Transcranial magnetic stimulation (TMS) of the visual cortex can induce phosphenes as can non-diagnostic ultrasound, the latter while participants have closed their eyes during Stimulation. Here we sought to study potential alteration of a visual target (a white crosshair) due to application of diagnostic ultrasound to the visual cortex. We applied a randomized series of actual or sham diagnostic ultrasound to the visual cortex of healthy participants while they stared at a visual target, with the (...) ultrasound device placed where TMS elicited phosphenes. These participants observed percepts 7 out of 10 times, consisting of extra or extensions of lines relative to the original crosshair, and additional colors. Observation of a percept occurred an average of 53.7 +/- 2.6% of the time over the course of the experiment for these participants. In contrast, 7 out of 10 participants exposed to sham-only diagnostic ultrasound observed comparable percepts an average of 36.3 +/ 1.9% of the time, a statistically significant difference (p < 0.00001). Moreover, on average, participants exposed to a combination of sham and actual ultrasound reported a net increase of 47.9 percentage points in the likelihood that they would report a visual effect by the end of the experiment. Our experiment demonstrated that a random combination of sham-only and actual diagnostic ultrasound applied to the visual cortex of participants increased the likelihood that they would observe visual effects, but not the type of effects, with that likelihood increasing over the course of the experiment. From this we conclude that repeated exposures by diagnostic ultrasound made the visual cortex more responsive to stimulation of their visual cortex by the visual target. These observations, consistent with other’s observation of effects of diagnostic ultrasound stimulation of human motor cortex and amygdala, as well as the FDA approved nature of diagnostic ultrasound, may lead to increased study of diagnostic ultrasound applied to human brain. (shrink)

Using medical imaging techniques, such as fMRI, the stimulation of certain acupuncture points can be shown to correlate with activity in corresponding regions of the brain. Identical activity is also seen if the acupoint is stimulated with a pulse of ultrasound rather than a needle. This article reviews the advantages offered by ultrasonic acupuncture and the impact on the practice of acupuncture.

With the cure rate for many pediatric malignancies now between 70% and 90%, infertility becomes an increasingly important issue. Strategies for preserving fertility in girls and adolescent women occur in two distinct phases. The first phase includes oophorectomy and cryopreservation of ovarian cortex slices or individual oocytes; ultrasound-guided needle aspiration of oocytes, with or without in vitro maturation, followed by cryopreservation; and ovarian autografting to a distant site. The second phase occurs if the woman chooses to pursue pregnancy, and (...) includes IVM of the oocytes, followed by in vitro fertilization and transfer of any created embryos to the woman's uterus. For ovarian autografting, the woman would undergo menotropin ovarian stimulation and retrieval of matured oocytes. The ethical challenges with each of these phases are many of fertility preservation and include issues of informed choice. The lack of proven benefit with these strategies and the associated potential physical and psychological harms require careful attention to the key elements of informed choice, which include decisional capacity, disclosure, understanding and voluntariness, and to the benefits of in-depth counseling to promote free and informed choice at a time that is emotionally difficult for the decision makers. (shrink)

This article analyzes the moral relevance of technological artifacts and its possible role in ethical theory, by taking the postphenomenological approach that has developed around the work of Don Ihde into the domain of ethics. By elaborating a postphenomenological analysis of the mediating role of ultrasound in moral decisions about abortion, the article argues that technologies embody morality and help to constitute moral subjectivity. This technological mediation of the moral subject is subsequently addressed in terms of Michel Foucault’s ethical (...) position, in which ethics is about actively co-shaping one’s moral subjectivity. Integrating Foucauldian ethics and postphenomenology, the article argues that the technological mediation of moral subjectivity should be at the heart of an ethical approach that takes the moral dimensions of technology seriously. (shrink)

