Introduction: Although deep brain stimulation often improves levodopa-responsive gait symptoms, robust therapies for gait dysfunction from Parkinson's disease remain a major unmet need. Walking speed could represent a simple, integrated tool to assess DBS efficacy but is often not examined systematically or quantitatively during DBS programming. Here we investigate the reliability and functional significance of changes in gait by directional DBS in the subthalamic nucleus.Methods: Nineteen patients underwent unilateral subthalamic nucleus DBS surgery with an eight-contact directional lead in the most (...) severely affected hemisphere. They arrived off dopaminergic medications >12 h preoperatively and for device activation 1 month after surgery. We measured a comfortable walking speed using an instrumented walkway with DBS off and at each of 10 stimulation configurations at the midpoint of the therapeutic window. Repeated measures of ANOVA contrasted preoperative vs. maximum and minimum walking speeds across DBS configurations during device activation. Intraclass correlation coefficients examined walking speed reliability across the four trials within each DBS configuration. We also investigated whether changes in walking speed related to modification of step length vs. cadence with a one-sample t-test.Results: Mean comfortable walking speed improved significantly with DBS on vs. both DBS off and minimum speeds with DBS on. Pairwise comparisons showed no significant difference between DBS off and minimum comfortable walking speed with DBS on. Intraclass correlations were ≥0.949 within each condition. Changes in comfortable walk speed were conferred primarily by changes in step length.Conclusion: Acute assessment of walking speed is a reliable, clinically meaningful measure of gait function during DBS activation. Directional and circular unilateral subthalamic DBS in appropriate configurations elicit acute and clinically significant improvements in gait dysfunction related to PD. Next-generation directional DBS technologies have significant potential to enhance gait by individually tailoring stimulation parameters to optimize efficacy. (shrink)

One of the most lasting contributions of Marr's posthumous book is his articulation of the different “levels of analysis” that are needed to understand vision. Although a variety of work has examined how these different levels are related, there is comparatively little examination of the assumptions on which his proposed levels rest, or the plausibility of the approach Marr articulated given those assumptions. Marr placed particular significance on computational level theory, which specifies the “goal” of a computation, its appropriateness for (...) solving a particular problem, and the logic by which it can be carried out. The structure of computational level theory is inherently teleological: What the brain does is described in terms of its purpose. I argue that computational level theory, and the reverse-engineering approach it inspires, requires understanding the historical trajectory that gave rise to functional capacities that can be meaningfully attributed with some sense of purpose or goal, that is, a reconstruction of the fitness function on which natural selection acted in shaping our visual abilities. I argue that this reconstruction is required to distinguish abilities shaped by natural selection—“natural tasks” —from evolutionary “by-products”, rather than merely demonstrating that computational goals can be embedded in a Bayesian model that renders a particular behavior or process rational. (shrink)

I extend Jones & Love's (J&L's) critique of Bayesian models and evaluate the conceptual foundations on which they are built. I argue that: (1) the part of Bayesian models is scientifically trivial; (2) theory is a fiction that arises from an inappropriate programming metaphor; and (3) the real scientific problems lie outside Bayesian theorizing.

Everyone agrees that testing hypotheses is important, but Bowers et al. provide scant details about where hypotheses about perception and brain function should come from. We suggest that the answer lies in considering how information about the outside world could be acquired – that is, learned – over the course of evolution and development. Deep neural networks (DNNs) provide one tool to address this question.

Although written consent forms are standard in clinical research, there is little regulatory or empirical guidance regarding how to most effectively review consent forms with potential participants. We developed an algorithm for embedding five questions with corrective feedback while reading consent forms with potential participants, and then applied it in the context of seven clinical research studies. A substantial proportion of participants within each protocol displayed initially inadequate responses to at least one question, but after the protocol elements were explained (...) again, most people demonstrated adequate understanding of them. These data illustrate the need for more attention not just to the content of consent forms, but also to the manner in which the forms are incorporated into the consent process. Embedding explicit inquiries about key protocol elements during consent form review and giving corrective feedback appears to be a simple yet effective way to foster better understanding of disclosed information. (shrink)

