Directional deep brain stimulation contacts provide greater spatial flexibility for therapy than traditional ring-shaped electrodes, but little is known about longitudinal changes of impedance and orientation. We measured monopolar and bipolar impedance of DBS contacts in 31 patients who underwent unilateral subthalamic nucleus deep brain stimulation as part of a randomized study. At different follow-up visits, patients were assigned new stimulation configurations and impedance was measured. Additionally, we measured the orientation of the directional lead during surgery, immediately after surgery, and (...) 1 year later. Here we contrast impedances in directional versus ring contacts with respect to local anatomy, active stimulation contact, and over time. Directional contacts display larger impedances than ring contacts. Impedances generally increase slightly over the first year of therapy, save for a transient decrease immediately post-surgery under general anesthesia during pulse generator placement. Local impedances decrease at active stimulation sites, and contacts in closest proximity to internal capsule display higher impedances than other anatomic sites. DBS leads rotate slightly in the immediate postoperative period but otherwise remain stable over the following year. These data provide useful information for setting clinical stimulation parameters over time. (shrink)

Introduction: Although deep brain stimulation often improves levodopa-responsive gait symptoms, robust therapies for gait dysfunction from Parkinson's disease remain a major unmet need. Walking speed could represent a simple, integrated tool to assess DBS efficacy but is often not examined systematically or quantitatively during DBS programming. Here we investigate the reliability and functional significance of changes in gait by directional DBS in the subthalamic nucleus.Methods: Nineteen patients underwent unilateral subthalamic nucleus DBS surgery with an eight-contact directional lead in the most (...) severely affected hemisphere. They arrived off dopaminergic medications >12 h preoperatively and for device activation 1 month after surgery. We measured a comfortable walking speed using an instrumented walkway with DBS off and at each of 10 stimulation configurations at the midpoint of the therapeutic window. Repeated measures of ANOVA contrasted preoperative vs. maximum and minimum walking speeds across DBS configurations during device activation. Intraclass correlation coefficients examined walking speed reliability across the four trials within each DBS configuration. We also investigated whether changes in walking speed related to modification of step length vs. cadence with a one-sample t-test.Results: Mean comfortable walking speed improved significantly with DBS on vs. both DBS off and minimum speeds with DBS on. Pairwise comparisons showed no significant difference between DBS off and minimum comfortable walking speed with DBS on. Intraclass correlations were ≥0.949 within each condition. Changes in comfortable walk speed were conferred primarily by changes in step length.Conclusion: Acute assessment of walking speed is a reliable, clinically meaningful measure of gait function during DBS activation. Directional and circular unilateral subthalamic DBS in appropriate configurations elicit acute and clinically significant improvements in gait dysfunction related to PD. Next-generation directional DBS technologies have significant potential to enhance gait by individually tailoring stimulation parameters to optimize efficacy. (shrink)

The US populace appears to be increasingly polarized on partisan lines. Political fissures bifurcate the country even on empirical matters like vaccine safety and anthropogenic climate change. There now exists an ever-expanding interdisciplinary research program in which theorists attempt to explain increases in political polarization and myriad other phenomena collected under the “post-truth” heading by appeal to social-epistemic structures, like echo chambers and epistemic bubbles, that affect the flow and uptake of information in various communities. In this paper, I critically (...) analyze C. Thi Nguyen’s important and popular analysis of echo chambers and epistemic bubbles. As I demonstrate, the explanatory mechanisms on which Nguyen focuses are, arguably, overly cognitive and obscure significant effects of social-epistemic structures on our affective lives. The broader lesson to draw from my discussion is the following: commonly used expressions intended to refer to social-epistemic problems, like “political polarization”, possess no univocal definition across theorists, and various ways of making the terms precise are differentially successful in characterizing verifiable phenomena. Theorizing about social-epistemic structures should be responsive to relevant empirical work on various phenomena that we have good reason to believe constitute real and substantive problems that result from the flow and uptake of information. (shrink)

On a version of consent theory that tempts many, predatory sexual relations involving significant power imbalances (e.g. between professors and students, adults and teenagers, or employers and employees) are wrong because they violate consent-centric norms. In particular, the wronged party is said to have been incapable of consenting to the predation, and the sexual wrong is located in the encounter’s nonconsensuality. Although we agree that these are sexual wrongs, we resist the idea that they are always nonconsensual. We argue instead (...) that it is possible for students, teenagers, employees, etc. to fully consent to sexually predatory encounters; denying as much renders survivors of predation vulnerable to compounding harms. Survivors face a dilemma: give up either their understanding of their experience as wrong, or their self-conception as an agent capable of consenting. We call the latter phenomenon agential demotion. (shrink)