We ought to treat others’ moral views with respect, even when we disagree. But what does that mean? This paper articulates a moral obligation to make ourselves open to sincere moral persuasion by others. Doing so allows us to participate in valuable relationships of reciprocal respect for agency. Yet this proposal can sound tritely agreeable. To explore its full implications, the paper applies the general obligation to one of the most challenging topics of moral disagreement: the morality of abortion. I (...) consider and reject arguments that abortion decisions have special features exempting them from the obligation to be open to moral persuasion. Further, I argue that viewing fetal ultrasound images can accomplish morally persuasion. Accordingly, in at least some cases a woman seeking abortion has an obligation to view fetal ultrasound images as a means of being open to moral persuasion. However, this conclusion does not support recent laws compelling women seeking abortion to view ultrasound images; such laws are in fact incompatible with the respect for agency that underwrites the obligation to be open to persuasion. (shrink)

Obstetric ultrasound has become a significant tool in obstetric practice, however, it has been argued that its increasing use may have adverse implications for women’s reproductive freedom. This study aimed to explore Australian obstetricians’ experiences and views of the use of obstetric ultrasound both in relation to clinical management of complicated pregnancy, and in situations where maternal and fetal health interests conflict.

This paper explores the rhetoric of obstetric ultrasound technology as it relates to the abortion debate, specifically the interpretation given to ultrasound images by opponents of abortion. The tenor of the anti-abortion approach is precisely captured in the videotape, Ultrasound:A Window to the Womb. Aspects of this videotape are analyzed in order to tease out the assumptions about the (female) body and about the access to truth yielded by scientific technology (ultrasound) held by militant opponents of (...) abortion. It is argued that the ultrasound images do not offer transparent confirmation of the ontological status of the embryo and fetus. Rather, the window of ultrasound is constructed through a complex combination of visual and verbal devices: ultrasound images, photographic images, verbal argument, and emotional appeal. (shrink)

As several studies, along with a book and movie depicting the true story of a former clinic director, have recently brought to the public’s attention, fetal ultrasound images dramatically impact some viewers’ normative judgments: a small but non-negligible proportion of viewers attribute increased moral status to fetal humans and even form the belief that abortion is impermissible. I consider three types of psychological explanation for a viewer’s shift in beliefs: increased bonding or empathy, various forms of cognitive bias, and (...) type of cognitive processing involved. I consider the normative implications of each explanation, arguing that in each case the viewer’s judgment is presumptively rational. (shrink)

Requiring that a woman who is seeking an abortion be given the opportunity to view an ultrasound of her fetus has spread from anti-abortion “pregnancy resource centers” to state laws. Proponents of these laws claim that having access to the ultrasound image is necessary for a woman to make a medically informed decision. In this paper, we argue that ultrasound examinations frame fetuses visually and linguistically as persons and interpellate pregnant women as mothers, with all of the (...) cultural meaning invested in those two normative concepts. Presenting these judgments as medical information is misleading. Because women are being subjected to these cultural expectations unknowingly, mandatory ultrasound laws in fact undermine women’s autonomy. Fully informed consent would include a critical engagement with social norms around femininity and a recognition that such laws are meant to advance the state’s interest in preserving potential life. (shrink)

Despite FDA recommendations against the practice, keepsake fetal imaging centers have become more common in the United States. U.S. ultrasound regulations construct keepsake imaging in relation to medical practice, yet these centers blur the boundary between medical and nonmedical. Analyzing keepsake imaging centers in two U.S. states demonstrates how centers both appeal to medical expertise to promote their services and extend an intensive mothering ideal to the prenatal stage. To understand keepsake ultrasound, we must account for the role (...) of consumerism in creating pregnant mothers and how keepsake centers constitute ultrasound as a means of expressing mother-love before birth. (shrink)

FOR women, it is supposed to trigger one of the most intense orgasms imaginable, with waves of pleasure spreading out across the whole body. If the "G spot orgasm" seems semi-mythical, however, that's because there has been scant evidence of its existence. Now for the first time gynaecological scans have revealed clear anatomical differences between women who claim to experience vaginal orgasms involving a G spot and those who don't. It might mean that there is a G spot, after all. (...) What's more, a simple test could tell you if it's time to give up the hunt, or if your partner just needs to try harder. (shrink)

