IntroductionIn highly developed countries, as many as 16 percent of children are physically abused each year. Traumatic brain injury (TBI) is the most common injury in non-accidental trauma (NAT) and is responsible for 80 percent of fatal NAT cases, with most deaths occurring in children younger than three years old. Cases of abusers who refuse withdrawal of life-sustaining medical treatment (LSMT) to avoid criminal charges have previously been reported. Therefore, we hypothesized that NAT is associated with a (...) lower risk for withdrawal LSMT in pediatric TBI.MethodsThe pediatric Trauma Quality Improvement Program database was analyzed (2014 to 2016) for patients aged 16 and younger with TBI and Glasgow Coma Scale (GCS) of 8 and lower on admission. Patients with a head Abbreviated Injury Scale (AIS) of 2 or less or who died within 48 hours were excluded. A multivariable logistic regression model was used for analysis.ResultsOf 2,209 TBI patients, 92 (4.2 percent) had withdrawal of LSMT. Compared to those without withdrawal of LMST, those with LMST had statistically similar median age (three years of age versus seven years, p = 0.07) and a higher rate of NAT (33.7 percent versus 13.5 percent, p < 0.001). The most common specified perpetrator was a father/stepfather/ male partner (70 percent). After adjusting for covariates, factors associated with higher risk for withdrawal of LSMT included age of less than three years (OR 2.38, CI 1.34-4.23, p < 0.05) and NAT (OR 1.86, CI 1.02-3.41, p < 0.05).ConclusionNAT is associated with increased risk for withdrawal of LSMT in pediatric TBI. Age of less than three years is similarly associated with a higher risk for withdrawal of LSMT. Future research in this population is needed to determine what other factors predict withdrawal of LSMT and what resources, such as social workers and/or ethics consults, are utilized. (shrink)

We conducted two experiments using naturalistic scene stimuli to test the resource theory and mindlessness theory of sustained attention. In experiment 1, 28 participants completed a traditional formatted vigilance task consisting of non-repeating forest or urban picture stimuli as target stimuli. Participants filled out pre- and post-task assessments of arousal and conscious thoughts. There was still a vigilance decrement, despite non-repetitive, natural target stimuli. Participants found the task demanding and were actively engaged in the task. In experiment 2, 25 participants (...) completed a Sustained Attention to Response Task using the stimuli from experiment 1. Participants performed significantly worse on this SART than either brain injury patients or controls performing equivalent numeric stimuli SARTs have in previous studies. Participants thought the task was demanding and they were actively engaged with the task. Overall, the results of both studies support a resource theory of sustained attention lapses, not a mindlessness theory. (shrink)

: The effects of head injury, even mild traumatic brain injury, are wide-ranging and profound. Persons with adult-onset head injury offer feminist philosophers important perspectives for philosophical methodology and philosophical research concerning personal identity, mind-body theories, and ethics. The needs of persons with head injury require the expansion of typical teaching strategies, and such adaptations appear beneficial to both disabled and non-disabled students.

The effects of head injury, even mild traumatic brain injury, are wide-ranging and profound. Persons with adult-onset head injury offer feminist philosophers important perspectives for philosophical methodology and philosophical research concerning personal identity, mind-body theories, and ethics. The needs of persons with head injury require the expansion of typical teaching strategies, and such adaptations appear beneficial to both disabled and non-disabled students.

Exploring the early development of an area of medical literature can inform contemporary medical debates. Different methods of inference include deduction, induction, abduction, and inference to the best explanation. I argue that early shaken baby research is best understood as using abduction to tentatively suggest that infants with unexplained intracranial and ocular bleeding have been assaulted. However, this tentative conclusion was quickly interpreted, by some at least, as a general rule that infants with these pathological signs were certainly cases of (...) abuse. Rather than focusing on inductive arguments, researchers today may be better off focusing on making a compelling inference to the best explanation. (shrink)

