Interoception can be broadly defined as the sense of signals originating within the body. As such, interoception is critical for our sense of embodiment, motivation, and well-being. And yet, despite its importance, interoception remains poorly understood within modern science. This paper reviews interdisciplinary perspectives on interoception, with the goal of presenting a unified perspective from diverse fields such as neuroscience, clinical practice, and contemplative studies. It is hoped that this integrative effort will advance our understanding of how interoception determines well-being, (...) and identify the central challenges to such understanding. To this end, we introduce an expanded taxonomy of interoceptive processes, arguing that many of these processes can be understood through an emerging predictive coding model for mind–body integration. The model, which describes the tension between expected and felt body sensation, parallels contemplative theories, and implicates interoception in a variety of affective and psychosomatic disorders. We conclude that maladaptive construal of bodily sensations may lie at the heart of many contemporary maladies, and that contemplative practices may attenuate these interpretative biases, restoring a person’s sense of presence and agency in the world. (shrink)

Health care is transitioning from genetics to genomics, in which single-gene testing for diagnosis is being replaced by multi-gene panels, genome-wide sequencing, and other multi-genic tests for disease diagnosis, prediction, prognosis, and treatment. This health care transition is spurring a new set of increased or novel liability risks for health care providers and test laboratories. This article describes this transition in both medical care and liability, and addresses 11 areas of potential increased or novel liability risk, offering recommendations to both (...) health care and legal actors to address and manage those liability risks. (shrink)

We develop and apply a multi-dimensional conception of explanatory depth towards a comparative analysis of inflationary and bouncing paradigms in primordial cosmology. Our analysis builds on earlier work due to Azhar and Loeb (2021) that establishes initial condition fine-tuning as a dimension of explanatory depth relevant to debates in contemporary cosmology. We propose dynamical fine-tuning and autonomy as two further dimensions of depth in the context of problems with instability and trans-Planckian modes that afflict bouncing and inflationary approaches respectively. In (...) the context of the latter issue, we argue that the recently formulated trans-Planckian censorship conjecture leads to a trade-off for inflationary models between dynamical fine-tuning and autonomy. We conclude with the suggestion that explanatory preference with regard to the different dimensions of depth is best understood in terms of differing attitudes towards heuristics for future model building. (shrink)

A collection of Essays dealing with themes in the philosophy of Wilfrid Sellars.

No consensus yet exists on how to handle incidental fnd-ings in human subjects research. Yet empirical studies document IFs in a wide range of research studies, where IFs are fndings beyond the aims of the study that are of potential health or reproductive importance to the individual research participant. This paper reports recommendations of a two-year project group funded by NIH to study how to manage IFs in genetic and genomic research, as well as imaging research. We conclude that researchers (...) have an obligation to address the possibility of discovering IFs in their protocol and communications with the IRB, and in their consent forms and communications with research participants. Researchers should establish a pathway for handling IFs and communicate that to the IRB and research participants. We recommend a pathway and categorize IFs into those that must be disclosed to research participants, those that may be disclosed, and those that should not be disclosed. (shrink)

Genomic research results and incidental findings with health implications for a research participant are of potential interest not only to the participant, but also to the participant's family. Yet investigators lack guidance on return of results to relatives, including after the participant's death. In this paper, a national working group offers consensus analysis and recommendations, including an ethical framework to guide investigators in managing this challenging issue, before and after the participant's death.

Chronologically sequenced chapter units give an overall historical perspective in this text on ethics, while chapter introductions include biographical, historical and other information.

