Deep brain stimulation is a well-established therapy for the motor symptoms of Parkinson’s disease, but there remains an opportunity to improve symptom relief. The temporal pattern of stimulation is a new parameter to consider in DBS therapy, and we compared the effectiveness of Temporally Optimized Patterned Stimulation to standard DBS at reducing the motor symptoms of PD. Twenty-six subjects with DBS for PD received three different patterns of stimulation while on medication and using stimulation parameters optimized for standard DBS. Side (...) effects and motor symptoms were assessed after 30 min of stimulation with each pattern. Subjects experienced similar types of side effects with TOPS and standard DBS, and TOPS were well-tolerated by a majority of the subjects. On average, the most effective TOPS was as effective as standard DBS at reducing the motor symptoms of PD. In some subjects a TOPS pattern was the most effective pattern. Finally, the TOPS pattern with low average frequency was found to be as effective or more effective in about half the subjects while substantially reducing estimated stimulation energy use. TOPS DBS may provide a new programing option to improve DBS therapy for PD by improving symptom reduction and/or increasing energy efficiency. Optimizing stimulation parameters specifically for TOPS DBS may demonstrate further clinical benefit of TOPS DBS in treating the motor symptoms of Parkinson’s disease. (shrink)

Substantial discussion in the neuroethical literature has addressed the possibility that deep brain stimulation (DBS) and adaptive DBS (aDBS) could result in changes in personality, agency, and ide...

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)

Background: Treating medication-refractory freezing of gait in Parkinson’s disease remains challenging despite several trials reporting improvements in motor symptoms using subthalamic nucleus or globus pallidus internus deep brain stimulation. Pedunculopontine nucleus region DBS has been used for medication-refractory FoG, with mixed findings. FoG, as a paroxysmal phenomenon, provides an ideal framework for the possibility of closed-loop DBS.Methods: In this clinical trial, five subjects with medication-refractory FoG underwent bilateral GPi DBS implantation to address levodopa-responsive PD symptoms with open-loop stimulation. Additionally, PPN (...) DBS leads were implanted for CL-DBS to treat FoG. The primary outcome of the study was a 40% improvement in medication-refractory FoG in 60% of subjects at 6 months when “on” PPN CL-DBS. Secondary outcomes included device feasibility to gauge the recruitment potential of this four-lead DBS approach for a potentially larger clinical trial. Safety was judged based on adverse events and explantation rate.Findings: The feasibility of this approach was demonstrated as we recruited five subjects with both “on” and “off” medication freezing. The safety for this population of patients receiving four DBS leads was suboptimal and associated with a high explantation rate of 40%. The primary clinical outcome in three of the five subjects was achieved at 6 months. However, the group analysis of the primary clinical outcome did not reveal any benefit.Interpretation: This study of a human PPN CL-DBS trial in medication-refractory FoG showed feasibility in recruitment, suboptimal safety, and a heterogeneous clinical effect in FoG outcomes. (shrink)

IntroductionDeep brain stimulation has become a standard treatment option for select patients with Parkinson’s disease. The selection process and surgical procedures employed have, to date, not been standardized.MethodsA comprehensive 58-question web-based survey was developed with a focus on DBS referral practices and peri-operative management. The survey was distributed to the Parkinson’s Foundation Centers of Excellence, members of the International Parkinson’s Disease and Movement Disorders Society, and the Parkinson Study Group between December 2015 and May 2016.ResultsThere were 207 individual respondents drawn (...) from 59 countries and 6 continents, of whom 64% received formal training in DBS. Thirteen percent of centers reported that DBS could proceed despite a confidence level of < 50% for PD diagnosis. A case-based approach to DBS candidacy was applied in 51.3% of centers without a cut-off for levodopa-responsiveness. Surprisingly, 33% of centers regularly used imaging for diagnostic confirmation of idiopathic PD. Thirty-one percent of centers reported that neuropsychological evaluation did not affect DBS target selection. Approximately half of the respondents reported determination of DBS candidacy based on a multidisciplinary committee evaluation and 1/3rd reported that a committee was used for target selection. Eight percent of respondents felt that psychosocial factors should not impact DBS candidacy nor site selection. Involvement of allied health professionals in the preoperative process was sparse. There was high variability in preoperative education about DBS outcome expectations. Approximately half of the respondents did not utilize a “default brain target,” though STN was used more commonly than GPi. Specific DBS procedure techniques applied, as well as follow-up timelines, were highly variable.ConclusionResults revealed high variability on the best approaches for DBS candidate selection, brain target selection, procedure type, and postoperative practices. Cognitive and mood assessments were underutilized. There was low reliance on multidisciplinary teams or psychosocial factors to impact the decision-making process. There were small but significant differences in practice across global regions, especially regarding multidisciplinary teams. The wide variability of responses across multiple facets of DBS care highlights the need for prospective studies to inform evidence-based guidelines. (shrink)