Evidentialism as an account of epistemic justification is the position that a doxastic attitude, D, towards a proposition, p, is justified for an intentional agent, S, at a time, t, iff having D towards p fits S’s evidence at t, where the fittingness of an attitude on one’s evidence is typically analyzed in terms of evidential support for the propositional contents of the attitude. Evidentialism is a popular and well-defended account of justification. In this paper, I raise a problem for (...) evidentialism on the grounds that there can be epistemic circumstances in which a proposition is manifestly and nonmisleadingly supported by an agent’s total evidence, and yet believing the proposition is not justified for the agent. As I argue, in order for an agent to have justification to believe a proposition, it needs to be the case that the belief as possessed by the agent could exhibit certain epistemic good making features, e.g., the propositional content of the belief as possessed by the agent would be supported by the agent’s evidence. As I demonstrate, the fact that a proposition, p, is supported by an agent’s total evidence at a time, t, doesn’t guarantee that a belief in p as possessed by the agent at t could exhibit any epistemic good making features, including having propositional contents (i.e., p) that would be supported by the agent’s evidence. Thus, the fact that a proposition is supported by an agent’s evidence doesn’t guarantee that the agent has justification to believe the proposition. (shrink)

This essay brings psychoanalytic theory on trauma together with film and television criticism on rape narrative in an analysis of Michael Coel’s 2020 series I May Destroy You. Beyond the limited carceral framework of the police procedural, which dislocates the act of violence from the survivor’s history and context, Coel’s polyvalent, looping narrative metabolizes rape television’s forms and genres in order to stage and restage both trauma and genre again and anew. Contesting common conceptions of vulnerability and susceptibility that prefigure (...) a violent breach of autonomy, Coel’s series and her interviews about it invite an ethics of looking that embraces a curiosity in the unknowable and untreatable kernel of subjective experience and defies and resists a policing of the survivor’s thoughts and emotions. By emphasizing and exploring what psychoanalysis calls the “afterwardness” of trauma, Coel foregrounds her main character’s subjectivity prior to her victimization, widens the sphere of consequence beyond the victim and criminal justice system to the survivor’s larger community, and entreats that community to preserve a space for her to look and look again at everything, without judgment. (shrink)

Researchers are studying how artificial intelligence (AI) can be used to better detect, prognosticate and subgroup diseases. The idea that AI might advance medicine’s understanding of biological categories of psychiatric disorders, as well as provide better treatments, is appealing given the historical challenges with prediction, diagnosis and treatment in psychiatry. Given the power of AI to analyse vast amounts of information, some clinicians may feel obligated to align their clinical judgements with the outputs of the AI system. However, a potential (...) epistemic privileging of AI in clinical judgements may lead to unintended consequences that could negatively affect patient treatment, well-being and rights. The implications are also relevant to precision medicine, digital twin technologies and predictive analytics generally. We propose that a commitment to epistemic humility can help promote judicious clinical decision-making at the interface of big data and AI in psychiatry. (shrink)

I propose a unified solution to two puzzles: Ross's puzzle and free choice permission. I begin with a pair of cases from the decision theory literature illustrating the phenomenon of act dependence, where what an agent ought to do depends on what she does. The notion of permissibility distilled from these cases forms the basis for my analysis of 'may' and 'ought'. This framework is then combined with a generalization of the classical semantics for disjunction — equivalent to Boolean disjunction (...) on the diagonal, but with a different two-dimensional character — that explains the puzzling facts in terms of semantic consequence. (shrink)

People frequently report that, at times, their thought has a vocal character. Thinking commonly appears to be accompanied or constituted by silently ‘talking’ to oneself in inner speech. In this paper, we explore the specifically epistemic role of inner speech in conscious reasoning. A plausible position—but one I argue is ultimately wrong—is that inner speech plays asolelyfacilitative role that is exhausted by (i) serving as the vehicle of representation for conscious reasoning, and/or (ii) allowing one to focus on certain types (...) of objects or relations, e.g., causal relations, abstracta, counterfactuals, etc., or to consciously entertain structured propositional contents that it would be hard (or impossible) to focus on or entertain with representations in other (e.g., imagistic) formats. According to this position, inner speech doesn't figure as a justificatory element in our reasoning or as the partial epistemic basis of our conclusions—it merely facilitates reasoning through (i) and/or (ii). In contrast to the view that inner speech is amerefacilitator, I establish that (outside of potentially playing roles (i) and/or (ii)) the language we use itself serves as a crucial source of information in reasoning. In other words, we reason from propositions about the language we use in inner speech as opposed to exclusively reasoning from the semantic contents of the speech. My conclusion follows from how we use language as a cognitive tool to keep track of information, e.g., the contents of premises, lemmas, previous reasoning results, etc., in reasoning. (shrink)