Surgical expertise does not have a clear definition and is often culturally associated with power, authority, prestige, and case number rather than more objective proxies of excellence. Multiple models of expertise progression have been proposed including the Dreyfus model, however, they all currently require subjective evaluation of skill. Recently, efforts have been made to improve the ways in which surgical excellence is measured and expertise is defined using artificial intelligence, video recordings, and accelerometers. However, these aforementioned methods of assessment are (...) still subjective or indirect proxies of expertise, thus uncovering the neural mechanisms that differentiate expert surgeons from trainees may enhance the objectivity of surgical expertise validation. In fact, some researchers have already suggested that their neural imaging-based expertise classification methods outperform currently used methods of surgical skill certification such as the Fundamentals of Laparoscopic Surgery scores. Such imaging biomarkers would not only help better identify the highest performing surgeons, but could also improve residency programs by providing more objective, evidence-based feedback and developmental milestones for those in training and perhaps act as a marker of surgical potential in medical students. Despite the potential advantages of using neural imaging in the assessment of surgical expertise, this field of research remains in its infancy. This systematic review identifies studies that have applied neuromonitoring in assessing surgical skill across levels of expertise. The goals of this review are to identify the strongest neural indicators of surgical expertise, the limitations of the current literature on this subject, the most sensible future directions for further study. We found substantial evidence that surgical expertise can be delineated by differential activation and connectivity in the prefrontal cortex across multiple task and neuroimaging modalities. Specifically, novices tend to have greater PFC activation than experts under standard conditions in bimanual and decision-making tasks. However, under high temporal demand tasks, experts had increased PFC activation whereas novices had decreased PFC activation. Common limitations uncovered in this review were that task difficulty was often insufficient to delineate between residents and attending. Moreover, attending level involvement was also low in multiple studies which may also have contributed to this issue. Most studies did not analyze the ability of their neuromonitoring findings to accurately classify subjects by level of expertise. Finally, the predominance of fNIRS as the neuromonitoring modality limits our ability to uncover the neural correlates of surgical expertise in non-cortical brain regions. Future studies should first strive to address these limitations. In the longer term, longitudinal within-subjects design over the course of a residency or even a career will also advance the field. Although logistically arduous, such studies would likely be most beneficial in demonstrating effects of increasing surgical expertise on regional brain activation and inter-region connectivity. (shrink)

During the latter half of the twentieth century, many philosophers in Europe and America turned towards social pragmatist and holistic accounts of concepts and theories. In this paper, I make the case that many forms of relativism—moral and otherwise—that emerge from this turn are misguided. While we must always operate from some framework of practices in which things may serve as reasons for us, most forms of relativism in recent decades have more boldly granted us immunity from external rational scrutiny. (...) I argue that this strong form of relativism is possible only with sharp divisions between communities of speakers that I call “strict boundaries” and that these are implausible. We are left with the possibility of social pragmatist theories that do not entail strong relativism. (shrink)

Few philosophers today doubt the importance of some notion of rigid designation, as suggested by Kripke and Putnam for names and natural kind terms. At the very least, most of us want our theories to be compatible with the most plausible elements of that account. Anaphoric theories of reference have gained some attention lately, but little attention has been given to how they square with rigid designation. Although the differences between anaphoric theories and many interpretations of the New Theory of (...) reference are substantial, I argue that rigid designation and anaphoric theories can be reconciled with one another and in fact complement one another in important ways. (shrink)

Returning genomic research results to family members raises complex questions. Genomic research on life-limiting conditions such as cancer, and research involving storage and reanalysis of data and specimens long into the future, makes these questions pressing. This author group, funded by an NIH grant, published consensus recommendations presenting a framework. This follow-up paper offers concrete guidance and tools for implementation. The group collected and analyzed relevant documents and guidance, including tools from the Clinical Sequencing Exploratory Research Consortium. The authors then (...) negotiated a consensus toolkit of processes and documents. That toolkit offers sample consent and notification documents plus decision flow-charts to address return of results to family of living and deceased participants, in adult and pediatric research. Core concerns are eliciting participant preferences on sharing results with family and on choice of a representative to make decisions about sharing after participant death. (shrink)

