The practice of covertly administering medication is controversial. Although condemned by some as overly paternalistic, others have suggested that it may be acceptable if patients have permanent mental incapacity and refuse needed treatment. Ethical, legal, and clinical considerations become more complex when the mental incapacity is temporary and when the medication actually serves to restore autonomy. We discuss these issues in the context of a young man with schizophrenia. His mother had been giving him antipsychotic medication covertly in his soup. (...) Should the doctor continue to provide a prescription, thus allowing this to continue? We discuss this case based on the “four principles” ethical framework, addressing the conflict between autonomy and beneficence/non-maleficence, the role of antipsychotics as an autonomy restoring agent, truth telling and the balance between individual versus family autonomy. (shrink)

Background: Freezing of gait is a common symptom in Parkinson’s disease and can be difficult to treat with dopaminergic medications or with deep brain stimulation. Novel stimulation paradigms have been proposed to address suboptimal responses to conventional DBS programming methods. Burst-cycling deep brain stimulation delivers current in various frequencies of bursts, while maintaining an intra-burst frequency identical to conventional DBS.Objective: To evaluate the safety and tolerability of BCDBS in PD patients with FOG.Methods: Ten PD subjects with STN or GPi DBS (...) and complaints of FOG were recruited for this single center, single blinded within-subject crossover study. For each subject, we compared 4, 10, and 15 Hz BCDBS to conventional DBS during the PD medication-OFF state.Results: There were no serious adverse events with BCDBS. It was feasible and straightforward to program BCDBS in the clinic setting. The benefit was comparable to conventional DBS in measures of FOG, functional mobility and in PD motor symptoms. BCDBS had lower battery consumption when compared to conventional DBS.Conclusions: BCDBS was feasible, safe and well tolerated and it has potential to be a viable future DBS programming strategy. (shrink)

DBS Think Tank IX was held on August 25–27, 2021 in Orlando FL with US based participants largely in person and overseas participants joining by video conferencing technology. The DBS Think Tank was founded in 2012 and provides an open platform where clinicians, engineers and researchers can freely discuss current and emerging deep brain stimulation technologies as well as the logistical and ethical issues facing the field. The consensus among the DBS Think Tank IX speakers was that DBS expanded in (...) its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. After collectively sharing our experiences, it was estimated that globally more than 230,000 DBS devices have been implanted for neurological and neuropsychiatric disorders. As such, this year’s meeting was focused on advances in the following areas: neuromodulation in Europe, Asia and Australia; cutting-edge technologies, neuroethics, interventional psychiatry, adaptive DBS, neuromodulation for pain, network neuromodulation for epilepsy and neuromodulation for traumatic brain injury. (shrink)

ObjectiveTo prospectively study the cingulate cortex for the localization and role of the grasping action in humans during electrical stimulation of depth electrodes.MethodsAll the patients with intractable focal epilepsy and a depth electrode stereotactically placed in the cingulate cortex, as part of their pre-surgical epilepsy evaluation from 2015 to 2017, were included. Cortical stimulation was performed and examined for grasping actions. Post-implantation volumetric T1 MRIs were co-registered to determine the exact electrode position.ResultsFive patients exhibited contralateral grasping actions during electrical stimulation. (...) All patients had electrodes implanted in the ventral bank of the right cingulate sulcus adjacent to the vertical anterior commissure line. Stimulation of other electrodes in adjacent regions did not elicit grasping.ConclusionGrasping action elicited from a localized region in the mid-cingulate cortex directly supports the concept of the cingulate cortex being crucially involved in the grasping network. This opens an opportunity to explore this region with deep brain stimulation as a motor neuromodulation target for treatment in specific movement disorders or neurorehabilitation. (shrink)

Objectives: To study the attitudes of both medical and non-medical students towards the do-not-resuscitate decision in a university in Hong Kong, and the factors affecting their attitudes.Methods: A questionnaire-based survey conducted in the campus of a university in Hong Kong. Preferences and priorities of participants on cardiopulmonary resuscitation in various situations and case scenarios, experience of death and dying, prior knowledge of DNR and basic demographic data were evaluated.Results: A total of 766 students participated in the study. There were statistically (...) significant differences in their DNR decisions in various situations between medical and non-medical students, clinical and preclinical students, and between students who had previously experienced death and dying and those who had not. A prior knowledge of DNR significantly affected DNR decision, although 66.4% of non-medical students and 18.7% of medical students had never heard of DNR. 74% of participants from both medical and non-medical fields considered the patient’s own wish as the most important factor that the healthcare team should consider when making DNR decisions. Family wishes might not be decisive on the choice of DNR.Conclusions: Students in medical and non-medical fields held different views on DNR. A majority of participants considered the patient’s own wish as most important in DNR decisions. Family wishes were considered less important than the patient’s own wishes. (shrink)

