RESUMEN El presente trabajo está dirigido a exponer elementos inherentes al modelo de superación profesional del tecnólogo de la salud en laboratorio clínico desde la integración ciencias básicas biomédicas-laboratorio. Entre los métodos teóricos empleados, el analítico-sintético permitió la determinación de los fundamentos epistemológicos y praxiológicos del proceso de superación, el inductivo-deductivo posibilitó la determinación de las categorías que surgen en el proceso investigativo, el sistémico estructural funcional para fundamentar el carácter de sistema del modelo y la modelación con la finalidad (...) de construirlo. Se concluye que se establecen como subsistemas del modelo, la proyección profesional de las ciencias básicas biomédicas, la contextualización profesional de la integración ciencias básicas biomédicas-laboratorio y la valoración contextual de la integración en el proceso de superación, lo que explica el proceso de superación del tecnólogo de la salud en laboratorio clínico. ABSTRACT This paper aims at setting out elements inherent to the health technologist in clinical laboratory’s professional training model from the integration of basic biomedical-laboratory sciences. Among the theoretical methods used, analysis-synthesis allowed establishing the epistemological and praxeological basis of the training process; the inductive-deductive method made it possible to determine the categories that result from the research process and the systemic-structural-functional method was used to support the system-like nature of the model and modelling with the end of building it. In conclusion, subsystems of the model are established: basic biomedical sciences professionals’ aims, professional conceptualization of the integration of basic biomedical-laboratory sciences and the contextual assessment of integration in the training process, which expounds the training process of the health technologist in clinical laboratory. (shrink)

El objetivo del trabajo fue fundamentar las bases teóricas que sustentan la importancia del trabajo independiente en el proceso de enseñanza aprendizaje en la Educación Médica Superior, así como aspectos relativos a su concepción, requerimientos y formas de aplicación. Se realizó un estudio bibliográfico acerca del tema y se llegó a las siguientes conclusiones: el trabajo independiente es un medio de organizar metodológicamente la actividad cognoscitiva independiente de los estudiantes que se expresa a través de un conjunto de tareas y (...) puede utilizarse durante la actividad docente y fuera de ella, así como en cualquiera de las formas de organización de que se trate. Es imprescindible que se tengan en cuenta al organizar el trabajo independiente las etapas de la actividad humana: planificación, orientación, ejecución y control. El trabajo independiente es un factor importante para estimular la independencia de los futuros profesionales de las Ciencias Médicas por lo que su perfeccionamiento exige al profesor una alta profesionalización de sus acciones. The objective of the work was to stablish the theorical bases that sustain the importance of the independent work in the teaching learning process in the medical education, as well as, relative aspects to its conception, requirements and application forms. A bibliographical study about the topic was carried out reaching the following conclusions the independent work is a way of organizing methologically the independent cognitive activity of the students that is expressed through out a group of tasks and it can be used during the teaching - learning in and out of the classroom; as well as in any of the forms of teaching organization. It is indispensable when organizing the independent work of the students to keep in mind the different stages of the human activity planning, orientation, execution and control. The independent work is an important factor to stimulate the independent of the future professionals of the medical sciences that is why its improvement demands a higher professionalism of its actions. (shrink)

El objetivo del trabajo consistió en destacar la significación del enfoque histórico-cultural de Vigotsky como sustento para el tratamiento de las relaciones interdisciplinarias en la educación médica superior. Se toma como referente psicológico sus aportes en cuanto a la enseñanza y el desarrollo; el concepto de zona de desarrollo próximo, su concepción sobre el aprendizaje y la categoría situación social del desarrollo. Se concluye que el enfoque histórico-cultural brinda conceptos claves que se deben tener presente para el tratamiento de las (...) relaciones interdisciplinarias. The objective of the paper was highlighting Vigostky historical-cultural approach to the interdisciplinary relationships treatment in the higher medical education. His contributions in teaching and development, the concept of the zone of proximal development, his conception on learning and the category of social situation of development are taken as psychological referent. As a conclusion, the paper refers that his historical-cultural approach offers key concepts that should be taken into account in the treatment of the interdisciplinary relationships. (shrink)