"Public reason" is one of the central concepts in modern liberal political theory. As articulated by John Rawls, it presents a way to overcome the difficulties created by intractable differences among citizens' religious and moral beliefs by strictly confining the place of such convictions in the public sphere. Identifying this conception as a key point of conflict, this book presents a debate among contemporary natural law and liberal political theorists on the definition and validity of the idea of public reason. (...) Its distinguished contributors examine the consequences of interpreting public reason more broadly as "right reason," according to natural law theory, versus understanding it in the narrower sense in which Rawls intended. They test public reason by examining its implications for current issues, confronting the questions of abortion and slavery and matters relating to citizenship. This energetic exchange advances our understanding of both Rawls's contribution to political philosophy and the lasting relevance of natural law. It provides new insights into crucial issues facing society today as it points to new ways of thinking about political theory and practice. (shrink)

Optimal foraging theory has been criticized for underestimating patch exploitation time. However, proper modeling of costs not only answers these criticisms, but it also explains apparently irrational behaviors like the sunk-cost effect. When a forager is sure to experience high initial costs repeatedly, the forager should devote more time to exploitation than searching in order to minimize the accumulation of said costs. Thus, increased recognition or reconnaissance costs lead to increased exploitation times in order to reduce the frequency of future (...) costs, and this result can be used to explain paradoxical human preference for higher costs. In fact, this result also provides an explanation for how continuing a very costly task indefinitely provides the optimal long-term rate of gain; the entry cost of each new task is so great that the forager avoids ever returning to search. In general, apparently irrational decisions may be optimal when considering the lifetime of a forager within a larger system. (shrink)

Books Received Kantian Review, FirstView Article.

In this paper, I will outline some of the important points made by Kripke and Putnam on the meaning of natural kind terms. Their notion of the baptism of natural kinds- the process by which kind terms are initially introduced into the language — is of special concern here. I argue that their accounts leave some ambiguities that suggest a baptism of objects and kinds that is free of additional theoretical commitments. Both authors suggest that we name the stuff and (...) then let the scientists tell us what properties it really has, and hence what the real meaning is. I contend that such a barren baptism, taken at face value, cannot succeed in the semantic roles it has been assigned and that softening the stance on baptism suggests a more subtle and complex relation between reference and theoretical commitment than has emerged thus far. (shrink)

Dubourg and Baumard's paper takes a different, and fruitful, approach to the study of imaginary worlds than what is usually found in Media Studies, but omits certain circumstances and influences that shaped their history; this article argues that psychological or behavioral factors are not enough to explain the growth of imaginary worlds, even as they may be important influences.

This article addresses recent claims made by Richard Rorty about antirepresentationalist theories of meaning. Rorty asserts that a faithful rendering of the core antirepresentationalist assumptions precludes even revised pieces of representationalist semantics like "refers" or "true" and epistemological correlates like "answering to the facts." Rorty even asserts that such notions invite reactionary authoritarian elements that would impede the development of a democratic humanism. I reject this claim and assert that such notions (suitably constructed) pose no greater threat to democratic humanism (...) than the alternatives and in fact are crucial to its maintenance and continuing success. These notions (suitably constructed) reflect a metatheoretical stance that I call "openness," which I believe lies at the heart of both democratic humanism and the pragmatism from which Rorty claims to take his inspiration. (shrink)

Much of the literature on speech acts and semantics assigns a type of theoretical priority to assertions; many philosophers assume, as Robert Brandom has put it, that assertion is the fundamental speech act. Others take a more pluralistic approach, with many categories interwoven as peers, and no one category as fundamental. I suggest there is a way to embrace a pluralistic approach and explain the importance of assertions without making them fundamental. Their role instead becomes one of supporting connections between (...) other categories, and surprisingly, turns on their unusually broad but very thin pragmatic character. (shrink)

