Deep brain stimulation (DBS) has become a widespread and valuable treatment for patients with movement disorders such as essential tremor (ET). However, current DBS treatment constantly delivers stimulation in an open loop, which can be inefficient. Closing the loop with sensors to provide feedback may increase power efficiency and reduce side effects for patients. New implantable neuromodulation platforms, such as the Medtronic Activa PC+S DBS system, offer important data sources by providing chronic neural sensing capabilities and a means of investigating dynamic stimulation based on symptom measurements. The authors implanted in a single patient with ET an Activa PC+S system, a cortical strip of electrodes on the hand sensorimotor cortex, and therapeutic electrodes in the ventral intermediate nucleus of the thalamus. In this paper they describe the effectiveness of the platform when sensing cortical movement intentions while the patient actually performed and imagined performing movements. Additionally, they demonstrate dynamic closed-loop DBS based on several wearable sensor measurements of tremor intensity.

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A B S T R A C T The universal features of the histopathology of fibrotic lung disease are derangement of parenchymal collagen and infiltration of the parenchyma with chronic inflammatory cells. To determine if this cellular reaction might be associated with autoimmunity to a constituent of the alveolar interstitium, peripheral blood lymphocytes were exposed to human type I collagen in vitro and evaluated for the production of migration inhibition factor and cytotoxicity. Data from 18 patients with idiopathic pulmonary fibrosis, 8 patients with pulmonary fibrosis other than idiopathic pulmonary fibrosis, 12 patients with nonfibrotic lung disease, and 9 normals demonstrated that circulating lymphocytes from more than 94% of patients with fibrotic lung disease take part in processes where the recognition of collagen results in migration inhibition factor production and lysis of collagen-coated sheep red blood cells. These collagen-induced cell-mediated phenomena are obviated with human T-lymphocyte antiserum. Collagen-induced migration inhibition factor production and cytotoxicity were found in less than 20%/o of patients with nonfibrotic disease and were not found in normals. Qualitatively, there was no organ (lung, skin) or species (human, rabbit) Send

Neural devices have the capacity to enable users to regain abilities lost due to disease or injuryfor instance, a deep brain stimulator (DBS) that allows a person with Parkinson's disease to regain the ability to fluently perform movements or a Brain Computer Interface (BCI) that enables a person with spinal cord injury to control a robotic arm. While users recognize and appreciate the technologies' capacity to maintain or restore their capabilities, the neuroethics literature is replete with examples of concerns expressed about agentive capacities: A perceived lack of control over the movement of a robotic arm might result in an altered sense of feeling responsible for that movement. Clinicians or researchers being able to record and access detailed information of a person's brain might raise privacy concerns. A disconnect between previous, current, and future understandings of the self might result in a sense of alienation. The ability to receive and interpret sensory feedback might change whether someone trusts the implanted device or themselves. Inquiries into the nature of these concerns and how to mitigate them has produced scholarship that often emphasizes one issueresponsibility, privacy, authenticity, or trustselectively. However, we believe that examining these ethical dimensions separately fails to capture a key aspect of the experience of living with a neural device. In exploring their interrelations, we argue that their mutual significance for neuroethical research can be adequately captured if they are described under a unified heading of agency. On these grounds, we propose an "Agency Map" which brings together the diverse neuroethical dimensions and their interrelations into a comprehensive framework. With this, we offer a theoretically-grounded approach to understanding how these various dimensions are interwoven in an individual's experience of agency.

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Deep-brain stimulation systems are an accepted and clinically effective form of neuroprosthetic treatment for a variety of common and debilitating neurological movement disorders: Essential Tremor, Parkinson's, and others. Most current implementations of DBS are "open-loop:" they remain active continuously, whether or not the user is experiencing symptoms. Recent research suggests that it is possible to devise more advanced systems where stimulation is delivered on demand. Their research offers a proof-of-concept for a Brain-Computer Interface-triggered DBS (BCI-DBS) system capable of detecting either signs of tremor or the user's neural commands through an additional set of co-implanted sensors. The system then delivers stimulation to meet the user's needs or demands. These technologies, however, come with a set of moral problems-in particular, problems for personal responsibility. This paper investigates whether giving users moment-to-moment neural control over their DBS system is ethically responsible given that users can make bad choices and thus harm others. We also ask what responsibilities medical professionals have have to support users as they learn to adapt to neuroprosthetic use. We guide our exploration of these issues through a series of hypothetical scenarios that BCI-DBS users may face.

Deep Brain Stimulation (DBS) is an FDA-approved treatment for symptoms of motor disorders—with experimental use for psychiatric disorders. DBS, however, causes a variety of side effects. Moral philosophers question DBS’s influence on users’ experiences of authenticity, identity, and/or autonomy. These characterizations of DBS, however, may not make sense of how DBS complicates, rather than simply impedes or bolsters, users’ abilities to exercise agency. Empirical work exploring DBS users’ lived-experiences and feminist accounts of relational autonomy demonstrate that the issues users face are better characterized in terms of the user’s relationship to their stimulator, that is, in terms of “relational agency.”

Novel neurotechnologies, like deep brain stimulation and brain‐computer interface, offer great hope for treating, curing, and preventing disease, but raise important questions about effects these devices may have on human identity, authenticity, and autonomy. After briefly assessing recent narrative work in these areas, we show that agency is a phenomenon key to all three goods and highlight the ways in which neural devices can help to draw attention to the relational nature of our agency. Drawing on insights from disability theory, we argue that neural devices provide a kind of agential assistance, similar to that provided by caregivers, family, and others. As such, users and devices participate in a kind of co‐agency. We conclude by suggesting the need for developing relational agency‐competencies—skills for reflecting on the influence of devices on agency, for adapting to novel circumstances ushered in by devices, and for incorporating the feedback of loved ones and others about device effects on agency.