Deep Brain Stimulation (DBS) is a relatively new, experimental treatment for patients suffering from treatment-refractory Obsessive Compulsive Disorder (OCD). The effects of treatment are typically assessed with psychopathological scales that measure the amount of symptoms. However, clinical experience indicates that the effects of DBS are not limited to symptoms only: patients for instance report changes in perception, feeling stronger and more confident, and doing things unreflectively. Our aim is to get a better overview of the whole variety of changes (...) that OCD patients experience during DBS treatment. For that purpose we conducted in-depth, semi-structured interviews with 18 OCD patients. In this paper, we present the results from this qualitative study.We list the changes grouped in four domains: with regard to (a) person, (b) (social) world, (c)characteristics of person-world interactions, and (d) existential stance. We subsequently provide an interpretation of these results. In particular, we suggest that many of these changes can be seen as different expressions of the same process; namely that the experience of anxiety and tension gives way to an increased basic trust and increased reliance on one’s abilities. We then discuss the clinical implications of our findings, especially with regard to properly informing patients of what they can expect from treatment, the usefulness of including CBT in treatment, and the limitations of current measures of treatment success. We end by making several concrete suggestions for further research. (shrink)

Prenatal ultrasound use is skyrocketing despite limited evidence of improved outcomes. One factor driving this trend is the widely recognized psychological appeal of real-time fetal imaging. Meanwhile, considering imperfect safety evidence, U.S. professional guidelines dictate that prenatal ultrasound—a screening test—should be governed by expected clinical benefits—an opportunity for intervention. However, when women’s healthcare professionals themselves are pregnant, their access to ultrasound technology permits informal, personal use that may deviate from standard-of-care, e.g., for reassurance. Highlighting a poignant case (...) wherein a pregnant obstetrician’s personal ultrasound use had unforeseen negative consequences, we explore this issue within context of professional ethics and informal medical care. We discuss how women’s health professionals’ self-care may influence and inform prenatal care at large. We advocate curtailing informal prenatal ultrasound use, but also potentially broadening accepted indications for or relaxing proscriptions against ultrasounds for patients. Further research and updated, evidence-based, ethically-sound guidelines are needed. (shrink)

Feminist scholarship has demonstrated the importance of sustained critical engagement with ultrasound visualizations of pregnant women’s bodies. In response to portrayals of these images as “objective” forms of knowledge about the fetus, it has drawn attention to the social practices through which the meanings of ultrasound are produced. This article makes a novel contribution to this project by addressing an empirical context that has been neglected in the existing feminist literature concerning ultrasound, namely, its use during pregnancies (...) that women decide to terminate. Drawing on semi-structured interviews with women concerning their experiences of abortion in England, I explore how the meanings of having an ultrasound prior to terminating a pregnancy are discursively constructed. I argue that women’s accounts complicate dominant representations of ultrasound and that in so doing, they multiply the subject positions available to pregnant women. (shrink)

We whole-heartedly agree with Mecacci and Haselager(2014) on the need to investigate the psychosocial effects of deep brain stimulation (DBS), and particularly to find out how to prevent adverse psychosocial effects. We also agree with the authors on the value of an embodied, embedded, enactive approach (EEC) to the self and the mind–brain problem. However, we do not think this value primarily lies in dissolving a so-called “maladaptation” of patients to their DBS device. In this comment, we challenge three (...) central claims of the authors on the basis of our direct experience with psychosocial effects of DBS in 45 obsessive- compulsive disorder (OCD) patients treated at the AMC in Amsterdam, The Netherlands, and our indepth qualitative interviews with 18 of them (de Haan et al. 2013). We end our comment by sketching out our perspective on the practical merits of an EEC approach to DBS. (shrink)