We estimate that 208,000 deep brain stimulation (DBS) devices have been implanted to address neurological and neuropsychiatric disorders worldwide. DBS Think Tank presenters pooled data and determined that DBS expanded in its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. The DBS Think Tank was founded in 2012 providing a space where clinicians, engineers, researchers from industry and academia discuss current and emerging DBS technologies and logistical and ethical issues facing the field. (...) The emphasis is on cutting edge research and collaboration aimed to advance the DBS field. The Eighth Annual DBS Think Tank was held virtually on September 1 and 2, 2020 (Zoom Video Communications) due to restrictions related to the COVID-19 pandemic. The meeting focused on advances in: (1) optogenetics as a tool for comprehending neurobiology of diseases and on optogenetically-inspired DBS, (2) cutting edge of emerging DBS technologies, (3) ethical issues affecting DBS research and access to care, (4) neuromodulatory approaches for depression, (5) advancing novel hardware, software and imaging methodologies, (6) use of neurophysiological signals in adaptive neurostimulation, and (7) use of more advanced technologies to improve DBS clinical outcomes. There were 178 attendees who participated in a DBS Think Tank survey, which revealed the expansion of DBS into several indications such as obesity, post-traumatic stress disorder, addiction and Alzheimer’s disease. This proceedings summarizes the advances discussed at the Eighth Annual DBS Think Tank. (shrink)

In this essay, I introduce the symposium on Jordan Wessling’s book, Love Divine: A Systematic Account of God’s Love for Humanity, by discussing its origin as a book panel, providing the context for the significance of Wessling’s contribution, and previewing the essays that follow.

Trenton Merricks has objected to dualist conceptions of the Incarnation in a similar way to Jaegwon Kim’s pairing problem. On the original pairing problem, so argues Kim, we lack a pairing relationship between bodies and souls such that body A is causally paired with soul A and not soul B. Merricks, on the other hand, argues that whatever relations dualists propose that do pair bodies and souls together (e.g. causal relations) are relations that God the Son has with all bodies (...) whatsoever via his divine attributes (e.g. God the Son could cause motion in any and all bodies via his omnipotence). So if we count these relations as sufficient for embodiment, then dualism implies that God the Son is embodied in all bodies whatsoever. I shall argue that while the original pairing problem might be easily answerable, the Christological pairing problem is not and that dualists must shift some of their focus from the defense of the soul’s existence to explicating the nature of the mind-body relationship. (shrink)

The etiology of visual hallucinations is largely undetermined in schizophrenia. Collerton et al.'s PAD model partly concurs with what we know about neurocognition in schizophrenia, but we need to specify the types of perceptual and attentional abnormalities that are implicated in recurrent complex visual hallucinations (RCVH). Available data suggest that abnormal attentional control and top-down processing play a larger role than the ventral stream deficits.