BackgroundResponsive neurostimulation has been utilized as a treatment for intractable epilepsy. The RNS System delivers stimulation in response to detected abnormal activity, via leads covering the seizure foci, in response to detections of predefined epileptiform activity with the goal of decreasing seizure frequency and severity. While thalamic leads are often implanted in combination with cortical strip leads, implantation and stimulation with bilateral thalamic leads alone is less common, and the ability to detect electrographic seizures using RNS System thalamic leads is (...) uncertain.ObjectiveThe present study retrospectively evaluated fourteen patients with RNS System depth leads implanted in the thalamus, with or without concomitant implantation of cortical strip leads, to determine the ability to detect electrographic seizures in the thalamus. Detailed patient presentations and lead trajectories were reviewed alongside electroencephalographic analyses.ResultsAnterior nucleus thalamic leads, whether bilateral or unilateral and combined with a cortical strip lead, successfully detected and terminated epileptiform activity, as demonstrated by Cases 2 and 3. Similarly, bilateral centromedian thalamic leads or a combination of one centromedian thalamic alongside a cortical strip lead also demonstrated the ability to detect electrographic seizures as seen in Cases 6 and 9. Bilateral pulvinar leads likewise produced reliable seizure detection in Patient 14. Detections of electrographic seizures in thalamic nuclei did not appear to be affected by whether the patient was pediatric or adult at the time of RNS System implantation. Sole thalamic leads paralleled the combination of thalamic and cortical strip leads in terms of preventing the propagation of electrographic seizures.ConclusionThalamic nuclei present a promising target for detection and stimulation via the RNS System for seizures with multifocal or generalized onsets. These areas provide a modifiable, reversible therapeutic option for patients who are not candidates for surgical resection or ablation. (shrink)

Many contextualist accounts in epistemology appeal to ordinary language and everyday practice as grounds for positing a low-standards knowledge (knowledgeL) that contrasts with high-standards prevalent in epistemology (knowledgeH). We compare these arguments to arguments from the height of “ordinary language” philosophy in the mid 20th century and find that all such arguments face great difficulties. We find a powerful argument for the legitimacy and necessity of knowledgeL (but not of knowledgeH). These appeals to practice leave us with reasons to accept (...) knowledgeL in the face of radical doubts raised by skeptics. We conclude by arguing that by relegating knowledgeH to isolated contexts, the contextualist fails to deal with the skeptical challenge head-on. KnowledgeH and knowledgeL represent competing, incompatible intuitions about knowledge, and we must choose between them. A fallibilist conception of knowledge, formed with proper attention to radical doubts, can address the skeptical challenge without illicit appeal to everyday usage. (shrink)

The semantics of natural kind terms has recently been seen as a problem of reference. Kripke and Putnam have suggested that their meaning begins with rigid designation, with any further implications emerging after empirical study. I part ways with this approach and instead offer an account that focuses on the contribution that these terms make to the inferential roles of different sorts of sentences. I note that natural kind terms play an odd array of grammatical roles, both as subject and (...) as parts of predicates, and explain why this dual role contributes something pragmatically significant to explanations of natural phenomena. (shrink)

Successful preimplantation genetic diagnosis to avoid creating a child affected by a genetically-based disorder was reported in 1989. Since then PGD has been used to biopsy and analyze embryos created through in viuo fertilization to avoid transferring to the mother’s uterus an embryo affected by a mutation or chromosomal abnormality associated with serious illness. PGD to avoid serious and early-onset illness in the child-to-be is widely accepted. PGD prevents gestation of an affected embryo and reduces the chance that the parents (...) will be faced with a difficult decision of whether to terminate the pregnancy. More controversial have been PGD to select the sex of the child-to-be for “family balancing”, PGD for mere susceptibility to disease and for late-onset disorders such as Alzheimer diseas, and most controversially, PGD to create a donor child who is Human Leukocyte Antigen (HLA-matched with a preexisting sibling in need of stem cell transplant. (shrink)