IntroductionDeep brain stimulation (DBS) is increasingly used to treat the symptoms of various neurologic and psychiatric conditions. People can undergo the procedure during reproductive years but the safety of DBS in pregnancy remains relatively unknown given the paucity of published cases. We thus conducted a review of the literature to determine the state of current knowledge about DBS in pregnancy and to determine how eligibility criteria are approached in clinical trials with respect to pregnancy and the potential for pregnancy.MethodsA literature (...) review was conducted in EMBASE to identify articles involving DBS and pregnancy. Two reviewers independently analyzed the articles to confirm inclusion. Data extracted for analysis included conditions treated, complications at all stages of pregnancy, neonatal/pediatric outcomes, and DBS target. A second search was then conducted using www.clinicaltrials.gov. The same two reviewers then assessed whether each trial excluded pregnant individuals, lactating individuals, or persons of childbearing age planning to conceive. Also assessed was whether contraception had to be deemed adequate prior to enrollment.ResultsThe literature search returned 681 articles. Following independent analysis and agreement of two reviewers, 8 pregnancy related DBS articles were included for analysis. These articles described 27 subjects, 29 pregnancies (2 with subsequent pregnancies), and 31 infants (2 twin pregnancies). There was 1 preterm birth at 35 weeks, and 3 patients who experienced discomfort from the DBS battery (i.e., impulse generator) placement site. All 27 patients had a DBS device implanted before they became pregnant, which remained in use throughout their pregnancy. There was exclusion of pregnant individuals from 68% of 135 interventional trials involving DBS. Approximately 44% of these trials excluded persons of childbearing age not on “adequate contraception” or wishing to conceive in the coming years. Finally, 22% excluded breastfeeding persons.ConclusionThe data from 29 pregnancies receiving DBS treatment during pregnancy was not associated with unexpected pregnancy or post-partum complication patterns. Many clinical trials have excluded pregnant individuals. Documentation of outcomes in larger numbers of pregnancies will help clarify the safety profile and will help guide study designs that will safely include pregnant patients. (shrink)

Objective: Deep brain stimulation targeted to the ventral intermediate nucleus of the thalamus is effective for motor symptoms in essential tremor, but there is limited data on cognitive outcomes. We examined cognitive outcomes in a large cohort of ET DBS patients.Methods: In a retrospective analysis, we used repeated-measures ANOVA testing to examine whether the age of tremor onset, age at DBS surgery, hemisphere side implanted with lead, unilateral vs. bilateral implantations, and presence of surgical complications influenced the cognitive outcomes. Neuropsychological (...) outcomes of interest were verbal memory, executive functioning, working memory, language functioning, visuospatial functioning, and general cognitive function.Results: We identified 50 ET DBS patients; 29 males; the mean age of tremor onset was 35.84 years with a median age of 38 years. The mean age at DBS was 68.18 years. There were 37 unilateral 30 left, seven right, and 13 bilateral brain implantations. In the subgroup analysis, there was a significant interaction between assessment and age of tremor onset ; F = 4.47; p = 0.043 for working memory. The post hoc testing found improvements for younger onset ET. Similarly, there was a significant interaction between assessment and complications vs. no complications subgroups; F = 4.34; p = 0.043 for verbal memory with worsening scores seen for ET patients with complications. The remaining tests were not significant.Conclusion: In this large cohort of ET patients with, DBS was not accompanied by a significant decline in many cognitive domains. These outcomes were possibly related to the selection of patients with normal cognitive functioning before surgery, unilateral DBS implantations for the majority, and selection of patients with optimal response to DBS. (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)