Rationale: Deep brain stimulation (DBS) of the hippocampus is proposed for enhancement of memory impaired by injury or disease. Many pre-clinical DBS paradigms can be addressed in epilepsy patients undergoing intracranial monitoring for seizure localization, since they already have electrodes implanted in brain areas of interest. Even though epilepsy is usually not a memory disorder targeted by DBS, the studies can nevertheless model other memory-impacting disorders, such as Traumatic Brain Injury (TBI). Methods: Human patients undergoing Phase II invasive (...) monitoring for intractable epilepsy were implanted with depth electrodes capable of recording neurophysiological signals. Subjects performed a delayed-match-to-sample (DMS) memory task while hippocampal ensembles from CA1 and CA3 cell layers were recorded to estimate a multi-input, multi-output (MIMO) model of CA3-to-CA1 neural encoding and a memory decoding model (MDM) to decode memory information from CA3 and CA1 neuronal signals. After model estimation, subjects again performed the DMS task while either MIMO-based or MDM-based patterned stimulation was delivered to CA1 electrode sites during the encoding phase of the DMS trials. Each subject was sorted (post hoc) by prior experience of repeated and/or mild-to-moderate brain injury (RMBI), TBI, or no history (control) and scored for percentage successful delayed recognition (DR) recall on stimulated vs. non-stimulated DMS trials. The subject’s medical history was unknown to the experimenters until after individual subject memory retention results were scored. Results: When examined compared to control subjects, both TBI and RMBI subjects showed increased memory retention in response to both MIMO and MDM-based hippocampal stimulation. Furthermore, effects of stimulation were also greater in subjects who were evaluated as having pre-existing mild-to-moderate memory impairment. Conclusion: These results show that hippocampal stimulation for memory facilitation was more beneficial for subjects who had previously suffered a brain injury (other than epilepsy), compared to control (epilepsy) subjects who had not suffered a brain injury. This study demonstrates that the epilepsy/intracranial recording model can be extended to test the ability of DBS to restore memory function in subjects who previously suffered a brain injury other than epilepsy, and support further investigation into the beneficial effect of DBS in TBI patients. (shrink)

Background: Mild traumatic brain injury results from an external force to the head or body causing neurophysiological changes within the brain. The number and severity of symptoms can vary, with some individuals experiencing rapid recovery, and others having persistent symptoms for months to years, impacting their quality of life. Current rehabilitation is limited in its ability to treat persistent symptoms and novel approaches are being sought to improve outcomes following mTBI. Neuromodulation is one technique used to encourage adaptive (...) neuroplasticity within the brain.Objective: To systematically review the literature on the efficacy of neuromodulation in the mTBI population.Method: A systematic review was conducted using Medline, Embase, PsycINFO, PsycARTICLES and EBM Review. Preferred Reporting Items for Systematic Reviews and the Synthesis Without Meta-analysis reporting guidelines were used and a narrative review of the selected studies was completed. Fourteen articles fulfilled the inclusion criteria which were published in English, investigating an adult sample and using a pre- and post-intervention design. Studies were excluded if they included non-mild TBI severities, pediatric or older adult populations.Results: Thirteen of fourteen studies reported positive reductions in mTBI symptomatology following neuromodulation. Specifically, improvements were reported in post-concussion symptom ratings, headaches, dizziness, depression, anxiety, sleep disturbance, general disability, cognition, return to work and quality of life. Normalization of working memory activation patterns, vestibular field potentials, hemodynamics of the dorsolateral prefrontal cortex and excessive delta wave activity were also seen. The studies reviewed had several methodological limitations including small, heterogenous samples and varied intervention protocols, limiting generalisability. Further research is required to understand the context in which neuromodulation may be beneficial.Conclusions: While these positive effects are observed, limitations included unequal representation of neuromodulation modalities in the literature, and lack of literature describing the efficacy of neuromodulation on the development or duration of persistent mTBI symptoms. Better clarity regarding neuromodulation efficacy could have a significant impact on mTBI patients, researchers, clinicians, and policy makers, facilitating a more productive post-mTBI population. Despite the limitations, the literature indicates that neuromodulation warrants further investigation. PROSPERO registration number: CRD42020161279. (shrink)

