Write an article based on this summary:

– Until now, the public debate of work-vs-family has focused more on female workers than male ones. So Max Schireson's decision to demote himself at a major software company and move back home with his family is turning a few heads, Jezebel reports. "Friends and colleagues often ask my wife how she balances her job and motherhood," wrote Schireson in a blog post. "Somehow, the same people don't ask me." His 19-month stint at the helm of MongoDB in New York City has been successful—he helped turn it "into a billion-dollar business," Fortune notes—but the time away from his wife, children, and puppy in Palo Alto, Calif., has proved just too hard. Among his reasons: "I have 3 wonderful kids at home, aged 14, 12 and 9, and I love spending time with them." His "amazing wife" has "an important career" as a doctor and Stanford professor. "I love her, I am forever in her debt for finding a way to keep the family working despite my crazy travel. I should not continue abusing that patience." "On pace to fly 300,000 miles this year," he's missed a lot of family fun plus his son's minor surgery and the puppy being hit by a car. A turning point came when his plane made an emergency landing in Tucson and he slept through the whole thing, he tells Forbes: "In that moment, I realized, 'What am I doing?'" "Will that cost me tens of millions of dollars someday?" he writes. "Maybe. Life is about choices. " Reactions on his blog are mostly enthusiastic, but Jezebel notes that a woman couldn't do this without people getting concerned. On a positive note, Fortune says it may be a "step towards leveling the playing field for top executives, regardless of their gender." One reaction was definitely favorable—a blog comment from Schireson's daughter: "I'm glad you will be able to spend more time with us at home. yayyyyy."

When Today Show host Matt Lauer sat down with General Motors’ (GM) CEO Mary Barra in late June, he asked the automaker’s first female leader:

 You said in an interview not long ago that your kids said they’re going to hold you accountable for one job, and that is being a mom. Given the pressure at General Motors, can you do both well?

 Barra graciously answered the question, telling Lauer that she has a great team, a wonderful family and a supportive husband. Notably, she didn’t turn that question back on Lauer to ask how he handles his demanding work schedule at NBC and still manages to be a good father.

 Male executives almost never hear that question. MongoDB’s now-former CEO Max Schireson can attest to that.

 The head of the database company decided to step down Tuesday after asking himself how he can balance the dual demands of fatherhood and running a company.

 “As a male CEO, I have been asked what kind of car I drive and what type of music I like, but never how I balance the demands of being both a dad and a CEO,” wrote Schireson in a blog post explaining why he decided to step down as the chief executive for MongoDB.

 Women are still the focus of the “having it all” debate and questions of whether or not they can be wildly successful at both a high-powered job and day-to-day parenting. Now their male counterparts are asking the same question of themselves.

 Schireson, who helped grow the database company into a billion-dollar business, is on pace to fly 300,000 miles this year between the normal CEO travel duties and commuting from his home in Palo Alto, Calif. to the company’s New York City office.

 All that time on the road adds up to many hours and days away from his family, including three kids.

 “During that travel, I have missed a lot of family fun, perhaps, more importantly, I was not with my kids when our puppy was hit by a car, or when my son had (minor and successful, and of course unexpected) emergency surgery.”

 He credits his wife for helping to pick up the slack when he was away. Not an easy task considering her high-pressure role as a doctor and Stanford professor.

 “Friends and colleagues often ask my wife how she balances her job and motherhood,” Schireson wrote. “Somehow, the same people don’t ask me.”

 Questions like these have gnawed at women, who openly debate the value of work and family. Sheryl Sandberg has encouraged women to “lean in.” Cover articles in national magazines have delved into the minutiae of making the right choice as a mom and a professional, not to mention the countless blog posts in response to both.

 While it’s enviable that Schireson can step down as CEO to simply work “normal full time” as vice chairman, the fact that a male CEO is asking the same questions that a female CEO might ask is an important step towards leveling the playing field for top executives, regardless of their gender.

 It’s time for the “having it all” debate to move beyond gender. The math is the same, as Schireson concludes, whether you’re male or female: ||||| Juliette Kayyem, who several years ago left the Department of Homeland Security soon after her husband, David Barron, left a high position in the Justice Department, says their joint decision to leave Washington and return to Boston sprang from their desire to work on the “happiness project,” meaning quality time with their three children. (She borrowed the term from her friend Gretchen Rubin, who wrote a best-selling book and now runs a blog with that name.)

 It’s time to embrace a national happiness project. As a daughter of Charlottesville, Virginia, the home of Thomas Jefferson and the university he founded, I grew up with the Declaration of Independence in my blood. Last I checked, he did not declare American independence in the name of life, liberty, and professional success. Let us rediscover the pursuit of happiness, and let us start at home.

 Innovation Nation

 As I write this, I can hear the reaction of some readers to many of the proposals in this essay: It’s all fine and well for a tenured professor to write about flexible working hours, investment intervals, and family-comes-first management. But what about the real world? Most American women cannot demand these things, particularly in a bad economy, and their employers have little incentive to grant them voluntarily. Indeed, the most frequent reaction I get in putting forth these ideas is that when the choice is whether to hire a man who will work whenever and wherever needed, or a woman who needs more flexibility, choosing the man will add more value to the company.

 In fact, while many of these issues are hard to quantify and measure precisely, the statistics seem to tell a different story. A seminal study of 527 U.S. companies, published in the Academy of Management Journal in 2000, suggests that “organizations with more extensive work-family policies have higher perceived firm-level performance” among their industry peers. These findings accorded with a 2003 study conducted by Michelle Arthur at the University of New Mexico. Examining 130 announcements of family-friendly policies in The Wall Street Journal, Arthur found that the announcements alone significantly improved share prices. In 2011, a study on flexibility in the workplace by Ellen Galinsky, Kelly Sakai, and Tyler Wigton of the Families and Work Institute showed that increased flexibility correlates positively with job engagement, job satisfaction, employee retention, and employee health.

 This is only a small sampling from a large and growing literature trying to pin down the relationship between family-friendly policies and economic performance. Other scholars have concluded that good family policies attract better talent, which in turn raises productivity, but that the policies themselves have no impact on productivity. Still others argue that results attributed to these policies are actually a function of good management overall. What is evident, however, is that many firms that recruit and train well-educated professional women are aware that when a woman leaves because of bad work-family balance, they are losing the money and time they invested in her.

 Even the legal industry, built around the billable hour, is taking notice. Deborah Epstein Henry, a former big-firm litigator, is now the president of Flex-Time Lawyers, a national consulting firm focused partly on strategies for the retention of female attorneys. In her book Law and Reorder, published by the American Bar Association in 2010, she describes a legal profession “where the billable hour no longer works”; where attorneys, judges, recruiters, and academics all agree that this system of compensation has perverted the industry, leading to brutal work hours, massive inefficiency, and highly inflated costs. The answer—already being deployed in different corners of the industry—is a combination of alternative fee structures, virtual firms, women-owned firms, and the outsourcing of discrete legal jobs to other jurisdictions. Women, and Generation X and Y lawyers more generally, are pushing for these changes on the supply side; clients determined to reduce legal fees and increase flexible service are pulling on the demand side. Slowly, change is happening.

 At the core of all this is self-interest. Losing smart and motivated women not only diminishes a company’s talent pool; it also reduces the return on its investment in training and mentoring. In trying to address these issues, some firms are finding out that women’s ways of working may just be better ways of working, for employees and clients alike.

 Experts on creativity and innovation emphasize the value of encouraging nonlinear thinking and cultivating randomness by taking long walks or looking at your environment from unusual angles. In their new book, A New Culture of Learning: Cultivating the Imagination for a World of Constant Change, the innovation gurus John Seely Brown and Douglas Thomas write, “We believe that connecting play and imagination may be the single most important step in unleashing the new culture of learning.”

 Space for play and imagination is exactly what emerges when rigid work schedules and hierarchies loosen up. Skeptics should consider the “California effect.” California is the cradle of American innovation—in technology, entertainment, sports, food, and lifestyles. It is also a place where people take leisure as seriously as they take work; where companies like Google deliberately encourage play, with Ping-Pong tables, light sabers, and policies that require employees to spend one day a week working on whatever they wish. Charles Baudelaire wrote: “Genius is nothing more nor less than childhood recovered at will.” Google apparently has taken note.

 No parent would mistake child care for childhood. Still, seeing the world anew through a child’s eyes can be a powerful source of stimulation. When the Nobel laureate Thomas Schelling wrote The Strategy of Conflict, a classic text applying game theory to conflicts among nations, he frequently drew on child-rearing for examples of when deterrence might succeed or fail. “It may be easier to articulate the peculiar difficulty of constraining [a ruler] by the use of threats,” he wrote, “when one is fresh from a vain attempt at using threats to keep a small child from hurting a dog or a small dog from hurting a child.”

 The books I’ve read with my children, the silly movies I’ve watched, the games I’ve played, questions I’ve answered, and people I’ve met while parenting have broadened my world. Another axiom of the literature on innovation is that the more often people with different perspectives come together, the more likely creative ideas are to emerge. Giving workers the ability to integrate their non-work lives with their work—whether they spend that time mothering or marathoning—will open the door to a much wider range of influences and ideas.

 Enlisting Men

 Perhaps the most encouraging news of all for achieving the sorts of changes that I have proposed is that men are joining the cause. In commenting on a draft of this article, Martha Minow, the dean of the Harvard Law School, wrote me that one change she has observed during 30 years of teaching law at Harvard is that today many young men are asking questions about how they can manage a work-life balance. And more systematic research on Generation Y confirms that many more men than in the past are asking questions about how they are going to integrate active parenthood with their professional lives.