People frequently report that their thought has, at times, a vocal character. Thinking commonly appears to be accompanied or constituted by silently ‘talking’ to oneself in inner speech. In this paper, I argue that inner speech ‘utterances’ can constitute occurrent propositional attitudes, e.g., occurrent judgments, suppositions, etc., and, thereby, we can consciously reason through tokening a series of inner speech utterances in working memory. As I demonstrate, the functional role a mental state plays in working memory is determined in a (...) flexible and context sensitive manner by metacognitive monitoring and control procedures. An inner speech utterance functions as an occurrent judgment (and, thus, as a premise, lemma, or conclusion in a line of conscious reasoning) when it is experienced with a level of certainty that exceeds one’s threshold of confidence for acceptance. In virtue of an agent experiencing an inner speech utterance with a sufficient level of certainty, the utterance plays the functional role of an occurrent judgment through, e.g., terminating inquiry and causing overt actions (like overtly asserting the words rehearsed in inner speech). (shrink)

There can be no doubt that Kant thought we should be reflective: we ought to care to make up our own minds about how things are and what is worth doing. Philosophical objections to the Kantian reflective ideal have centred on concerns about the excessive control that the reflective person is supposed to exert over her own mental life, and Kantians who feel the force of these objections have recently drawn attention to Kant’s conception of moral virtue as it is (...) developed in his later work, chiefly the Metaphysics of Morals. Melissa Merritt’s book is a distinctive contribution to this recent turn to virtue in Kant scholarship. Merritt argues that we need a clearer, and textually more comprehensive, account of what reflection is, in order not only to understand Kant’s account of virtue, but also to appreciate how it effectively rebuts long-standing objections to the Kantian reflective ideal. (shrink)

Programs, policies, and technologies — particularly those concerned with health equity — are often designed with justice envisioned as the end goal. These policies or interventions, however, frequently fail to recognize how the beneficiaries have historically embodied the cumulative effects of marginalization, which undermines the effectiveness of the intended justice. These well-meaning attempts at justice are bounded by greater socio-historical constraints. Bounded justice suggests that it is impossible to attend to fairness, entitlement, and equity when the basic social and physical (...) infrastructures underlying them have been eroded by racism and other historically entrenched isms. Using the case of Brazil’s National Health Policy for the Black Population, this paper proposes that bounded justice can contribute to justice discourses by serving as a concept, a proffering to a multi-disciplinary conceptual framework, and a potential analytic for those interested in the design of policy, technology, and programmatic interventions towards health equity. (shrink)

Ethics researchers advise managers of organizations to link rewards and punishments to ethical and unethical behavior, respectively. We build on prior research maintaining that organizations operate at Kohlbergs stages of moral reasoning, and explain how the over-reliance on rewards and punishments encourages employees to operate at Kohlbergs lowest stages of moral reasoning. We advocate designing organizations as ethical communities and relying on different assumptions about employees in order to foster ethical reasoning at higher levels. Characteristics associated with ethical communities are (...) identified and AES Corporation and Semco S/A serve as examples of corporations exhibiting the design characteristics and assumptions of ethical organizations. (shrink)

In light of recent social psychological literature, I expand Miranda Fricker’s important notion of testimonial injustice. A fair portion of Fricker’s account rests on an older paradigm of stereotype and prejudice. Given recent empirical work, I argue for what I dub prescriptive credibility deficits in which a backlash effect leads to the assignment of a diminished level of credibility to persons who act in counter-stereotypic manners, thereby flouting prescriptive stereotypes. The notion of a prescriptive credibility deficit is not merely an (...) interesting conceptual addendum that can be appended to Fricker’s theory without need for further emendation. I develop the wider implications of prescriptive credibility deficits and argue that they pose a challenge to Fricker’s conception of the function of credibility assignments in conversational exchange and how a virtuous listener should respond to the potential threat of a prejudicial stereotype affecting her credibility assignments. (shrink)

Many extant theories of placebo focus on their causal structure wherein placebo effects are those that originate from select features of the therapy (e.g., client expectations or “incidental” features like size and shape). Although such accounts can distinguish placebos from standard medical treatments, they cannot distinguish placebos from everyday occurrences, for example, when positive feedback improves our performance on a task. Providing a social-epistemological account of a treatment context can rule out such occurrences, and furthermore reveal a new way to (...) distinguish clinical placebos from standard medical treatments. (shrink)

The application of artificial intelligence and machine learning technologies in healthcare have immense potential to improve the care of patients. While there are some emerging practices surro...