Using a longitudinal case study design, we have tracked the recovery of motor function following severe traumatic brain injury (TBI) through a multimodal neuroimaging approach. In 2006, Canadian Soldier Captain (retired) Trevor Greene (TG) was attacked with an axe to the head while on tour in Afghanistan. TG continues intensive daily rehabilitation, which recently included the integration of physical therapy (PT) with neuromodulation using translingual neurostimulation (TLNS) to facilitate neuroplasticity. Recent findings with PT+TLNS demonstrated that recovery of motor (...) function occurred beyond conventional time limits, currently extending past 14-years post-injury. To investigate whether PT+TLNS similarly resulted in associated cognitive function improvements, we examined event-related potentials (ERPs) with the brain vital signs framework. In parallel with motor function improvements, brain vital signs detected significant increases in basic attention (as measured by P300 response amplitude) and cognitive processing (as measured by contextual N400 response amplitude). These objective cognitive improvements corresponded with TG’s self-reported improvements, including a noteworthy and consistent reduction in ongoing symptoms of post-traumatic stress disorder (PTSD). The findings provide valuable insight into the potential importance of non-invasive neuromodulation in cognitive rehabilitation, in addition to initial indications for physical rehabilitation. (shrink)

Head injuries are an inherent risk of participating in the major collision sports played in Australia. Protocols introduced by the governing bodies of these sports are ostensibly designed to improve player safety but do not prevent players suffering from repeated concussions. There is evidence that repeated traumatic brain injuries increase the risk of developing a number of long term problems but scientific and popular debates have largely focused on whether there is a causal link between concussion and chronic traumatic (...) encephalopathy. We argue that the governing bodies of collision sports played in Australia have used uncertainty about CTE to justify a “wait and see” approach instead of attempting to prevent repeated head injuries. This stance is difficult to defend when these governing bodies claim to give a high priority to protecting player welfare. (shrink)

This study investigated the relationship between concussions and medication adherence among 247 adults experiencing homelessness in Oklahoma City, Oklahoma, who were prescribed medication for a psychiatric disorder. Participants were asked whether they had “ever experienced a blow to the head that caused a concussion,” and medication adherence was measured by asking participants whether they had taken their psychiatric medication yesterday. The data were analyzed using univariate and multivariable logistic regressions. Results showed that more than half of the sample had (...) a concussion history, and homeless adults with a concussion history had higher odds of non-adherence to psychiatric medications compared with those who reported no concussion history [OR = 2.13 ]. Findings suggest that medication non-adherence is associated with incurred concussions. Raising awareness among service providers of the relationship between traumatic brain injury and medication adherence may increase efforts to improve adherence in this underserved population. (shrink)

If the laws of nature are as the Humean believes, it is an unexplained cosmic coincidence that the actual Humean mosaic is as extremely regular as it is. This is a strong and well-known objection to the Humean account of laws. Yet, as reasonable as this objection may seem, it is nowadays sometimes dismissed. The reason: its unjustified implicit assignment of equiprobability to each possible Humean mosaic; that is, its assumption of the principle of indifference, which has been attacked on (...) many grounds ever since it was first proposed. In place of equiprobability, recent formal models represent the doxastic state of total ignorance as suspension of judgment. In this paper I revisit the cosmic coincidence objection to Humean laws by assessing which doxastic state we should endorse. By focusing on specific features of our scenario I conclude that suspending judgment results in an unnecessarily weak doxastic state. First, I point out that recent literature in epistemology has provided independent justifications of the principle of indifference. Second, given that the argument is framed within a Humean metaphysics, it turns out that we are warranted to appeal to these justifications and assign a uniform and additive credence distribution among Humean mosaics. This leads us to conclude that, contrary to widespread opinion, we should not dismiss the cosmic coincidence objection to the Humean account of laws. (shrink)

Knowledge excludes luck. According to the received view, this intuition reveals that knowing is essentially modal in character. This paper demurs. Either knowledge does not exclude luck, or the entailment reveals nothing about its conceptual character. It is argued that knowledge excludes accidentality, and that this notion is not modal but causal‐explanatory. There are three central tasks. The first is to explicate the concept of accident. The second is to argue that the concepts of luck and accident are “intensionally distinct,” (...) which is to say that no member of the intension of either holds on both. The third is to argue that an anti‐accident requirement on knowledge is preferable to an anti‐luck analogue on abductive grounds. (shrink)