 Abstract aspirations are easier than concrete trade-offs, of course. These young men have not yet faced the question of whether they are prepared to give up that more prestigious clerkship or fellowship, decline a promotion, or delay their professional goals to spend more time with their children and to support their partner’s career.

 Yet once work practices and work culture begin to evolve, those changes are likely to carry their own momentum. Kara Owen, the British foreign-service officer who worked a London job from Dublin, wrote me in an e-mail:

 I think the culture on flexible working started to change the minute the Board of Management (who were all men at the time) started to work flexibly—quite a few of them started working one day a week from home.

 Men have, of course, become much more involved parents over the past couple of decades, and that, too, suggests broad support for big changes in the way we balance work and family. It is noteworthy that both James Steinberg, deputy secretary of state, and William Lynn, deputy secretary of defense, stepped down two years into the Obama administration so that they could spend more time with their children (for real).

 Going forward, women would do well to frame work-family balance in terms of the broader social and economic issues that affect both women and men. After all, we have a new generation of young men who have been raised by full-time working mothers. Let us presume, as I do with my sons, that they will understand “supporting their families” to mean more than earning money.

 I have been blessed to work with and be mentored by some extraordinary women. Watching Hillary Clinton in action makes me incredibly proud—of her intelligence, expertise, professionalism, charisma, and command of any audience. I get a similar rush when I see a front-page picture of Christine Lagarde, the managing director of the International Monetary Fund, and Angela Merkel, the chancellor of Germany, deep in conversation about some of the most important issues on the world stage; or of Susan Rice, the U.S. ambassador to the United Nations, standing up forcefully for the Syrian people in the Security Council.

 These women are extraordinary role models. If I had a daughter, I would encourage her to look to them, and I want a world in which they are extraordinary but not unusual. Yet I also want a world in which, in Lisa Jackson’s words, “to be a strong woman, you don’t have to give up on the things that define you as a woman.” That means respecting, enabling, and indeed celebrating the full range of women’s choices. “Empowering yourself,” Jackson said in her speech at Princeton, “doesn’t have to mean rejecting motherhood, or eliminating the nurturing or feminine aspects of who you are.”

 I gave a speech at Vassar last November and arrived in time to wander the campus on a lovely fall afternoon. It is a place infused with a spirit of community and generosity, filled with benches, walkways, public art, and quiet places donated by alumnae seeking to encourage contemplation and connection. Turning the pages of the alumni magazine (Vassar is now coed), I was struck by the entries of older alumnae, who greeted their classmates with Salve (Latin for “hello”) and wrote witty remembrances sprinkled with literary allusions. Theirs was a world in which women wore their learning lightly; their news is mostly of their children’s accomplishments. Many of us look back on that earlier era as a time when it was fine to joke that women went to college to get an “M.R.S.” And many women of my generation abandoned the Seven Sisters as soon as the formerly all-male Ivy League universities became coed. I would never return to the world of segregated sexes and rampant discrimination. But now is the time to revisit the assumption that women must rush to adapt to the “man’s world” that our mothers and mentors warned us about.

 I continually push the young women in my classes to speak more. They must gain the confidence to value their own insights and questions, and to present them readily. My husband agrees, but he actually tries to get the young men in his classes to act more like the women—to speak less and listen more. If women are ever to achieve real equality as leaders, then we have to stop accepting male behavior and male choices as the default and the ideal. We must insist on changing social policies and bending career tracks to accommodate our choices, too. We have the power to do it if we decide to, and we have many men standing beside us.

 We’ll create a better society in the process, for all women. We may need to put a woman in the White House before we are able to change the conditions of the women working at Walmart. But when we do, we will stop talking about whether women can have it all. We will properly focus on how we can help all Americans have healthy, happy, productive lives, valuing the people they love as much as the success they seek.

 We want to hear what you think about this article. Submit a letter to the editor or write to letters@theatlantic.com. ||||| In a blog post on his personal site Tuesday, Max Schireson, the CEO of the software company MongoDB, announced that he was leaving his position because he couldn't continue to properly run the company in New York and support his family in California.

 "Friends and colleagues often ask my wife how she balances her job and motherhood," Schireson wrote, citing recent high profile interviews with the CEO of GM or the CEO of Pepsi. "Somehow, the same people don't ask me."

 "As a male CEO, I have been asked what kind of car I drive and what type of music I like, but never how I balance the demands of being both a dad and a CEO," Schireson added, explaining that he loves spending time with his kids but doesn't love what he's missing when he's away from them because of his job. He also discussed the amount of work his wife – herself a doctor and a professor – does when he's gone.

 Schireson will remain with the company as Vice Chairman, supporting MongoDB's new CEO. In an interview with Forbes, he said that choosing to spend time with his family (which is often a code phrase people use when they've been forced out) "is not a euphemism."

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 "I hope that me telling this story in my position will help others feel more comfortable in making similar choices," Schireson told The Today Show. "And help people in senior leadership roles be more public about it."

 On his site, Schireson wrote that he's aware that this decision might put him out of the running "from some future CEO role":

 Will that cost me tens of millions of dollars someday? Maybe. Life is about choices. Right now, I choose to spend more time with my family and am confident that I can continue to have an meaningful and rewarding work life while doing so. At first, it seemed like a hard choice, but the more I have sat with the choice the more certain I am that it is the right choice.

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 The responses to his blog post are overwhelmingly positive; even his daughter wrote in to say, "I'm glad you will be able to spend more time with us at home. yayyyyy."

 It's somewhat fascinating, however, to consider what the response would be if a woman did the same thing as Schireson; she'd probably be at the receiving end of concern from other women that she was giving up her career. (Though as Schireson touches on, women who focus too much on their careers are judged just as much. Women: they can't win.). But with regards to work-life balance, men and women are struggling to each be accepted for doing the thing the other one has traditionally done without notice or praise. Maybe eventually we'll meet in the middle. ||||| Earlier this summer, Matt Lauer asked Mary Barra, the CEO of GM, whether she could balance the demands of being a mom and being a CEO. The Atlantic asked similar questions of PepsiCo’s female CEO Indra Nooyi. As a male CEO, I have been asked what kind of car I drive and what type of music I like, but never how I balance the demands of being both a dad and a CEO.

 While the press haven’t asked me, it is a question that I often ask myself. Here is my situation:

 * I have 3 wonderful kids at home, aged 14, 12 and 9, and I love spending time with them: skiing, cooking, playing backgammon, swimming, watching movies or Warriors or Giants games, talking, whatever.

 * I am on pace to fly 300,000 miles this year, all the normal CEO travel plus commuting between Palo Alto and New York every 2-3 weeks. During that travel, I have missed a lot of family fun, perhaps more importantly, I was not with my kids when our puppy was hit by a car or when my son had (minor and successful, and of course unexpected) emergency surgery.

 * I have an amazing wife who also has an important career; she is a doctor and professor at Stanford where, in addition to her clinical duties, she runs their training program for high risk obstetricians and conducts research on on prematurity, surgical techniques, and other topics. She is a fantastic mom, brilliant, beautiful, and infinitely patient with me. I love her, I am forever in her debt for finding a way to keep the family working despite my crazy travel. I should not continue abusing that patience.

 Friends and colleagues often ask my wife how she balances her job and motherhood. Somehow, the same people don’t ask me.

 A few months ago, I decided the only way to balance was by stepping back from my job. MongoDB is a special company. In my nearly 4 years at the company, we have raised $220 million, grown the team 15x and grown sales 30x. We have amazing customers, a great product which gets better with every release, the strongest team I have ever worked with, and incredible momentum in the market. The future is bright and MongoDB deserves a leader who can be “all-in” and make the most of the opportunity.

 Unfortunately, I cannot be that leader given the geography of the majority of the company in New York and my family in California.

 I recognize that by writing this I may be disqualifying myself from some future CEO role. Will that cost me tens of millions of dollars someday? Maybe. Life is about choices. Right now, I choose to spend more time with my family and am confident that I can continue to have an meaningful and rewarding work life while doing so. At first, it seemed like a hard choice, but the more I have sat with the choice the more certain I am that it is the right choice.

 In one month, I will hand the CEO role to an incredibly capable leader in Dev Ittycheria. He will have the task of leading the company through its next phase of growth (though thankfully not of commuting across the country while doing it!). I know the company will be in great hands; his skills fit our next phase of growth better than mine do. And I will be there to help (full time, but “normal full time” and not “crazy full time”) in whatever areas he needs help. More about the announcement can be found in today’s press release.

 I hope I will be able to find a way to craft a role at MongoDB which is engaging, impactful, and compatible with the most important responsibilities in my life. As great as this job has been, I look forward to creating one which is even better.

 — Max ||||| Billion-dollar database company MongoDB has announced a new CEO, outsider Dev Ittycheria, after just one year with Max Schireson at the helm. A former software CEO turned investor, Ittycheria will become president and CEO as of September 3, when Schireson will drop into a vice chairman role.

 Ittycheria joins from OpenView Partners, a middle-stage venture capital firm focused on software. Before that, he did a quick stint as a venture partner at Sand Hill Road stalwart Greylock Partners. An electrical engineer by trade, Ittycheria's managing experience comes as president of BMC Software and as cofounder and CEO of BladeLogic, a company he sold to BMC in 2008 for $900 million.

 The Palo Alto-based Schireson had been CEO of MongoDB for a year and a few months, assuming the title last January after joining the company in 2011 as president. But Schireson says his tour of duty as leader was really more the almost four years he spent in the two roles, because as he puts it, "There wasn't a heck of a lot of difference as CEO from when I was president, because everyone except [cofounder and chairman] Dwight [Merriman] had to answer to me." He had joined the company from MarkLogic, where he'd served as COO, as well as nine years as a vice president at Oracle .

