic entities and IIT’s purported knowledge about it. This is closely related to our second worry. If extrinsic entities do not truly exist, for themselves, but only relative to conscious observers, then intuitively, they would not exist-in-themselves either, as noumena beyond how they appear to us, i.e., they would be purely phenomena. In other words, there is a metaphysical contradiction between the Kantian reply that extrinsic entities have a noumenal, albeit, unknowable nature, and IIT’s implication that they have no noumenal nature at all.A third potential reply is Kantian in flavour. It says that causally powerful extrinsic entities do exist mind-independently, as things-in-themselves or We claim that there is at least one straightforward plausible alternative for IIT to deal with this apparent contradiction. The solution is to take other experiences as the only type of entities that exist independently of one’s own experience. In other words, our proposal interprets IIT’s realist statement that “something exists independently of our own experience”  (p. 6) arealist and anti-realist versions of idealism [esse est percipi (to be is to be perceived), according to which things exist only insofar they are perceived by a mind.To clarify our interpretation of IIT’s realism as the most plausible solution to the tension we are dealing with, and its plausibility as a form of realism, it is useful to evaluate it in light of Chalmers’ distinction between idealism . Accordiidealism  (p. 592)In the realist idealism, in contrast, the claim that reality is exhausted by how things appear to conscious minds is rejected; “the physical world really exists out there, independently of our observations; it just has a surprising nature”  (p. 592)realist idealism, with respect to Chalmers’ classification. The nature of conscious (subregions of) brains, conscious neuromorphic hardware, or even minimally conscious photodiodes, according to our proposed reading of IIT, is certainly not exhausted by how they appear to external observers. That is, their nature is not even closely conveyed by being, say, a wrinkled, pinkish-grey mass (brain), a complex network of tiny, interconnected metallic components (neuromorphic hardware), or a small, shiny rectangle, encased in a protective material (photodiode). Nor would their true nature be expressed by a more refined and technical vocabulary along the same lines. Their true nature is how they exist for themselves, that is, what it is like to be them from their own perspective.With this distinction in place, we believe that, according to our proposed understanding of IIT 4.0′s ontology  and corrSo, in line with Chalmers’ account of realist idealism, these physical substrates of consciousness (excluding my own PSC), truly exist independently of my own subjective consciousness and not as how they appear to me. It is just that their nature is eminently experiential, they are definite, specific, and irreducible structures of intrinsic phenomenal existence. Thus, while the PSC of my own consciousness is just a way to interact and describe my consciousness from the outside, the PSCs of other systems’ experiences are ontologically independent of my own consciousness, they really exist out there in the world, it is just that their true nature is not physical but experiential.Φ-structures”, or as “physical substrates of consciousness” (PSCs).This interpretation respects IIT’s rejection of solipsism, which seems to be a core motivation for endorsing realism in the first place  (p. 6). φs values, and that, hence, exist only relative to conscious observers (mind-dependently). As such, our idealistic reading of IIT’s realism is the only one that would respect the theory’s “great divide of being” [In this sense, the more traditional form of realism is discarded, namely, the view according to which the external world really exists independently of one’s own mind and is fundamentally constituted by non-conscious physical entities such as quarks and electrons. In accordance with IIT’s idealistic ontology, especially due to its principle of true existence , quarks,f being”  (p. 8) bIn sum, we regard our idealistic interpretation of IIT’s realism as the most parsimonious solution to the logical tension we exposed in Φ-structures and physical substrates of consciousness (PSCs), and eliminativism about non-conscious physical entities . The entities that are ontologically eliminated include, presumably, atoms, fMRI scanners, cerebellums, living bodies, and distant galaxies, among many others .In the present article, we have tried to advance a better philosophical understanding of IIT 4.0, centred on the apparent tension between its idealistic ontology and realism. After presenting the fundamentals of the theory , we arguentities . That isnon-solipsistic idealist realism. We also evaluated the resulting metaphysical picture in light of Chalmers’ [Then, in halmers’  distinctprima facie imply that an engineer can create a conscious physical system  using individual components that did not exist , such as separate logic gates and wires. In other words, it seems that existence can be engineered from non-existence; a very uncomfortable implication. Additionally, the common belief that consciousness originated at some point in the evolution of life, under IIT’s metaphysics, apparently means that consciousness originated from nothing ; again, a very unpalatable implication. Importantly, IIT’s notion of an “ontological dust” [In sum, we claim that the overall metaphysical picture we have proposed clarifies and further advances our understanding of IIT’s ontological implications; and moreover, it resolves the fundamental tension between its idealistic ontology and realism, showing the kind of realism that is compatible with IIT’s ontology. Nevertheless, future work should address several other issues that arise from IIT’s ontological elimination of every non-conscious entity . For insal dust”  may be uIn future work , we will


In the last few years, the volume of research produced on phage lysins has grown spectacularly due to the interest in using them as alternative antimicrobials. As a result, a plethora of naming customs has sprouted among the different research groups devoted to them. While the naming diversity accounts for the vitality of the topic, on too many occasions it also creates some confusion and lack of comparability between different works. This article aims at clarifying the ambiguities found among names referring to phage lysins. We do so by tackling the naming customs historically, framing their original adoption, and employing a semantic classification to facilitate their discussion. We propose a periodization of phage lysin research that begins at the discovery era, in the early 20th century, enriches with a strong molecular biology period, and grows into a current time of markedly applied research. During these different periods, names referring to the general concepts surrounding lysins have been created and adopted, as well as other more specific terms related to their structure and function or, finally, names that have been coined for the antimicrobial application and engineering of phage lysins. Thus, this article means to serve as an invitation to the global lysin community to take action and discuss a widely supported, standardized nomenclature. Research on “phage lysins” is a hot topic these days: in this so-called “post-antibiotic” world to come, the questions