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In lieu of an abstract, here is a brief excerpt of the content:The Journal of Aesthetic Education 40.1 (2006) 35-53 [Access article in PDF] "Truth Is What Works": Francisco J. Varela on Cognitive Science, Buddhism, the Inseparability of Subject and Object, and the Exaggerations of Constructivism—A Conversation Francisco J. Varela Bernhard Poerksen Institut für Journalistik und Kommunikationswissenschaft Universität Hamburg Francisco J. Varela (1946-2001) studied biology in Santiago de Chile, obtained his doctorate 1970 at Harvard University with a (...) dissertation on the insect eye, and worked there for some time in the laboratory of Torsten Wiesel, the later Nobel Laureate for medicine. From his scientific beginnings as a researcher in biology, he not only studied and practiced biology but, resisting the dominating mainstream, pursued a research program that ignored and broke down traditional disciplinary boundaries. This research program is best characterized as experimental epistemology, a concept introduced by the neuropsychiatrist and cybernetician Warren S. McCulloch. Francisco J. Varela's great aspiration was to examine and answer the philosophical ur-question of cognition with scientific precision and with the help of the best possible theoretical framework. [End Page 35]Having obtained his doctorate, he went back to Chile to work as a professor of biology together with Humberto R. Maturana. He contributed to the writing of the theory of autopoiesis, which was to cause a furor in the world of science as a universally applicable explanatory model. After the overthrow of Allende and the installation of the dictatorship by the putsch general Pinochet, Francisco J. Varela first escaped to Costa Rica, then became a professor at the American University of Colorado and University of New York, and finally returned in 1980 to the University of Chile in Santiago for five years. Temporary positions as guest professor for neurobiology, philosophy, and cognitive science in Germany, Switzerland, and France led him to Paris in the end, where he worked as research director of the Centre National de Recherche Scientifique until his death on May 28, 2001.In his research work embracing cognitive science, evolutionary theory, and immunology, Francisco J. Varela, constantly inspired by his fundamental interest in the key questions of epistemology, gave the epistemological debate a new orientation. In his thinking he refuses to accept the strict separation of subject and object, of knower and known, which as a rule unites realists and constructivists alike. Francisco J. Varela rejects the fundamental dualism dividing mind and world, which had shaped Western philosophy from its earliest beginnings. He does not subscribe to the idea that human individuals can invent their own realities—blindly and arbitrarily, and without experiencing any resistance from the external world and all other things given. He equally distances himself, however, from the diametrically opposite position that overstates the eigenpower of the world of objects. The external world and all other things given cannot determine what happens in an organism. Varela's claim is that individual and world create each other. The Computational Model of the Mind Poerksen: The ancient key questions of philosophy are at the center of modern cognitive science. What is the essence of the mind? Do our conceptions represent a given world, which is independent from our minds? What is the formative power of external objects over our perceptions? How does cognition function? The search for an adequate answer and an improved understanding of the human mind has led many cognitive scientists to entertain the assumption that the brain is actually a kind of computer. Memory is taken to be a store. Thinking and perceiving are understood as data processing in the sense that an independent external world is computationally transformed into symbols and represented in the organism in this manner. You are very critical of this view. Why?Varela: If the brain is considered as a kind of computer, then cognitive research is limited to discovering certain self-sufficient shapes—the symbols—together with the rules [End Page 36] governing them—the programs. But this search for symbols and programs will never be profitable because it... (shrink)

No presente artigo pretendo apresentar a Autopoiesis, uma teoria formulada pelo biólogo chileno Humberto Maturana e pelo médico chileno Francisco Varela. Além de mostrar as similaridades entre o processo orgânico e o processo epistemológico, presentes nesta teoria, busco ressaltar a importância da Autopoiesis não somente no campo científico, como teoria epistemológica, mas também no campo ético e cultural, como uma teoria que ressalta desde a dinâmica interna do ser vivo, enquanto unidade, até a importância de sua interação com (...) o mundo em que vive. Assim, descrevo a formação do processo cognitivo através dos fundamentos autopoiéticos e de conceitos centrais, tais como: fronteira membranosa, metabolismo dinâmico, sistema operacionalmente fechado, acoplamento estrutural e deriva natural. A Autopoiesis demonstra que a experiência cognitiva do observador é intrínseca a sua estrutura biológica, ressaltando, assim, o papel do observador e questionando a validade de suas certezas sobre o que se propôs observar. A proposta deste trabalho será, portanto, trazer a discussão sobre a forma como conhecemos e sobre o processo de aprendizagem do homem e a influência de sua estrutura biológica e toda complexidade de fatores que estão envolvidos na extensa rede da vida que serão considerados aqui, fatores que são, antes de tudo, biológico-culturais. (shrink)