In recent years, a number of US states have adopted laws that require pregnant women to have an ultrasound examination, and be shown images of their foetus, prior to undergoing a pregnancy termination. In this paper, I examine one of the basic presumptions of these laws: that seeing one’s foetus changes the ways in which one might act in regard to it, particularly in terms of the decision to terminate the pregnancy or not. I argue that mandatory ultrasound (...) laws compel women into a position of moral spectatorship and require them to recognise the foetus as a being for whom they are responsible, particularly through empathic responses to ultrasound images. The approach I propose extends the project of a bioethics of the image and highlights the need for a critical analysis of the political mobilization of empathy in discussions of abortion. (shrink)

Foetal images have been central to the medicalized abortion debate since the 1960s. Feminists have extensively analysed such pictures, arguing that the pregnant body is separated from the foetus and erased from view, and that the rights of women and foetuses are set in opposition. In this article I introduce the latest image in this debate, the 3D sonogram, which is widely reported as new evidence for a reduction in the gestational time limit. Through close analysis of two examples, I (...) argue that the rhetorical use of these images can be characterized by a conflation of knowing with seeing. With the new clarity of sonograms to the untrained eye, image producers are legitimated by a discourse of public information and concerned citizens are called upon to exercise their rights to see/know. For feminist theory, this implies the need for continued analysis of the epistemology of foetal images and renewed focus on the subject position of the viewer. (shrink)

Owing to technological advances, genomic medicine is moving from specific to broader genetic analyses and from specialised to mainstream services. Sahan et al 1 point to complex ethical cases encountered by clinical laboratory scientists in the context of genomic medicine’s expansion. The authors discuss debates on interpreting and reporting genetic results, offering extended genetic testing and differences in the perceived responsibility of clinical laboratory scientists in different settings. As demonstrated by the case examples in the article, while genomic medicine holds (...) the promise of providing clinical answers, its mainstreaming can introduce a new type of ‘odyssey’ for patients and/or relatives, such as when there are uncertain findings. The integration of genomics in healthcare at large can also impact communication decisions and perceptions of responsibility for clinical laboratory scientists. Clinical laboratory scientists might report less to non-specialists than to genetic/genomic specialists, as they feel responsible for minimising the potential of non-specialists misunderstanding, misinterpreting or miscommunicating the genetic findings to patients.1 In this way, the perceived responsibility affects patients and the type and amount of genetic information they receive. We agree with the authors that current limitations in knowledge and capabilities among non-specialist clinicians necessitate identifying effective ways to communicate outcomes and …. (shrink)

During preparation for early abortion in Norway, an ultrasound examination is usually performed to determine gestation and viability. This article aims to provide a deeper understanding of women’s and health care personnel’s experiences with ultrasound viewing during abortion preparation in the first trimester. Qualitative in-depth interviews with women who had been prepared for early abortion and focus group interviews with HCP from gynaecological units were carried out. A hermeneutic-phenomenological analysis, inspired by van Manen, was chosen. Thirteen women who (...) were pregnant and considering abortion in their first trimester and 20 HCP, namely, 19 registered nurses and one medical doctor, were recruited from gynaecological units at six hospitals. The study was approved by the ethics committee. The essential meaning structure of ‘autonomy under pressure’ consisted of two themes that expressed the different experiences of both the women and the HCP, namely, expectations versus precautions and choice versus protection. The women and HCP expressed different attitudes before the consultation that affected their experiences of the ultrasound examination. While the women had expectations of a clarification based on their choice to either see or not see the ultrasound image, HCP seemed to be more concerned with predetermined rules that they believed would protect the women. Consequently, the basis for dialogue was not optimal, and women’s autonomy was under pressure. Health care personnel are ethically challenged during preabortion ultrasound examinations. Meeting the individual woman’s needs and respecting her autonomy during preparation for abortion requires sensitivity, involvement, and dialogue skills by health personnel. According to the woman’s desire to be informed about the possibility of viewing the image during the abortion preparations, a dialogue that is focused in this direction should arise before the examination. (shrink)

Deep-brain stimulation has been used to treat advanced Parkinson disease and other neurological and psychiatric disorders that have not responded to other treatments. While deep-brain stimulation can modulate overactive or underactive regions of the brain and thereby improve motor function, it can also cause changes in a patient’s thought and personality. This paper discusses the trade-offs between the physiological benefit of this technique and the potential psychological harm.