Explores the challenges facing democracies in the twenty-first century In Democratic Failure, Melissa Schwartzberg and Daniel Viehoff bring together a distinguished group of interdisciplinary scholars in political science, law, and philosophy to explore the key questions and challenges facing democracies, both in the past and present, around the world. In ten timely essays, contributors examine the fascinating, centuries-old question of whether or not democracy can ever fulfill the promise of its ideals. Together, they explore lessons from the history of (...) democracy, various failures of democratic representation, and more. Ultimately, this latest installment of the NOMOS series provides thought-provoking insights into how we conceptualize, measure, and address democratic erosion in our present-day world. (shrink)

This article explains the problems with Alan Shewmon’s critique of brain death as a valid sign of human death, beginning with a critical examination of his analogy between brain death and severe spinal cord injury. The article then goes on to assess his broader argument against the necessity of the brain for adult human organismal integration, arguing that he fails to translate correctly from biological to metaphysical claims. Finally, on the basis of a deeper metaphysical analysis, I offer a revised (...) rationale for the validity of the neurological criterion of human death. (shrink)

Should animals have similar rights as humans? -- Is it moral to eat animals? -- Should animals be used for entertainment? -- Is it ethical to experiment on animals?

Building trust between academic medical centers and certain communities they depend on in the research process is hard, particularly when those communities consist of minoritized or historically marginalized populations. Some believe that engagement activities like the creation of advisory boards, town halls, or a research workforce that looks more like community members will establish or reestablish trust between academic medical centers and racialized communities. However, without systematic approaches to dismantle racism, those well‐intended actions become public performativity, and trust building will (...) fail. In this essay, we draw upon foundational ethical principles of trust, distrust, and trust building; apply the concept of bounded justice to performative trust acts; and center the works of Black and Indigenous feminist bioethicists to revisit some of the wisdom and valuable lessons they have contributed. Rebuilding trust is hard to do because people and institutions are often not honest about how hard it is and there is no simple box‐checking task that can disentangle our society's injustices, but there are steps to take in this direction. Individuals and institutions can recognize valuable relevant work that has already been written, partake in critical reflection, and then apply insights gained to take both small and sustainable steps toward transformational change and deeper trust. (shrink)

Liberalism is the political philosophy of equal persons, yet liberalism has denied equality to those it saw as black sub-persons. In Black Rights/White Wrongs: The Critique of Racial Liberalism, political philosopher Charles Mills challenges mainstream accounts that ignore this history and its current legacy in the United States today.

Journal of Philosophy of Education, EarlyView.

Since ancient Athens, democrats have taken pride in their power and inclination to change their laws, yet they have also sought to counter this capacity by creating immutable laws. In Democracy and Legal Change, Melissa Schwartzberg argues that modifying law is a fundamental and attractive democratic activity. Against those who would defend the use of 'entrenchment clauses' to protect key constitutional provisions from revision, Schwartzberg seeks to demonstrate historically the strategic and even unjust purposes unamendable laws have typically served, (...) and to highlight the regrettable consequences that entrenchment may have for democracies today. Drawing on historical evidence, classical political theory, and contemporary constitutional and democratic theory, Democracy and Legal Change reexamines the relationship between democracy and the rule of law from a new, and often surprising, set of vantage points. (shrink)

Within the growing developmental literature on children's testimonial learning, the emphasis placed on children's evaluations of testimonial evidence has shielded from view some of the more collaborative dimensions of testimonial learning. Drawing on recent philosophical work on testimony and interpersonal trust, we argue for an alternative way of conceptualizing the social nature of testimonial learning. On this alternative, some testimonial learning is the result of a jointly collaborative epistemic activity, an activity that aims at the epistemic goal of true belief, (...) but that does so by means of an irreducibly social process. (shrink)