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)

There is a loud and persistent drum beat of support for schools, for citizenship, for diversity and inclusion, and increasingly for labor market readiness with very little critical attention to the assumptions underlying these agendas, let alone to their many internal contradictions. Accordingly, in this book I examine the philosophical, motivational, and practical challenges of education theory, policy, and practice in the twenty-first century. As I proceed, I do not neglect the historical, comparative international context so essential to better understanding (...) where we are, as well as what is attainable in terms of educational justice. I argue that we must constructively critique some of our most cherished beliefs about education if we are to save the hope of real justice from the rhetoric of imagined justice. (shrink)

Recently we proposed a theory of consciousness, the attention schema theory, based on findings in cognitive psychology and systems neuroscience. In that theory, consciousness is an internal model o...

At the University of Sheffield between 2011 and 2012, a leading group of philosophers, psychologists, and others gathered to explore the nature and significance of implicit bias. The two volumes of Implicit Bias and Philosophy emerge from these workshops. Each volume philosophically examines core areas of psychological research on implicit bias as well as the ramifications of implicit bias for core areas of philosophy. Volume II: Moral Responsibility, Structural Injustice, and Ethics is comprised of three parts. “Moral Responsibility for Implicit (...) Bias” contains chapters examining the relationship of implicit biases to concepts that are central to moral responsibility, including control, awareness, reasons-responsiveness, and alienation. The chapters in the second part—“Structural Injustice”—explore the connections between the implicit biases held by individuals and the structural injustices of the societies in which they are situated. And finally, the third part—“The Ethics of Implicit Bias: Theory and Practice”—contains chapters examining strategies for implicit attitude change, the ramifications of research on implicit bias for philosophers working in ethics, and suggestions for combating implicit biases in the fields of philosophy and law. (shrink)

The elephant in the room -- Crabs and octopuses -- The central intelligence of a frog -- The cerebral cortex and consciousness -- Social consciousness -- Yoda and Darth: how can we find -- Consciousness in the brain? -- The hard problem and other perspectives on consciousness -- Conscious machines -- Uploading minds -- How to build visual consciousness.

In this essay I defend the following prima facie argument: civic virtue is not dependent on integration and in fact may be best fostered under conditions of segregation. I demonstrate that civic virtue can and does take place under conditions of involuntary segregation, but that voluntary separation—as a response to segregation—is a more effective way to facilitate it. While segregation and disadvantage commonly coexist, spatial concentrations, particularly when there is a strong voluntary aspect present, often aid in fostering civic virtue. (...) Accordingly, so long as separation provides the conditions necessary for the promotion of civic virtue, integration is not an irreducible good. (shrink)

A recalcitrant emotion is one which conflicts with evaluative judgement. (A standard example is where someone is afraid of flying despite believing that it poses little or no danger.) The phenomenon of emotional recalcitrance raises an important problem for theories of emotion, namely to explain the sense in which recalcitrant emotions involve rational conflict. In this paper I argue that existing ‘neojudgementalist’ accounts of emotions fail to provide plausible explanations of the irrationality of recalcitrant emotions, and develop and defend my (...) own neojudgementalist account. On my view, recalcitrant emotions are irrational insofar as they incline the subject to accept an evaluative construal that the subject has already rejected. (shrink)

The traditional desire view of painfulness maintains that pain sensations are painful because the subject desires that they not be occurring. A significant criticism of this view is that it apparently succumbs to a version of the Euthyphro Dilemma: the desire view, it is argued, is committed to an implausible answer to the question of why pain sensations are painful. In this paper, I explain and defend a new desire view, and one which can avoid the Euthyphro Dilemma. This new (...) view maintains that painfulness is a property, not of pain sensations, but of a pain experience, understood as a relational state constituted by a pain sensation and a desire that the sensation not be occurring. (shrink)