"Knowing how we know" is the subject of this book. Its authors present a new view of cognition that has important social and ethical implications, for, they assert, the only world we humans can have is the one we create together through the actions of our coexistence. Written for a general audience as well as for students, scholars, and scientists and abundantly illustrated with examples from biology, linguistics, and new social and cultural phenomena, this revised edition includes a new afterword (...) by Dr. Varela, in which he discusses the effect the book has had in the years since its first publication. (shrink)

In spite of the relevance of Aurelius Augustine (354-430) for the intellectual environment in which Søren Kierkegaard (1813-1855) lived, the studies concerning the relations between these two thinkers are still incipient. In this field of investigation, one of the most intriguing questions is the fact that Kierkegaard apparently changed his view of the Bishop of Hippo, going from admiration during the decade of 1840 to disapproval during the decade of 1850. This paper intends to examine how the problems of truth (...) and of the relations between time and eternity, as approached by Augustine in his works Confessions and The Teacher, are strongly related to the Christian doctrine of creatio ex nihilo, and how the arguments developed in these Augustinian books can be read as presuppositions of the arguments that support the Kierkegaardian idea of Absolute Paradox developed centuries later by the Danish philosopher in his book Philosophical Fragments, published under the pseudonym Johannes Climacus in 1844, when the thinker of Copenhagen still seemed to express a great admiration for the Roman-Berber priest of Late Antiquity. Keywords: Kierkegaard, Augustine, time, eternity, truth. (shrink)

El Patronato de Misiones Pedagógicas desarrolló una importante labor de recuperación y difusión de la cultura musical, especialmente del folklore musical español, en los primeros años de la II República española, al poner en marcha un servicio de música y un coro que se encargaron de acercar diferentes estilos y géneros musicales a los habitantes de las zonas rurales más deprimidas. En este artículo se presenta un estudio documental sobre el trabajo llevado a cabo por los integrantes del coro y (...) por las personas que se encargaron de custodiar los recursos musicales cedidos por el Patronato y de programar las diferentes actividades musicales en los municipios que gozaron de dichos recursos. A su vez, se recogen diversos testimonios que dan fe del cometido realizado por esta institución y del impacto cultural y musical que supuso en los habitantes de las localidades donde se desarrollaron las diferentes actividades misionales. (shrink)

Machines and Biology have been, since antiquity, closely related. From the zoological figures present in astronomical simulacra, through renaissance mechanical imitations of animals, through Decartes' wind pipe nerves, to present day discussions on the computer and the brain, runs a continuous thread. In fact, the very name of mechanism for an attitude of inquiry throughout the history of Biology reveals this at a philosophical level. More often than not, mechanism is mentioned in opposition to vitalism, as an assertion of the (...) validity of the objectivity principle in biology: there are no purposes in animal nature; its apparent purposefulness is similar to the purposefulness of machines. Yet, the fact that one picks machines as a set of objects comparable to living systems, deserves a closer look. What in machines makes it possible to establish such a connection? (shrink)

The phenomenon of size constancy is defined as the apparent perceptual invariance of the linear dimensions of a seen object as this approaches the eye or recedes from it. It has been interpreted as resulting from the application by the brain of a size correction, made possible by the subject's apprehension of distance cues present in the image. We present several observations which, by dissociating accommodation from distance of the seen object and by suppressing the optic effects of accommodation on (...) the visual image itself, show that this interpretation is incorrect, and that in fact the size correction of the visual image is a function of the central effort of accommodation, not of the distance of the seen object. (shrink)

Este texto reflete sobre o memoricídio, consequente à presunção racial branca, como vestígio de operações para o genocídio dos corpos e das mentes negras a partir da Peleja de Inácio da Catingueira contra Romano. Sob o jogo discursivo da humilhação, já se encontrava a vontade brutal de destruição de qualquer traço, perspectiva, visão remanescente de saberes e culturas africanas ou descendentes, fossem de cunho material, simbólico, reflexivo, imagético, expressivo, na língua, no corpo. No embate, Inácio, negro, escravizado, já rebaixado sob (...) a égide do sistema escravocrata, embate-se contra a tentativa presunçosa de aniquilamento perpetrada por seu oponente. (shrink)

