This is the first article in a two-part series describing subject and family perspectives from the central thalamic deep brain stimulation for the treatment of traumatic brain injury using the Medtronic PC + S first-in-human invasive neurological device trial to achieve cognitive restoration in moderate to severe traumatic brain injury, with subjects who were deemed capable of providing voluntary informed consent. In this article, we report on interviews conducted prior to surgery wherein we asked participants about their experiences recovering from (...) brain injury and their perspectives on study enrollment and participation. We asked how risks and benefits were weighed, what their expectations and fears were, and how decisions were reached about trial participation. We found that informed consent and enrollment decisions are fraught. Subjects and families were often split, with subjects more focused on putative benefits and families concerned about incremental risk. Both subjects and families viewed brain injury as disruptive to personal identity and relationships. As decisions were made about study enrollment, families struggled with recognizing the re-emergent agency of subjects and ceding decision-making authority to subjects who had previously been dependent upon them for protection and guidance. Subjects and family members reported a hope for the relief of cognitive disabilities, improved quality of life, normalization of interpersonal interactions, and a return to work or school as reasons for study participation, along with altruism and a desire to advance science. Despite these aspirations, both subjects and families appreciated the risks of the intervention and did not suffer from a therapeutic misconception. A second essay to be published in the next issue of Cambridge Quarterly of Healthcare Ethics—Clinical Neuroethics will describe interviews conducted after surgery, the effects of cognitive restoration for subjects, families, and challenges presented to the social structures they will call upon to support them through recovery. This subsequent article will be available online prior to its formal publication in October 2023. (shrink)

This is the second paper in a two-part series describing subject and family perspectives from the CENTURY-S (CENtral Thalamic Deep Brain Stimulation for the Treatment of Traumatic Brain InjURY-Safety) first-in-human invasive neurological device trial to achieve cognitive restoration in moderate to severe traumatic brain injury (msTBI). To participate, subjects were independently assessed to formally establish decision-making capacity to provide voluntary informed consent. Here, we report on post-operative interviews conducted after a successful trial of thalamic stimulation. All five msTBI subjects met (...) a pre-selected primary endpoint of at least a 10% improvement in completion time on Trail-Making-Test Part B, a marker of executive function. We describe narrative responses of subjects and family members, refracted against that success. Interviews following surgery and the stimulation trial revealed the challenge of adaptation to improvements in cognitive function and emotional regulation as well as altered (and restored) relationships and family dynamics. These improvements exposed barriers to social reintegration made relevant by recoveries once thought inconceivable. The study’s success sparked concerns about post-trial access to implanted devices, financing of device maintenance, battery replacement, and on-going care. Most subjects and families identified the need for supportive counseling to adapt to the new trajectory of their lives. (shrink)

Over 40 years of research have shown that traumatic brain injury affects brain volume. However, technical and practical limitations made it difficult to detect brain volume abnormalities in patients suffering from chronic effects of mild or moderate traumatic brain injury. This situation improved in 2006 with the FDA clearance of NeuroQuant®, a commercially available, computer-automated software program for measuring MRI brain volume in human subjects. More recent strides were made with the introduction of NeuroGage®, commercially available software that is based (...) on NeuroQuant® and extends its utility in several ways. Studies using these and similar methods have found that most patients with chronic mild or moderate traumatic brain injury have brain volume abnormalities, and several of these studies found—surprisingly—more abnormal enlargement than atrophy. More generally, 102 peer-reviewed studies have supported the reliability and validity of NeuroQuant® and NeuroGage®. Furthermore, this updated version of a previous review addresses whether NeuroQuant® and NeuroGage® meet the Daubert standard for admissibility in court. It concludes that NeuroQuant® and NeuroGage® meet the Daubert standard based on their reliability, validity, and objectivity. Due to the improvements in technology over the years, these brain volumetric techniques are practical and readily available for clinical or forensic use, and thus they are important tools for detecting signs of brain injury. (shrink)

Introduction.--Aristotle.--The seventeenth century.--The eighteenth century.--Biology.--Nature.--Evolution.--The problem.--The three elements.--The teleological order.--Appendix: Clerk Maxwell on determinism and free will. Fechner on the tendency to stability.