In this article I formulate a skeptical argument against the possibility of adhering to the divine will in a non-accidental way. In particular, my focus in the article is on a widely embraced modal condition of accidentality, according to which non-accidentality has to do with a person manifesting dispositions that result in a given outcome in a modally robust way. The skeptical argument arises from two observations: first, various authors in the epistemology of religion have argued that it is (...) often not possible to reason reliably about religious matters, and second, non-accidentally adhering to a given norm is often associated with reasoning about the requirements of the norm in question in a reliable way. In addition to pointing out the existence of the argument, I outline strategies in which religious thinkers could reasonably challenge it by denying that reliable reasoning about the requirements of divine will is necessary for adhering to it in a non-accidental manner. Hence, I argue that the possibility of non-accidental adherence to the divine will does not depend solely on whether it is possible to reliably reason about what it requires one to do. (shrink)

I offer a counterexample to Timothy Williamson’s conjecture that knowledge is the most general factive mental state; i.e., that every factive mental state entails knowledge. I describe two counterexamples (Ernest Sosa’s and Baron Reed’s) that I find unpersuasive, and argue that they fail due to a specific feature they have in common. I then argue that there is a primitive mental state that is factive but does not entail knowledge, and that constitutes a counterexample to Williamson’s conjecture that is not (...) subject to the problems faced by Sosa’s and Reed’s counterexamples. Je propose un contre-exemple à la conjecture de Timothy Williamson selon laquelle la connaissance est l’état mental factif le plus général, c’est-à-dire que tout état mental factif implique la connaissance. Je décris deux contre-exemples (développés par Ernest Sosa et Baron Reed) que je considère comme étant peu probants, et je souligne que l’un et l’autre échouent à convaincre de par une caractéristique spécifique qu’ils partagent. Je soutiens ensuite qu’il existe un état mental primitif, factif mais n’impliquant pas la connaissance : ce dernier constitue un contre-exemple à la conjecture de Williamson sans être sujet aux problèmes rencontrés par les deux contre-exemples précédents. (shrink)

This paper defends an account of moral worth. Moral worth is a status that some, but not all, morally right actions have. Unlike with merely right actions, when an agent performs a morally worthy action, she is necessarily creditworthy for doing the right thing. First, I argue that two dominant views of moral worth have been unable to fully capture this necessary connection. On one view, an action is morally worthy if and only if its agent is motivated by the (...) features of the action that make it right. On the other, an action is morally worthy if and only if its agent is motivated by the action’s rightness itself. Neither of these views captures the connection between moral worth and creditworthiness, because each view leaves room for cases of accidentally doing the right thing. Next, I develop a new account, which I call the Guise of Moral Reasons Account. On my account, morally worthy actions are right actions that are motivated by moral reasons as such. This account rules out cases of accidentally doing the right thing, thus capturing the necessary connection between moral worth and creditworthiness for doing the right thing. (shrink)

A series of experiments was performed in which subjects indicated whether two four-dot patterns were the same, although possibly viewed from different directions, or different, paired at random. Analyses of responses times and error rates suggest that the subjects' performance in this affine matching task is based on non-accidental properties such as convexity, parallelism, collinearity, and proximity, rather than on real affine invariants such as the ratio of triangular areas.

ABSTRACT There are two tenets about free agency that have proven difficult to combine: free agency is grounded in an agent’s possession or exercise of their reasons-responsiveness, only actual sequence features can ground free agency. This paper argues that and can only be reconciled if we recognise that their clash is just the particular manifestation of a wider conflict between two approaches to the notion of non-accidentality. According to modalism, p is non-accidentally connected to q iff p modally tracks q. (...) According to explanationism, p is non-accidentally connected to q iff q explains p in the right way. The conflict between these two approaches becomes manifest in Frankfurt-like cases for many notions, in which p and q are intuitively non-accidentally connected even though there is no modal tracking between them. Thus, and can’t be combined because the Frankfurt-cases upon which rests track explanationist intuitions, while the non-accidentality requirement of reasons-responsiveness in is usually spelled out in modalist terms. Hence, the possibility of an actual sequence reasons-responsiveness account depends on finding an explanationist approach to the non-accidentality requirement of reasons-responsiveness. (shrink)