Nanomedicine is yielding new and improved treatments and diagnostics for a range of diseases and disorders. Nanomedicine applications incorporate materials and components with nanoscale dimensions where novel physiochemical properties emerge as a result of size-dependent phenomena and high surface-to-mass ratio. Nanotherapeutics and in vivo nanodiagnostics are a subset of nanomedicine products that enter the human body. These include drugs, biological products, implantable medical devices, and combination products that are designed to function in the body in ways unachievable at larger scales. (...) Nanotherapeutics andin vivonanodiagnostics incorporate materials that are engineered at the nanoscale to express novel properties that are medicinally useful. These nanomedicine applications can also contain nanomaterials that are biologically active, producing interactions that depend on biological triggers. Examples include nanoscale formulations of insoluble drugs to improve bioavailability and pharmacokinetics, drugs encapsulated in hollow nanoparticles with the ability to target and cross cellular and tissue membranes and to release their payload at a specific time or location, imaging agents that demonstrate novel optical properties to aid in locating micrometastases, and antimicrobial and drug-eluting components or coatings of implantable medical devices such as stents. (shrink)

Successful preimplantation genetic diagnosis to avoid creating a child affected by a genetically-based disorder was reported in 1989. Since then PGD has been used to biopsy and analyze embryos created through in viuo fertilization to avoid transferring to the mother’s uterus an embryo affected by a mutation or chromosomal abnormality associated with serious illness. PGD to avoid serious and early-onset illness in the child-to-be is widely accepted. PGD prevents gestation of an affected embryo and reduces the chance that the parents (...) will be faced with a difficult decision of whether to terminate the pregnancy. More controversial have been PGD to select the sex of the child-to-be for “family balancing”, PGD for mere susceptibility to disease and for late-onset disorders such as Alzheimer diseas, and most controversially, PGD to create a donor child who is Human Leukocyte Antigen (HLA-matched with a preexisting sibling in need of stem cell transplant. (shrink)

We adjudicate a recent dispute concerning the desire theory of well-being. Stock counterexamples to the desire theory include “quirky” desires that seem irrelevant to well-being, such as the desire to count blades of grass. Bruckner claims that such desires are relevant to well-being, provided that the desirer can characterize the object in such a way that makes it clear to others what attracts the desirer to it. Lin claims that merely being attracted to the object of one’s desire should be (...) sufficient for it to be relevant to one’s well-being. The capacity to characterize the desire as Bruckner requires does no work in the explanation of the welfare-relevance of the desire, Lin claims, especially since Lin’s account and Bruckner’s account are extensionally equivalent. In response, we provide a conceptual analysis of desire based on conceptual role semantics. Our analysis shows the plausibility of and motivation for Bruckner’s account. As well, it shows that the extensional equivalence of the accounts is no accident, but due to what it is to have a desire. Lin has not succeeded in providing an alternative to Bruckner’s account, but merely reformulated it, though in an illuminating way that supports Bruckner’s original case. (shrink)

Predictive genetic testing poses fundamental questions for disability insurance, a crucial resource funding basic needs when disability prevents income from work. This article, from an NIH-funded project, presents the first indepth analysis of the challenging issues: Should disability insurers be permitted to consider genetics and exclude predicted disability? May disabilities with a recognized genetic basis be excluded from coverage as pre-existing conditions? How can we assure that private insurers writing individual and group policies, employers, and public insurers deal competently and (...) appropriately with genetic testing? (shrink)

Genetic testing poses fundamental questions for insurance. Testing can predict a low probability of future illness and disability, which can help promote the insurability of individuals with a family history of genetic risk, but it can also invite insurers to reject applicants, increase premiums, exclude people with certain illnesses and disabilities, and otherwise adjust the underwriting processes for individuals with certain genotypes. In the workplace, these issues may cause employers who offer or pay for insurance to alter their hiring behavior, (...) either by selecting those with desirable genetic makeup or rejecting, dismissing, or reassigning those who carry an unwanted risk, ultimately threatening employability and the safety net that insurance is intended to provide. (shrink)