 [Update]: In a call with Forbes, Schireson says that he decided to step down because of the toll imposed on him by constant travel between the company's New York City and Palo Alto headquarters and from customer visits. Spending more time with his family, the outgoing CEO says, "is not a euphemism. It's something I needed to do for my family, and there's never a convenient time."

 A tipping point for Schireson came on a long-delayed overnight flight to Austin. The CEO woke up in Tuscon to discover his flight had gone through an emergency landing and needed to replace some crew members traumatized by the experience--all while he slept, desperately trying to catch up on rest. "In that moment, I realized, 'What am I doing?'"

 Schireson's also been a CEO at times uncomfortable with the spotlight. Back in September, he wrote a blog post, "The Challenge of Being an Introverted CEO," in which he noted that he struggled to meet new employees and handle the more social aspects of the job. He reflected:

 "As for my effectiveness in running the company, perhaps I would be more effective if I were more gregarious with the team. Certainly they would like it day to day. On the other hand, I do think there are advantages to my style. In larger groups I often like to hang back and listen. One of the hardest things for a CEO as a company gets large is having good data. While I am not a magnetic outgoing leader, I think I can listen well and I have high empathy. And I think we have built a strong team and they are pointed in a good direction."

 Schireson says he's most proud of of the trust the company's gained from major customers like banks and big internet companies, but he also oversaw the company's ascent to the top of the private tech company ranks in New York City. Back in October, the company raised $150 million in October of 2013 from investors led by Fidelity Investments and with new investors Altimeter Capital and T. Rowe Price. That deal valued the company at $1.2 billion, putting it in the ranks of unicorn billion-dollar startups, and also validated its NoSQL database approach with some other tech heavyweights, as Salesforce.com , Intel Capital and Red Hat all invested alongside top venture firms Sequoia Capital and New Enterprise Associates.

 Ittycheria inherits a company with over $231 million in funding and more than 600 customers including Cisco, MetLife, MTV and Forbes, charging them annual subscription revenues per server for its database solution and additional features.

 The company once known at 10gen remains dual-headquartered in both New York and Palo Alto, where Schireson was based, with more than 400 employees across at least 8 global offices. 10gen had been founded in 2007 by Merriman, a cofounder of ad tech company DoubleClick that became the backbone of Google's online advertising offerings, as well as by ShopWiki cofounder Eliot Horowitz, now the company's CTO. Merriman also cofounded Business Insider and Gilt Groupe alongside longtime business partner Kevin Ryan and remains chairman of MongoDB.

 "We are delighted that Dev will be leading the next leg of our amazing growth," Merriman said in a press release on the news. "Max has built a world-class team that has shipped great software, raised a record amount of money from smart investors, attracted hundreds of great partners and generated millions in revenue from the world's leading companies. Dev's skills are a fantastic addition as we continue to grow our leadership in the market."

 Ittycheria brings more operations expertise than the company's two previous CEOs, both with technical backgrounds, which Schireson says will be critical for the company to continue to expand global sales. But perhaps most importantly, Ittycheria's willing to take up the bi-coastal challenge, which Schireson argues is tough on the top executive but good for customers who get local executive presences and sales reps.

 Most importantly, Ittycheria's got the spotlight from now on, as Schireson gets his wish for a future of more anonymity.

 This story has been updated with comment from MongoDB CEO Max Schireson. |||||


Summarize this article:

Paramount moves swiftly in reviewing its promotional materials for "Jack Reacher," which opens in theaters Friday.

 Hollywood continued to rejigger its publicity plans for holiday releases Monday in the wake of the school shooting in Newtown, Conn.

 Paramount has decided to make several tweaks to the marketing materials for Jack Reacher, the gritty crime-action pic starring Tom Cruise as a hard-boiled former military cop trying to prove that an alleged sniper was framed. The film opens Friday.

 VIDEO: 'Jack Reacher' Trailer: Tom Cruise Is 'Not a Hero,' But Werner Herzog Is the Villain

 The studio wouldn't officially say what the changes are, but a source confirmed that a scene of Cruise's character firing off a semi-automatic weapon is being cut from promotional spots.

 Jack Reacher, rated PG-13 and opening with sniper fire, isn't the only Christmas movie laced with violence.

 Django Unchained, opening Christmas Day, is directed by Quentin Tarantino, known for his over-the-top violence. The R-rated Django stars Jamie Foxx as a slave promised his freedom if he helps a bounty hunter (Christoph Waltz ) track down a plantation owner (Leonardo DiCaprio).

 STORY: 'Jack Reacher' Lincoln Center Screening Postponed; Pittsburgh Premiere Set for Dec. 19

 On Monday, The Weinstein Co. announced it was cancelling Tuesday night's Django premiere in Los Angeles because of the school tragedy.

 “Our thoughts and prayers go out to the families of the tragedy in Newtown, Conn., and in this time of national mourning we have decided to forgo our scheduled event," the company said in a statement, adding that it would still hold a screening for cast and crew.

 At a junket for Django on Saturday in New York, Tarantino said he is weary of defending the violence in his movies.

 "I just think there's violence in the world. Tragedies happen," the filmmaker said. "[Django} is a Western. Give me a break."

 Foxx, however, said Hollywood can't "ignore" that violence in movies has an impact. And this summer, Harvey Weinstein, an advocate for gun control, called for a summit on violence in film after the Aurora theater shooting during a midnight screening of The Dark Knight Rises.

 In scrubbing the Django premiere, The Weinstein Co. was following the cue of Paramount, which postponed Saturday's planned Jack Reacher premiere in Pittsburgh (the event has been rescheduled for Wednesday).

 FILM REVIEW: 'Jack Reacher'

 The Film Society of Lincoln Center in New York City also postponed a special screening of Jack Reacher on Monday night that was to be accompanied by a discussion with Cruise and director Christopher McQuarrie, saying it was doing so out of respect for the families of the victims.

 The Weinstein Co. declined to say whether it was changing its marketing materials for Django in the wake of the shooting.

 On Sunday, Warner Bros. used NFL football to advertise its upcoming period pic Gangster Squad. The spot was heavy on gunfire.

 Gangster Squad was supposed to open in September, but the studio pushed back the release after the Colorado shootings in order to remove a scene depicting a gunfight in a movie theater. ||||| Tarantino film ‘Django Unchained’ latest to be pulled after school massacre

 By Agence France-Presse

 Tuesday, December 18, 2012 1:26 EST

 A Hollywood premiere of notoriously violent director Quentin Tarantino’s latest film “Django Unchained” was canceled Monday, the latest such response to the Connecticut school massacre.

 A string of movies and TV shows have been pulled or postponed since Friday’s shootings, while sporting events have held moments of silence and players have worn black armbands to honor the victims, 20 of whom were young children.

 The Weinstein Company said that a premiere scheduled Tuesday in Los Angeles of “Django Unchained” – which is due to open on Christmas Day in US theaters – had been called off.

 “Our thoughts and prayers go out to the families of the tragedy in Newtown, Connecticut, and in this time of national mourning we have decided to forgo our scheduled event,” said a Weinstein Company spokesperson.

 The studio will still hold a screening for cast and crew and their friends and families, industry daily “Variety” reported.

 Tarantino is known for screen violence, in movies from 1992′s “Reservoir Dogs” to 2009′s “Inglorious Basterds.”

 In his new film, a slave-turned-bounty hunter sets out to rescue his wife from a brutal plantation owner.

 The move came after the weekend premiere of Tom Cruise’s latest movie, “Jack Reacher” – about a homicide investigator probing a trained military sniper who shot five random victims – was postponed.

 “Our hearts go out to all those who lost loved ones,” said studio Paramount, adding that it took the action “out of honor and respect for the families of the victims whose lives were senselessly taken.”

 Fox canceled a weekend red carpet event and after-party for “Parental Guidance” starring Bette Midler and Billy Crystal “in light of the horrific tragedy.”

 The studio also replaced planned broadcasts Sunday of episodes of “Family Guy” and “American Dad” to avoid any insensitivities to the massacre.

 A moment of silence was observed at National Football League (NFL) games across the country Sunday to remember those killed in the normally peaceful town of Newtown, Connecticut.

 While some events were canceled because of content, others did not appear to be.

 PG-rated “Parental Guidance” got its parental warning for some rude humor, not for violence, according to the IMDb industry website.

 Veteran crooner Barry Manilow postponed a planned Friday night show in Palm Desert, California until Sunday, saying on his website: “Perhaps this small gesture of solidarity will help support these families on this terrible day.”

 Celebrities were quick to join online expressions of shock and sympathy.

 Pop star Justin Bieber tweeted: “My prayers go out to all those suffering in this tragedy. it’s just wrong. Everyone please pray for them.”

 “God have mercy!!!! No one deserves this! Praying for the families of the victims of the Connecticut shooting!! What a Christmas it will be,” added singer Rihanna on the micro-blogging site. |||||

– Hollywood has been responding to the Newtown tragedy with a slew of cancellations, postponements, and other changes to movies: Tonight's LA premiere of Django Unchained, the latest violent film from Quentin Tarantino, has been canceled. "In this time of national mourning we have decided to forgo our scheduled event," says a Weinstein Company rep, according to the New York Times. A private screening will be held instead of a big red carpet gala. Two events related to Tom Cruise's new movie, Jack Reacher, have been postponed: last Saturday's Pittsburgh premiere as well as a Film Society of Lincoln Center screening involving Cruise. Paramount is also tweaking the marketing materials for the movie, according to the Hollywood Reporter. A source says a scene in which Cruise's character, a former military cop, uses a semiautomatic weapon is being removed from promos. Even a comedy, Parental Guidance, saw its red carpet premiere and after-party canceled over the weekend "in light of the horrific tragedy," AFP reports. The film stars Bette Midler and Billy Crystal. Also over the weekend, episodes of Family Guy and American Dad were yanked.


