Deep brain stimulation — a novel surgical procedure — is emerging as a treatment of last resort for people diagnosed with neuropsychiatric disorders such as severe obsessive-compulsive disorder. The US Food and Drug Administration granted a so-called humanitarian device exemption to allow patients to access this intervention, thereby removing the requirement for a clinical trial of the appropriate size and statistical power. Bypassing the rigors of such trials puts patients at risk, limits opportunities for scientific discovery, and gives device manufacturers (...) unique marketing opportunities. We argue that Congress and federal regulators should revisit the humanitarian device exemption to ensure that it is not used to sidestep careful research that can offer valuable data with appropriate patient safeguards. (shrink)

Neurosurgery for psychiatric disorders, also sometimes referred to as psychosurgery, is rapidly evolving, with new techniques and indications being investigated actively. Many within the field have suggested that some form of guidelines or regulations are needed to help ensure that a promising field develops safely. Multiple countries have enacted specific laws regulating NPD. This article reviews NPD-specific laws drawn from North and South America, Asia and Europe, in order to identify the typical form and contents of these laws and to (...) set the groundwork for the design of an optimal regulation for the field. Key challenges for this design that are revealed by the review are how to define the scope of the law, what types of regulations are required, and how to approach international harmonization given the potential migration of researchers and patients. (shrink)

Precision targeting of specific white matter bundles that traverse the subcallosal cingulate has been linked to efficacy of deep brain stimulation for treatment resistant depression. Methods to confirm optimal target engagement in this heterogenous region are now critical to establish an objective treatment protocol. As yet unexamined are the time-frequency features of the SCC evoked potential, including spectral power and phase-clustering. We examined these spectral features—evoked power and phase clustering—in a sample of TRD patients with implanted SCC stimulators. Electroencephalogram was (...) recorded during wakeful rest. Location of electrical stimulation in the SCC target region was the experimental manipulation. EEG was analyzed at the surface level with an average reference for a cluster of frontal sensors and at a time window identified by prior study. Morlet wavelets generated indices of evoked power and inter-trial phase clustering. Enhanced phase clustering at theta frequency was observed in every subject and was significantly correlated with SCC-EP magnitude, but only during left SCC stimulation. Stimulation to dorsal SCC evinced stronger phase clustering than ventral SCC. There was a weak correlation between phase clustering and white matter density. An increase in evoked delta power was also coincident with SCC-EP, but was less consistent across participants. DBS evoked time-frequency features index mm-scale changes to the location of stimulation in the SCC target region and correlate with structural characteristics implicated in treatment optimization. Results also imply a shared generative mechanism between evoked potentials evinced by electrical stimulation and evoked potentials evinced by auditory/visual stimuli and behavioral tasks. Understanding how current injection impacts downstream cortical activity is essential to building new technologies that adapt treatment parameters to individual differences in neurophysiology. (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)

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: Electroconvulsive therapy is one of the most effective treatments for major depressive disorder. Recently, there has been increasing attention to evaluate the effect of ECT on resting-state functional magnetic resonance imaging. This study aims to compare rs-fMRI of depressive disorder patients with healthy participants, investigate whether pre-ECT dynamic functional network connectivity network estimated from patients rs-fMRI is associated with an eventual ECT outcome, and explore the effect of ECT on brain network states.Method: Resting-state functional magnetic resonance imaging data were (...) collected from 119 patients with depression or depressive disorder, and 61 healthy participants, with an age mean of 52.25 years old. The pre-ECT and post-ECT Hamilton Depression Rating Scale were 25.59 ± 6.14 and 11.48 ± 9.07, respectively. Twenty-four independent components from default mode and cognitive control network were extracted, using group-independent component analysis from pre-ECT and post-ECT rs-fMRI. Then, the sliding window approach was used to estimate the pre-and post-ECT dFNC of each subject. Next, k-means clustering was separately applied to pre-ECT dFNC and post-ECT dFNC to assess three distinct states from each participant. We calculated the amount of time each subject spends in each state, which is called “occupancy rate” or OCR. Next, we compared OCR values between HC and DEP participants. We also calculated the partial correlation between pre-ECT OCRs and HDRS change while controlling for age, gender, and site. Finally, we evaluated the effectiveness of ECT by comparing pre- and post-ECT OCR of DEP and HC participants.Results: The main findings include depressive disorder patients had significantly lower OCR values than the HC group in state 2, where connectivity between cognitive control network and default mode network was relatively higher than other states, Pre-ECT OCR of state, with more negative connectivity between CCN and DMN components, is linked with the HDRS changes. This means that those DEP patients who spent less time in this state showed more HDRS change, and The post-ECT OCR analysis suggested that ECT increased the amount of time DEP patients spent in state 2.Conclusion: Our finding suggests that dynamic functional network connectivity features, estimated from CCN and DMN, show promise as a predictive biomarker of the ECT outcome of DEP patients. Also, this study identifies a possible underlying mechanism associated with the ECT effect on DEP patients. (shrink)

