From driverless dilemmas to more practical commonsense tests for automated vehicles.

For the first time in history, automated vehicles (AVs) are being deployed in populated environments. This unprecedented transformation of our everyday lives demands a significant undertaking: endowing complex autonomous systems with ethically acceptable behavior. We outline how one prominent, ethically relevant component of AVs-driving behavior-is inextricably linked to stakeholders in the technical, regulatory, and social spheres of the field. Whereas humans are presumed (rightly or wrongly) to have the "common sense" to behave ethically in new driving situations beyond a standard driving test, AVs do not (and probably should not) enjoy this presumption. We examine, at a high level, how to test the common sense of an AV. We start by reviewing discussions of "driverless dilemmas," adaptions of the traditional "trolley dilemmas" of philosophy that have sparked discussion on AV ethics but have limited use to the technical and legal spheres. Then, we explain how to substantially change the premises and features of these dilemmas (while preserving their behavioral diagnostic spirit) in order to lay the foundations for a more practical and relevant framework that tests driving common sense as an integral part of road rules testing.

Clinical and Genetic Characterization of Brazilian Patients with Ataxia and Oculomotor Apraxia.

BACKGROUND: Ataxia with oculomotor apraxia (AOA) is characterized by early-onset cerebellar ataxia associated with oculomotor apraxia. AOA1, AOA2, AOA3, and AOA4 subtypes may present pathogenic variants in APTX, SETX, PIK3R5, and PNKP genes, respectively. Mutations in XRCC1 have been found to cause autosomal recessive spinocerebellar ataxia-26 (SCAR26) now considered AOA5. OBJECTIVES: To examine a cohort of Brazilians with autosomal recessive cerebellar ataxia plus oculomotor apraxia and determine the frequencies of AOA subtypes through genetic investigation. METHODS: We evaluated clinical, biomarkers, electrophysiological, and radiological findings of 52 patients with AOA phenotype and performed a genetic panel including APTX, SETX, PIK3R5, PNKP, and XRCC1. RESULTS: We found pathogenic variants in SETX (15 patients), PNKP (12), and APTX (5). No mutations in PIK3R5 or XRCC1 were identified. CONCLUSIONS: AOA2 and AOA4 were the most common forms of AOA in Brazil. Mutations in PIK3R5 and XRCC1 were not part of this genetic spectrum. © 2022 International Parkinson and Movement Disorder Society.

Common knowledge, coordination, and strategic mentalizing in human social life.

People often coordinate for mutual gain, such as keeping to opposite sides of a stairway, dubbing an object or place with a name, or assembling en masse to protest a regime. Because successful coordination requires complementary choices, these opportunities raise the puzzle of how people attain the common knowledge that facilitates coordination, in which a person knows X, knows that the other knows X, knows that the other knows that he knows, ad infinitum. We show that people are highly sensitive to the distinction between common knowledge and mere private or shared knowledge, and that they deploy this distinction strategically in diverse social situations that have the structure of coordination games, including market cooperation, innuendo, bystander intervention, attributions of charitability, self-conscious emotions, and moral condemnation.

Subthalamic Nucleus Deep Brain Stimulation Lessens Acquired Dystonia: Report of Two Patients and Systematic Review of Published Cases.

INTRODUCTION: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an efficient treatment of primary dystonia. Few studies have reported the effect of STN-DBS on secondary or acquired dystonia. METHODS: We reported 2 patients with acquired dystonia treated by subthalamic DBS and followed up for 24 months, besides providing a systematic review and meta-analysis of published series. RESULTS/CONCLUSIONS: Both patients had thalamic vascular or autoimmune lesions within the ventral and the pulvinar nuclei. A reduction of 67.2% on the Burke-Fahn-Marsden Dystonia Rating Scale and 90% improvement in disability scores were shown in the first patient, while the second patient showed a lower reduction in both dystonia symptoms (28.6%) and disability scores (44%). Both patients had a significant mean improvement in the quality of life (62.5% in the first and 57.9% in the second) and were free of drugs postoperatively. A systematic review showed a mean follow-up of 13 months in 19 patients, including our 2 patients. The review showed a significant Burke-Fahn-Marsden Dystonia Scale (BFMDRS) score median reduction of 19 points (52.4%; confidence interval [CI]: 11.0-25.0) and a significant median reduction of 6 points in disability scores (44.5%; 95% CI: 4.0-14.0), thereby improving quality of life. Age at surgery was inversely correlated with postoperative improvement (r = 0.63; p = 0.039). Hemidystonia had a nonsignificant better improvement than generalized dystonia (55.3 vs. 43.5%; p = 0.4433). No association between etiology and postoperative improvement and no serious complications were found. Although few data reported so far, subthalamic DBS is likely efficient for acquired dystonia.