Researchers are beginning to transition from studying human–automation interaction to human–autonomy teaming. This distinction has been highlighted in recent literature, and theoretical reasons why the psychological experience of humans interacting with autonomy may vary and affect subsequent collaboration outcomes are beginning to emerge (de Visser et al., 2018;Wynne and Lyons, 2018). In this review, we do a deep dive into human–autonomy teams (HATs) by explaining the differences between automation and autonomy and by reviewing the domain of human–human teaming to make (...) inferences for HATs. We examine the domain of human–human teaming to extrapolate a few core factors that could have relevance for HATs. Notably, these factors involve critical social elements within teams that are central (as argued in this review) for HATs. We conclude by highlighting some research gaps that researchers should strive toward answering, which will ultimately facilitate a more nuanced and complete understanding of HATs in a variety of real-world contexts. (shrink)

Errata slip inserted. Bibliography: p. 309-310.

Background: Neurotypical young adults show task-based modulation and stability of their eye movements across tasks. This study aimed to determine whether persons with aphasia (PWA) modulate their eye movements and show stability across tasks similarly to control participants. Methods: Forty-eight PWA and age-matched control participants completed four eye-tracking tasks: scene search, scene memorization, text-reading, and pseudo-reading. Results: Main effects of task emerged for mean fixation duration, saccade amplitude, and standard deviations of each, demonstrating task-based modulation of eye movements. Group by (...) task interactions indicated that PWA produced shorter fixations relative to controls. This effect was most pronounced for scene memorization and for individuals who recently suffered a stroke. PWA produced longer fixations, shorter saccades, and less variable eye movements in reading tasks compared to controls. Three-way interactions of group, aphasia subtype, and task also emerged. Text-reading and scene memorization were particularly effective at distinguishing aphasia subtype. Persons with anomic aphasia showed a reduction in reading saccade amplitudes relative to their respective control group and other PWA. Persons with conduction/Wernicke’s aphasia produced shorter scene memorization fixations relative to controls or PWA of other subtypes, suggesting a memorization specific effect. Positive correlations across most tasks emerged for fixation duration and did not significantly differ between controls and PWA. Conclusions: PWA generally produced shorter fixations and smaller saccades relative to controls particularly in scene memorization and text-reading respectively. The effect was most pronounced recently after a stroke. Selectively in reading tasks, PWA produced longer fixations and shorter saccades relative to controls, consistent with reading difficulty. PWA showed task-based modulation of eye movements, though the pattern of results was somewhat abnormal relative to controls. All subtypes of PWA also demonstrated task-based modulation of eye movements. However, persons with anomic aphasia showed reduced modulation of saccade amplitude and smaller reading saccades, possibly to improve reading comprehension. Controls and PWA generally produced stabile fixation durations across tasks and did not differ in their relationship across tasks. Overall, these results suggest there is potential to differentiate among PWA with varying subtypes and from controls using eye movement measures of task-based modulation, especially reading and scene memorization tasks. (shrink)

While the early Confucians were largely content to maintain the rituals of ancient kings as the core of moral education in their time, it is not obvious that contemporary humans could, or should, draw from the particulars of such a tradition. Indeed, even if one takes ritual seriously as a tool for cultivation, there remains a question of how to design moral education programs incorporating ritual. This essay examines impediments faced by a ritualized approach to moral education, how they might (...) be overcome, and how a ritual method could be developed in modernity. I contend that a Confucian notion of ritual, particularly as elaborated in the Xunzi, is both compatible with modern moral education and capable of making a distinct contribution to moral education in terms of how rituals can be used to structure and inculcate a shared climate of respect and humaneness both in- and outside the classroom. Specifically, the ritual education method includes emphases on inculcating moral fluency via symbolic practices and distinctions, training and appropriately associating promoral dispositions, enhancing moral imagination, and developing awareness of other minds. The model is thus a multifaceted approach to moral education through (meta)cognitive development. (shrink)

The basic principles of scientific research from the great French physiologist whose contributions in the 19th century included the discovery of vasomotor nerves; nature of curare and other poisons in human body; more.