and answers on how to handle antibiotic-resistant bacteria are one of the most apparent drivers for innovation in antimicrobial discovery. Under the influence of this contemporary challenge, bacteriophage research has drifted towards an eminently applied focus of breadth and intensity unheard of (in the West) since the early days of phage. That is how we end up today with a globally growing community of researchers putting their efforts not only on the development of full virion phage therapy ,2 but alAll of these new research efforts come with their own nomenclature innovations as much as they have continued the naming traditions of the field, with diverse emphases and novel uses. Therefore, we stand at a point where names in the phage lysin field proliferate and are sometimes used too flexibly, which, in turn, creates a sometimes -ambiguous research ecosystem, which is difficult to penetrate for the lysin-layman and exhausting to navigate for experts. Indeed, the naming proliferation reflects the vitality of the phage lysin field. However, it also faces us with what can become an uncontrollable Tower of Babel, in which retrieving and comparing data from all the international stakeholder groups becomes increasingly complicated. This article thus intends to establish the basis for an ordered discussion on the naming customs in the phage lysin field.If we are to discuss “customs”, the appropriate way to do so is by relying on the historical circumstances that explain them. At least three “eras” can be clearly described in the history of lysin nomenclature, and each of them encompasses a set of names and concepts devised within it .(1)Discovery era: roughly between the early 20th century and the 1940s, the fundamental terminology in the field was developed at the same time that phenomena were first time described.(2)Molecular era: in the central and final years of the 20th century, phage research entered the molecular biology era in which the infection and enzyme activity mechanisms were elucidated.(3)Applied era: since the beginning of the 21st century, phage lysin research entered a more markedly applied stage driven by the antibiotic resistance crisis. At this point, more distinctions came into place, many of which are related to the new role of lysins as antimicrobials. Even more remarkable is the plethora of common names given to the vast number of new lysins being described and investigated, both wild type and engineered, following the most diverse reasonings.In this work, lysin-related names will be thematically reviewed, attending to their different semantic levels: (1) general terminology for lysins, (2) terms related to the structure and function of lysins, (3) names for lysins as antibacterial agents and (4) nomenclature of individual lysins. For each case, the appropriate historical background will also be provided, considering the periodization established above .According to our PubMed-based survey , the terOf note, phage depolymerases  have also been considered as “phage lytic enzymes” , althougThe similar but more meaningful term “endolysin” seems now to be preferred to the simpler “lysin” . This naThis is important because phages do not only encode lysins at their lytic cassette, i.e., not all phage lysins are, in fact, endolysins. Since the mid-20th century, a muralytic activity was known to be present within the viral particles of some phages . At thatWhile, in the beginning, the actual point of discussion was the nature of the phage itself as a differentiated biological entity, this became clearer with the development of electron microscopy and its early application to the “bacteriophage phenomenon”, which allowed identifying new “sperm-shaped” particles (as worded by Helmut Ruska in 1941 ) that, iN-acetylmuramic acid and N-acetyl-d-glucosamine residues in peptidoglycan . However, “lysozyme” was still being metonymically and traditionally applied to peptidoglycan-degrading enzymes with other catalytic specificities and mechanisms. The historical tradition of “lysozyme” can clearly be appreciated in the numbers found in In this respect, one of the earliest names given to phage lysins was “lysozyme”. Controversy over correct nomenclature has spurred over time with this name. It was originally coined by Alexander Fleming in a seminal paper in which he thoroughly described the bacteriolytic effects of human secretions—thus first describing this bacteriolytic enzyme as a component of innate immunity . Later, N-acetylmuramoyl amidase (a name sometimes abbreviated as “NAM-amidase” or just “amidase”) that breaks the peptidoglycan between an N-acetylmuramoyl residue acid and the first l-amino acid residue of the stem peptide. It is thus not a true lysozyme. The name T7 lysozyme is still routinely used, for example, in the context of the T7 inducible expression systems, even if Inouye et al. (1973) already proved its different catalytic specificity and implicitly called the name into question [Phage_lysozyme (PF00959). All these lysozyme-like enzymes share homologous structural features and are indeed thought to be part of the same evolutionary family. In fact, the line between canonical, hydrolytic lysozymes and lytic transglycosylases seems rather blurred. For example, the hen egg white lysozyme has been shown to display both hydrolytic activity and transglycosylation [N-acetylmuramic acid and N-acetyl-d-glucosamine residues in a peptidoglycan and between N-acetyl-d-glucosamine residues in chitodextrins”). The same should apply to other names regarding the catalytic specificity , for which an accepted definition is given in The establishment of “lysozyme” as just the name for muramidase activity created many nomenclature dissonances in the phage field, as has already been pointed out . One of question . The casquestion ,41. Of nsylation ,43, and sylation , which ahttps://www.cazypedia.org/index.php/Transglycosylases (accessed on 5 August 2023).In yet another turn of the screw, there is one more general term presumedly equivalent to “lysins” or “peptidoglycan-degrading enzymes”: the name “peptidoglycan hydrolases”, often abbreviated as PGHs, or the synonym “murein hydrolases”—since murein is another name for peptidoglycan. However, this may also be conflicting. Hydrolases are enzymes that use water to catalyze the breakage of a chemical bond. While most of the known catalytic diversity of lysins are, at least as predicted, hydrolases  it is quThe issue can be further complicated in the case of mycobacteriophages. These phages comprise a couple of so-called “lysins” with different catalytic specificities. While mycobacteriophage lysin A can fall under the peptidoglycan-degrading paradigm presented for all “lysins”, lysin B, in fact, has the function of detaching the arabino-mycolyl outer layer of mycobacteria . As such, lysins B are, in fact, esterases that cleave the arabino-mycolyl ester bond. While it may be correct to denominate lysins B as “(endo)lysins” since they are indeed directly and enzymatically involved in bacterial cell lysis, it is less clear that they would fit under the terms “peptidoglycan-degrading enzyme” or PGHs. As esterases, they perform a hydrolytic reaction, thus they are hydrolases, but it is rather inaccurate to say that they degrade the peptidoglycan.Streptococcus pneumoniae phages [We may say that the main features of a module are two: (1) its ability to carry out its function in a relatively autonomous way, and (2) its interchangeability