Tracking the changing feature of a moving object.

The mind can track not only the changing locations of moving objects, but also their changing features, which are often meaningful for guiding action. How does the mind track such features? Using a task in which observers tracked the changing orientation of a rolling wheel's spoke, we found that this ability is enabled by a highly feature-specific process which continuously tracks the orientation feature itself--even during occlusion, when the feature is completely invisible. This suggests that the mental representation of a changing orientation feature and its moving object are continuously transformed and updated, akin to studies showing continuous tracking of an object's boundaries alone. We also found a systematic error in performance, whereby the orientation was reliably perceived to be further ahead than it truly was. This effect appears to occur because during occlusion the mental representation of the feature is transformed beyond the veridical position, perhaps in order to conservatively anticipate future feature states.

The health risks of generative AI-based wellness apps.

Artificial intelligence (AI)-enabled chatbots are increasingly being used to help people manage their mental health. Chatbots for mental health and particularly 'wellness' applications currently exist in a regulatory 'gray area'. Indeed, most generative AI-powered wellness apps will not be reviewed by health regulators. However, recent findings suggest that users of these apps sometimes use them to share mental health problems and even to seek support during crises, and that the apps sometimes respond in a manner that increases the risk of harm to the user, a challenge that the current US regulatory structure is not well equipped to address. In this Perspective, we discuss the regulatory landscape and potential health risks of AI-enabled wellness apps. Although we focus on the United States, there are similar challenges for regulators across the globe. We discuss the problems that arise when AI-based wellness apps cross into medical territory and the implications for app developers and regulatory bodies, and we outline outstanding priorities for the field.

Psychological factors underlying attitudes toward AI tools.

What are the psychological factors driving attitudes toward artificial intelligence (AI) tools, and how can resistance to AI systems be overcome when they are beneficial? Here we first organize the main sources of resistance into five main categories: opacity, emotionlessness, rigidity, autonomy and group membership. We relate each of these barriers to fundamental aspects of cognition, then cover empirical studies providing correlational or causal evidence for how the barrier influences attitudes toward AI tools. Second, we separate each of the five barriers into AI-related and user-related factors, which is of practical relevance in developing interventions towards the adoption of beneficial AI tools. Third, we highlight potential risks arising from these well-intentioned interventions. Fourth, we explain how the current Perspective applies to various stakeholders, including how to approach interventions that carry known risks, and point to outstanding questions for future work.

Self-orienting in human and machine learning.

A current proposal for a computational notion of self is a representation of one's body in a specific time and place, which includes the recognition of that representation as the agent. This turns self-representation into a process of self-orientation, a challenging computational problem for any human-like agent. Here, to examine this process, we created several 'self-finding' tasks based on simple video games, in which players (N = 124) had to identify themselves out of a set of candidates in order to play effectively. Quantitative and qualitative testing showed that human players are nearly optimal at self-orienting. In contrast, well-known deep reinforcement learning algorithms, which excel at learning much more complex video games, are far from optimal. We suggest that self-orienting allows humans to flexibly navigate new settings.

Response: Clinical wisdom and evidence-based medicine are complementary.

A long-debated question in the philosophy of health, and contingent disciplines, is the extent to which wise clinical practice ("clinical wisdom") is, or could be, compatible with empirically validated medicine ("evidence-based medicine"--EBM). Here we respond to Baum-Baicker and Sisti, who not only suggest that these two types of knowledge are divided due to their differing sources, but also that EBM can sometimes even hurt wise clinical practice. We argue that the distinction between EBM and clinical wisdom is poorly defined, unsupported by the methodology employed, and ultimately incorrect; crucial differences exist, we argue, not in the source of a particular piece of clinical knowledge, but in its dependability. In light of this subtle but fundamental revision, we explain how clinical wisdom and EBM are--by necessity--complementary, rather than in conflict. We elaborate on how recognizing this relationship can have far-reaching implications for the domains of clinical practice, medical education, and health policy.