Observers have difficulty detecting visual changes. However, they are unaware of this inability, suggesting that people do not have an accurate understanding of visual processes. We explored whether this error is related to participants’ beliefs about the roles of intention and scene complexity in detecting changes. In Experiment 1 participants had a higher failure rate for detecting changes in an incidental change detection task than an intentional change detection task. This effect of intention was greatest for complex scenes. However, participants (...) predicted equal levels of change detection for both types of changes across scene complexity. In Experiment 2, emphasizing the differences between intentional and incidental tasks allowed participants to make predictions that were less inaccurate. In Experiment 3, using more sensitive measures and accounting for individual differences did not further improve predictions. These findings suggest that adults do not fully understand the role of intention and scene complexity in change detection. (shrink)

Scholars exploring the logic of Rousseau's voting rules have typically turned to the connection between Rousseau and the Marquis de Condorcet. Though Condorcet could not have had a direct influence on Rousseau's arguments about the choice of decision rules in "Social Contract," the possibility of a connection has encouraged the view that Rousseau's selection of voting rules was based on epistemic reasons. By turning to alternative sources of influence on Rousseau--the work of Hugo Grotius and particularly that of Samuel Pufendorf--a (...) moral, and not purely epistemic, logic of rules governing collective decision making emerges. For Rousseau, as for Pufendorf, the proper choice of voting rule can elicit the appropriate attitude of an individual with respect to the decision of the whole, and can support the morally significant activity of acknowledging error upon discovering that one has voted against the general will. (shrink)

Our conscious thought, at least at times, seems suffused with language. We may experience thinking as if we were “talking in our head”, thus using inner speech to verbalize, e.g., our premises, lemmas, and conclusions. I take inner speech to be part of a larger phenomenon I call inner semiotics, where inner semiotics involves the subjective experience of expressions in a semiotic (or symbol) system absent the overt articulation of the expressions. In this paper, I argue that inner semiotics allows (...) us to bootstrap our way into entertaining thoughts about exact numbers and quantities that we couldn't prior to our competence with a numeric code. I establish that our arithmetic thoughts literally occur as (internal ‘articulations’ of) expressions in a numeric code. However, a problem arises for my view: just as we can slip in overt speech, producing an utterance that deviates from what we mean to say, there is very good evidence that we can slip in inner speech as well. If our arithmetic thought occurs in a numeric code, it's far from clear how we determine when a covert utterance constitutes a slip. In closing, I provide an account of what makes an inner speech utterance a slip. (shrink)

As is clear in the 2008 report of the President's Council on Bioethics, the brain death debate is plagued by ambiguity in the use of such key terms as ‘integration’ and ‘wholeness’. Addressing this problem, I offer a plausible ontological account of organismal unity drawing on the work of Hoffman and Rosenkrantz, and then apply that account to the case of brain death, concluding that a brain dead body lacks the unity proper to a human organism, and has therefore undergone (...) a substantial change. I also show how my view can explain hard cases better than one in which biological integration is taken to imply ontological wholeness or unity. (shrink)

Disclosure in clinical practice is aimed at promoting patient autonomy, usually culminating in patient choice (e.g., to consent to an operation or not, or between different medications). In medical ethics, there is an implicit background assumption that knowing more about (X) automatically translates to greater, or more genuine, autonomy with respect to one's choices involving (X). I challenge this assumption by arguing that in rare cases, withholding information can promote a patient's autonomy (understood as the capacity for rational choice in (...) alignment with one's values and goals). (shrink)

Political scientist Melissa Orlie asks what it means to live freely and responsibly when advantages are distributed disproportionately according to race, gender ...

Farmers’ willingness and ability to adapt to climate change are in part influenced by their social networks and sources of information. Drawing on assemblage theory and social network analysis in a novel way, this study explores the influence of Oregonian small farmers’ social and informational networks on their beliefs about and responses to climate change. The use of assemblage theory, which focuses on many disparate elements as they co-function in a space, allows for multiple entities within farmers’ networks and the (...) ways they interact to be examined, while the use of social network analysis highlights broader patterns in the structure and composition of farmers’ networks. Theoretically, this study brings these two distinct yet similar bodies of theory and methodologies together for the first time to expand the utility of both fields and explore farmers’ networks in a novel way. Results indicate that small farmers’ connections to other farmers and media in their networks are influencing their beliefs about climate change, while their responses are influenced by their ties to various agricultural and climatological information sources, as well as other nearby farmers. Finally, while farmers’ ties to other farmers are largely limited to those nearby, certain central individuals and entities, particularly beginning farmers, can act as bridges linking distinct groups of farmers. An understanding of these networks can be used to better disseminate critical information, such as forecasts and adaptation strategies, to help farmers adapt. (shrink)