or possibility to be compatibly integrated into other higher-order units comprising different combinations of modules ;The domain, on the other hand, simply means a structural, functional or evolutionary unit of a protein .With the spectacular development of lysin combinatorial engineering from the beginning of the 21st century, the terms referring to the “building blocks” of lysins have also become increasingly relevant. The “mosaic” nature of phage genomes has been known since the second half of the 20th century. In fact, the realization that phage genomes are made up of DNA stretches that are conserved across many different phages , even tre phages ,48. The e phages , and sine phages . Within On this basis, and although there is much debate in the literature on the proper definitions, we may say that the main difference between these concepts lies in the “interchangeability” or “mobility” that comes with the term “module”. In any case, we do not see any conflict in using both terms interchangeably in the field of phage lysins.Lysins are therefore composed of different protein domains, which behave as modules that can be exchanged naturally, as a part of the evolutionary process at the bacteria/phage interplay, or artificially to engineer new lysin variants. Some lysins contain only a single domain, which carries out the catalytic activity . Bearing a single domain is typical for lysins from Gram-negative-infecting phages . HoweverOnce lysins were conceptualized as a new class of antibacterials in the context of the antibiotic resistance crisis, i.e., from the 2000s on, some new terms applied to lysins started to emerge. “Enzybiotics” is a name given to phage lysins purposed as antimicrobial agents. It is obviously a contraction of “enzyme-based antibiotics”, but the word misses the moiety “anti”, which has an essential meaning in “antibiotic” as “opposing life”. “Enzybiotic” is rather a term willing to indicate the use of enzymes as antibiotics by making up a similar word. This is to say, it would be a term applied to enzymes used to treat bacterial infections in a similar fashion as antibiotics. It was first coined by the V. Fischetti group , and sin®s, although this is a registered name by the company Lysando. Other engineering concepts focusing on outer membrane transfer have also been proposed, namely “innolysins” . Further on, more “creative” names started to appear, mostly playing on the name and/or circumstances of the phage . These  phage K ), LysGH1age GH15 ), LysAB2e phiAB2 ), and so, PlySs2 ,65). The, PlySs2 ,67) or n, PlySs2 ) by “gp”, PlySs2 ; or 1D10, PlySs2 ) but als, PlySs2 ,72,73). rom LysK ) or LysRrom LysK ). Namingrom LysK ). Other LysK [®s . In any (1)The first one exemplified by the liberal use of the term “lysin” at the early stages, applied in general to a still undescribed agent causing lysis and thus confusingly referring to what later would be defined as either true endolysins, structural lysins, phage depolymerases, or even the phage itself. The driver for confusion at this stage was not precisely knowing the nature of what was actually causing cell lysis ;(2)A second one driven by the initial lack of evidence or tools able to precisely define biochemical specificity, which at some point derived from the naming of lysins in general as “lysozymes”, a tradition that survived even after the name “lysozyme” was reserved for a precisely described catalytic mechanism of peptidoglycan hydrolysis;(3)A third one is our current era of engineered lysins, which is being driven by a variety of techniques or conceptualizations, and whose result is a remarkable diversification both in particular names for engineering strategies and naming schemes for individual lysins.Science aims at using well-defined, standardized names to conceptualize and refer to the objects it works with. As such, specific names are a tool essential to the communicative and generalizable aspect of science: accurate names allow effective discussion to take place at the global scientific agora. This is a good enough reason for taking some time and effort reflect on how nomenclature is used within our very own research field and maybe even on how it can become more uniform in the near future. Phage research already has a very long tradition. As it has become clear throughout this review, the names used in the field of phage lysins have changed linked to the respective historical circumstances. From our point of view, there have been at least three waves that have caused naming diversification and/or confusion with definitions around phage lysins:To these three, a fourth one may be added on top if we consider the names developed by companies devoted to phage lysin development for the purpose of market positioning. These range from general names for their lysin-based products  to new naming schemes for individual molecules .https://www.enzyme-database.org (accessed on 5 August 2023)) or the ICTV position on the naming of phages [At this point, we believe efforts toward correct name use and standardization should be welcomed to promote sharing and profit from the huge amount of data being produced around the world. For further clarity, a provisional glossary of phage lysin-related names discussed in this review can be found in f phages , which c


There is some evidence of the benefits of physical activity (PA) in patients with lung cancer; however, there is a lack of understanding of acceptable PA for patients with established cachexia and how to facilitate sustainable behaviour change to promote PA. Therefore, this study explored the views of healthcare professionals (HP), patients with lung cancer and cachexia, and their carers on preferences for, barriers and facilitators of homebased PA.This qualitative study involved ten telephone interviews with HPs and face-to-face interviews with seven patients with lung cancer and cachexia and their carers. Interviews were transcribed and analysed thematically. The Capability, Opportunity, Motivation and Behaviour (COM-B) model was used as a framework for the thematic cross-group analysis.n = 7), their carers (n = 7) and HPs (n = 10) were functional, flexible, individualised and initially of short duration and low intensity. PA was influenced by themes within physical and psychological Capability, physical and social Opportunities as well as automatic and reflective Motivation.The types of homebased PA suggested by patients with lung cancer and cachexia (Based on a behaviour change theory, principles to promote homebased PA were developed. These principles need to be integrated into tools to promote PA in people with lung cancer and weight loss.The application of the proposed principles by clinicians will promote physical activity, enhancing the function and wellbeing of patients with lung cancer and reducing burden on carers.The online version contains supplementary material available at 10.1007/s11764-023-01376-3. Lung cancer is one of the most common types with a particularly poor prognosis and many patients present with advanced disease . Approxi6 months .n = 40) using a mobile application demonstrated increases in PA, physical role functioning and a trend of improved dyspnoea in patients with stage 3 and 4 lung cancer [Physical activity (PA) is any muscle movement that requires energy, and includes exercise, which is defined as planned, structured, repetitive activity intended to improve or maintain physical fitness . There ig cancer . Howeverg cancer .There is a lack of guidance on the types of PA which are acceptable to patients, and how to promote PA to people with lung cancer and in particular those with cancer cachexia . BehavioThis qualitative study included semi-structured telephone interviews with healthcare professionals and face-to-face interviews with patients with lung cancer and cachexia and their carers, where possible. A schematic of the study is presented in Fig. n = 10) with at least 2 years of experience in cancer care were purposively recruited in person from the Council for Allied Health Professional Research events and existing networks via email. The sample size was based on a systematic review suggesting 9–17 participants are required for data saturation [Healthcare professionals n = 0 with atn = 7) and their carers (n = 7) were purposively recruited from NHS Palliative clinics in the UK. The planned sample size was up to 10 based on the literature [Patients  read and coded the transcripts to identify themes and sub themes inductively using thematic analysis with verbatim quotes selected to represent a range of views . Two tran = 8) at a variety of locations and health boards, with 2 outside Wales. The duration of the interviews ranged from 34 to 71 min.The healthcare professionals included five physiotherapists, one physiotherapy technician, two occupational therapists and two nurses. Their experience in cancer ranged 2–23 years, most were located in South Wales ‘well it's really the breathing mainly, it's the breathing, because, it's got better yeah but I don't want to be overdoing it.’ ‘I think her balance is a bit off but that's her eyesight. I don't think it's a physical thing’ Capability: An individual’s capacity to engage in the activity concerned . PatientI say to physios that I wouldn't do too much with them, because they're not taking enough nutrition on board, so if they're, if they're not taking enough calories ‘so they might not manage a walk down to the shop but if I say to them well let's get you standing while you clean your teeth, ok you might have a perching stool there, I want you to stand for a few minutes and then sit down because that will, you know, keep the strength in your legs so that we can then work towards you perhaps going out.’ HPs identified that nutritional status, pacing, grading activities and equipment were important for physical capability.‘I mean the main thing probably I would ask for is just sort of guidance, you know, something, something that's likely to be productive and achieve an end rather than me just randomly trying to think something up or spending hours in front of the computer.’ ‘many of the lung cancer patients that came through thought they'd had this diagnosis they couldn't do anything, that they had to stop everything, thinking now we're never going to do that again, there were so many that lost their confidence so quickly.’ Psychological capability components identified by HPs and patients as important included knowledge (what and how to do activities), attitude — including confidence — and fear of harm.I really do think having a DVD is more beneficial than having something written down because it feels like you've got company. sometimes you have to think of a worst-case scenario, if you can’t walk you have to use equipment to get about. You know, when I use a rollator (Carlos patient)‘if they're managing to complete the task and if they're not then we use equipment then to, to assist them with that.’ Opportunity: External factors that make possible or prompt the behaviour . Physicaso often the intervention is based around sort of educating as well as kind of giving the exercise advice and then maybe dispelling some of the myths about what physical activity or exercise involves, ‘I think again that's a good opportunity and, um, particularly the family members are missed out, these things are all, they're all safe and there's no reason that, that they shouldn't join in.’ ‘I've been bowling for years when I lived in Weston. …it's the people as well, it's very social we have a good laugh.’ Social opportunities included education and advice from HPs as well as support such as prompting from carers and including carers/friends in planning and undertaking activity.‘The use of motivational interviewing and similar techniques to try and encourage patients to, kind of I suppose, identify what they'd like to be able to do, what their goals are, what they'd like to be able to achieve and how they think they can manage that themselves.’ ‘Swimming also, he went with them or with family time, so um, it's going to be a matter of, you know, but these are the most two things he used to like to do’ Motivation: All the brain processes that energise and direct behaviour . Themes After mapping the themes, barriers and facilitators were identified. Barriers included symptoms, suboptimal nutrition, health variability, lack of knowledge, attitude, fear, confidence and environment. Facilitators were the environment, equipment, guidance, resources, planning, social support, attitude, beliefs, goal setting, personal role, enjoyment, reinforcement and confidence.intervention functions  were identified with examples  [Based on the themes identified, six les Fig. . They weivation)  were ideivation)   to encompass daily activities rather than exercise  . Based oBoth HPs, patients and carers were open to the idea of homebased PA despite there being no current guidance in patients with lung cancer and cachexia. It was suggested that PA should be individualised, functional (including mobility), adaptable to individual and variable capability; starting small  and potentially increased gradually. There were some concerns about risk of falls, and the need for a safe environment. The results of the HP interviews here align with the results of a study investigating the perspectives of 21 HPs on the type of lifestyle advice for cancer survivors. This interview study concluded that the optimal delivery of lifestyle advice should be (1) tailored to the individual and delivered throughout the cancer journey, (2) focused on small and achievable changes framed as part of their treatment regimen and (3) cost-effective for wide-scale implementation [The results also align with our previous work  and the A targeted PA intervention should be designed to overcome some of the potential barriers to physical capability including suboptimal nutrition, symptoms, variability and psychological capability such as knowledge and confidence/attitude. These results align with a previous qualitative study exploring the views, attitudes and beliefs of patients and HPs towards exercise for people with lung cancer post-surgery . Themes Opportunities to facilitate PA in this study included the environment and equipment, a choice of resources including guidance and education of when, how and why to do activity along with a PA plan. Resources should be individualised as some patients preferred paper means while others favoured technology. A number of exercise resources, including booklets, videos and PA diaries, are available for patients with cancer, e.g. in the UK  and AustSocial opportunities include family, HPs and other support networks, recognised by patients. Support groups, face-to-face and telephone follow-ups were also suggested. This aligns with results from a survey of exercise coordinators from Canada which suggested that programme enablers were patient participation , partnerships, advocacy