Deliberately prejudiced self-driving vehicles elicit the most outrage.

Should self-driving vehicles be prejudiced, e.g., deliberately harm the elderly over young children? When people make such forced-choices on the vehicle's behalf, they exhibit systematic preferences (e.g., favor young children), yet when their options are unconstrained they favor egalitarianism. So, which of these response patterns should guide AV programming and policy? We argue that this debate is missing the public reaction most likely to threaten the industry's life-saving potential: moral outrage. We find that people are more outraged by AVs that kill discriminately than indiscriminately. Crucially, they are even more outraged by an AV that deliberately kills a less preferred group (e.g., an elderly person over a child) than by one that indiscriminately kills a more preferred group (e.g., a child). Thus, at least insofar as the public is concerned, there may be more reason to depict and program AVs as egalitarian.

Behavioral and neural representations en route to intuitive action understanding.

When we observe another person's actions, we process many kinds of information - from how their body moves to the intention behind their movements. What kinds of information underlie our intuitive understanding about how similar actions are to each other? To address this question, we measured the intuitive similarities among a large set of everyday action videos using multi-arrangement experiments, then used a modeling approach to predict this intuitive similarity space along three hypothesized properties. We found that similarity in the actors' inferred goals predicted the intuitive similarity judgments the best, followed by similarity in the actors' movements, with little contribution from the videos' visual appearance. In opportunistic fMRI analyses assessing brain-behavior correlations, we found suggestive evidence for an action processing hierarchy, in which these three kinds of action similarities are reflected in the structure of brain responses along a posterior-to-anterior gradient on the lateral surface of the visual cortex. Altogether, this work joins existing literature suggesting that humans are naturally tuned to process others' intentions, and that the visuo-motor cortex computes the perceptual precursors of the higher-level representations over which intuitive action perception operates.

Clinical and molecular characterization of a large cohort of childhood onset hereditary spastic paraplegias.

The present study aimed to characterize clinical and molecular data of a large cohort of subjects with childhood-onset hereditary spastic paraplegias (HSPs). A multicenter historical cohort was performed at five centers in Brazil, in which probands and affected relatives' data from consecutive families with childhood-onset HSP (onset < 12 years-old) were reviewed from 2011 to 2020. One hundred and six individuals (83 families) with suspicion of childhood-onset HSP were evaluated, being 68 (50 families) with solved genetic diagnosis, 6 (5 families) with candidate variants in HSP-related genes and 32 (28 families) with unsolved genetic diagnosis. The most common childhood-onset subtype was SPG4, 11/50 (22%) families with solved genetic diagnosis; followed by SPG3A, 8/50 (16%). Missense pathogenic variants in SPAST were found in 54.5% of probands, favoring the association of this type of variant to childhood-onset SPG4. Survival curves to major handicap and cross-sectional Spastic Paraplegia Rating Scale progressions confirmed the slow neurological deterioration in SPG4 and SPG3A. Most common complicating features and twenty variants not previously described in HSP-related genes were reported. These results are fundamental to understand the molecular and clinical epidemiology of childhood-onset HSP, which might help on differential diagnosis, patient care and guiding future collaborative trials for these rare diseases.

Fields of Forel Brain Stimulation Improves Levodopa-Unresponsive Gait and Balance Disorders in Parkinson's Disease.

BACKGROUND: Gait and balance disturbance are challenging symptoms in advanced Parkinson's disease (PD). Anatomic and clinical data suggest that the fields of Forel may be a potential surgical target to treat these symptoms. OBJECTIVE: To test whether bilateral stimulation centered at the fields of Forel improves levodopa unresponsive freezing of gait (FOG), balance problems, postural instability, and falls in PD. METHODS: A total of 13 patients with levodopa-unresponsive gait disturbance (Hoehn and Yahr stage ≥3) were included. Patients were evaluated before (on-medication condition) and 1 yr after surgery (on-medication-on-stimulation condition). Motor symptoms and quality of life were assessed with the Unified Parkinson's Disease Rating scale (UPDRS III) and Quality of Life scale (PDQ-39). Clinical and instrumented analyses assessed gait, balance, postural instability, and falls. RESULTS: Surgery improved balance by 43% (95% confidence interval [CI]: 21.2-36.4 to 35.2-47.1; P = .0012), reduced FOG by 35% (95% CI: 15.1-20.3 to 8.1-15.3; P = .0021), and the monthly number of falls by 82.2% (95% CI: 2.2-6.9 to -0.2-1.7; P = .0039). Anticipatory postural adjustments, velocity to turn, and postural sway measurements also improved 1 yr after deep brain stimulation (DBS). UPDRS III motor scores were reduced by 27.2% postoperatively (95% CI: 42.6-54.3 to 30.2-40.5; P < .0001). Quality of life improved 27.5% (95% CI: 34.6-48.8 to 22.4-37.9; P = .0100). CONCLUSION: Our results suggest that DBS of the fields of Forel improved motor symptoms in PD, as well as the FOG, falls, balance, postural instability, and quality of life.