Over the course of the last four decades, William Leon McBride has distinguished himself as one of the most esteemed and accomplished philosophers of his generation. This volume—which celebrates the occasion of his seventy-fifth birthday—includes contributions from colleagues, friends, and formers students and pays tribute to McBride’s considerable achievements as a teacher, mentor, and scholar.

In this paper, I discuss Moore’s assessment of Lewis’s metaphysical theorizing. While I am sympathetic to Moore’s complaint that much contemporary metaphysics lacks the scope and reach of older metaphysical theories, I take issue with Moore’s diagnosis: neither lack of self-consciousness, nor Quinean naturalism, nor the post-Quinean restitution of necessity is to blame. Rather, the lack of impact of Lewis’s system should be attributed to the very high weight he attaches to conservatism: the preservation of commonsense and ordinary (...) thought and talk. Yet one can agree with Quine that there should be no first philosophy without, as Lewis does, putting philosophy last. Finally, I argue against Moore that, for the Quinean naturalist, there is no conflict between the metaphysician’s armchair methodology and the view that the truths so discovered are on a par with science. (shrink)

Henry Bugbee is a curious figure in the annals of American Philosophers. It seems that most philosophers either cherish his work dearly or have never heard of him. Albert Borgmann described his work as “both inconspicuous and consequential”. As of this writing, he has no entries on The Internet Encyclopedia of Philosophy, The Stanford Encyclopedia of Philosophy, or even Wikipedia. Among those who know his work, most only know his book, The Inward Morning. And few of those who know the (...) book have seen fit to write about it. It is not that Bugbee’s career was on the margins. To the contrary, with a Princeton BA, a Berkeley PhD, and a faculty position at Harvard, a colleague of both C.I. Lewis and W.V.O. Quine... (shrink)

A major criticism of David Lewis’ counterfactual theory of causation is that it allows too many things to count as causes, especially since Lewis allows, in addition to events, absences to be causes as well. Peter Menzies has advanced this concern under the title “the problem of profligate causation.” In this paper, I argue that the problem of profligate causation provides resources for exposing a tension between Lewis’ acceptance of absence causation and his modal realism. The result (...) is a different problem of profligate causation—one that attacks the internal consistency of Lewisian metaphysics rather than employing common sense judgments or intuitions that conflict with Lewis’ extensive list of causes. (shrink)

The essays in this collection treat historical, literary, and philosophical topics related to Ayn Rand's Anthem, an anti-utopia fantasy set in the future. The first book-length study on Anthem, this collection covers subjects such as free will, political freedom, and the connection between freedom and individual thought and privacy.

Pancreatitis is a complex, progressively destructive inflammatory disorder. Alcohol was long thought to be the primary causative agent, but genetic contributions have been of interest since the discovery that rare PRSS1, CFTR and SPINK1 variants were associated with pancreatitis risk. We now report two associations at genome-wide significance identified and replicated at PRSS1-PRSS2 and X-linked CLDN2 through a two-stage genome-wide study. The PRSS1 variant likely affects disease susceptibility by altering expression of the primary trypsinogen gene. The CLDN2 risk allele is (...) associated with atypical localization of claudin-2 in pancreatic acinar cells. The homozygous CLDN2 genotype confers the greatest risk, and its alleles interact with alcohol consumption to amplify risk. These results could partially explain the high frequency of alcohol-related pancreatitis in men. © 2012 Nature America, Inc. All rights reserved. (shrink)