This paper analyses the arguments for and against what we have called automatic organ procurement model in relation to the organs of the deceased. For this purpose, this work provides empirical evidence to assess the potential impact of this model on donation rates and on public opinion. Specifically, we examine first the reasons supporting this model, with special reference to utilitarian and justice arguments. On the other hand, we analyse both the approaches based on the violation of pre mortem and (...) post mortem interests opposing this theoretical model and the rejection the model would generate in the population. Finally, we point out the aspects that, in our opinion, should be exhaustively regulated if this model were implemented. In particular, we refer to the legal status of the human body, the treatments for end-of-life patients, the incentives for health professionals and the recognition of the right to conscientious objection. (shrink)

Este artigo apresenta o projeto de G. Vico para o estabelecimento da ciência moral. Vico esteve empenhado na emancipação do estudo das manifestações objetivas do espírito por intermédio da reforma do racionalismo cartesiano. A crítica ao iluminismo é feita com a retomada do conceito de barbárie no âmbito da filosofia, contrapondo-o ao conceito de esclarecimento do Século das Luzes.

El objetivo de este trabajo es examinar cómo engarza la noción de autonomía biológica con las nociones de autonomía que se manejan habitualmente en filosofía. A partir de los años setenta del siglo XX, los biológos chilenos Humberto Maturana y Francisco Varela desarrollaron la teoría de la vida como autopoiesis, que origina una nueva concepción de autonomía: la autonomía biológica. El desarrollo de este concepto supone una cierta recuperación de la noción de organismo en un contexto científico en (...) el que la biología y la filosofía de la biología están marcadas por el estudio del gen, propiciado por la biología molecular, y de la evolución por selección... natural, por la llamada Síntesis Moderna. En este artículo trataremos de mostrar algunas de las implicaciones que el concepto de vida como autonomía tiene para la biología actual y cómo puede entenderse este concepto a la luz de otras nociones de autonomía más habituales en filosofía. The aim of this article is to examine how the notion of biological autonomy may be linked to other notions of autonomy usual in philosophical discussions. Starting in the 70s, the Chilean biologists Humberto Maturana and Francisco Varela developed a theory of life as autopoiesis which gives rise to a new conception of autonomy: biological autonomy. The development of this concept implies the recovery of the notion of the organism in a scientific context in which biology and philosophy of biology are focused on the study of the gene by Molecular Biology and evolution by natural selection, by the so called Modern Synthesis. Here we try to show some implications of the concept of life as autonomy for current biology and how this concept can be related to other more usual ones in philosophy. (shrink)

O objetivo do estudo foi investigar a prevalência e motivos do uso de álcool, tabaco e outras drogas por acadêmicos. A amostra foi composta por 560 estudantes, entre 17 e 74 anos ( M = 31,16, DP = 11,10). As substâncias com maior prevalência de uso na vida foram álcool e tabaco. Dentre as drogas ilí..

Context: In 1974, Humberto Maturana and Francisco Varela published De Máquinas y Seres Vivos Autopoiesis: La organización de lo vivo in Santiago, Chile as a little book. A second edition of this publication was proposed in 1994, and the present document is a recent translation of Maturana’s reflections “twenty years after.” Problem: The book clearly enunciates what it means to say that living systems are molecular autopoietic systems, and this Preface reflects on the shift of understanding from earlier (...) notions of self-referred or auto-referred systems to the concept of autopoiesis. Implications: The Preface describes the systemic quality that is human living and human sense-making. It marks what we can retrospectively see as the bridge between the explicitly biological studies of Maturana (and Varela), and the later, more anthropological and therapeutic work of Maturana with Gerda Verden-Zöller between 1989 and 1994 and, especially, with Ximena Dávila Yáñez since the year 1999. Results: The underlying understanding implicit in this document outlines in great clarity the implications of Maturana’s fundamental insights. It presents both a logical and passionately argued case for mutual respect, grounded in scientific findings in biology. The Preface is a clear vision of why Maturana’s work has been so influential for reflexivity and constructivism. (shrink)