Here is a news article: Despite partial success, communication has remained impossible for persons suffering from complete motor paralysis but intact cognitive and emotional processing, a state called complete locked-in state (CLIS). Based on a motor learning theoretical context and on the failure of neuroelectric brain–computer interface (BCI) communication attempts in CLIS, we here report BCI communication using functional near-infrared spectroscopy (fNIRS) and an implicit attentional processing procedure. Four patients suffering from advanced amyotrophic lateral sclerosis (ALS)—two of them in permanent CLIS and two entering the CLIS without reliable means of communication—learned to answer personal questions with known answers and open questions all requiring a “yes” or “no” thought using frontocentral oxygenation changes measured with fNIRS. Three patients completed more than 46 sessions spread over several weeks, and one patient (patient W) completed 20 sessions. Online fNIRS classification of personal questions with known answers and open questions using linear support vector machine (SVM) resulted in an above-chance-level correct response rate over 70%. Electroencephalographic oscillations and electrooculographic signals did not exceed the chance-level threshold for correct communication despite occasional differences between the physiological signals representing a “yes” or “no” response. However, electroencephalogram (EEG) changes in the theta-frequency band correlated with inferior communication performance, probably because of decreased vigilance and attention. If replicated with ALS patients in CLIS, these positive results could indicate the first step towards abolition of complete locked-in states, at least for ALS.

 Despite scientific and technological advances, communication has remained impossible for persons suffering from complete motor paralysis but intact cognitive and emotional processing, a condition that is called completely locked-in state. Brain–computer interfaces based on neuroelectrical technology (like an electroencephalogram) have failed at providing patients in a completely locked-in state with means to communicate. Therefore, here we explored if a brain–computer interface based on functional near infrared spectroscopy (fNIRS)—which measures brain hemodynamic responses associated with neuronal activity—could overcome this barrier. Four patients suffering from advanced amyotrophic lateral sclerosis (ALS), two of them in permanent completely locked-in state and two entering the completely locked-in state without reliable means of communication, learned to answer personal questions with known answers and open questions requiring a “yes” or “no” by using frontocentral oxygenation changes measured with fNIRS. These results are, potentially, the first step towards abolition of completely locked-in states, at least for patients with ALS.

 Funding: The work was funded by grants from the following: Deutsche Forschungsgemeinschaft (DFG, Bi195, Kosellek, http://www.dfg.de/ ), which supported NB, UC, and BX; Stiftung Volkswagenwerk (VW, https://www.volkswagenstiftung.de/ ), which supported NB; German Ministry of Education and Research (BMBF grant No.: MOTOR-BIC (FKZ 136W0053, https://www.bmbf.de/ ), which supported NB; Baden-Württemberg Stiftung, EMOIO from the Federal Ministry of Education and Research (524-4013-16SV7196, https://www.bwstiftung.de/startseite/ ), which supported NB; Eva and Horst Köhler-Stiftung, (Berlin, http://eva-luise-und-horst-koehler-stiftung.de/ ), which supported NB; National Natural Science Foundation of China (Grant number: 61550110252, http://www.nsfc.gov.cn/publish/portal1/ ), which supported UC; and EU grant LUMINOUS (Grant number: 686764, https://ec.europa.eu/programmes/horizon202 ), which supported NB and UC. SS was supported by regular salary from San Camillo hospital in Venice, Italy. LG was supported by the intramural research program of the NINDS, NIH. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

 Data Availability: All the data pertaining to the results presented in the manuscript can be found on Zenondo. Within the manuscript, the URL corresponding to the data has been provided within the paper and its Supporting Information files.

 This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

 A single case report by Gallegos-Ayala et al. (2014) [ 42 ] used fNIRS to measure and classify cortical oxygenation and deoxygenation following the “yes” or “no” thinking of the CLIS patient in response to true or false questions, respectively. The report described a CLIS patient with ALS achieving BCI control and “yes” and “no” communication to simple questions with known positive answers or negative answers and some open questions over an extensive time period. Although it was not spontaneous and voluntary, controlled communication, it at least enabled the individual without any means of communication to transmit “yes” and “no” to questions framed by family members and/or caregivers. The result opened a venue to provide at least some means of communication to individuals in CLIS who are otherwise left communicationless. Hence, an extensive study was performed on four ALS patients in CLIS to train them to communicate “yes” and “no.” In the present study, which is the first of its kind, fNIRS-based BCI was used for binary communication in four ALS patients in CLIS. The fNIRS-based BCI was employed successfully to train patients to regulate their frontocentral brain regions in response to auditorily presented questions. After training a classifier separating “yes” from “no” answers for several days, the patients were given feedback of their affirmative or negative response to questions with known answers and open questions over weeks.

 Because none of the BCI techniques outlined above are able to provide viable means of communication [ 5 ], the patients in CLIS due to ALS, without any muscular control, are rendered communicationless. We are then faced with the dilemma of defining communication in CLIS. Does it only mean to express one’s feelings, thoughts, and intentions in a fluent, automatized manner? Or, alternatively, does it mean to convey one’s intent or one’s feelings and thoughts to questions? As mentioned, all the existing BCIs rely on two elements: first, the neuroelectric signal (EEG or ECoG) control and second at least an intact eye muscle; the neuroelectric signal–based BCI did not work so far in patients in CLIS, in which eye movement control is lost.

 In a meta-analysis of the scientific literature of all ALS patients in CLIS [ 13 ], it was found that none of the existing techniques such as the P300 event-related brain potential (ERP), SCP, frequency analyses of various frequency bands of the electroencephalogram (EEG), and invasive electrocorticogram (ECoG) recordings [ 31 ] allowed reliable and meaningful communication with BCI. All BCI procedures mentioned above were based on effortful and explicit (conscious) voluntary control of a neuroelectric brain response such as learning with feedback and reward, during which patients learned to increase or decrease amplitudes of the SCP [ 12 ] to produce event-related desynchronization (ERD) of the central alpha-rhythm [ 32 ] to focus attention on a visually or auditorily presented sequence of letters in order to select a desired letter with the brain response. P300 [ 21 , 22 , 24 ] is also used in a similar manner to visually select a desired letter. The required activation of explicit-voluntary (controlled) attention in these BCI tasks, none of them resulting in stable learning of brain-based communication, prompted us to propose the theoretical psychophysiological notion of “extinction of goal directed cognition and thought” [ 13 ] in complete paralysis with otherwise intact cognitive processing. This theoretical account—certainly highly speculative in light of the complete lack of data about cognition and inner speech and motivational processing in CLIS—we substantiated with the failure to replicate initial positive reports about instrumental (volitional) [ 33 , 34 ] learning of autonomic responses in the curarized (paralysed) rat. The persistent incapability to replicate these experiments suggests that intact or partially intact motor functions and somatic-motor system mediation of autonomic functions (i.e., subtle postural or muscle tension changes to affect the desired physiological changes) is a mandatory requirement for instrumental learning and control of physiological functions. Theoretical views of this problem, like the one proposed, are not new but were expressed already in Greek philosophy by Aristotle [ 35 ] and by the philosophers of volition, particularly Arthur Schopenhauer in his monumental account of “Die Welt als Wille und Vorstellung” [ 36 ] (The World as Volition and Imagery) and during twentieth century learning theory [ 37 , 38 ]. Conscious of the fact that it is problematic to justify a theory on negative facts (lack of instrumental learning in the curarized rat and missing BCI control of BCIs requiring controlled attention in CLIS), we argue that [ 27 ] classical reflexive conditioning and learning might circumvent volitional effort in instrumental control. Thus, an experimental procedure involving processing of overlearned (“automatic”) questions (i.e., “Berlin is the capital of France,” “You are in pain”) asking for automatic cognitive processing only may fulfill this criterion. Thinking but not voluntary imagining affirmative “yes” and negative “no” to overlearned questions occurs effortlessly, such as automatic nodding of the head in a conversation: the extensive literature (mostly Russian) on semantic classical conditioning [ 39 ] and implicit attention and memory [ 40 ] provides ample support of this notion. However, for the case of patients in CLIS, one is faced with the dilemma that we cannot expect a learning curve characteristic of skill learning (usually exponential) or classical conditioning in a BCI task asking for overlearned “yes” and “no” responses as used on the present BCI system [ 29 , 30 ]. Patients were confronted in their lifetime with these questions (“Berlin is the capital of France”) before entering (or on the verge of) CLIS, and we can assume with certain confidence that no further learning at the time of assessment with the BCI is necessary and thus no learning curve can be expected. The same holds true for personal questions (“Your husband’s name is Joachim”). Thus, at an experimental level, it remains difficult to prove the speculation of intact classical conditioning but lack of instrumental voluntary learning in CLIS patients involved in a BCI task after entering CLIS. Only one patient in the literature [ 31 ] using an electrocorticographic-based BCI before and after transitioning from LIS to CLIS was published. This patient was unable to communicate with the BCI after entering CLIS. However, observation of a single case cannot serve as strong evidence comparable to the animal experiments [ 33 , 34 ] using curarization for the creation of reversible paralysis. We are also aware of the fact that a single case of a cognitively intact CLIS patient or curarized organism learning to instrumentally drive a BCI disproves our hypothesis. Experimental descriptions of patients with ALS or subcortical stroke in locked-in state (LIS) or who are severely paralysed using spiking frequency changes of motor neurons to move a robotic arm [ 10 , 11 , 41 ] cannot disprove our account. Patients in those studies [ 10 , 11 , 41 ] still had intact motor control of eye movements and some remaining muscles and thus could use the remaining muscular forces (somatomotor mediation) for instrumental learning and BCI control.