Work was conducted among traditional, subsistence whale hunters in Lamalera, Indonesia, in order to test if strict biological kinship or lineage membership is more important for explaining the organization of cooperative hunting parties ranging in size from 8 to 14 men. Crew identifications were collected for all 853 hunts that occurred between May 3 and August 5, 1999. Lineage identity and genetic relatedness were determined for a sample of 189 hunters. Results of matrix regression show that genetic kinship explains little (...) of the hunters’ affiliations independent of lineage identity. Crew members are much more closely related to each other than expected by chance, but this is due to the correlation between lineage membership and genetic kinship. Lineage members are much more likely to affiliate in crews, but kin with r<0.5 are just as likely not to affiliate. The results are discussed vis-à-vis the evolution of cooperation and group identity. (shrink)

The process of partner selection reflects ethnographic realities where cooperative rewards obtain that would otherwise be lost to loners. Baumard et al. neglect frequency-dependent processes exemplified by games of coordination. Such games can produce multiple equilibria that may or may not include fair outcomes. Additional, group-selection processes are required to produce the outcomes predicted by the models.

The perceptual model of emotions maintains that emotions involve, or are at least analogous to, perceptions of value. On this account, emotions purport to tell us about the evaluative realm, in much the same way that sensory perceptions inform us about the sensible world. An important development of this position, prominent in recent work by Peter Goldie amongst others, concerns the essential role that virtuous habits of attention play in enabling us to gain perceptual and evaluative knowledge. I think that (...) there are good reasons to be sceptical about this picture of virtue. In this essay I set out these reasons, and explain the consequences this scepticism has for our understanding of the relation between virtue, emotion, and attention. In particular, I argue that our primary capacity for recognizing value is in fact a non-emotional capacity. (shrink)

The perceptual model of emotions maintains that emotions involve, or are at least analogous to, perceptions of value. On this account, emotions purport to tell us about the evaluative realm, in much the same way that sensory perceptions inform us about the sensible world. An important development of this position, prominent in recent work by Peter Goldie amongst others, concerns the essential role that virtuous habits of attention play in enabling us to gain perceptual and evaluative knowledge. I think that (...) there are good reasons to be sceptical about this picture of virtue. In this essay I set out these reasons, and explain the consequences this scepticism has for our understanding of the relation between virtue, emotion, and attention. In particular, I argue that our primary capacity for recognizing value is in fact a non-emotional capacity. (shrink)

The emotions of guilt, shame, disappointment and grief, and the bodily states of pain and suffering, have something in common, at least phenomenologically: they are all unpleasant, they feel bad. But how might we explain what it is for some state to feel bad or unpleasant? What, in other words, is the nature of negative affect? In this paper I want to consider the prospects for evaluativist theories, which seek to explain unpleasantness by appeal to negative evaluations or appraisals. In (...) particular, I want to consider versions of evaluativism that seek to explain negative affect in terms of a kind of negative perceptual experience. These views thus attempt to explain feeling bad in terms of seeing bad. Now the most prominent evaluativist accounts of negative affect have been developed in the pain literature, and so my paper will primarily be focused on the question of whether evaluativism can provide a plausible account of the painfulness or unpleasantness of pain. I will argue that evaluativism faces serious objections on this score. Since my conclusions can be extended to cover negative affect more generally, however, we have good reason to reject evaluativist accounts of the negative affect involved in emotional experience. My arguments will thus have implications for those interested in the nature of emotional valence. I'll conclude with some brief remarks about the shape that a ‘relational’ account of painfulness in particular, and of negative affect in general, should take, in light of these criticisms of evaluativism. In my view, such views should appeal, not to negative evaluations to explain feeling bad, but to dislike. (shrink)

Emotions are important for virtue, both moral and intellectual. This chapter aims to explain the significance of emotion for intellectual virtue along two dimensions. The first claim is that epistemic emotions can motivate intellectual inquiry, and thereby constitute ways of 'being for' intellectual goods. As a result, such emotions can constitute the motivational components of intellectual virtue. The second claim is that other emotions, rather than motivating intellectual inquiry and questioning, instead play a vital role in the regulation and control (...) of intellectual activities. Emotions are usually characterized, in philosophy and psychology, as having a number of components or elements. Thus emotions are held to involve elements of perception, appraisal, feeling, attention, valence, facial expression, and motivation. (shrink)

Originally published: Oxford: Clarendon, 1997.

Message from the planet -- When prophecy fails -- Energy and empire -- Climate economics -- Ethical emissions -- Dwelling in the light -- Mobility and pilgrimage -- Faithful feasting -- Remembering in time.

