Why do we spend so much of our time passing on amusing anecdotes, making wisecracks,watching The Simpsons? In Inside Jokes, Matthew Hurley, DanielDennett, and Reginald Adams offer an evolutionary and cognitive perspective.

Rapid advancements in artificial intelligence and machine learning (AI/ML) in healthcare raise pressing questions about how much users should trust AI/ML systems, particularly for high stakes clinical decision-making. Ensuring that user trust is properly calibrated to a tool’s computational capacities and limitations has both practical and ethical implications, given that overtrust or undertrust can influence over-reliance or under-reliance on algorithmic tools, with significant implications for patient safety and health outcomes. It is, thus, important to better understand how variability in trust (...) criteria across stakeholders, settings, tools and use cases may influence approaches to using AI/ML tools in real settings. As part of a 5-year, multi-institutional Agency for Health Care Research and Quality-funded study, we identify trust criteria for a survival prediction algorithm intended to support clinical decision-making for left ventricular assist device therapy, using semistructured interviews (n=40) with patients and physicians, analysed via thematic analysis. Findings suggest that physicians and patients share similar empirical considerations for trust, which were primarilyepistemicin nature, focused on accuracy and validity of AI/ML estimates. Trust evaluations considered the nature, integrity and relevance of training data rather than the computational nature of algorithms themselves, suggesting a need to distinguish ‘source’ from ‘functional’ explainability. To a lesser extent, trust criteria were also relational (endorsement from others) and sometimes based on personal beliefs and experience. We discuss implications for promoting appropriate and responsible trust calibration for clinical decision-making use AI/ML. (shrink)

Background Deep brain stimulation is approved for treating refractory obsessive-compulsive disorder in adults under the US Food and Drug Administration Humanitarian Device Exemption, and studies have shown its efficacy in reducing symptom severity and improving quality of life. While similar deep brain stimulation treatment is available for pediatric patients with dystonia, it is not yet available for pediatric patients with obsessive-compulsive disorder, although soon could be. The prospect of growing indications for pediatric deep brain stimulation raises several ethical concerns relating (...) to bodily integrity, the ability to offer informed assent, and the role pediatric patients play in the decision-making process. Objective The aim of this study is to solicit and assess the views of stakeholders (children, parents, clinicians) on pediatric assent, autonomy, and bodily integrity in the context of potential pediatric deep brain stimulation for obsessive-compulsive disorder. Methods Semi-structured interviews were conducted with pediatric obsessive-compulsive disorder patients ( n = 21), caregivers of pediatric obsessive-compulsive disorder patients aged 14–18 ( n = 19), and clinicians with experience treating refractory obsessive-compulsive disorder ( n = 25). Interviews were transcribed and coded in MAXQDA 2018 and 2020 software and processed for thematic content analysis to isolate and compare specific themes. Results A majority of respondents (74%, 48/65) across all three stakeholder groups voiced that the decision-making process should be collaborative and involve everyone (clinicians: 84% or 21/25, caregivers 71% or 15/21, and patients 63% or 12/19). We identified a split between respondents’ views on who should have the final say in the event of disagreement (38% or 25/65 favored the patient versus 35% or 23/65 favoring caregivers). A split between respondents also emerged concerning the maturity relevant for deep brain stimulation decision-making, with 45% (29/65) favoring developmental maturity (age/physiological development) and 45% (29/65) favoring decisional maturity (capacity to understand and weigh information). A majority of clinicians indicated that they would not move forward with deep brain stimulation without securing patient assent (80% or 20/25), with some stating the only exception is if patient quality of life was very poor and/or they lacked insight. Both caregivers and patients expressed a significant respect for the patient's right to bodily integrity, with 67% of caregivers (14/21) and 68% of patients (13/19) justifying patient involvement in decision-making specifically with reference to infringements of bodily integrity. Conclusion Our findings demonstrate that despite broad agreement across stakeholders that the decision-making process for pediatric deep brain stimulation for obsessive-compulsive disorder should be collaborative and somehow involve pediatric patients, there is disagreement about what this process entails and what factors determine patient involvement in the process. However, there is agreement that children have a right to bodily and brain integrity, which should only be infringed upon in rare circumstances. (shrink)

The ongoing debate within neuroethics concerning the degree to which neuromodulation such as deep brain stimulation (DBS) changes the personality, identity, and agency (PIA) of patients has paid relatively little attention to the perspectives of prospective patients. Even less attention has been given to pediatric populations. To understand patients’ views about identity changes due to DBS in obsessive-compulsive disorder (OCD), the authors conducted and analyzed semistructured interviews with adolescent patients with OCD and their parents/caregivers. Patients were asked about projected impacts (...) to PIA generally due to DBS. All patient respondents and half of caregivers reported that DBS would impact patient self-identity in significant ways. For example, many patients expressed how DBS could positively impact identity by allowing them to explore their identities free from OCD. Others voiced concerns that DBS-related resolution of OCD might negatively impact patient agency and authenticity. Half of patients expressed that DBS may positively facilitate social access through relieving symptoms, while half indicated that DBS could increase social stigma. These views give insights into how to approach decision-making and informed consent if DBS for OCD becomes available for adolescents. They also offer insights into adolescent experiences of disability identity and “normalcy” in the context of OCD. (shrink)