The purpose of this study is to elucidate various practices for the structuring of images on an ultrasound monitor during prenatal ultrasound examinations. This study focuses on the practices that healthcare providers employ to invite pregnant women to differentiate a gray-tone image on the ultrasound monitor from the image’s background. In sequential environments in which pregnant women display difficulty in differentiating an image on the screen in response to the healthcare provider’s invitation, the healthcare provider employs practices (...) that require additional bodily involvement to structure the images on the screen. Furthermore, on certain occasions, the healthcare provider also points to a particular abdominal location with the ultrasound transducer, which is held against the abdomen to produce the very image being differentiated. This study demonstrates that the image on the ultrasound monitor is intrinsically embodied and spatially and modally distributed. In addition, the study suggests an interaction-organizational ground for an aspect of the ‘personification of the fetus’ through obstetric ultrasound. (shrink)

Deep brain stimulation has been of considerable interest to bioethicists, in large part because of the effects that the intervention can occasionally have on central features of the recipient’s personality. These effects raise questions regarding the philosophical concept of authenticity. In this article, we expand on our earlier work on the concept of authenticity in the context of deep brain stimulation by developing a diachronic, value-based account of authenticity. Our account draws on both existentialist and essentialist approaches to (...) authenticity, and Laura Waddell Ekstrom’s coherentist approach to personal autonomy. In developing our account, we respond to Sven Nyholm and Elizabeth O’Neill’s synchronic approach to authenticity, and explain how the diachronic approach we defend can have practical utility, contrary to Alexandre Erler and Tony Hope’s criticism of autonomy-based approaches to authenticity. Having drawn a distinction between the authenticity of an individual’s traits and the authenticity of that person’s values, we consider how our conception of authenticity applies to the context of anorexia nervosa in comparison to other prominent accounts of authenticity. We conclude with some reflections on the prudential value of authenticity, and by highlighting how the language of authenticity can be invoked to justify covert forms of paternalism that run contrary to the value of individuality that seems to be at the heart of authenticity. (shrink)

Davis called for “extreme caution” in the use of non-invasive brain stimulation to treat neurological disorders in children, due to gaps in scientific knowledge. We are sympathetic to his position. However, we must also address the ethical implications of applying this technology to minors. Compensatory trade-offs associated with NIBS present a challenge to its use in children, insofar as these trade-offs have the effect of limiting the child’s future options. The distinction between treatment and enhancement has some normative force (...) here. As the intervention moves away from being a treatment toward being an enhancement—and thus toward a more uncertain weighing of the benefits, risks, and costs—considerations of the child’s best interests diminish, and the need to protect the child’s autonomy looms larger. NIBS for enhancement involving trade-offs should therefore be delayed, if possible, until the child reaches a state of maturity and can make an informed, personal decision. NIBS for treatment, by contrast, is permissible insofar as it can be shown to be at least as safe and effective as currently approved treatments, which are themselves justified on a best interests standard. (shrink)