 Brain–computer interface (BCI) represents a promising strategy to establish communication with paralyzed ALS patients [ 5 – 7 ], as it does not need motor control. BCI research includes invasive (implantable electrodes on or in the neocortex) [ 8 – 11 ] and noninvasive means, including electroencephalography [ 12 , 13 ], functional magnetic resonance imaging (fMRI) [ 14 ], and functional near-infrared spectroscopy (fNIRS) [ 15 ], to record brain activity for conveying the user’s intent to devices such as simple word-processing programs [ 12 ]. The first BCI for communication in ALS patients with intact eye muscles was demonstrated by Birbaumer et al. (1999) [ 12 ]. With at least intact eye muscles and the rest of the body paralyzed, the condition is known as locked-in state (LIS) [ 4 ]. Since then, several invasive and noninvasive BCIs have been developed for communication in ALS patients. Noninvasive methods, namely slow cortical potential (SCP)-BCI [ 12 , 16 , 17 ], sensory motor rhythm SMR-BCI [ 18 – 20 ], and P300-BCI [ 21 – 24 ], have been utilized more frequently than invasive methods [ 25 – 27 ] for communication in people with ALS [ 6 , 12 , 27 – 30 ]. Irrespective of the types of BCI, during the BCI session patients selected letters or words after learning self-regulation of the particular brain signal or by focusing their attention to the desired letter or a letter matrix [ 21 , 23 ], and the attention-related brain potential selects the desired letter.

 Communication is the process of expressing and sharing feelings, thoughts, and intentions with one another by verbal and various nonverbal means. Communication skills appear automatic but can pose severe challenges to individuals suffering from motor neuron disorders. The most devastating of motor neuron diseases is amyotrophic lateral sclerosis (ALS) [ 1 ], which is progressive and renders an individual motionless, severely affecting his or her communication ability [ 2 ]. As the disorder progresses, it destroys the respiratory and bulbar functions, forcing the individual to make vital decisions. If they opt for life and accept artificial respiration, they can no longer communicate verbally, and assistive communication devices that rely on nonverbal signals such as finger movement and gaze fixation are then used for communication [ 3 ]. In ALS, the disorder progresses in most patients until the patient loses control of the last muscular response, usually the eye muscles, a condition known as completely locked-in state (CLIS) [ 4 ].

 The correlation analysis between fNIRS classification accuracy and low-frequency bands’ (those more related to vigilance) mean power revealed some interesting results (see S1 Table , section B). In three (G, B, and W) out of four patients, the median of the negative averaged correlation between low-theta band mean power and fNIRS classification accuracy was significantly different from zero (patient G: r = –0.365; patient B: r = –0.264; patient W: r = –0.386; all p < 0.05). However, in patient F, who had the longest time period in CLIS, the median of the positive averaged correlation between delta and high-theta band mean power and fNIRS classification accuracy was significantly different from zero (delta: r = 0.233; high-theta: r = 0.213; all p < 0.05). The low-frequency bands’ mean power distribution medians of successful and unsuccessful days (i.e., days with classification accuracy above chance-level threshold were considered successful) was further investigated for each patient to ascertain the difference, if any. In patient G, the low-theta band mean power of successful days was significantly smaller than that of unsuccessful days (p < 0.05). In patient B, the high-theta band mean power of successful days was significantly smaller than that of unsuccessful days (p < 0.05). This strengthens the above results of lower-frequency bands’ dominance for more unsuccessful performance. Additional details are provided in the Results section of S1 Text and in S1 Table .

 The patients showed the following stable dominant frequencies: F, 6.75 Hz; G, 6.25 Hz; B, 7 Hz; and W, 8 Hz. Power spectrum density of electroencephalographic signals corresponding to "true/yes" and "false/no" sentences’ ISI acquired from channel FC6 is shown in S1 Fig . The middle-frequency bands’ (high-theta, low-alpha, and high-alpha) mean power comparison between "true/yes" and "false/no" sentences’ ISI revealed no main effects of conditions and channels in any patient (all p > 0.05). The middle-frequency bands’ (high-theta, low-alpha, and high-alpha) spectral features comparison between sentence presentation interval and sentences’ ISI revealed some main effects of the intervals factor, as reported in S1 Table , section A. In two (G and B) out of four patients, a smaller low-alpha band “power variability” in the sentences’ ISI compared to the sentence presentation interval was found (p < 0.05). In patient W, a higher high-theta, low-alpha, and high-alpha bands’ mean power in the sentences’ ISI compared to the sentence presentation interval was found (ISI was synchronized compared to sentence presentation). Patient F did not show any significant difference in the middle-frequency bands’ mean power and “power variability” (all p > 0.05). See Results section of S1 Text for details.

 The results of ANOVA and post hoc t-test (see Table 1 , row G, H, I, and J) further emphasize a significant difference between the classification accuracy of O 2 Hb versus EEG and O 2 Hb versus EOG, with no significant difference between EEG and EOG. There is one exception in the case of patient W, as no significant difference was found between the classification accuracy of O 2 Hb versus EOG. Patient W (23 y of age) suffering from juvenile ALS with an extremely rapid disease progression (2 y from diagnosis to CLIS) was not asked open questions because of the supposedly difficult emotional state at that early stage of BCI communication but continues to train the BCI at present.

 ( A) Number of days with CA above chance level; (B) number of delivered sentences with CA above chance level; (C) maximum chance-level upper limit, calculated using the metric described in BCI effectiveness metric section; and (D) mean and standard deviation of CA above chance level, obtained using the fNIRS, EEG, and EOG signal data for patients F, G, B, and W. For the training sessions, the CA is reported for fNIRS, EEG, and EOG signals. For feedback and open question sessions, CA is only reported for the fNIRS signal because the feedback was provided using only the fNIRS signal as a result of superior CA of the fNIRS signal during the training sessions as compared to EEG and EOG signals. Table 2 data is located at https://doi.org/10.5281/zenodo.191884 ; https://doi.org/10.5281/zenodo.191887 ; https://doi.org/10.5281/zenodo.191891 ; https://doi.org/10.5281/zenodo.191899 .

 Linear SVM CA across “training sessions—offline CA” (histogram in grey), “feedback sessions—online CA” (green dot), and “open question session—online CA” (plus sign in red), obtained using (A) relative change in O 2 Hb, (B) EEG, and (C) EOG data. The classification accuracy reported here is daywise, as all the “training sessions” in a day were used to calculate the average classification accuracy of all the “training sessions” in a day. In the figure panels A, B, and C, the x-axis is the number of days and the y-axis is the classification accuracy. The solid black and dotted horizontal lines represent the chance-level threshold calculated using the metric described in the BCI effectiveness metric section for “training sessions” and “feedback sessions,” respectively. Since the feedback during the feedback and open question sessions was provided using the O 2 Hb, the online CA of the feedback and open question sessions is reported only for the fNIRS data. Fig 2 data is located at https://doi.org/10.5281/zenodo.191884 .

 The support vector machine (SVM) classifier’s classification of true sentences as true, false sentences as false, true sentences as false, and false sentences as true was used to calculate the false positive rate (FPR) and true positive rate (TPR) for each training and feedback session and also for all the training sessions and feedback sessions separately for each patient. FPR and TPR was plotted to obtain the receiver operating characteristic (ROC) curve of the binary SVM classifier during training and feedback sessions for each patient, as shown in S2 Fig , S3 Fig , S4 Fig and S5 Fig for patients F, G, B, and W, respectively. The change in oxygenated hemoglobin (O 2 Hb), EOG, and EEG power spectrum in response to true and false questions, obtained from the frontocentral region of the brain, across all the sessions from each patient was used to determine the SVM classification accuracy of "true/yes" and "false/no" answers. Successively, the daywise CA (i.e., averaging CA of all sessions in a single day) of each patient was compared to the adjusted chance-level threshold (described in BCI effectiveness metric section), as shown in Figs 2 , 3 , 4 and 5 for patients F, G, B, and W, respectively, and Table 2 . The offline CA is reported using O 2 Hb, EEG, and EOG signals for training sessions, while online CA is reported using only O 2 Hb for feedback and open question sessions because feedback was provided online only using the O 2 Hb signal. The answering concordance between semantically paired questions ("Paris is the capital of Germany," "Paris is the capital of France"), expressed as the percentage of concordant answers over pairs' repetition, was as follows: F, 68%; G, 67%; B, 67%; W, 70%. Thus, the semantic concordance rate (SCR) ranges from 67 to 78% (see S12 Table ). Median values of SCR are significantly different from 50% (all p < 0.0001), in which 50% is the SCR expectation of a random classifier.

 Total number of (A) training, (B) feedback, and (C) open question sessions performed by each patient. The total number of sessions averaged and degrees of freedom used to perform t-tests between the true and false sentences’ ISI corresponding to (D) O 2 Hb, (E) EEG, and (F) EOG signals. (G) ANOVA using support vector machine (SVM) classification accuracy (CA) of O 2 Hb, EEG, and EOG signals. Post hoc t-test performed between (H) O 2 Hb versus EEG, (I) O 2 Hb versus EOG, and (J) EEG versus EOG classification accuracy. Note that each session contains 20 questions: 10 asking for a “yes” and 10 semantically equivalent questions asking for a “no” answer.