Doubting Driverless Dilemmas.

The alarm has been raised on so-called driverless dilemmas, in which autonomous vehicles will need to make high-stakes ethical decisions on the road. We argue that these arguments are too contrived to be of practical use, are an inappropriate method for making decisions on issues of safety, and should not be used to inform engineering or policy.

Ophthalmological changes in hereditary spastic paraplegia and other genetic diseases with spastic paraplegia.

Ophthalmological abnormalities may occur in specific subtypes of hereditary spastic paraplegia (HSP) and in genetic diseases that present with spastic paraplegia mimicking HSP. These ophthalmological changes may precede the motor symptoms and include pigmentary retinal degeneration, ophthalmoplegia, optic atrophy, cataracts and nystagmus. Some ophthalmological abnormalities are more prevalent in specific forms of HSP. Considering that the diagnosis of HSP is usually difficult and complex, specific ophthalmological changes may guide the genetic testing. There are other genetic diseases such as autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS), X-linked adrenoleukodystrophy and spastic paraplegia, optic atrophy and neuropathy (SPOAN) that may mimic HSP and also may present with specific ophthalmological changes. In this article, we review the main ophthalmological changes observed in patients with HSP and HSP-like disorders.

Maimonides' ladder: States of mutual knowledge and the perception of charitability.

Why do people esteem anonymous charitable giving? We connect normative theories of charitability (captured in Maimonides' Ladder of Charity) with evolutionary theories of partner choice to test predictions on how attributions of charitability are affected by states of knowledge: whether the identity of the donor or of the beneficiary is revealed to the other. Consistent with the theories, in Experiments 1-2 participants judged a double-blind gift as more charitable than one to a revealed beneficiary, which in turn was judged as more charitable than one from a revealed donor. We also found one exception: Participants judged a donor who revealed only himself as slightly less, rather than more, charitable than one who revealed both identities. Experiment 3 explains the exception as a reaction to the donor's perceived sense of superiority and disinterest in a social relationship. Experiment 4 found that donors were judged as more charitable when the gift was shared knowledge (each aware of the other's identity, but unsure of the other's awareness) than when it was common knowledge (awareness of awareness). Experiment 5, which titrated anonymity against donation size, found that not even a hundredfold larger gift could compensate for the disapproval elicited by a donor revealing his identity. Experiment 6 showed that participants' judgments of charitability flip depending on whose perspective they take: Observers disapprove of donations that they would prefer as beneficiaries. Together, these experiments provide insight into why people care about how a donor gives, not just how much. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Your visual system provides all the information you need to make moral judgments about generic visual events.

To what extent are people's moral judgments susceptible to subtle factors of which they are unaware? Here we show that we can change people's moral judgments outside of their awareness by subtly biasing perceived causality. Specifically, we used subtle visual manipulations to create visual illusions of causality in morally relevant scenarios, and this systematically changed people's moral judgments. After demonstrating the basic effect using simple displays involving an ambiguous car collision that ends up injuring a person (E1), we show that the effect is sensitive on the millisecond timescale to manipulations of task-irrelevant factors that are known to affect perceived causality, including the duration (E2a) and asynchrony (E2b) of specific task-irrelevant contextual factors in the display. We then conceptually replicate the effect using a different paradigm (E3a), and also show that we can eliminate the effect by interfering with motion processing (E3b). Finally, we show that the effect generalizes across different kinds of moral judgments (E3c). Combined, these studies show that obligatory, abstract inferences made by the visual system influence moral judgments.