The patient was a 19-year-old man who was the victim of an accidental head injury. The attending neurosurgeon felt that, due to uncontrollable and repeated elevated intracranial pressures, the patient would die within 48 hours. The patient's mother requested that the neurosurgeon contact a urologist to collect the patient's sperm for implantation into the patient's girlfriend. The neurosurgeon felt that the situation raised a number of ethical issues and requested that the hospital's bioethics committee consider the case.

If the cultural variations concerning knowledge and research on ordinary reasoning are part of cultural history, what kind of historiographical method is needed in order to present the history of its evolution? This paper proposes to introduce the study of theories of reasoning into a historiographic perspective because we assume that the answer to the previous question does not only depend of internal controversies about how reasoning performance is explained by current theories of reasoning. [...].

The present study investigated the mediating role of negative emotion in the relationship between cybervictimization and non-suicidal self-injury, and the moderating role of friendship quality in the indirect relationship. This model was tested with 1,326 Chinese adolescents who suffered from cyberbullying in the last 1 year; 727 were boys and 591 were girls, and their mean age was 13.67 years. Participants filled out questionnaires regarding cybervictimization, negative emotion, friendship quality, and non-suicidal self-injury. After demographic variables were controlled, cybervictimization (...) was significantly positively associated with non-suicidal self-injury. Mediation analysis revealed that negative emotion partially mediated the association between cybervictimization and non-suicidal self-injury. Moderated mediation analysis further indicated that the mediated path was weaker for adolescents with higher levels of friendship quality. These findings underscore the importance of identifying the mechanisms that moderate the mediated path between cybervictimization and non-suicidal self-injury among adolescents. (shrink)

In his influential paper “Grasping the Third Realm,” John Bengson raises the question of how we can non-accidentally grasp abstract facts. What distinguishes successful intuition from hallucinatory intuition? Bengson answers his “non-accidental relation question” by arguing for a constitutive relationship: The intuited object is a literal constituent of the respective intuition. Now, the problem my contribution centers around is that Bengson’s answer cannot be the end of the story. This is because, as Bar Luzon and Preston Werner have recently (...) pointed out, this answer leads to the follow-up question of why certain intuitional experiences are constituted by the facts, but others are not. My objective is to answer this question by specifying precisely what is epistemically defective about intellectual hallucinations. My result is that, in stark contrast to perception, intellectual hallucinations are epistemically defective in the sense that something is overlooked. In successful intuition, by contrast, all relevant possibilities/scenarios are considered/imagined. This has crucial epistemological implications. In particular, I argue that intuitions exhibiting a certain phenomenology cannot fail to successfully grasp abstract facts. I call this the non-accidental correctness thesis, which constitutes the main thesis of this paper. (shrink)

Argues that there are two distinct senses in which knowledge is incompatible with accidental truth - each of which can be traced to a distinct role played by everyday knowledge attributions.

ABSTRACTGrounded in Emotional Cascade Theory, we explored whether rumination and multisensory imagery-based cognitions moderated the relationships between affect and both odds of non-suicidal self-injury, and frequency of the behaviour. A sample of 393 university students completed self-report questionnaires assessing the constructs of interest. Contrary to expectations, rumination did not emerge as a significant moderator of the affect-NSSI relationship. However, the relationship between affect and frequency of NSSI was moderated by the use of imagery. Further, the relationship between negative affect (...) and NSSI was moderated by positive affect, underscoring the need to consider both negative and positive affect in models of NSSI. Most youth who self-injured reported thinking in images while the urge to self-injure was strong, with 53% thinking in images at least half the time. Future work is needed to explore how positive and negative affect work in concert to govern NSSI, and how imagery might eit... (shrink)