and support, and appropriate program characteristics . Based oThemes identified within motivation included reinforcement, goals setting, perceived benefit, fear and attitude. Patients talked about enjoyment and past activities, HPs also identified maintaining role as a potential facilitator for PA interests, enjoyment or past activity. This mirrors the observations by Granger et al.  in patieIn keeping with our study results, a previous focus group study of barriers and facilitators to exercise in 26 patients with cancer-related fatigue with a range of cancer types and severities found that exercise motivators were related to perceived exercise benefits. Barriers were related to personal factors such as cancer related symptoms or treatment, lack of motivation and environmental factors such as cost, and the lack of exercise facilities tailored to patients with cancer. Facilitators of exercise were group programmes being, supervised, individually tailored, and gradually progressed . As wellPromoting a PA intervention informed by the COM-B has potential to counteract previously identified patient barriers including, symptoms, lack of knowledge the environment, lack of social support and low motivation. Therefore, personalised activity and lifestyle planning is required by cancer care workers to counter act these barriers.The main strength of this study is the inclusion of healthcare professionals, patients and carers to develop principles to promote homebased physical activities based on a recognised tool the Behaviour Change Wheel. Although the sample size was small, which may limit the applicability of the findings, the age and gender of the patients who participated were representative of the UK lung cancer statistics . Given tPatients with lung cancer have low levels of PA which affects function and quality of life. Healthcare professionals are key to promoting PA; however, specific guidance to promote PA in patients with lung cancer and cachexia has not been established. Based on the insights of healthcare professionals, patients and carers, principles to promote homebased PA have been presented including six intervention functions based on behaviour change theory. These principles may assist the promotion of PA in people with lung cancer and cachexia and further research needs to evaluate the effects on physical function and emotional wellbeing.Supplementary file1 (DOCX 51 KB)Below is the link to the electronic supplementary material.


This work presents a generalization of game theory and new perspectives on utility and value. Using quantum formalism, we prove that classical game theory is a special case of quantum game theory. We show that the von Neumann entropy and von Neumann–Morgenstern utility are equivalent and that the Hamiltonian operator represents value.This article is part of the theme issue ‘Thermodynamics 2.0: Bridging the natural and social sciences (Part 1)’. The first and most obvious question is, what does quantum theory have to do with economics? Quantum theory provides the basis for the unobserved choice of an individual, representing the state of a game before a decision is made/acted upon.The quantum world is a world in which observation has not yet occurred. Here, choice exists as simultaneous potentials of multiple possibilities in what is known as a quantum superposition. Then, making things more abstract, the system decoheres from its quantum state by becoming entangled with its environment, now behaving in a purely classical context.Like in physics, the classical world is the only world we can measure/observe; the classical observed world is the rational world. Because our observations must obey classical probability theory, it becomes apparent that, in economics, decoherence is the act of making a decision, and that the quantum state represents unrealized choice.Thus, classical game theory never truly represented the decision-making process, which is why there has been a considerable effort, particularly in mathematical psychology –4, to deOur most significant departure from classical –8 and quElementary Principles in Statistical Mechanics , p. 20Nash took the connection of the payout observable to vNM utility as being given . Because (a)(i)The essential difference between quantum and classical theory is that the latter represents a strategy’s observed outcome; the former represents a strategy before making a decision. Where deciding collapses the wave function, causing a quantum strategy to behave classically.1We begin by defining the space of games.2The space, We define a dual-vector space, Like classical formalism, quantum formalism defines pure strategies but with some notable differences. The quantum formalism also adds a new vector, the basis vector. Basis strategy vectors, ies, πj A pure strategy is a superposition of basis strategies, (ii)Economic observables possess a transformation that is orthogonal to the payout  events If we consider The time-evolution of an isolated strategy is given by the unitary operator There is a more profound significance to our interpretation of Pfanzagl’s ability .(iii)Pfanzagl left the The Schrödinger equation only applies to isolated systems, where knowledge of the internal state has not been communicated to the surroundings. What is surprising is that these internal preferences are not stable over time with experimental evidence supporting equation  We define an observable (a measurable quantity) as being,An observable, Because e axiom To satisfy Pfanzagl’s requirement that the observables, ‘commodities’, be real-valued,The possible outcomes of the observable (v)The rationality of economic actors played a significant role during EU’e development, –7, and iTo say something is rational, we must be able to measure/count what is being observed by Axiom 2.4. Thus, if it is observed, it is rational. Whether or not we can attribute a justification to a measurement is irrelevant to its rationality. Thus,Rational economic behaviour is observable behaviour.(vi)Because Using the Born rule, the probability of outcome From equation (2.3), From the Born rule, any observable To describe a mixture of strategies, we need to be able to decompose the game into a set of sub-games.The decomposition of a game into sub-games is the tensor product of its sub-games, The strategies of a composite game may be entangled. In this case, a composite pure strategy of two games Axiom 2.8 does not allow us to represent a mixed strategy with a ket-vector. To resolve this, we take a similar approach to Nash’s mixed strategy vectors Using the trace operation, (vii)The presented formalism depicts strategies that change with time and observables that do not change; this is called the Schrödinger picture. We can also consider the equivalent Heisenberg picture, where the observations evolve with time, but the strategies do not. To arrive at the Heisenberg picture, we examine the operator Looking at the time evolution of In the case where the Hamiltonian is not conserved, the solution is to break the Hamiltonian up into small enough time steps such that for each interval, the Hamiltonian is constant with time Commuting Hermitian operators also possess a valuable property: the existence of (at least) one shared orthonormal basis.Ifandare two commuting Hermitian operators, then there exists (at least) a common orthonormal basis.