 Fig 1 illustrates the change in O 2 Hb during “true/yes” sentences’ ISI—which is significantly different from the “false/no” sentences’ ISI—as corroborated by the t-test performed between the averages of true and false sentences’ ISI using the relative change in O 2 Hb across the four patients (p < 0.05), shown in Table 1 , row D. The same analysis performed using the EEG signals in the time domain across all the training sessions showed no significant differences (p > 0.05) between the true and false sentences’ ISI across each patient, as shown in Table 1 , row E. The eye movements measured with an electrooculogram (EOG) (vertical or horizontal; patients were free to use any direction) for patients F, G, B, and W while they were performing the “ja” (German word for yes) or “nein” (German word for no) thinking task showed no significant difference in the eye movements between the true and false sentences’ ISI for all patients, confirmed by the t-test (all p > 0.05), as shown in Table 1 , row F, and S1B Fig .

 (A) Patient F, (B) patient G, (C) patient B, and (D) patient W. (E) Channel configuration: Eight sources and eight detectors placed on the frontocentral brain region translated into 20 channels, 10 on each side of each hemisphere. For clearly displaying the relative change in O 2 Hb, 10 channels on each side of hemisphere were further subdivided in groups of 5 channels—i.e., 20 channels were divided into four groups, each consisting of 5 channels. In each subplot, the x-axis is time in seconds and the y-axis is relative change in O 2 Hb, and the five different colored lines correspond to relative change in O 2 Hb across 5 different channels, as depicted in the channel configuration map. Fig 1 data is located at https://doi.org/10.5281/zenodo.192386 ; https://doi.org/10.5281/zenodo.192388 ; https://doi.org/10.5281/zenodo.192390 ; https://doi.org/10.5281/zenodo.192391 .

 In patients completely motionless over a period of years with restricted vision because of eye muscle paralysis and compromised vision because of drying and reduced or absent afferent input from the sensorimotor system, reduced vigilance measured with EEG and an irregular sleep–wake cycle was documented by Ramos et al. (2011) [ 31 ] and Soekadar et al. (2013) [ 54 ]. De Massari et al. (2013) [ 45 ] have shown that reduction of P300 amplitude across the BCI paradigm presentation predicted negative performance, again suggesting excessive loss and excessive variation of wakefulness and attention as a major limiting factor for BCI applications in such severely compromised patients. Thus, we modified the existing fNIRS–BCI–system in a hybrid EEG–fNIRS–BCI, with the EEG allowing online corrections of excessive reduction of vigilance indicated by appearance of delta and low-theta periods. This new hybrid system should allow further improvement of communication in CLIS.

 Multielectrode EEG recordings used simultaneously with the fNIRS system and quantitative source analysis of the different frequency bands at different sites are necessary to clarify these questions. For the study reported here, only portable devices and a few EEG channels could be used in the interest of the bedside, home-based strategy selected. Thus, our interpretation of the EEG frequency bands’ variations remains speculative.

 For a robust validation of the BCI binary communication system in CLIS, two main unsolved questions remain: (i) the physiological identification of the cognitive processes underlying the listening to “yes–no” questions and the answerer’s mental state and (ii) the online identification of decreased vigilance states that are detrimental (lowering performance) for BCI binary communication purposes, such as decreased alertness, drowsiness, and sleeping.

 Three patients (G, B, and W) showed a negative averaged correlation between low-theta band mean power and fNIRS classification accuracy [ 53 ], meaning the smaller the low-theta band mean power, the higher the performance, except in patient F, who has been in CLIS for more than 4 y. The correlations analysis between daywise classified BCI performance and low-frequency bands across all intervals and all electrodes for each patient separately gave consistent and highly significant results (see Results section of S1 Text for details). The binary communication performance worsened with lower frequencies in two patients (G and B) as predicted. The number of days for patient W was limited (i.e., 6 d), thus it is quite unlikely to expect a significant difference in low-frequency bands’ mean power for successful and unsuccessful days (see S1 Table , section B). Decrease in vigilance reflected in slow frequencies impedes BCI performance and communication. Patient F, who had an extremely long history of CLIS without any communication over the years, showed a positive correlation in the delta and high-theta band with performance. She was the patient with very slow dominant frequency during rest, and it may be speculated that in such a deprived brain, superposition of delta and high-theta frequency represent a sign of increased attention and focus. For instance, low-theta band mean power can be used in future BCIs to stop a BCI session or to avoid the presentation of the sentences and/or questions during decreased vigilance.

 The unreliable discrimination between "true/yes" and "false/no" sentences’ ISI by means of EEG signals (see Results section of S1 Text for details) is consistent with the results of a very similar auditory paradigm used for discriminating delayed, conditioned brain responses and tested in fourteen healthy participants [ 46 ]. However, with the exception of patient F, the comparison of middle-frequency bands’ spectral features (averaged across days) between sentence presentation interval and sentences’ ISI confirms the fact that two different states of arousal were present during sentence presentation and sentences’ ISI (see Results section of S1 Text for details). We cannot infer about the “qualia” of the two specific brain states occurring during listening to “yes–no” questions and executing the answers mentally, but at least we can state that the two mental states were different, meaning that differential cognitive processing occurred during the BCI task [ 47 , 48 ]. We do not have a physiologically plausible explanation as to why fNIRS responses to “yes” and “no” are different, as they are in three patients showing oxygenation increase during the answering interval (ISI) for “yes” responses with negligible topographical differences and oxygenation decrease during negative answers, again without topographical differences throughout the frontal cortical area. Only the very young patient W, with an extremely rapid course of the disease and a strong genetic variant, shows a variable fNIRS pattern with different slow oscillatory oxygenation changes between “yes” and “no” answering periods. In an animal study with nonhuman primates [ 49 ], we identified oxygenation increase as highly correlated with nearby recorded multiunit activity. Assuming a similar situation in the human brain, a “yes” answer may indicate a more coherent and more active brain state, probably supporting cellular associative binding [ 50 – 52 ] more readily than negative answering states. However, such a generalization remains highly speculative.

 Four patients in CLIS communicated with frontocentral cortical oxygenation-based BCI with an above-chance-level correct response rate over 70% during a period of several weeks. The performance of the binary SVM classifier across all the patients, except a few training sessions of patient B, was above chance level. None of the sessions were eliminated in the analysis, and only very few sessions had to be interrupted because of life-saving measures such as sucking saliva; thus, no bias for selecting “successful” sessions incriminates the results. Correct response rate for feedback and open questions sessions, as judged by the criteria mentioned in the Material and Methods section (Experimental Procedures), exceeded 75% in three out of four patients (F: 78.6%; G: 78.8%; B: 75.8%). Patients F, G, and B answered open questions containing quality of life estimation repeatedly with a “yes” response, indicating a positive attitude towards the present situation and towards life in general, as reported in larger samples of ALS patients [ 43 , 44 ]. Repeated presentation of an open question is necessary to ascertain the validity of the answer. From the ROC curve of each patient, it can be deduced that if the patient answers a question seven out of ten times with the same answer, then we can be sufficiently certain of the answer if the questioning is repeated over a long time period as done here. Correct classification of “yes” and “no” answers given mentally through fNIRS exceeded classification of EEG oscillations from 0–30 Hz and vertical and horizontal EOG classification. However, despite the absence of reliable eye communication in all patients as the inclusion criteria in the study and by the definition of CLIS condition, EOG classification was at some sessions, albeit rarely, above chance, mainly in patient W. Nonetheless, the inability of the social environment to perceive them and their instability and the eye tracker’s failure to use them for communication [ 45 ] prevents the use of this physiological signal.

 Materials and Methods

 The Internal Review Board of the medical faculty of the University of Tubingen approved the experiment reported in this study, and the patients’ legal representative gave informed consent for the study with permission to publish the results and show the face of patients in the publication. The study was in full compliance with the ethical practice of medical faculty of the University of Tubingen. The clinical trial registration number is ClinicalTrials.gov Identifier: NCT02980380. At the time of this study, prospective clinical trial registration was not mandatory for nonpharmacological studies; it was therefore registered retrospectively.

 Instrumentation A continuous wave (CW)-based fNIRS system, NIRSPORT (NIRX), which performs dual-wavelength (760 nm and 850 nm) CW near-infrared spectroscopic measurement at a sampling rate of 6.25 Hz, as shown in in Fig 6A, was used. The NIRS optodes were placed on the frontocentral regions as shown in Fig 6B. During the BCI sessions, the EEG was also recorded with a multichannel EEG amplifier (Brain Amp DC, Brain Products, Germany) from ten Ag/AgCl passive electrodes mounted on the head cap. Six electrodes (FC5, FC1, FC6, CP5, CP1, and CP6) were used to acquire EEG signals and four electrodes were used to acquire the vertical and horizontal EOGs. The signals were bandpass filtered using a finite impulse response filter with a bandpass of 0.5–30 Hz. The EOG was filtered with different bandpass filters (0.5–3.5 Hz, 0.5–10 Hz, and 0.5–30 Hz), but none of these filters led to significant differences of neurophysiological patterns related to the ocular activity. Question- or response-related eye movements were not detected in any of the patients over the whole time period of many weeks. Each EEG channel was referenced to an electrode on the right mastoid and grounded to the electrode placed at Fz location of the scalp. Electrode impedances were kept below 10 kΩ and the EEG signal was sampled at 500 Hz. During all BCI sessions, the spontaneous EEG was visually controlled by one of the authors (NB or BX) to avoid longer periods of slow-wave sleep during the BCI evaluation. A BCI session was initiated only if the EEG was free of high-amplitude slow activity below 4 Hz. PPT PowerPoint slide