As religiões de matriz africana foram e ainda são intensamente estudadas buscando compreender sobre o seu funcionamento, as relações construídas entre os fiéis, assim como entre os fiéis e as entidades. Essa sociedade, enquanto sociedade não-europeia, é estudada com base nos conhecimentos eurocêntricos, o que torna possível compreender as formas de abordagem do conhecimento universal sobre o Candomblé, colocando assim, o conhecimento Europeu como nativo. Dessa forma, sigo o caminho proposto pela antropóloga Marimba Ani, para pensar a roça de Candomblé (...) e a herança africana, a partir das epistemologias oriundas do terreiro. Utilizo a poesia do ogan Wesley Correia, os pensadores negros em diáspora e os africanos enquanto uma encruzilhada de caminhos possíveis a ser construído em diálogo com o romance “O mundo se despedaça”, de Chinua Achebe para enriquecer a discussão de visão-de-mundo e produção de sentido. Palavras-chave: Marimba Ani; encruzilhada; nativo; conhecimento universal; Wesley Correia. (shrink)

En el presente conjunto de poemas, provenientes del libro titulado Vispoiesis, Pliegos de la visión n° 96 (2019), Restrepo se presenta como un operador visual que conjuga acabadamente la vocación experimental y conceptual. Encabalgado sobre preocupaciones políticas diversas, con cada una de sus piezas consigue persuadirnos de que es posible la práctica de una poesía visual que se imbrique profundamente con el contexto y que se arriesgue en un posicionamiento crítico, algo que se impone casi como una urgencia en una (...) realidad que exige el compromiso de todo poeta y artista en la construcción de nuevos horizontes y sentidos. (shrink)

La niñez es un tema que aparece a menudo en la filosofía de Vico. En la Sn44 la niñez del mundo es la barbarie de los sentidos y la niñez de la persona singular del siglo de las luces es la barbarie del intelecto. Deseamos en este artículo investigar en los primeros escritos de Vico las consideraciones que fueron hechas respecto a la niñez singular y que, más adelante, sirvieron de soporte para las investigaciones de los tiempos oscuros. La Vita (...) es el texto privilegiado para la realización de nuestro propósito; aunque son pocos los renglones referidos a los primeros años de la vida del filósofo, la narración del accidente –la caída por una escalera– sufrido cuando Vico tenía siete años nos ofrece la comprensión de la concepción filosófica de la niñez de Vico.Childhood is indeed a subject which appears quite often in Vico’s philosophy. In Sn 44 the world’s childhood is sense perception’s barbarism as that of the eighteen century enlightened singular person’s is intellect’s barbarism. We purport to study in this paper the account Vico gives about singular person’s childhood in his early writings which later is used to shed some light on the enquiries about the dark ages. The Vita is –or thus is claimed– a privileged text to achieve our aims and, though few are lines devoted to his own infancy, it gives the key to understanding Vico’s philosophical view of childhood. (shrink)

La presente investigación tuvo por objetivo analizar la percepción del profesorado en el constructo igualdad de género. Se diseñó un estudio cuantitativo exposfacto utilizando la Escala de Igualdad de Género Oculta que se aplicó sobre una muestra incidental de 391 docentes de la Comunidad de Madrid. Para el análisis de datos se aplicaron las pruebas de Student, ANOVA y MANOVA. Los resultados revelaron diferencias significativas en las principales dimensiones de la escala IGOE. La dimensión Situación de Género en la Escuela (...) actuó como la principal transmisora de estereotipos, actitudes y conductas sexistas mediante el currículo oculto. (shrink)

Artificial intelligence is a current tool that is used in different areas of the human life with the purpose of facilitating and directing the processes in distinct sceneries of society. This research aimed to use AI as an educational resource in teaching and learning process in the area of biology for students at the Adventist School CEA Cambulos in the city of Cali. A qualitative research methodology was used, with data collection techniques such as observation and interviews, presenting an action (...) research approach. The main results were the potential of AI to enhance learning, the disposition of students to learn through it, and the need for training in the educational sector for its inclusive use and achieving responsible and effective results. That is how it is considered the challenge of reflecting the imminent arrival of AI in the student context and being prepared to be part of the transformation that can be generated in pedagogical processes. (shrink)