Libet discovered that a substantial duration (> 0.5-1.0 s) of direct electrical stimulation of the surface of the somatosensory cortex at threshold currents is required before human subjects can report that a conscious somatosensory experience had occurred. Using a reaction time method we confirm that a similarly long stimulation duration at threshold currents is required for activation of elementary visual experiences (phosphenes) in human subjects following stimulation of the surface of the striate cortex. However, the reaction times (...) for the subject to respond to the cessation of the visual experience after the end of electrical stimulation could be as brief as 225-242 ms. We also carried out extensive studies in cats under a variety of anesthetic conditions using the same electrodes and parameters of stimulation employed in the human studies to study the patterns of neuronal activity beneath the stimulating surface electrode. Whereas sufficiently strong currents can activate neurons within milliseconds, stimulating currents close to threshold activate sustained neural activity only after at least 350-500 ms. When currents are close to threshold, some neurons are inhibited for several hundreds of millisecond before the balance between inhibition and excitation shifts towards excitation. These results suggest that the prolonged latencies, i.e., latencies beyond 200-250 ms, for the emergence of conscious experience following direct cortical stimulation result from a delay in the sustained activation of underlying cortical neurons at threshold currents rather than being due to any unusually long duration in central processing time. Intracellular records from cortical neurological cells during repetitive electrical stimulation of the surface of the feline striate cortex demonstrate that such stimulation induces a profound depolarizing shift in membrane potential that may persist after each stimulus train. Such a depolarization is evidence that extracellular K+ concentrations have increased during electrical stimulation. Such an increase in extracellular K+ progressively increases cortical excitability until the threshold for sustained activation of cortical neurons is reached and then exceeded. Consequently, the long latency for threshold activation of cortical neurons depends upon a dynamically increasing cortical facilatory process that begins hundreds of milliseconds before there is sustained activation of such neurons. In some cases, this facilatory process must overcome an initial stimulus-induced inhibition before neuronal firing commences. (shrink)

Multidisciplinary healthcare committees meet regularly to discuss patients’ candidacy for emerging functional neurosurgical procedures, such as Deep Brain Stimulation . Through debate and discussion around the surgical candidacy of particular patients, functional neurosurgery programs begin to mold practice and policy supported both by scientific evidence and clear value choices. These neurosurgical decisions have special considerations not found in non-neurologic committees. The professional time used to resolve these conflicts provides opportunities for the emergence of careful, ethical practices simultaneous with the (...) expansion of therapy applications. (shrink)

Since the introduction of ultrasound technology in the 1960s as a tool to visibly articulate the interiors of the pregnant body, feminist scholars across disciplines have provided extensive critique regarding the visual culture of fetal imagery. Central to this discourse is the position that fetal images occupy- as products of a visualizing technology that at once penetrates and severs pregnant and fetal bodies. This visual excision, feminist scholars describe, has led not only to an erasure of the female body (...) from fetal images but also to an erasure of the pregnant body in social, political, and biomedical discourses. Vital to feminist scholarship is, thereby, an engagement with fetal images in ways that reinscribe the pregnant body onto fetal images and into political discourses pertaining to reproductive rights. In this paper, similar to the feminist aim, I am interested in engaging with fetal images as way to gain agency for pregnant women and their bodies. The critical question that I ask is: Can we conceive of medical technology in an embodied way -one that interacts organically, dynamically, and through multisensory dimensions with pregnant bodies? In attempting to answer this question, I turn to Bruno Latour and Gilles Deleuze’s articulations of how bodies and machines interact to produce visual fact. (shrink)

Auditory stimulation training (AST) has been proposed as a potential treatment for chil-dren with specific language impairments (SLI). The current study was designed to test this as-sumption by using an AST with technically modulated musical material (ASTM) in a random-ized control group design. A total of 101 preschool children (62 male, 39 females; mean age = 4.52 years, SD = 0.62) with deficits in speech comprehension and poor working memory ca-pacity were randomly allocated into one of two treatment groups (...) or a control group. Children in the ASTM group (n = 40) received three 30-minute sessions per week over 12 weeks, whereas children in the comparison group received pedagogical activities during these intervals (n = 24). Children in the control group (n = 37) received no treatment. Working memory, phoneme dis-crimination and speech perception skills were tested prior to (baseline) and after treatment. Chil-dren in the ASTM group showed significantly greater working memory capacity, speech per-ception, and phoneme discrimination skills after treatment, whereas children in the other groups did not show such improvement. Taken together, these results suggest that ASTM can enhance auditory cognitive performance in children with SLI. (shrink)