If Lewis prefers the political Plato to the apolitical Socrates, I take my stand with Socrates. I also regard Plato as having been more profoundly invested in establishing a philosophical religion than in establishing a philosophical politics. Cultivating trust in the Good is ultimately of more importance than arming a state against potential enemies. Courage is a virtue greater than prudence. Plato’s Laws, on my reading, is less concerned with maintaining the order of the state than with civilizing its (...) inhabitants. In light of this contention, I understand Plato as being more Socratic—more open to question and thus more flexible—than Lewis’s reading seems to allow. This is why I think Plato provides more attention to his extended preambles to the laws than to the laws themselves. As seriously as Plato took the quest for true law, he realized that any positive code of law has to be subject to constant revision. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Notes and Fragments PLATONIC ELEMENTS IN KAFKA'S "INVESTIGATIONS OF A DOG" by Lewis W. Leadbeater Few critics of Kafka, and certainly few German critics of Kafka, have been willing to allow for much of any classical influence on his works. There are exceptions, but for the most part these commentators can bring themselves to admit only the fact Kafka endured with distaste his lengthy involvement with the classical (...) languages and literature and that, if in any way, he was influenced only in terms of syntax or style.1 Yet it is certain that Kafka read classical literature with interest and that he was well acquainted with classical epic, tragedy, philosophy, and mythology. The wandering Odysseus, the sea god Poseidon, tortured Prometheus —all these and other classical figures are to be found in his works. Indeed, a recent interpretation of The Trial involves a discussion of it in comparison with the trial of Socrates.2 The fact is that Kafka knew Plato's Apology and counted as one of his prized possessions a copy of Plato's Phaedrus. He and Brod read Plato together in high school.3 Are we really to assume, then, that, given Kafka's philosophical bent, he saw no relationship between Plato and the later philosophers, like Kierkegaard for instance, with whom he was quite taken, and that given his fertile mind and penchant for metaphor, Kafka reflects only Platonic syntax?4 Quite the contrary; we must, I think, cede his classicism to Kafka, and in the discussion which follows I should like to point out that in one of the short stories, "Investigations of a Dog," parable and metaphor blend as well as they do because of Platonic influence, and especially that of the Apology and the Phaedrus. Kafka's animals pervade his works in both metaphor and simile. Gregor Samsa awakes one morning to find himself transformed into a gigantic beetle; Joseph K dies, at the end of his trial, like a dog, and it is a questioning canine which investigates the meaning of dog104 Lewis W. Leadbeater105 ness in "Forschungen eines Hundes." Generally the animalistic metaphor involves removal, alienation, and isolation— a loss of kinship with humanity to be sure, but more important a loss of communication, an inability to communicate, and hence an emphasis on all-encompassing, frustrating silence. The natural result for these people turned animal is an involvement in a process of severe introspection frequently linked with the pursuit of some idea or ideal which will provide a hitherto unknown, transcendent nourishment for a famished, alienated soul. Such is certainly the case with Gregor Samsa and quite possibly the case with Joseph K; it is in fact such pursuits which lie at the heart of the researches of our investigating Dog. Though any attempt to pinpoint the source of Kafka's penchant for animalistic metaphors is quite certainly futile, one might well posit as paradigmatic the alienation plays of Aristophanes involving animals, and certainly the notion of a psychological link between man and beast is present in Plato's Phaedrus, a dialogue in which the soul metaphor itself involves horses, and one in which there is considerable discussion of the interchangeability of the souls of men and beasts.5 As noted above such interchangeability or transformation occurs regularly in Kafka; within the ugly form of beetle lay the psyche of Gregor Samsa. Perhaps within the not-so-ugly canine form of our investigating hound lies the soul of Socrates. Consider for a moment the character of our Dog in light of Plato's Socrates as he appears in the Apology. To begin with, the Dog, as he tells us, is a solitary creature, withdrawn and involved solely in his "investigations" (p. 278).6 In addition, he fully realizes that he is different from the rest of his species (p. 279) and that indeed at times he feels rejected by his kind, realizing as he does that his investigations run counter to the traditional values of his species, a species by which he had hoped at one time to be accepted with great honor (p. 308). What he has capitulated to is "questions" which, furthermore, have quite removed him from normal... (shrink)