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 larger image TIFF original image Download: Fig 6. The procedure and flow diagram of the brain–computer interface (BCI) for communication in ALS patients. (A) The continuous wave-based portable NIRX NIRSport instrument. The device consists of eight near-infrared light sources (highlighted in red), eight detectors (highlighted in green), and the NIRS data acquisition hardware is highlighted in yellow. (B) Depicts the placement of sources and detectors (optodes) on the frontocentral region of the scalp (blue). Four sources (highlighted in red) and four detectors (highlighted in green) were placed on each hemisphere to form a channel. https://doi.org/10.1371/journal.pbio.1002593.g006

 Patients Patient F (female, 68 y old, completely locked-in state) was diagnosed with bulbar sporadic ALS in May 2007, was diagnosed as locked-in in 2009, and was diagnosed as completely locked-in May 2010, based on the diagnoses of experienced neurologists. She has been artificially ventilated since September 2007, fed through a percutaneous endoscopic gastrostomy tube since October 2007, and is in home care. No communication with eye movements, other muscles, or assistive communication devices was possible since 2010. Further details of this patient are described in Gallegos-Ayala et al. (2014) [30]. Patient G (female, 76 y old, CLIS) was diagnosed with bulbar ALS in 2010. She lost speech and capability to walk by 2011. She has been fed through a percutaneous endoscopic gastrostomy tube since September 2011, artificially ventilated since March 2012, and is in home care. She started using assistive communication devices employing one finger for communication in February 2013. Later, she was diagnosed with degeneration of vision because of cornea defects in September 2013. After the failure of the finger-communication device, an attempt was made to communicate using eye tracking in early 2014. She stopped communicating with the eye in August 2014, before the BCI was introduced, and an attempt was made to communicate with the subtle twitch of an eye lid, which was not reliable. The husband and caretakers declared no communication with her since August 2014. Patient B (male, 61 y old, CLIS) was diagnosed with nonbulbar ALS in May 2011. He has been artificially ventilated since August 2011, fed through a percutaneous endoscopic gastrostomy tube since October 2011, and is in home care. He started communicating with a speech device in his throat from December 2011, which ultimately failed, and he started using the MyTobii eye-tracking device in April 2012. He was able to communicate with MyTobii until December 2013, after which the family members attempted to communicate by training him to move his eyes to the right to answer “yes” and to the left to answer “no,” but the response was variable. No communication was possible since August 2014. Patient W (female, 24 y old, locked-in state on the verge of CLIS) was diagnosed with juvenile ALS in December 2012. She was completely paralyzed within half a year after diagnosis and has been artificially ventilated since March 2013, fed through a percutaneous endoscopic gastrostomy tube since April 2013, and is in home care. She was able to communicate with eye tracking from early 2013 to August 2014 but was unable to use the eye-tracking device after the loss of eye control in August 2014. After August 2014, family members were able to communicate with her by training her to move her eyes to the right to answer “yes” and to the left to answer “no” questions until December 2014. In January 2015, eye control was completely lost, she tried to answer yes by twitching the right corner of her mouth, that too varied considerably, and parents lost reliable communication contact. All four patients reported in this manuscript were enrolled consecutively. Patients’ family approached us to get enrolled in the study because of the past work and public appearance of the corresponding author. Patients were never screened and excluded for this study. The only criterion for the inclusion in this study was that the patient should be in completely locked-in state (CLIS) or on the verge of CLIS, and family members could not communicate with eye movements or any other response with the patient. The CLIS state was then verified with confirmation of the attending neurologist, EOG recordings, and video recordings of the families’ failures to achieve contact with the patient.

 Experimental Procedures The schematic depicting the experimental procedure, acquisition, and analysis of fNIRS and EEG data during BCI sessions is shown in Fig 6. An auditory paradigm was employed to (a) train patients on questions with known answers, termed as training sessions; (b) give feedback on questions with known answers, termed as feedback sessions (i.e., “Your husband’s name is Joachim,” and after classification during ISI: “your answer was recognized as ‘yes’/‘no’); and (c) answer open questions, termed as open question sessions (“You have back pain”). Known questions are personal questions based on patient’s biography. For every known question with a clear “yes” answer, a semantically related question with a clear “no” answer was constructed and vice versa; for example, “You were born in Berlin” and “You were born in Paris.” Patients were asked to think “yes” or “no” answers and, if possible, also to use their previously successful eye movements. They were explicitly instructed not to imagine the answer or visually or auditorily imagine the word (i.e., as a visual or sound form) “yes” or “no”. Open questions are general questions related to quality of life and questions of caretakers whose answers can only be known by the patient. A total of at least 200 known questions and 40 open questions were constructed for each patient with family members before the initiation of the BCI study. Each patient was visited for 4 to 5 d in a month, except patient W. Three to four sessions were performed each day depending upon the health condition reported by the caretakers of the patient. Every session lasted for 9 min, and a session in progress was terminated extremely rarely (i.e., if removal of saliva became urgent). In such a rare event, the session was started again. Since each session lasted for 9 min, the caretaker or the family member was always instructed to take care of the needs of the patient before the start of the session, and the session was always started with the permission of the caretaker or the family member. A session, once in progress, was never terminated for patients F, G, and W. For patient B, a session was terminated while in progress three times because of removal of saliva, and the data were not included in any kind of analysis. Acoustically presented instructions about the procedure were given repetitively before each training, feedback, and open questions sessions, allowing patients to recall and consolidate the required task to listen and answer mentally. Each BCI session started with training sessions, during which the patients were instructed to listen to 20 personal questions (with known answers) consisting of 10 true and 10 semantically equivalent false sentences. The sentences were presented randomly in such a way that two semantically related questions never played one after another. Family members were always present throughout the BCI session, and they never prompted the patient to answer the question. Complete pin-drop silence was maintained during the session, and only the recorded sentences were presented via audio presentation software connected to sound box with the voice of a family member or caregiver. Patients were asked to think “ja, ja…” (German for “yes”) and “nein, nein…” (German for “no”) for 15 s during the ISI until they heard the next sentence after an interval of 5 s of rest, as shown in Fig 6. After the end of each session, the fNIRS feature necessary to differentiate between “yes” and “no” answers during ISI was extracted and classified. Only training sessions were performed during the first few days, and upon several successful training sessions (as described below in BCI effectiveness metric section), the online feedback session was performed. During training sessions, both the patient and the algorithm were trained. Patients learned to mentally answer the question, and the algorithm learned to classify the “yes” and “no” fNIRS pattern of a particular patient. This kind of “mutual learning” seems important to optimize the “yes” versus “no” classification outcome and to customize and/or adapt the BCI system to each individual patient. At the end of each training session with 20 sentences (questions), patients were told the average classification accuracy of the session (calculated using the SVM classifier) to motivate and help patients in learning. In the course of an online feedback session, patients were presented the known questions as described above, but now at the end of the 15 s ISI they were given auditory feedback of accuracy, during which the computer said, “Your answer was recognized as yes” or “Your answer was recognized as no” depending upon the question (all sessions were videotaped and are available on request). Feedback to strengthen the conditioned response was provided only if the classification accuracy was greater than the chance-level upper limit to guide the conditioned learning toward meaningful answers and to avoid frustration by negative feedback already at the beginning of a daily session. Feedback was driven by the fNIRS classifier, calculated using the data acquired during the training sessions. After successful training and feedback sessions, the patients were presented with open questions, during which they were always given the auditory feedback of their answer. The validity of answers to open questions can only be estimated by (a) face validity (i.e., questions of pain in the presence of an open wound); (b) stability over time; (c) external validity, estimated by family members and caretakers; and (d) internal validity between questions (i.e., the concordance between the answer to “I love to live” with the answer to “I rarely feel sad” [presented to all patients—except W—regularly]). Table 1, rows A, B, and C enumerate the total number of training, feedback, and open questions sessions performed by each patient, respectively. Patient W received no open questions because of low classification accuracy, which we and the parents attributed to her emotional state distracting her from concentrating on the responses because of the short time period of adaptation to the CLIS.

 BCI Effectiveness Metric The binary BCI system effectiveness and robustness depends on its capability of correctly classifying the neurophysiological correlates of “yes” and “no” answers to true and false questions. The proposed true and false questions have two possible outcomes only, which are equally distributed with a probability of 0.5. To ensure that the classification of “yes” and “no” answers is not at chance-level, a reliable metric has to be used. Based on binomial distribution theoretical background, Müller-Putz et al. [59] defined a metric for experimental procedures with a binary outcome and multiple repetitions to determine the chance-level threshold above which the classification accuracy results can be considered as not resulting from chance. Because type and number of questions (personal questions with known answers and open questions) are partly different over days (i.e., the experimental conditions were different) the chance-level threshold was calculated on a daily basis. The daily-based chance level was computed using the formulas described in Müller-Putz et al. [59] and by taking into account the number of true and false sentences presented in a single day to each patient.