Libet demonstrated that a substantial duration (>0.5-1.0 s) of direct electrical stimulation of the surface of a sensory cortex at a threshold or liminal current is required before a subject can experience a percept. Libet and his co-workers originally proposed that the result could be due either to spatial and temporal facilitation of the underlying neurons or additionally to a prolonged central processing time. However, over the next four decades, Libet chose to attribute the prolonged latency for evoking conscious (...) experience to a prolonged central processing time. In my view, Libet has not provided any convincing evidence, either on the basis of his own past work or in his critique of my paper, for his hypothesis of a central processing time exceeding 0.5s before conscious experience emerges following direct electrical threshold stimulation of the cortical surface. I stand by my original results and conclusion that such prolonged latencies are largely the consequence of a dynamically increasing cortical facilitatory process that begins hundreds of milliseconds before there is a sustained neuronal activation. In some cases, the facilitatory process must overcome an initial stimulus-induced inhibition before neuronal firing commences. (shrink)

_Riassunto_: La _Deep Brain Stimulation _(DBS) è un dispositivo annoverato tra le interfacce-cervello computer e che si qualifica come una promettente soluzione medica per far fronte al decorso di alcune malattie neurodegenerative come il Parikinson. Decenni di utilizzo clinico della DBS hanno permesso di comprenderne gli effetti collaterali e il loro impatto sul PIAAAS (_Personality, Identity, Agency, Authenticity, Autonomy and Self_). In tal senso, per sondare cambiamenti psicologici legati all’uso della DBS si è fatto ricorso a metodi quantitativi, come (...) questionari incentrati su valutazioni di ordine numerico, e metodi qualitativi, che si appoggiano alle esperienze riportate dai pazienti tramite interviste. Questo articolo ha l’obiettivo di evidenziare come, a prescindere dai metodi di indagine utilizzati, la ricerca sia stata sempre focalizzata sugli effetti collaterali della DBS e gli eventuali cambiamenti sulle dimensioni comprese nel PIAAAS, lasciandosi sfuggire l’occasione di usare i numerosi dati raccolti per effettuare un’analisi fenomenologica che potesse restituirci una descrizione della sintesi uomo-macchina. Per colmare questo iato, proponiamo l’utilizzo sinergico di due metodi di raccolta e analisi dati di origine fenomenologica. _Parole chiave_: Deep Brain Stimulation; Effetti collaterali; Sintesi uomo-macchina; Fenomenologia _Deep Brain Stimulation and the human-machine synthesis: A possible phenomenological perspective_ _Abstract_: Deep Brain Stimulation (DBS) is a device included among the brain-computer interfaces and that qualifies as a promising medical solution to cope with the course of some neurodegenerative diseases such as Parikinson’s. Decades of clinical use of DBS have allowed us to understand its side effects and their impact on PIAAAS (_Personality, Identity, Agency, Authenticity, Autonomy and Self_). In this sense, to investigate psychological changes related to the use of DBS, quantitative methods, such as questionnaires focused on numerical assessments, and qualitative techniques, which are based on experiences by patients through interviews, have been used. This article aims to highlight how, regardless of the survey methods used, research has always been focused on the side effects of DBS and possible changes in the concepts included in the PIAAAS, missing the opportunity to use the numerous data collected to carry out a phenomenological analysis that could give us a description of the human-machine synthesis. To bridge this hiatus, we propose the synergistic use of two phenomenological methods of data collection and analysis. _Keywords_: Deep Brain Stimulation; Side Effects; Human-machine synthesis; Phenomenology. (shrink)

In “Body, Cyborgs and the Politics of Incarnation,” Bruno Latour recounts the story of Professor Paul Churchland, his colleague, carrying a portrait of his wife. “Nothing unusual in this,” Latour writes. “No, except that this picture was an image produced by computed tomography, a CT scan of his wife’s inner brain, in full colour”. The image of Professor Church-land proudly showing off a full-color CT of his wife’s beautiful brain has a wonderful sense of absurdity to it, and its punch (...) line depends on the reader being jolted by the strangeness of medical imagery standing in place of portraiture—no matter how stunning the cerebellum.However.. (shrink)