Drawing on the behavioral theory, this study examines how the misalignment between a firm's environmental effort and the level of subsidies received from the government in affecting the firm's investment in non-environmental R&D. Based on a sample of Chinese A-share listed firms from 2008 to 2019 and using polynomial regression techniques, our findings reveal that firms in the “low effort-high subsidies” group exhibit lower non-environmental R&D intensity compared to firms in the “high effort-low subsidies” group. This study contributes to the (...) literature by shedding light on the interplay between corporate environmental efforts, government subsidies, and non-environmental R&D investment. The findings suggest the importance of aligning the environmental efforts of firms with subsidy levels from the government to effectively allocate resources for different types of R&D. The implications of this research suggest that firms should carefully consider aligning their environmental efforts with government subsidies to optimize their investment in non-environmental R&D and overall innovation strategy. Furthermore, the study indicates that firms and governments should prudently balance the relationship between environmental R&D and non-environmental R&D to avoid any negative impact on the latter. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hermeneutics, Neuroscience and PsychiatryMichael T. H. Wong, MBBS, MD, MA, MDiv, PhD, FRCPsych, FRANZCP, FHKAM (bio)Hermeneutic practice in mental health has been a theme in Philosophy, Psychiatry, & Psychology (PPP) since its very beginnings. In this essay I argue that hermeneutics, the theory and practice of interpretation, promotes therapeutic interaction between mental health professionals, patients and their family.Why does this patient present in such a way at this (...) particular point in time? The distressing symptoms are there. The changes in behavior are obvious. Impairments of functions are hurting. A mental illness clearly runs in the family. There were early losses of loved ones, physical abuse at home, bullying by peers and self-medication with drugs and alcohol. Three in four adults with a mental illness first experienced that before they turned 24. The brain goes through major reorganization during adolescence and early adulthood. If synaptic pruning went wrong, psychoses emerged. When stresses activated the hypothalamic–pituitary–adrenal axis the elevated cortisol level impacted the size and function of the hippocampus and amygdala in the genetically vulnerable; anxiety, depression, bipolar, and personality disorders developed. The patient needs a voice/language to describe all these experiences and events and the psychiatrist needs a discourse to make sense of them.Eisenberg laments the swings between "brainlessness" and "mindlessness" in psychiatry. Engel argues for a "biopsychosocial" discourse. The major challenge for psychiatry is how to organize clinical information of different nature (categories, dimensions, narratives; i.e., objective vs. subjective, personal vs. interpersonal) into a coherent and comprehensible account for us all. Mental illnesses are not only neuropsychiatric spectrum disorders but also dysfunctions of social relationship and environmental/ecological adaptation. Psychiatry as a clinical neuroscience per se lacks the semantics to address the rich interactions between the physical, psychological, social, cultural, and spiritual in the illness experience of our patients. Explanation in the diagnostic formulation (objective scientific discourse on cause and effect) and understanding in the patient narrative (subjective ordinary everyday discourse on significance and meaning) are irreducible to each other (Wong, 2018). They instead interact with one another to achieve an integrative formulation, not through merging different discourses into a single assertion/monologue but via the dialectic/dialogue of "explaining more in order to understand better," as Ricoeur puts it, and between "the whole and the parts," as Schleiermacher highlights.This "therapeutic hermeneutic circle" of "explanation vs understanding" and "the whole vs the parts" includes symptoms behavior function and life events. It correlates between bio-psychosociocultural-spiritual dimensions/perspectives and does not reduce them to any particular/single [End Page 13] stance. The whole integrates the parts and the parts enrich the whole. It explains but does not explain away. It understands through an articulation of meaning and significance. This discourse is a multilayered (bio-psycho-social-cultural-spiritual) personal narrative that formulates diagnosis and care in a correlative (linking different voices/discourses) and non-reductive (no particular voice/discourse is prejudiced against) manner that is comprehensible to us all (Wong, 2021).PPP will be an excellent forum for discussing clinical hermeneutics in the future. In this digital era of social media and virtual reality, hermeneutics has the never-ending task to tackle the unprecedented challenges to meaning illness and health posed by polarizing discourses.Michael T. H. Wong Michael T.H. Wong, MBBS, MD, MA, MDiv, PhD, FRCPsych, FRANZCP, FHKAM, is Hon Clinical Professor, Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, HKSAR, China. Michael is Chair, Section of Philosophy & Humanities in Psychiatry, World Psychiatric Association. He is an Organizational Partner & International Lead with The Collaborating Centre for Values-Based Practice in Health and Social Care, St Catherine's College Oxford. He is Advisor to the Chinese Health Foundation of Australia.ReferencesWong M. T. H. (2018). Ricoeur and the third discourse of the person: From philosophy and neuroscience to psychiatry and theology. London: Lexington Books. Google ScholarWong, M. T. H. (2021). Values, meanings, hermeneutics and mental health. In Stoyanov, D., Fulford, K. M. W. F., Stanghellini, G., Van Staden, W., & Wong, M. TH. (Eds.), International perspectives in values-based mental health practice: Case studies and commentaries (pp. 341–349... (shrink)

According to Kant, we refer to what is out there in the world by performing a demonstrative act, like pointing at an object with a finger. A Kantian mode of demonstrative reference is characterized by the existence of a real, 2-placed affective relation between an intuiting subject and the referent. Parsons suggests that Kantian intuition is both singular and immediate, and immediacy demands an object of intuition to be present, a condition clearly satisfied by objects within our immediate perceptual field. (...) But since we do not have an immediate relation with remote objects, the scope of our demonstrative reference is severely restricted by intuitional immediacy. I wish to develop a global Kantian intuition in order to extend the scope of demonstrative reference. Kant's ontology of space entails that the global representability of space be given to an intuiting subject as a form of intuition. According to Melnick, Kantian intuition is a kinematic operation which involves directing attention and moving about. To make contact with the world, the subject must move away from its locale: although a spatially remote object is not immediately present, we can shift our location by taking a path such that W will become so. Once we are close enough to be affected by W, we will be able to point at W and say "This." Thus, the intuitive scope of demonstrative reference is globalized as we shift our location. (shrink)