 Online Data Analysis The fNIRS data was acquired online throughout all the sessions, namely training, online feedback, and open question sessions. The fNIRS data acquired online was normalized, filtered using different bandpass filters (0.0016–0.3), (0.01–0.3) and (0.02–0.3) and processed using modified Beer–Lambert law [60,61] to calculate the relative change in concentration of oxyhemoglobin (O 2 Hb) and deoxyhemoglobin (RHb). The choice of bandpass filter had no effect on the waveforms of signal. The relative change in O 2 Hb computed online during each session was used to train a SVM classifier model. The mean of relative change in O 2 Hb across each channel was used as a feature to train the SVM model through a 5-fold cross-validation procedure. In this study, only the relative change in O 2 Hb was used, as after the end of sessions with known answers it was observed that O 2 Hb provided stable and higher cross-validation classification accuracy than RHb. In an invasive animal study with nonhuman primates, we have also measured a superior covariation of oxygenation changes compared to deoxygenation, with intracortically recorded neural activity [49] supporting this clinical observation. Since the classification accuracy achieved was higher for O 2 Hb, the SVM model generated using O 2 Hb was used to provide online feedback for known as well as open questions sessions. If the classification accuracies for at least three consecutive “training” sessions with questions with known answers were greater than the chance-level threshold, a new model was generated using the relative change in O 2 Hb across three training sessions to give online feedback. During an online feedback session, fNIRS data acquired online corresponding to each ISI was processed to obtain the relative change in O 2 Hb, as described above, across all the channels. The mean of the relative change in O 2 Hb across all the channels was used as test feature to map onto model space. Upon mapping of this test feature onto the model space, the SVM predicted (called predict label) the side of the hyperplane the test feature fell on. Depending on the value of the predict label, appropriate feedback was provided to the patient: if the predict label was 0, the patient was given feedback that his or her answer was recognized as “no,” and if the predict label was 1, the patient was given feedback that his or her answer was recognized as “yes.”

 Offline Data Analysis fNIRS provides three different signals: oxyhemoglobin (O 2 Hb), deoxyhemoglobin (RHb) and total hemoglobin (THb) [60,61]. As mentioned in the section Online data analysis, since the classification accuracy achieved was higher for O 2 Hb, only the results from the offline processing of O 2 Hb data will be shown along with the EEG and EOG data. The relative change in O 2 Hb, EEG, and EOG data were processed offline to determine: a). The statistical difference in the particular physiological signal (O 2 Hb, EEG, and EOG) during the ISI of true (yes) and false (no) sentences (in the time domain). To ascertain the difference between the averaged ISI of true and false sentences, t-tests were performed. t-test was performed separately for O 2 Hb, EEG, and EOG signals acquired from all the sessions and across all the channels in a session, averaged over many sessions varying slightly between patients. Furthermore, t-tests were also performed for each session between the ISI of all the ten true sentences and all the ten false sentences (“Berlin is the capital of France,” “Berlin is the capital of Germany”) across different channels in a session. b). The statistical difference in the offline classification accuracy of the relative change in O 2 Hb, the EOG signal, and the EEG signal power spectrum during ISI corresponding to true and false sentences. For the EEG, frequencies between 0 and 30 Hz, estimated by Welch’s method [62], were used for classification and statistical testing. ANOVA and post hoc t-test were used. c). The statistical difference of frequency bands’ (i.e., delta 0.25–3.5Hz, low-theta 3.5–5Hz, high-theta 5–8Hz, low-alpha 8–10Hz, and high-alpha 10–13Hz) features averaged daily-wise from EEG signals and their relationships with fNIRS SVM classification accuracy. Frequency bands’ mean power and their “variability” were estimated using Welch’s method [44,58]. For each patient, middle-frequency bands’ (i.e., high-theta, low-alpha, and high-alpha) features of “true/yes” and “false/no” sentences’ ISI were compared, as well as middle-frequency bands’ features of sentence presentation and interstimulus intervals. Successively, the averaged correlation between each low-frequency band (i.e., delta, low-theta, and high-theta) mean power and fNIRS classification accuracy was computed to find relevant relationships of low EEG rhythms with the BCI experimental procedure outcome. Details are provided in the Methods section of S1 Text.

 Performance of SVM Classifier The performance of the binary SVM classifier was ascertained by plotting the ROC curve. The ROC curve was created by plotting the TPR against the FPR (obtained from the contingency table created for each session) and the average of all the sessions, separately for each patient, using the four possible outcomes of a binary SVM classifier. The formation of contingency table for training and feedback sessions for each participant is described in the Receiver operating characteristic curve section of S2 Text. Further chi-square test was performed to determine the statistical significance of the observed outcomes in the contingency table, also described in the Receiver operating characteristic curve section of S2 Text. ||||| Using a device which detects patterns in brain activity, patients paralysed by ALS can answer ‘yes’ or ‘no’ – and tell doctors they are ‘happy’ with life

 Doctors have used a brain-reading device to hold simple conversations with “locked-in” patients in work that promises to transform the lives of people who are too disabled to communicate.

 The groundbreaking technology allows the paralysed patients – who have not been able to speak for years – to answer “yes” or “no” to questions by detecting telltale patterns in their brain activity.

 Three women and one man, aged 24 to 76, were trained to use the system more than a year after they were diagnosed with completely locked-in syndrome, or CLIS. The condition was brought on by amyotrophic lateral sclerosis, or ALS, a progressive neurodegenerative disease which leaves people totally paralysed but still aware and able to think.

 “It’s the first sign that completely locked-in syndrome may be abolished forever, because with all of these patients, we can now ask them the most critical questions in life,” said Niels Birbaumer, a neuroscientist who led the research at the University of Tübingen.

 Facebook Twitter Pinterest Activation of a “yes” response vs. a “no” response in both the hemisphere of the brain. The blue colour indicates a lesser concentration of oxy-hemoglobin and red indicates and increased concentration. Illustration: Wyss Center, www.wysscenter.ch

 “This is the first time we’ve been able to establish reliable communication with these patients and I think that is important for them and their families,” he added. “I can say that after 30 years of trying to achieve this, it was one of the most satisfying moments of my life when it worked.”

 All of the patients, who are fed through tubes and kept alive on ventilators, are cared for at home by family members. To train the patients on the system, doctors asked them to think “yes” or “no” in response to a series of simple questions, such as “Your husband’s name is Joachim” and “Berlin is the capital of France.”

 During the sessions, the patients wore a cap that uses infrared light to spot variations in blood flow in different regions of the brain. As they answered the questions, a computer hooked up to the cap learned to distinguish the blood flow patterns for “yes” and “no” in each patient.

 When the patients scored at least 70% on the training questions, the doctors moved on to more personal questions. The most important of these were about quality of life. Perhaps unexpectedly, all four patients indicated that they were “happy” with life, suggesting that locked-in syndrome might not be the living hell many presume it to be.

 But while the renewed ability to communicate with the world was a boon for the patients and their carers, not all of the answers went down well. One patient was a 61-year-old man whose 26-year-old daughter asked whether she should marry her boyfriend, “Mario”. Her father said “no” nine times out of ten. “She went ahead anyway,” Birbaumer told the Guardian. He did not ask if she regretted ever posing the question.

 The findings, reported in the journal Plos Biology, do not mean that all locked-in patients are content with their lives. The four patients involved in the study had all chosen to be kept alive on a ventilator once their own breathing had failed, a decision that suggested they did not wish to die. Only a small percentage of CLIS patients who are moved on to ventilators survive the transition. “We have never had a patient who survived outside family care,” Birbaumer said.

 But patients with locked-in syndrome have reported a good quality of life before, even matching that of healthy people of the same age. Birbaumer said the reasons are unclear, but he wonders if patients become focused on the good social interactions around them, and even experience something akin to a state of meditation because they cannot feel or move their bodies. “We find that they see life in a more positive way,” he said.

 For his next project, Birbaumer wants to build a system that allows patients to communicate more proactively, rather than simply answer questions. In the 1990s, the French journalist, Jean-Dominique Bauby, who became locked-in after a massive stroke, dictated his bestselling memoir, The Diving Bell and the Butterfly, by blinking his left eye to select letters from the alphabet. Birbaumer believes a system that reads brain activity could achieve the same ends for completely locked-in patients who cannot even move their eyelids.

 Adrian Owen, a neuroscientist at the University of Western Ontario, has been exploring whether the same technology, known as functional near-infrared spectroscopy, or fNIRS, can be used to communicate with other kinds of brain-injured patients, including those who are presumed to be in a vegetative state. “The results of this study suggest that we are on the right track,” he said.

 “Finding a portable, cost-effective and reliable means for communicating with patients who are entirely physically non-responsive is the holy grail for those of us working in this field. If these findings can be replicated in a larger group of patients they suggest that fNIRS may be the answer.

 “One of the most surprising outcomes of this study is that these patients reported being ‘happy’ despite being physically locked-in and incapable of expressing themselves on a day-to-day basis, suggesting that our preconceived notions about what we might think if the worst was to happen are false. Indeed, previous research has shown that most locked-in patients are actually reasonably satisfied with their quality of life,” he added. |||||
A summary of this is?

– Four paralyzed patients unable to communicate for years were finally able to do so through a potentially groundbreaking brain-reading system. And it turns out that one of them really didn't want his daughter to marry her boyfriend. The patients all had advanced ALS and were unable to control even their eyes, reports the Guardian. In other words, they had "locked-in syndrome," meaning total motor paralysis in spite of normal cognitive and emotional processing. Researchers at the University of Tübingen in Germany fitted the patients with caps through which they could observe changes in blood flow in different parts of the brain, they explain in the journal PLOS Biology. They first asked the patients to think yes or no in response to simple statements such as their spouse's name, and moved on to more personal questions when that was mastered. “It’s the first sign that completely locked-in syndrome may be abolished forever, because with all of these patients, we can now ask them the most critical questions in life,” says researcher Niels Birbaumer. The patients, all of whom are on ventilators and being cared for at home, range in age from 24 to 76. The team did stumble on a couple surprises. For instance, all four patients suggested they were "happy" with their lives in spite of being locked-in. (Birmbaumer suggests this might be because of something akin to meditation.) And one patient, who is 61, answered "no" nine times out of 10 when his 26-year-old daughter asked if she should marry her boyfriend Mario. "But they got married," one of the researchers tells the BBC. "Nothing can come between love." (Researchers can't explain how Stephen Hawking has lived this long.)