The problem of 'no fault' compensation for patients who suffer adverse effects as a result of their participation in clinical trials is discussed in the light of the guidelines issued by the Association of the British Pharmaceutical Industry (ABPI) and our recent experiences in reviewing protocols submitted to the local ethics of surgical research sub-committee. We have found a variety of qualifications being applied by pharmaceutical firms which are not in the spirit of the guidelines, let alone the interests of (...) the patient, and we suggest a means whereby the patients can be assured of fair treatment in the event of 'no fault' injury. (shrink)

This article describes the situated nature of two intertwined dimensions of the context of medical encounters - expertise and compliance - within the interactional practices of referrals and accounts of referrals. Families who display their expertise and compliance have referral and account sequences with notably different features compared to sequences with families who display a lack of compliance and expertise. The display of expertise significantly affects the course of the interaction, and asymmetrical sequences often occur in interactions when the professionals (...) see families' expertise and compliance as problematic. (shrink)

This function of die body and mind in creating for a short while their own miniature universes is, in fact, no more than an illusion; yet the fleeting sense of happiness in human life owes much to precisely this type of ‘false order’. It is a kind of protective function of life in face of the chaos around it, and resembles the way a hedgehog rolls itself up into a tight round ball.

Objective: To audit doctors’ knowledge of informed consent.Design: 10 consent scenarios with “true”, “false”, or “don’t know” answers were completed by doctors who care for children at a large district general hospital. These questions tested clinicians’ knowledge of who could give consent in different clinical situations.Setting: Royal United Hospital, Bath, UK.Results: 51 doctors participated . Paediatricians scored higher than other clinicians . Only 36% of paediatricians and 8% of other clinicians realised that the biological father of a child born before (...) 1 December 2003 needed a court order or a parental responsibility agreement to acquire parental responsibility, and thus be able to consent on behalf of his child, if he was not married to the child’s mother. Non-paediatric clinicians were unsure or incorrect when tested on situations where people with parental responsibility do not agree, or where young people , who are Fraser competent do not want to consult their parents. Most clinicians did not know that the parents of a 20-year-old man with severe learning difficulties are unable to consent to surgery on his behalf, and many non-paediatricians were unclear on who could give consent when a child lived with foster parents.Conclusion: Clinicians who obtain consent for the treatment of children need to increase their knowledge on who is able to give informed consent to ensure best practice. (shrink)

(1886). ON THE SUBJECTIVE CAUSES OF EVOLUTION AS ILLUSTRATED BY THE GEOGRAPHICAL DISTRIBUTION OF PLANTS. Transactions of the South African Philosophical Society: Vol. 5, No. 2, pp. 275-294.

During the heyday of the medieval period of the Scholastics, robust philosophical speculations about spiritual realities apart from God flourished. Since then, discussions by philosophers about thi...

In an attempt to learn from COVID-19, this essay features six responses to the question: what did COVID-19 teach us, expose in us, or purge out of us when it comes to spiritual formation in Christ? Each response was written independently of the others by one of the coauthors. Diane J. Chandler focuses in on how COVID-19 exposed grievous inequities for ethnic groups in the American church and broader society. Kelly M. Kapic reminds us of the goodness of human finitude (...) and how COVID restrictions have forced many of us to embrace our limitations. Siang-Yang Tan reflects on eight lessons he has learned during this pandemic year in his role shepherding a local church. James C. Wilhoit calls us to consider the structures that are needed for local church leadership to make wise and godly decisions in times of crisis. Richard Peace draws our attention to what might be learned from the forced monasticism brought about by COVID-19 quarantines. Finally, Ruth Haley Barton pauses to consider the interdependence of human life that has been dramatically illustrated by this pandemic. While these six responses certainly do not exhaust all there is for the church to learn from COVID, we present them in the spirit of “O Lord, teach us what we do not see” and hope they will inspire your own reflections. (shrink)

Directional deep brain stimulation contacts provide greater spatial flexibility for therapy than traditional ring-shaped electrodes, but little is known about longitudinal changes of impedance and orientation. We measured monopolar and bipolar impedance of DBS contacts in 31 patients who underwent unilateral subthalamic nucleus deep brain stimulation as part of a randomized study. At different follow-up visits, patients were assigned new stimulation configurations and impedance was measured. Additionally, we measured the orientation of the directional lead during surgery, immediately after surgery, and (...) 1 year later. Here we contrast impedances in directional versus ring contacts with respect to local anatomy, active stimulation contact, and over time. Directional contacts display larger impedances than ring contacts. Impedances generally increase slightly over the first year of therapy, save for a transient decrease immediately post-surgery under general anesthesia during pulse generator placement. Local impedances decrease at active stimulation sites, and contacts in closest proximity to internal capsule display higher impedances than other anatomic sites. DBS leads rotate slightly in the immediate postoperative period but otherwise remain stable over the following year. These data provide useful information for setting clinical stimulation parameters over time. (shrink)