Introduction Deep brain stimulation (DBS) is approved under a humanitarian device exemption to manage treatment-resistant obsessive-compulsive disorder (TR-OCD) in adults. It is possible that DBS may be trialed or used clinically off-label in children and adolescents with TR-OCD in the future. DBS is already used to manage treatment-resistant childhood dystonia. Evidence suggests it is a safe and effective intervention for certain types of dystonia. Important questions remain unanswered about the use of DBS in children and adolescents with TR-OCD, including whether (...) mental health clinicians would refer pediatric patients for DBS, and who would be a good candidate for DBS.Objectives To explore mental health clinicians’ views on what clinical and psychosocial factors they would consider when determining which children with OCD would be good DBS candidates.Materials and Methods In depth, semi-structured interviews were conducted with n = 25 mental health clinicians who treat pediatric patients with OCD. The interviews were transcribed, coded, and analyzed using thematic content analysis. Three questions focused on key, clinical, and psychosocial factors for assessing candidacy were analyzed to explore respondent views on candidacy factors. Our analysis details nine overarching themes expressed by clinicians, namely the patient’s previous OCD treatment, OCD severity, motivation to commit to treatment, presence of comorbid conditions, family environment, education on DBS, quality of life, accessibility to treatment, and patient age and maturity.Conclusions Clinicians generally saw considering DBS treatment in youth as a last resort and only for very specific cases. DBS referral was predominantly viewed as acceptable for children with severe TR-OCD who have undertaken intensive, appropriate treatment without success, whose OCD has significantly reduced their quality of life, and who exhibit strong motivation to continue treatment given the right environment. Appropriate safeguards, eligibility criteria, and procedures should be discussed and identified before DBS for childhood TR-OCD becomes practice. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:How Philosophers Trivialize Art: Bleak House, Oedipus Rex, "Leda and the Swan"Michael D. HurleyIIt is a Perverse but unsurprising irony that answers to the question of whether art can give us knowledge characteristically trivialize that which draws us to individual artworks in the first place. The experience of art is sidelined in favor of the apparent after-effect of that experience. Even those writing against each other tend to converge (...) on this. In an essay contesting Nelson Goodman's epistemic claims for art, Gordon Graham nonetheless agrees that, "The question to be asked of such a work is not, 'Does this effectively capture the scene portrayed?', but 'Does this make us see this sort of occasion differently?'"1 Even attempts to distinguish art as "gift" as opposed to commodity predictably figure its value in terms of what might be taken away: "I went to see a landscape painter's works, and that evening, walking among pine trees near my home, I could see the shapes and the colors I had not seen the day before."2This state of affairs is perversely ironic for two reasons. Firstly, because the possibility of art's cognitive content is only prompted at all by the immediate experience it offers: without this, art would not excite us the way it does and there would be no debate to be had. Secondly, and more significantly, because a defining part of what constitutes an interest in art is, I should like to suggest, an experience of knowledge; or, more accurately, an experience of knowing. This irony is unsurprising because it is merely another expression of a recalcitrant prejudice in western epistemology that idealizes knowledge as an objectively true, justified belief—perforce excluding the possibility of knowing as a subjective [End Page 107] experience of believing. No wonder the author of Theætetus elsewhere finds poets incapable of offering anything but lies.Plato's lingering legacy assures that the cognitive content of art be assized according to what might be extracted from the artwork—cashed in like so many casino chips—when we are done with our experience of it. This applies whether the knowledge-bearing being argued for, or against, is conceptual or propositional (e.g., Putnam, Novitz, John),3 or imaginative (e.g., Goodman, Robinson, Currie),4 as well as for the claim that art can offer us moral instruction (e.g., Beardsmore, Eldridge, Nussbaum, Sharpe, Kieran, John).5 There is less consensus as to whether the capacity of art to give us knowledge enriches the aesthetic value of that artwork, but those who would advance this position have been on the back-foot in recent years following a wave of criticisms from, among others, Beardsley, Lamarque and Olsen, Diffey, and Gaut.6This article addresses art's capacity to give us knowledge as well as the conjunct of whether such knowledge might inform its value qua art. In so doing, it presses a case that has already been disallowed by the terms in which the question of the relationship between art and knowledge is typically put. Whatever efferent knowledge art might offer, it also provides the conditions for a kind of knowing that cannot be translated beyond itself. Only such an experience of knowledge-as-knowing, which is realized through the untranslatable singularity of an artwork, may be considered constitutive of art's aesthetic value. Couched another way: epistemology meets aesthetics not where it has most often been located, in the perfective, at the congruence of the thought and the felt, but in the present continuous, in the engagement of thinking and feeling. Connecting the epistemic and the aesthetic in this way is, then, exactly the opposite proposition to that presented by Douglas Morgan, for whom, "although many words in many arts can and do give us knowledge of many kinds, nonetheless if this knowledge were the key and limit to the love of art, the world of art would be even sorrier than it now is."7IILiterature has generated by far the greatest volume of commentary in the debate on art and knowledge. This is to be expected given the bias towards categorizing knowledge as something like data... (shrink)

In their article, Cho and Martinez-Martin (2023) argue that developers and users of digital simulacra for modelling health and disease should involve a continued focus on causality of health states...

This paper is a polemic against the science of linguistics, to the extent that, with its relentlessly reductive methodologies, it has encouraged the marginalization of the aesthetic in literary studies—particularly in the field of metrics. The paper also suggests how this aesthetic imperative might yet be reclaimed through study of the audible reading of poetry.