Two essays on utilitarianism, written from opposite points of view, by J. J. C. Smart and Bernard Williams. In the first part of the book Professor Smart advocates a modern and sophisticated version of classical utilitarianism; he tries to formulate a consistent and persuasive elaboration of the doctrine that the rightness and wrongness of actions is determined solely by their consequences, and in particular their consequences for the sum total of human happiness. In Part II Bernard Williams offers a sustained (...) and vigorous critique of utilitarian assumptions, arguments and ideals. He finds inadequate the theory of action implied by utilitarianism, and he argues that utilitarianism fails to engage at a serious level with the real problems of moral and political philosophy, and fails to make sense of notions such as integrity, or even human happiness itself. This book should be of interest to welfare economists, political scientists and decision-theorists. (shrink)

Unpublished correspondence with Elsie Ripley Clapp, along with extensive notes for a 1911 course, ‘The Analysis of Experience’, provide the context for a consideration of John Dewey's discussion of the relation between desire and thinking. Dewey's philosophic point of view is portrayed as it was developing in his own mind. The “unity of thought and desire”, the necessity of making objects of inquiry, the identification of thinking and acting, are themes in these materials which would appear in their published form (...) in such works as Essays in Experimental Logic, Democracy and Education, and Human Nature and Conduct. In the unpublished materials, Dewey is seen as a naturalist at work in his laboratory, reworking his ideas and acknowledging Clapp's assistance in getting Dewey to connect “practical situations” in life with the “philosophic distinctions” under development. The 1911 materials are an excellent connection between problematics in Dewey's earlier writings on ethics, epistemology, and logic, and his later writings, on the same subjects in the 1920's and 1930's. (shrink)

This paper begins with a Davidsonian puzzle in the epistemology of perception and introduces two solutions to that puzzle: the Truth-Maker View (TMV) and the Content Model. The paper goes on to elaborate (TMV), elements of which can be found in the work of Kalderon (2011) and Brewer (2011). The central tenant of (TMV) is the claim that one's reason for one's perceptual belief should, in all cases, be identified with some item one perceives which makes the proposition believed true. (...) I defend an argument against (TMV) which appeals to (a) the claim that the reason for which one believes should always to be identified with the explanans of the rationalising explanation to which one's belief is subject and (b) the claim that the explanantia of rationalising explanations must be identified with truths. I finish by replying to two objections to the argument. (shrink)

In this article I try to refute the so-called "libertarian" theory of free will, and to examine how our conclusion ought to modify our common attitudes of praise and blame. In attacking the libertarian view, I shall try to show that it cannot be consistently stated. That is, my dscussion will be an "analytic-philosophic" one. I shall neglect what I think is in practice an equally powerful method of attack on the libertarian: a challenge to state his theory in such (...) a way that it will fit in the modern biology and psychology, which are becoming increasingly physicalistic. (shrink)

Book reviewed in this article:F.H. Bradley, Collected Works Volumes 1–5.

La situación laboral de los países desarrollados impone a la filosofía la tarea de pensar el trabajo en cuanto que los cambios producidos pueden afectar - y de hecho afectan- a la concepción de la persona, de la sociedad y del mundo actual. En este artículo, después de cuestionar que estemos asistiendo al final del trabajo a causa de la revolución tecnológica, analizaremos dos propuestas de reducción y reorganización del tiempo de trabajo, y otras dos que hacen referencia a un (...) cambio de paradigma: una rompe la actual barrera entre trabajo asalariado y trabajo no monetarizado, y la otra defiende el subsidio universal garantizado. (shrink)

"Might this be a dream?" In this book, distinguished philosopher J. J. Valberg approaches the familiar question about dream and reality by seeking to identify its subject matter: what is it that would be the dream if "this" were a dream? It turns out to be a subject matter that contains the whole of the world, space, and time but which, like consciousness for Sartre, is nothing "in itself." This subject matter, the "personal horizon," lies at the heart of the (...) main topics--the first person, the self, and the self in time--explored at length in the book. The personal horizon is, Valberg contends, the subject matter whose center each of us occupies, and which for each of us ceases with death. This ceasing to be presents itself solipsistically not just as the end of everything "for me" but as the end of everything absolutely. Yet since it is the same for everyone, this cannot be. Death thus confronts us with an impossible fact: something that cannot be but will be. The puzzle about death is one of several extraphilosophical puzzles about the self that Valberg discusses, puzzles that can trouble everyday consciousness without any contribution from philosophy. Nor can philosophy resolve the puzzles. Its task is to get to the bottom of them, and in this respect to understand ourselves--a task philosophy has always set itself. (shrink)

Nesta obra, o propósito fundamental foi o de fornecer liberdade de investigação dentro do amplo leque tópico que, desde o início, marca a abertura problemática e problematizante do protocolo entre a UNISINOS e a FDUC. Desde as dimensões filosóficas às dimensões históricas, passando pelas dimensões teoréticas e dogmáticas do direito e do estado, aqui vem a convergir os interesses científicos do relevante número de investigadores e professores activamente comprometidos neste projecto.