BackgroundDiagnostic ultrasound has long been a part of a physician’s armamentarium, but transcranial focused ultrasound (FUS) is an emerging treatment of neurological disorders. Consequently, the literature in this field is increasing at a rapid pace.ObjectiveThis analysis was aimed to identify the top-cited articles on FUS to discern their origin, spread, current trends highlighting future impact of this novel neurosurgical intervention.MethodsWe searched the Web of Science database on 28th May 2021 and identified the top 100 cited articles. These articles (...) were analyzed with various scientometric parameters like the authors, corresponding authors, country of corresponding author, journal of publication, year of publication. Citation based parameters including total citations, mean citations per article and mean citations, citation count, and the citation per year, citations per year and co-authors per document were studied as well in addition to Hirsch h-index, g-index, m-index, Bradford’s Law, Lotka’s law and Collaboration index.ResultsThe 100 top-cited articles were published between 1998 and 2019 in 45 different journals. The average citations per document and citations per document per year were 97.78 and 12.47, respectively. The most prolific authors were Hynynen K (Medical Biophysics—Toronto), Elias WJ (Neurosurgery—Virginia), Zadicario (InSightec). The Journal of Neurosurgery published the most top-cited articles (n = 11), and most articles originated from the United States, followed by Canada. Among individual institutions, the University of Toronto was the most productive.ConclusionFUS is an emerging treatment of neurological disorders. With its increasing application, the FUS literature is increasing rapidly. Eleven countries contributed to the top 100 cited articles, with the top 2 countries (the United States and Canada) contributing to more than half of these articles. (shrink)

There is a growing interest in non-invasive stimulation interventions as treatment strategies to improve functional outcomes and recovery after spinal cord injury. Repetitive transcranial magnetic stimulation is a neuromodulatory intervention which has the potential to reinforce the residual spinal and supraspinal pathways and induce plasticity. Recent reviews have highlighted the therapeutic potential and the beneficial effects of rTMS on motor function, spasticity, and corticospinal excitability modulation in SCI individuals. For this scoping review, we focus on the stimulation (...) parameters used in 20 rTMS protocols. We extracted the rTMS parameters from 16 published rTMS studies involving SCI individuals and were able to infer preliminary associations between specific parameters and the effects observed. Future investigations will need to consider timing, intervention duration and dosage that may depend on the stage, the level, and the severity of the injury. There is a need for more real vs. sham rTMS studies, reporting similar designs with sufficient information for replication, to achieve a significant level of evidence regarding the use of rTMS in SCI. (shrink)

Iris Marion Young’s classic paper on the phenomenology of pregnancy chronicles the alienating tendencies of technology-ridden maternal care, as the mother’s subjective knowledge of the pregnancy gets overridden by the objective knowledge provided by medical personnel and technological apparatuses. Following Fredrik Svenaeus, the authors argue that maternal care is not necessarily alienating by looking specifically at the proper attention paid by sonographers in maternal care when performing ultrasound examinations. Using Martin Heidegger’s philosophy as a theoretical lens, the authors argue (...) that sonographers who cultivate technical mastery, build patient rapport, explain the process and significance of the ultrasound, and understand the patient’s world are able to provide excellent patient care. The authors utilize Hans-Georg Gadamer’s hermeneutics to show how sonographers can frame the ultrasound in a way that acknowledges both the subjective knowledge of the mother and the objective data obtained by the sonographer through the use of technology. Ultimately, the authors argue that the common practice of framing the ultrasound as the chance to “meet the baby” is inappropriate, as it exacerbates the tendency to regard objective knowledge as the only legitimate knowledge in medical contexts. They recommend a more balanced approach that elicits a fusion of horizons between the patient’s subjective knowledge and the objective data that is obtained by the sonographer via the ultrasound, thus respecting and bolstering patient autonomy. (shrink)