Theoretical perspectives on non-suicidal self-injury have long underscored the affective regulating properties of NSSI. Less attention has been given to the processes through which individuals choose to engage in NSSI, specifically, to regulate their distress. In the present study, we tested one theoretical model in which recent stressful experiences facilitates NSSI through emotional reactivity. Further, we tested whether the indirect link between stressful experiences and NSSI was moderated by several NSSI specific risk factors. Given the widespread prevalence of NSSI (...) among community-based samples of adolescents and emerging adults, we surveyed 1,125 emerging adults in first-year university at a large academic institution. Participants completed an online survey three times, reporting on their recent stressful experiences in university, emotional reactivity, NSSI, as well as three NSSI specific risk factors. As expected, path analysis revealed that there was a significant indirect effect of recent stressful experiences on NSSI engagement, through emotional reactivity. However, this effect was maintained across moderator analyses. These novel findings underscore the salient role of proximally occurring stressors in the prediction of NSSI among emerging adults in university, and can inform developing theoretical perspectives on NSSI. (shrink)

Objectives: Self-compassion functions as a psychological buffer in the face of negative life experiences. Considering that suicidal thoughts and behaviors and non-suicidal self-injury are often accompanied by intense negative feelings about the self, self-compassion may have the potential to alleviate these negative attitudes and feelings toward oneself. This meta-analysis investigated the associations of self-compassion with STBs and NSSI.Methods: A literature search finalized in August 2020 identified 18 eligible studies, including 8,058 participants. Two studies were longitudinal studies, and the remainder (...) were cross-sectional studies. A random-effects meta-analysis was conducted using CMA 3.0. Subgroup analyses, meta-regression, and publication bias analyses were conducted to probe potential sources of heterogeneity.Results: With regard to STBs, a moderate effect size was found for self-compassion. Positively worded subscales exhibited statistically significant effect sizes: self-kindness, common humanity, and mindfulness. For NSSI, a small effect size was found for self-compassion. There was a large heterogeneity, and publication bias was minimal. Subgroup analysis results showed that sample characteristic was a moderator, such that a larger effect size was witnessed in clinical patients than sexually/racially marginalized individuals, college students, and healthy-functioning community adolescents.Conclusions: Self-compassion was negatively associated with STBs and NSSI, and the effect size of self-compassion was larger for STBs than NSSI. More evidence is necessary to gauge a clinically significant protective role that self-compassion may play by soliciting results from future longitudinal studies or intervention studies. (shrink)

Although stressful life events have been shown to be a key risk factor for adolescent NSSI, the potential mediators and moderators of this relationship are unclear. Based on the social development theory and the organism-environment interaction model, we tested whether the link between stressful life events and adolescent NSSI was explained in part by deviant peer affiliation, and whether this process was buffered by gratitude. Chinese adolescents anonymously completed questionnaires to assess the study variables. The present study demonstrated that stressful (...) life events was linked to NSSI in part because of deviant peer affiliation, and high gratitude was a key protective factor to buffer this indirect effect. Teaching gratitude may be a helpful component of prevention and intervention programs to reduce adolescent NSSI. (shrink)

Genetic testing can be used to determine if unexplained fractures in children could have resulted from a predisposition to bone fractures, e.g., osteogenesis imperfecta. However, uncertainty is introduced if a variant of unknown significance is identified. Proper interpretation of VUS in these situations is critical because of its influence on clinical care and in court rulings. This study sought to understand how VUS are interpreted and used by practitioners when there is a differential diagnosis including both osteogenesis imperfecta and non- (...) class='Hi'>accidental injury.A 15-question survey was emailed to physicians who requested analysis of two genes, COL1A1 and COL1A2, from the University of Washington from 2005-2013 for patient cases involving suspicion of child abuse.Among the 89 participants, responses differed about when genetic testing should be ordered for osteogenesis imperfecta, who should be consulted about utilization of VUS test results, follow-up procedures, and who should receive the VUS results.There are no clear guidelines for how to interpret and follow up on VUS. In the legal setting, misinterpreted VUS could lead to unintended consequences and deleterious ramifications for family members. The need for better practice guidelines to help promote more equitable handling of these sensitive legal cases is clear. (shrink)