Libertarians such as J.R. Lucas have abandoned traditional Christian doctrines because they cannot reconcile them with the freedom of the will. Traditional Christian thinkers such as Augustine have repudiated libertarianism because they cannot reconcile it with the dogmas of the Faith. In Free Will and the Christian Faith, W.S. Anglin demonstrates that free will and traditional Christianity are ineed compatible. He examines, and solves, puzzles about the relationships between free will and omnipotence, omniscience, and God's goodness, using the idea of (...) free will to answer the question of why God allows evil, and presenting arguments that link free will to eternal life and to the nature of revelation. Topics covered include the meaning of life, the soul and Lesbegue measure, and strategies for discerning the voice of God. (shrink)

The most recent and by far the best edition of this work is that of H. M. Hine , to which I refer for full bibliographical information. Many passages of the text are most helpfully discussed in the same scholar's Studies in the Text of Seneca's Naturales Quaestiones . ut nubes infici possint, … sol ad hoc apte ponendus est; non enim idem facit undecumque effulsit, et ad hoc opus est radiorum idoneus ictus. Seneca is dealing with rainbows. Hine shares (...) Axelson's suspicion of ictus, but is unhappy both with Axelson's situs and with my tractus, ‘direction’ ; very tentatively he suggests angulus. Much more credible palaeographically and still yielding good sense and a good clausula would be i etus, a noun which is very common in this work of Seneca's. Hostius fuit Quadra obscenitatis in scaenam usque perductae. (shrink)

The most recent and by far the best edition of this work is that of H. M. Hine, to which I refer for full bibliographical information. Many passages of the text are most helpfully discussed in the same scholar's Studies in the Text of Seneca's Naturales Quaestiones. ut nubes infici possint, … sol ad hoc apte ponendus est; non enim idem facit undecumque effulsit, et ad hoc opus est radiorum idoneus ictus. Seneca is dealing with rainbows. Hine shares Axelson's suspicion (...) of ictus, but is unhappy both with Axelson's situs and with my tractus, ‘direction’ ; very tentatively he suggests angulus. Much more credible palaeographically and still yielding good sense and a good clausula would be i etus, a noun which is very common in this work of Seneca's. Hostius fuit Quadra obscenitatis in scaenam usque perductae. (shrink)

In CQ 45 , 547–50, S. J. Harrison and M. Winterbottom propose a series of emendations to the text of the recently discovered passage of Donatus which contains his commentary on Aen. 6.1–157. I offer some further emendations.

In CQ 45, 547–50, S. J. Harrison and M. Winterbottom propose a series of emendations to the text of the recently discovered passage of Donatus which contains his commentary on Aen. 6.1–157. I offer some further emendations.

The pseudo-Ciceronian Epistula ad Octavianum enjoys the unmerited distinction of being preserved not only in most of the manuscripts which contain the Ad Atticum letters but also in some of those which contain the second half of the Ad Familiares letters; the former tradition is usually designated Ω, the latter I shall designate X. It was on the Ω tradition that the earliest printed texts were based. In the sixteenth century Cratander and Turnebus introduced a number of readings from the (...) X tradition; some of these were incorporated in the vulgate, but the printed editions from that of Lambinus to that of Purser still continued to be based mainly on Ω. In 1913, in an article in Eranos, xiii. 136–46, Sjögren set himself to prove that the value of Ω had been overrated in the establishment of the text, and that greater importance should be attached to X than to Ω; and in accordance with this view, in his 1914 Teubner text, Sjögren follows X, as against Ω, about twice as often3 as Purser does. This view of Sjögren's, I believe, will not stand examination, and to disprove it is the purpose of the present article. (shrink)

‘Ist die zweite Stelle des Satzes bereits durch ein anderes Enklitikon besetzt, so tritt enim auch in klassischer Prosa oft an die 3. und 4. Stelle zurück’ . How often, and in what circumstances, does enim in Cicero occupy any place but the second? The answer to this question is sometimes relevant to the establishment of the text. And the answer is: there are many instances which fall into categories A and B below; in all other categories, C-G below, there (...) are comparatively few. (shrink)

‘Ist die zweite Stelle des Satzes bereits durch ein anderes Enklitikon besetzt, so tritt enim auch in klassischer Prosa oft an die 3. und 4. Stelle zurück’. How often, and in what circumstances, does enim in Cicero occupy any place but the second? The answer to this question is sometimes relevant to the establishment of the text. And the answer is: there are many instances which fall into categories A and B below; in all other categories, C-G below, there are (...) comparatively few. (shrink)

Agr. 2.53. ‘Te volo curare ut mihi Sinopae praesto sis auxiliumque adducas, dum eos agros quos tuo labore cepisti ego mea lege vendam.’ an Pompeium non adhibebit? in eius provincia vendet manubias imperatoris?

