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Paradoxical Lucidity
A similar phenomenon called paradoxical lucidity can also occur in people with advanced stages of dementia who have permanently lost the ability to communicate rationally. A 2020 research screened for what the authors designated as "paradoxical lucidity", a general term for unexpected remissions in dementias, independent of whether it followed a terminality process or not; it found strong association of the condition as a near-death phenomenon and stated that it can overlap the concept of "terminal lucidity" in some cases. A 2021 systematic review attempted to clearly define the parameters of paradoxical lucidity and established three criteria that must be fulfilled.

Firstly, the person must present with a neurological condition. Alzheimer's disease and Alzheimer's disease related dementia are obvious examples of neurological conditions that compromise cognition but lucid episodes have also been reported in other neurological diseases such as brain tumors, meningitis, and stroke (4), just to name a few. Indeed, the variability between diseases makes it more difficult to identify when this phenomenon will occur.

Secondly, the disease must be irreversible.

2) the condition is irreversible and 3) hinders normal verbal/behavioral capabilities.(3)

Paradoxical and terminal lucidity may occur through a common pathway and having a good understanding of both types of phenomenon can help scientists further expand their research.

Paradoxical lucidity is considered a challenge to the irreversibility paradigm of chronic degenerative dementias such as Alzheimer's.

Further Discussion
Understanding the mechanism behind terminal lucidity has important ethical implications which can impact how researchers can move forward when formulating a study design. Participants who take part in these type of studies are a vulnerable population. Persons with severe neurological disorders such as schizophrenia or Dementia may not have the capacity to provide informed consent. Indeed, informed consent is one of the most important pillars in ethical research and safeguards an individual's autonomy. Another important issue to consider is whether participation in the study is voluntary. This can become an issue for individuals whose primary residence are in nursing homes or long-term care facilities and these institutions may exert undue influence on the individual. Often, "voluntarism of vulnerable subjects is usually compromised" ,therefore, it is essential to have policy discussions and protocols in place that can address and ideally, minimize the potential for harm to the individual to an absolute minimum.

Peer Review
Part 1:

Lead - Concise and clearly describes the topic. The last sentence mentions 3 different designs of consul anal inserts but the article highlights 6 types of anal plugs, not sure why these were chosen. Do these 6 fall under the 3 different designs (if so, maybe categorize them by design)?

The group edits do substantially improve the article. The article is written without bias, in a neutral tone and addition of images were helpful in understanding what an anal plug is. The article is well cited using secondary sources but I did have trouble accessing some sources (some required payment and one had an invalid link). The introduction was clear and concise. I did have one question regarding the last sentence that mentions 3 different designs of consul anal inserts. Do the 6 types of anal plugs highlighted in the article fall under these 3 different designs? Is that why those products were highlighted?

Content - Part 2: Not all sources are freely available. The sources that are from the Journal Lancet are not freely available (this includes references #1 and 2) and reference #8 is also not freely available. The doi linked to #11 in references is an invalid link. Everything else is well cited and used systematic or meta-analyses.