(viii)We can express the uncertainty of any two simultaneous measurements as beingFor example, consider the relationship between time and the Hamiltonian. Using equation  in equat(ix)When we observe a particular event, the wave function, Classical mixed strategy vectors, withare equivalent to quantum mixed strategies at the classical limit. (b)To resolve utility’s apparent disconnection from quantum formalism, we will use Pfanzagl’s clear and precise exposition of classical utility. Aside from Pfanzagl’s formal treatment of utility as a functional, his most significant contributions are: the three conditions that qualify observables for representation theory, each observable’s connection to utility, that representation theory contains the von Neumann–Morgenstern utility and that vNM utility is equivalent to his utility functional.Our integration with Pfanzagl’s approach is in four areas: integrate his notation with ours, show that any quantum observable is in representation theory, represent his utility functional with a quantum observable and identify von Neumann entropy as utility’s quantum observable.(i)Before beginning, we need to define the operators and relations that Pfanzagl used in representation theory.The set of all possible events,  obtain Between any two possible outcomes of a particular event, their transitive relationship is either strict preference or indifference, aPb≿aQb Let  of a∈A (ii)To show that the axioms of quantum theory satisfy Pfanzagl’s representation theory, we need to prove that any quantum observable’s expectation satisfies the safety equivalent wager’s properties and two additional conditions  (a)Any quantum observable’s expectation satisfies the safety equivalent wager’s properties: (i)is intern exceptorwhereandare the impossible and sure thing events. (ii) (iii)is increasing in both variables except (iv)is continuous. (v)for all (vi)The following statements are equivalent: —for at least one pair —for all — (b)Indifference between observables requires that the operators commute.All quantum observables are compatible with representation theory because they satisfy theorem 2.16 and the following conditions:(iii)Pfanzagl proved that definition 2.18 is equivalent to vNM utility  (b)There exist increasing and continuous functions The functions ith P≁O We must explore two philosophical concepts used to justify two postulates necessary for creating economic ensembles. To do this, we turn to political philosophy adopting two principles similar to Rawls’ ‘veil of ignorance’ and the ‘first principle of justice’ . Since R(i)We use Rawls’ veil of ignorance for guidance in developing the indistinguishability principle. ‘[The veil of ignorance] ensures that no one is advantaged or disadvantaged in the choice of principles by the outcome of natural chance or the contingency of social circumstances’ .Generalizing this concept, we see that uniformly constrained people would act similarly under similar circumstances and natural chance. We can extend this idea across time and see that given the same historical circumstance that we would have acted similarly to our ancestors, and they would act as we do now. This concept is why Justice is blind and why Common Law treats all case history as informing our decisions today. For these reasons, we adopt the principle that,Individuals are indistinguishable from one another.(ii)The second philosophical point is that individuals act independently. We apply Rawls’ first principle of justice, ‘Each person is to have an equal right to the most extensive total system of equal basic liberties compatible with a similar system of liberties for all’ Similarly, the rules of society are comported so that society does not inhibit the actions of individuals and protects individuals from being inhibited by others. Thus,Ensembles of strategies are separable. (d)The indistinguishability principle has some unique consequences in quantum theory. The primary consequence is that strategies are isomorphic between people, meaning that we cannot, even in principle, distinguish between the members of a system.Take a system of two indistinguishable individuals, Alice and Bob, with strategy vectors To describe other possible configurations, we use the permutation operator, Because Alice and Bob are indistinguishable, post hoc classical construction. The classical view allows us to track an individual’s history, a quantum impossibility.By observing the quantum system as a participant or as an outside observer, the quantum strategies decohere, resulting in their collapse. The problem is that we could not tell who Alice or Bob was, just that one had a particular outcome, and the other had another. After the strategies collapse, we could label each strategy based on the observed outcome and then track the outcomes classically; however, such identification is a  (e)We can now formally develop economic ensembles, the mathematical representations of populations. Gibbs described the basic formulation of an ensemble as being ‘rategy] .’rategy] (i)We now consider another operator central in constructing ensembles, the von Neumann entropy Entropy shares the density matrix’s orthonormal basis. The distinction between the two are their eigenvalues: gλj|j⟩ Entropy is essential because it represents the multiplicity of system configurations. As Boltzmann pointed out, entropy is the ensemble’s log-multiplicity, 4In the quantum context, pure strategies have a von Neumann entropy of 0. The degree to which an ensemble is entangled results in a reduction of the von Neumann entropy from the ensemble’s Shannon entropy. The decomposition of a density matrix demonstrates this effect. The Shannon entropy of the strategy weights is hogonal  —Entropy is a concave functional  —Entropy is continuous when −βH^]<∞  —Entropy is unique to an additive constant, probability’s normalization factor . —Entropy is subadditive and constrained by the Araki–Lieb triangle inequality There are several important properties of von Neumann entropy:(ii)Ensembles do not necessarily need to be in equilibrium. They are, after all, a generic construction with no restriction on their time evolution. However, by placing ensembles in an equilibrium state, we can derive several useful properties by maximizing their von Neumann entropy.Conversely, one can adopt the formalism of non-equilibrium statistical mechanics and relax this constraint, which is a well-defined process. However, we will only consider the equilibrium condition here. We define an ensemble in statistical equilibrium asWe previously noted that strategies indifferent across time must commute with the Hamiltonian. Moreover, considering the uncertainty principle, the density matrix is also complementary with time. The consequence is that simultaneous measurement of preference and time is impossible, and there is an absolute minimum uncertainty, (iii)5 All four derivations are extensions of their predecessors’ work, with Gibbs being the foundation. Every approach assumes the independence and indistinguishability principles when defining the ensemble.There are many ways we can develop the functional relationships of the Gibbs ensemble. The most notable derivations of these relationships come from Gibbs Probability,  (ii)Entropy,  (iii)Number of people (size of the ensemble),  (iv)6Other observables, Since we are talking about the observable outcomes of an ensemble, here is a list of what we know:We maximize entropy using the method of Lagrangian multipliers, For an ensemble total, its annotation for a given observable is the operator’s upper-case