Wisdom is a multi-component trait that is important for mental health and well-being. In this study, we sought to understand gender differences in relative strengths in wisdom. A total of 659 individuals aged 27–103 years completed surveys including the 3-Dimensional Wisdom Scale and the San Diego Wisdom Scale. Analyses assessed gender differences in wisdom and gender’s moderating effect on the relationship between wisdom and associated constructs including depression, loneliness, well-being, optimism, and resilience. Women scored higher on average on the 3D-WS (...) but not on the SD-WISE. Women scored higher on compassion-related domains and on SD-WISE Self-Reflection. Men scored higher on cognitive-related domains and on SD-WISE Emotion Regulation. There was no impact of gender on the relationships between wisdom and associated constructs. Women and men have different relative strengths in wisdom, likely driven by sociocultural and biological factors. Tailoring wisdom interventions to individuals based on their profiles is an important next step. (shrink)

La pertinence de la métaphysique analytique a fait l'objet de critiques : Ladyman et Ross, par exemple, ont suggéré d'abandonner ce domaine. French et McKenzie ont défendu la métaphysique analytique en affirmant qu'elle développe des outils qui pourraient s'avérer utiles pour la philosophie de la physique. Dans cet article, nous montrons dans un premier temps que cette défense heuristique de la métaphysique peut être étendue au domaine scientifique de l'ontologie appliquée, qui utilise des théories et outils issus de la métaphysique (...) analytique. Dans un deuxième temps, nous développons le parallèle que font French et McKenzie entre les mathématiques et la métaphysique pour montrer que l'ensemble du domaine de la métaphysique analytique, étant donné son utilité non seulement pour la philosophie mais également pour la science, devrait continuer à exister en tant que domaine largement autonome. (shrink)

In his _Being Known_ Peacocke sets himself the task of answering how we come to know about metaphysical necessities. He proposes a semantic principle-based conception consisting of, first, his Principles of Possibility which pro­vide necessary and sufficient conditions for a new concept 'admissibility', and second, characterizations of possibility and of necessity in terms of that new con­cept. I focus on one structural feature; viz. the recursive application involved in the specification of 'admissibility'. After sketching Peacocke’s proposal, I intro­duce a fictional (...) protagonist, Cautious Peacocke, whose coherence I claim shows that Peacocke s proposal cannot be made good. I conclude with the conjecture that similar failure will attend any such semantic-based attempts to ground the epistemology of metaphysical necessity. -/- Dans son livre intitulé Being Known, C. Peacocke se propose de repondre à la question de savoir comment nous en venons a connaitre des nécessités métaphysiques. Il développe une conception sémantique reposant sur des principes comprenant, d’une part, ses Principes de Possibilité — qui fournissent les conditions nécessaires et suffisantes pour un nouveau concept, « l’admissibilité » — et d’autre part des caractérisations de la possibilité et de la nécessité a l’aide de ce nouveau concept. Je me concentre sur une caractéristique structurelle, a savoir l’application récursive a l’œuvre dans la spécification de «l’admissibilité ». Apres avoir esquisse la proposition de Peacocke, j’introduis un personnage fictif, Peacocke-prudent. Je soutiens que la cohérence de ce personnage montre que la proposition de Peacocke ne peut pas être satisfaite. Je conclus en conjecturant qu’un échec similaire se présentera pour toutes les tentatives de fonder l’épistemologie de la nécessité métaphysique sur de telles bases semantiques. (shrink)

Plato's views on the nature of the soul, by W.K.C. Guthrie.--Die Erneuerung der Philosophie in der Zeit Ciceros, von O. Gigon.--Gott und Seele im kaiserzeitlichen Denken, von W. Theiler.--Interprétations néo-platonisantes du livre VI de l'Énéide, par P. Courcelle.--Der Platonismus und die altchristliche Gedankenwelt, von J.H. Waszink.--Humanisme et christianisme chez Clément d'Alexandrie d'après le "Pédagogue," par H.I. Marrou.--Some aspects of Platonism in Islamic philosophy, by R. Walzer.