This music score was submitted for the Kaleidoscope 2020 Call for Scores, an open access collaboration with the UCLA Music Library.

Are the differences between human and alloanimal cognition a matter of kind or of degree? This question continues to generate controversial arguments for the uniqueness of certain features of human cognition, with no clear consensus in sight (see, e.g., Hauser, Chomsky & Fitch, 2002; Suddendorf & Corbalis, 2007). To move the debate into fresh territory, this symposium develops a proposal from conceptual blending theory (CBT: Fauconnier & Turner, 2002; Turner, 2014) to argue that the differences in question are both a matter of kind and of degree. The symposium also takes up a line of inquiry initiated by Pelkey, who has proposed synthesizing CBT with related insights from Charles S. Peirce, Jakob Johann von Uexküll, and biosemiotics to build a stronger case for alloanimal blending. We bring together a diverse group of researchers to discuss human-unique cognitive abilities through the lens of CBT. Turner introduces CBT and outlines the cross- species cline of conceptual blending. Pelkey provides evidence for various types of blends in bats and discusses the conclusions of these analyses. Leonardis, Semenuks, and Coulson emphasize the importance of taking non-human perspectives in analyzing behaviors with CBT. Adachi discusses work on metaphorical and cross-modal mapping in primates. Forster serves as the moderator.

Objective

There is uncertainty about surgical procedures for adult patients aged 18-60 years undergoing aortic valve replacement (AVR). Options include conventional AVR (mechanical, mAVR; tissue, tAVR), the pulmonary autograft (Ross) and aortic valve neocuspidisation (Ozaki). Transcatheter treatment may be an option for selected patients. We used formal consensus methodology to make recommendations about the suitability of each procedure.

Methods

A working group, supported by a patient advisory group, developed a list of clinical scenarios across seven domains (anatomy, presentation, cardiac/non-cardiac comorbidities, concurrent treatments, lifestyle, preferences). A consensus group of 12 clinicians rated the appropriateness of each surgical procedure for each scenario on a 9-point Likert scale on two separate occasions (before and after a 1-day meeting).

Results

There was a consensus that each procedure was appropriate (A) or inappropriate (I) for all clinical scenarios as follows: mAVR: total 76% (57% A, 19% I); tAVR: total 68% (68% A, 0% I); Ross: total 66% (39% A, 27% I); Ozaki: total 31% (3% A, 28% I). The remainder of percentages to 100% reflects the degree of uncertainty. There was a consensus that transcatheter aortic valve implantation is appropriate for 5 of 68 (7%) of all clinical scenarios (including frailty, prohibitive surgical risk and very limited life span).

Conclusions

Evidence-based expert opinion emerging from a formal consensus process indicates that besides conventional AVR options, there is a high degree of certainty about the suitability of the Ross procedure in patients aged 18-60 years. Future clinical guidelines should include the option of the Ross procedure in aortic prosthetic valve selection.