letter, e.g. The ensemble’s total extensive entropy functional isThe first-order homogeneous observables are called extensive, and the zeroth-order ones are called intensive. Thus, equation  expresseExploring the intensive entropy functional further, we can express (iv)Until now, we refrained from formally defining any economic observables other than connecting Nash’s mixed strategy vector to the density matrix, 7 The other commodities will continue using the But first, we define the quantity of money, the ‘payout’ which is a commodity, as the money observable, Pfanzagl identified six conditions that a utility functional needs to satisfy in definition 2.18:The von Neumann entropy measures von Neumann–Morgenstern utility.When we consider von Mises’ formulation of human action, it is that it is something ‘put into operation and transformed into agency’ .What economic quantity does the Hamiltonian represent? We answer this with what we anticipate as being the most controversial definition,The Hamiltonian operator represents economic value.We exchange money, goods and services because they have value. We often conflate value with utility, but this is for a good reason, as they are both increasing functionals of each other8 The terms in parentheses in the utility representations are the marginal utilities in terms of the marginal values.Our notation will be the following for representing the Hamiltonian as economic value: the operator, the basis vectors, and the eigenvalues, Because the Hamiltonian is conserved, so is value. This is the first law. Equation  is the s. 3To conclude, we provide an example of how to use ensembles and quantum decision theory; we turn to the Allais paradox. Its keystone is the apparent violation of vNM/Savage independence . In our In the quantum framework, the researcher’s objective, like the physicist's, is to create a model of the Hamiltonian that adequately explains the data. To do this, we use List & Haigh’s experiment on two cohorts of people, college students and professional traders, testing the Allais paradox . The coh (i)Choice A: win $7 with certainty. Choice B: win $7 with 75% probability, $10 with 20% probability, and $0 with 5% probability. (ii)Choice A: win $7 with 25% probability and win $0 with 75% probability. Choice B: win $10 with 20% probability and win $0 with 80% probability. (iii)Choose A or B between each of the previous two games. The payout will be from one of the two games, (i) or (ii), with a 50% probability.Following Allais, List & Haigh presented each cohort with three different games:a priori probability of each state’s occupancy, vNM independence. The assumption of equal a priori probability maximizes the ensemble’s von Neumann entropy. While this is not always an accurate assumption, it provides an absolute reference point and should always be the first step of any analysis.We begin by constructing the Hamiltonians for each of the games. Assuming no quantum effects, the Hamiltonians are diagonal matrices of the expected payouts for each of the games, weight , as two independent games. Whereas the traders correctly assessed the joint game and followed the canonical distribution, equation . A is preferred more than what is canonically represented. To understand why this is, we need to look at the temperatures of each cohort’s choices for each game.Each cohort represents a distinct but uniform population; each game must have the same temperature for each cohort by the third law. The fact that they do not suggests that something is skewing their choices at the quantum level. The students had temperatures of $2.0 and $0.23 for games (i) and (ii), respectively. The traders had a similar pattern of $0.29, $0.12 and $0.23 for games (i), (ii) and (iii), respectively, suggesting that they are less risk-averse than the students, while retaining the ambiguity aversion [The stronger preference for the guaranteed return of choice (i).A is apparent for both cohorts. However, it results in a lower overall utility for both. While the traders could evaluate the joint game with a higher utility, being nearly canonical, their entanglement of a slight ambiguity aversion resulted in slightly lower utility/von Neumann entropy from the maximum possible.


Purpose: Andrological diseases have an important social and economic impact as they cause a serious impairment of the quality of life of the affected patient. Epidemiologically, the impact of these disorders is progressively increasing, as demonstrated by the ever-growing prevalence of male infertility. This evidence justifies the rapid development of research in andrology that the scientific community has undertaken in recent decades. This study aims to evaluate the productivity index of the main andrological topics studied and reported in the literature. Methods: The total number of published articles was extracted from the Scopus database by entering the following keywords and mesh terms: “Male Infertility”, “Erectile Dysfunction”, “Premature Ejaculation”, “Male Hypogonadism”, “Testicular Tumors”, “Prostate Cancer”, “Prostatic hyperplasia”, “Prostate hyperplasia”, “Prostatitis”, “Prostate inflammation”, and “Male Accessory Gland Infections”. Furthermore, a list of the top 50 researchers sorted by productivity was created for each topic. For male infertility, a further search was performed by combining the search term “male infertility” with the above-mentioned terms. Thus, a list of the top 30 authors in order of productivity was also extracted. The graphs were created using Excel. Results and Conclusions: As could be expected, we observed that prostate cancer and male infertility were the two most investigated topics, followed by benign prostatic hyperplasia and erectile dysfunction, whose prevalence is set to increase given the progressive aging of the population. Less investigated is the inflammation of the accessory sexual glands. In conclusion, this study provides a ranking of the main andrological topics investigated in the literature, also presenting the top list of the most productive authors for each one. Endocrine disorders represent an important cause of morbidity and mortality that significantly impact quality of life. In particular, among endocrine diseases, disorders of gonadal function have an epidemiological impact second only to that of metabolic disorders . It is aSince the field of andrology covers diverse and wide-ranging topics, we have decided to focus our attention on diseases with the highest prevalence and the greatest impact on the quality of life of affected patients.Therefore, a thorough search was performed on the Scopus database by entering the following keywords and mesh terms: “Male Infertility”, “Erectile Dysfunction”, “Premature Ejaculation”, “Male Hypogonadism”, “Testicular Tumors”, “Prostate Cancer”, “Prostatic hyperplasia”, “Prostate hyperplasia”, “Prostatitis”, “Prostate inflammation”, and “Male Accessory Gland Infections”.For these topics, the total number of published articles was evaluated, and then, using the Scopus function that allows the subdivision of articles by author, the list of the top 50 researchers sorted by productivity was extracted. As far as male infertility is concerned, a further search was carried out by inputting combinations of the following keywords: “Male infertility AND varicocele”, “Male infertility AND male hypogonadism”, “Male infertility AND diabetes”, “Male infertility AND prostatitis”, “Male infertility AND prostate