This article surveys recent work on Vedānta, focusing on English-language secondary scholarship since the year 2000. The article consists of two parts. The first part (published previously) identified trends within recent scholarship, highlighting several promising areas of new research: the social history of Vedānta, Vedānta in the early modern period, vernacular Vedānta, Persian Vedānta, colonial and post-colonial Vedānta, and pedagogy and practice. It also covered edited volumes, special journal issues, and ongoing collaborative research projects. The second part (published here) provides (...) an overview of scholarship on specific schools of Vedānta (Advaita, Viśiṣṭādvaita, Dvaita, etc.), as well as a survey of philosophical, theological, and comparative studies. The article concludes with suggestions for further research. (shrink)

The concept of causation is fundamental to ascribing moral and legal responsibility for events. Yet the precise relationship between causation and responsibility remains unclear. This book clarifies that relationship through an analysis of the best accounts of causation in metaphysics, and a critique of the confusion in legal doctrine.

The field of science and religion is undergoing a transition today requiring assessment of its past movements and identifying its future trajectories by the next generation of science and religion scholars. This essay provides such assessment and advice. To focus efforts on the past, I turn to Ian Barbour's own stock taking of the field some forty years ago in an essay entitled “Science and Religion Today” before giving some personal comments where I argue that much of the field has (...) traditionally focused on the conversation between Christianity and the natural sciences. At present, however, we are beginning to see that the future of the conversation lies beyond the dialogue between the natural sciences and Christianity. I suggest that the future dialogue will and ought to expand in several directions: into non-Christian religions and theology, into the human sciences, into science and technology Studies, and into the humanities more broadly. (shrink)

The concept of causation is fundamental to ascribing moral and legal responsibility for events. Yet the precise relationship between causation and responsibility remains unclear. This book clarifies that relationship through an analysis of the best accounts of causation in metaphysics, and a critique of the confusion in legal doctrine. The result is a powerful argument in favour of reforming the moral and legal understanding of how and why we attribute responsibility to agents.

This article explores the relationships between legal proof and fundamental epistemic concepts such as knowledge and justification. A survey of the legal literature reveals a confusing array of seemingly inconsistent proposals and presuppositions regarding these relationships. This article makes two contributions. First, it reconciles a number of apparent inconsistencies and tensions in accounts of the epistemology of legal proof. Second, it argues that there is a deeper connection between knowledge and legal proof than is typically argued for or presupposed in (...) the legal literature. This connection is illustrated through a discussion of the Gettier problem in epistemology. It is argued that the gap or disconnect between truth and justification that undermines knowledge in Gettier cases also potentially undermines the success of legal verdicts. (shrink)

This chapter focuses on the positive epistemic value that individual and group emotion can have. It explains how group emotion can help to bring about the highest epistemic good, namely group understanding. It is argues that this group good would be difficult to achieve, in very many cases, in the absence of group emotion. Even if group emotion sometimes—indeed often—leads us astray, we would be worse off, from the standpoint of achieving the highest epistemic good, without it. The chapter illustrates (...) the connection between group emotion and group understanding by focusing on the phenomenon of public inquiries. (shrink)

This article highlights that in our rush to call for the democratization of science and expertise we must not forget to speak to what type of democratization we are calling for. In short, not all participatory forms are the same. In developing this argument, I examine one such form that has yet to receive much attention from science and technology studies scholars: the agricultural field day. In examining the field day, we find that its orientation—that is, toward either the conventional (...) or sustainable model of agriculture—shapes significantly its democratic approach to knowledge coproduction. To help inform how we understand conventional and sustainable field days, I turned to two conceptual frameworks of participation: namely, that of Wynne and Funtowicz and Ravetz. In doing this, we find that conventional field days mirror closely that form of public participation detailed by Funtowicz and Ravetz, while sustainable field days reflect that conceptualized by Wynne. (shrink)

This is the first scholarly study of Atlas Shrugged, covering in detail the historical, literary, and philosophical aspects of Ayn Rand's magnum opus. Topics explored in depth include the history behind the novel's creation, publication, and reception; its nature as a romantic novel; and its presentation of a radical new philosophy.

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.