Este artigo homenageia a atualidade do curso A hermenêutica do sujeito, proferido por Foucault no Collège de France em 1982. Sabe-se que o tema central do curso é o cuidado de si como tekhné tou biou, examinado pelo filósofo nos momentos socrático-platônico, helenístico e cristão. Porém, tomaremos a questão da amizade, que atravessa as técnicas de si antigas analisadas por Foucault, para problematizar nosso presente. Após discutir a recepção que fazemos do curso quarenta anos depois, discutimos o atual momento do (...) neoliberalismo e as políticas de inimizade por ele engendradas, de modo a pensar a prática da amizade como contraconduta, como prática de resistência. A amizade anarquista como forma de associação é tomada como máquina de guerra possível contra as atuais políticas de inimizade neoliberais. Palavras-chave: amizade; técnicas de si; ética; política; anarquismo. In defense of friendship: life’s proofs in the subjecvity wars of the contemporary enmity policies Abstract: This article pays homage to the actuality of the course The hermeneutics of the subject, given by Foucault at the Collège de France in 1982. It is known that the central theme of the course is the care of the self as tekhné tou biou, examined by the philosopher in three moments: Socratic-Platonic, Hellenistic, and Christian. However, we will take the question of friendship, which crosses the ancient techniques of the self analyzed by Foucault, to problematize our present. After discussing our reception of the course forty years later, we discuss the current moment of neoliberalism and the enmity policies engendered by it, in order to think about the practice of friendship as a counter-conduct, as a practice of resistance. Anarchist friendship as a form of association is taken as a possible war machine against current neoliberal policies of enmity. Key words: friendship; techniques of the self; ethics; politics; anarchism. En defensa de la amistad: pruebas de vida en las guerras de subjetividad de las políticas de enemistad contemporáneas Resumen: En este artículo prestamos homenaje a la actualidad del curso La hermenéutica del sujeto, presentado por Foucault en 1982 en el Collège de France. Se sabe que el tema que es el centro del curso ha sido la inquietud de sí como tekhné tou biou, examinada por el filósofo en tres momentos de la antigüedad: el socrático-platónico, el helenístico y el cristiano. Aún así, tomamos la cuestión de la amistad, que es transversal a las técnicas de sí antiguas analizadas por Foucault, para problematizar nuestro tiempo presente. Después de discutir la recepción que nosotros hacemos del curso cuarenta años más tarde, ponemos en debate el momento actual del neoliberalismo y sus políticas de enemistad, de manera a pensar la práctica de la amistad como contra conducta, como práctica de resistencia. Tomamos la amistad anarquista como como forma de asociación como posible maquina de guerra contra las políticas de enemistad neoliberales actuales. Palabras clave: amistad; técnicas de sí; ética; política; anarquismo Data de registro: 10/07/2022 Data de aceite: 26/10/2022. (shrink)

Presentamos un estudio de la situación de las científicas del área de Ciencia y Tecnologías Físicas en el CSIC, El estudio incluye datos numéricos en cuanto a presencia porcentual de mujeres en las distintas escalas y comisiones de evaluación, así como testimonios personales, reflexiones y consideraciones generales. Se pone de manifiesto el bajo porcentaje de investigadoras en esta Área, Se concluye el estudio con una serie de recomendaciones.

Este texto reflete sobre o memoricídio, consequente à presunção racial branca, como vestígio de operações para o genocídio dos corpos e das mentes negras a partir da Peleja de Inácio da Catingueira contra Romano. Sob o jogo discursivo da humilhação, já se encontrava a vontade brutal de destruição de qualquer traço, perspectiva, visão remanescente de saberes e culturas africanas ou descendentes, fossem de cunho material, simbólico, reflexivo, imagético, expressivo, na língua, no corpo. No embate, Inácio, negro, escravizado, já rebaixado sob (...) a égide do sistema escravocrata, embate-se contra a tentativa presunçosa de aniquilamento perpetrada por seu oponente. (shrink)

The concept of disease is deeply rooted in medical practice, and one can hardly conceive of caring for patients without this tool. Nevertheless, under this seemingly uncontroversial idea there are some highly polemical axioms that we usually take for granted, even though they often lead us to some uncomfortable inconsistencies and contradictions. Some of the conceptual issues derived from our traditional view of disease, which condition the way we conceive and practice medicine, include:We conceive of disease as a real entity (...) that affects a previously healthy person, thus making him ill. The purpose of medicine is to identify and fight this entity. If it succeeds, the patient is cured; otherwise, the patient will .. (shrink)