inflammation”, “Male infertility AND male accessory gland infection”, “Male infertility AND testicular cancer”, “Male infertility AND sperm DNA fragmentation”, “Male infertility AND FSH treatment”, and “Male infertility AND obesity”. As for the first search, the total number of articles was evaluated, but in this case, a list of the top 30 authors in order of productivity was extracted. The graphs were created using Excel.The list of the main andrological topics in order of productivity is shown in Immediately after prostate cancer, the topic that would seem to be most investigated is male infertility, which, unlike other topics  has its origins in more recent research, but for which interest from the scientific community has grown exponentially.The form of male sexual dysfunction that has seen the highest number of publications is erectile dysfunction, which is also the third most investigated topic. However, it is possible to observe that in the last 10 years, there has been a rapid growth in the number of publications compared to the past 20 years. Conversely, premature ejaculation is one of the least investigated andrological topics.A similar trend of rapid growth over the past 20 years can also be observed for male hypogonadism, which ranks sixth on this list. The inflammatory aspect, on the other hand, although it is one the topics that was studied in the past, when andrology was not yet considered a branch with its own identity, has been less investigated, with only 13,042 articles found when the term “prostatitis” was input and even fewer when the terms “prostatic inflammation” and “male accessory gland infections (MAGI)”  were useThe analysis of the researchers in order of productivity in terms of individual topics is shown in Regarding the sub-research on male infertility, we observed that the largest number of articles was concerned with the association between male infertility and genetics. In particular, it can be seen from In fourth place were publications on male infertility and testicular tumors, followed by publications that correlated the main metabolic diseases, DM and obesity, to infertility. In particular, for these last two subtopics, interest has increased especially in recent years and research trends seem to demonstrate that the interest in the association between dysmetabolism and infertility will progressively increase. Again, the association between infertility and inflammation has been studied the least .The analysis of the researchers in order of productivity on the individual topics of this sub-research is shown in Despite the significant impact of andrological diseases and although male infertility is a global health problem, considerable progress is still needed regarding the management of these diseases, especially in the area of male reproductive health . This arOur research strategy identified male infertility as the second most investigated topic in andrology. This is likely due to the significant global impact of infertility, as mentioned above. In particular, the rapid growth of research in the field of male infertility would appear to correlate directly with the rapid improvement in the genetic study of this condition. In fact, 1/6 of the publications on male infertility seem to be related to genetic aspects, which therefore appear to be the most investigated subtopics. This is probably due to the introduction of next-generation sequencing techniques in the last twenty years, which have made it possible to identify a large percentage of genes involved in the pathogenesis of non-obstructive azoospermia and infertility hitherto identified as idiopathic ,13. ProbThe association between tumor and infertility is another close relationship that we found. In particular, it is known that the treatments that are carried out to cure neoplastic diseases damage fertility . HoweverIn the context of male infertility, we found that the most studied association is with varicocele. In fact, although in general the varicocele topic is among the least investigated in the andrological field, most of the publications that include it studied its relationship in association with male infertility. Not by chance, varicocele is considered the most common correctable cause of male infertility, and a recent meta-analysis confirmed that varicocele repair is able to improve conventional sperm parameters compared to untreated controls . The extOur search strategy subsequently highlighted that hypogonadism, another condition closely associated with infertility, has been extensively studied. Indeed, hypogonadism has a considerable impact on the quality of life of the individual and on fertility, as suggested by the fact that in 75% of infertility cases, a primary testicular dysfunction is present . However6 would seem to be a model capable of predicting with high accuracy the presence of SDF. All of this evidence explains why SDF is a hot topic in andrology today [Our results also noted that among the most studied associations was that between male infertility and SDF. Consequently, the extensive literature that has been published over the years led the World Health Organization in 2021 to introduce the SDF test as a test to be requested under certain circumstances for a better assessment of the fertility status, giving this test a diagnostic value and not only value in scientific research . Howevergy today .Much less investigated are the inflammatory aspects and their impact on fertility. In our opinion, this result is quite surprising given the high prevalence of inflammatory diseases on the male population. Indeed, 5–40% of men suffer from MAGI . FurtherFinally, our results showed wide attention to scientific research on two other highly prevalent andrological conditions: BPH and ED. Regarding the former, attention from the scientific community is not surprising, since BPH has a very large impact on the quality of life of the patients who suffer from it. In fact, in 2017, it was estimated that the years lived with disease attributed to BPH/lower urinary tract syndrome were 2,247,334, compared to 843,226 for prostate cancer. This impact is expected to increase considering the progressive aging of the general population . SimilarOur study has some limitations. First, the search was performed on a single database, although Scopus was the database that produced the most results after keyword entry compared to others, such as PubMed or Web of Science . AnotherAndrological diseases have a significant social and economic impact and compromise the quality of life of affected patients. Undoubtedly, the extensive research in this area has led, over the years, to a better understanding of the pathophysiological mechanism of these diseases and the clinical management of patients suffering from them. However, much remains to be done. Indeed, the progressive increase in age will lead to an ever-higher prevalence of some of these diseases . Similarly, for male infertility, much remains to be understood about the pathophysiological mechanisms underlying this condition and its correct management. Surprisingly, the inflammatory diseases of the male accessory glands appear to be less explored, despite their impact on the quality of life of affected patients and other associated andrological conditions. Our study provides a global overview of andrological research to date, revealing which topics are most investigated and which authors have contributed most to the research on each topic.