Agr. 2.53. ‘Te volo curare ut mihi Sinopae praesto sis auxiliumque adducas, dum eos agros quos tuo labore cepisti ego mea lege vendam.’ an Pompeium non adhibebit? in eius provincia vendet manubias imperatoris?

Human motor learning is governed by a suite of interacting mechanisms each one of which modifies behavior in distinct ways and rely on different neural circuits. In recent years, much attention has been given to one type of motor learning, called motor adaptation. Here, the field has generally focused on the interactions of three mechanisms: sensory prediction error SPE-driven, explicit, and reinforcement learning. Studies of these mechanisms have largely treated them as modular, aiming to model how the outputs of each (...) are combined in the production of overt behavior. However, when examined closely the results of some studies also suggest the existence of additional interactions between the sub-components of each learning mechanism. In this perspective, we propose that these sub-component interactions represent a critical means through which different motor learning mechanisms are combined to produce movement; understanding such interactions is critical to advancing our knowledge of how humans learn new behaviors. We review current literature studying interactions between SPE-driven, explicit, and reinforcement mechanisms of motor learning. We then present evidence of sub-component interactions between SPE-driven and reinforcement learning as well as between SPE-driven and explicit learning from studies of people with cerebellar degeneration. Finally, we discuss the implications of interactions between learning mechanism sub-components for future research in human motor learning. (shrink)

That conditional, if-then reasoning does not emerge until 4–5 years has long been accepted. Here we show that children barely 3 years old can do conditional reasoning. All that was needed was a superficial change to the stimuli: When color was a property of the shapes rather than of the background, 3-year-olds could succeed. Three-year-olds do not seem to use color to inform them which shape is correct unless color is a property of the shapes themselves. While CD requires integrating (...) color and shape information, the dimensional change card sort task requires keeping those dimension cognitively separate – inhibiting attention to one when sorting by the other. For DCCS, a superficial change to the stimuli that is the inverse of what helps on CD enables 3-year-olds to succeed when normally they do not until ∼4⁤12 years. As we and others have previously shown, 3-year-olds can succeed at DCCS when color is a property of the background, instead of a property of the stimulus. Our findings on CD and DCCS suggest that scaffolding preschoolers’ emerging conceptual skills by changing the way stimuli look enables 3-year-olds to demonstrate reasoning abilities long thought beyond their grasp. Evidently, children of 3 years have difficulty mentally separating dimensions of the same object and difficulty mentally integrating dimensions not part of the same object. Our present CD findings plus our earlier DCCS findings provide strong evidence against prominent cognitive complexity, conditional reasoning, and graded memory theories for why 3-year-olds fail these two tasks. The ways we have traditionally queried children may have obscured the budding reasoning competencies present at 3 years of age. (shrink)

The authors' novel approach to some interesting mathematical concepts - not normally taught in other courses - places them in a historical and philosophical setting. Although primarily intended for mathematics undergraduates, the book will also appeal to students in the sciences, humanities and education with a strong interest in this subject. The first part proceeds from about 1800 BC to 1800 AD, discussing, for example, the Renaissance method for solving cubic and quartic equations and providing rigorous elementary proof that certain (...) geometrical problems posed by the ancient Greeks cannot be solved by ruler and compass alone. The second part presents some fundamental topics of interest from the past two centuries, including proof of G del's incompleteness theorem, together with a discussion of its implications. (shrink)

In an article on ‘The Name of the Euxine Pontus’ in C.Q.xxxiv , pp. 123 ff., A. C. Moorhouse rejects the suggestion made by M. Vasmer and supported by Boisacq that the original Greek title ξενος was a popular rendering of the Avestan adjective αχṦαệνα, ‘of dark colour’. Moorhouse raises the following objections to this theory: i. There is no direct evidence of the Avestan adjective ever being applied to the Black Sea. ii. In historical times ‘Avestan is a long (...) way from Greek’ and in prehistorical times it is doubtful whether the speakers of Avestan had any close connexion with the Black Sea. iii. Assuming πόντος to denote ‘way’, ‘the dark way’ would be a fantastic name for any sea. iv. The early Greek form is ξενος, and only metri gratia ξεινος, whereas if the word is a loan from αχṧαēνα we should expect the phonetically closer form ξενος. (shrink)