Am 1. Februar 2010 ist das Gendiagnostikgesetz (GenDG) in Kraft getreten. Die Debatte um einige Regelungsbereiche, wie beispielsweise das Neugeborenenscreening, reißt nicht ab. Ein Aspekt des Gesetzes ist im Rahmen der Debatte um die Präimplantationsdiagnostik (PID) in Deutschland unter neuen Vorzeichen zu diskutieren: Das – international bislang einzigartige – Verbot der pränatalen Diagnostik so genannter spätmanifestierender Erkrankungen, die erst nach der Vollendung des 18. Lebensjahres ausbrechen. In diesem Beitrag möchten wir Hinweise zur differenzierten Diskussion dieser in § 15(2) GenDG bestimmten (...) Verbotsnorm liefern. Obgleich Argumente, insbesondere das Recht auf Nichtwissen des geborenen Kindes, für ein solches Verbot sprechen, kommen wir aufgrund der medizinischen Sachlage und nach einer Analyse der Pro- und Kontraargumente aus ethischer und rechtlicher Sicht zu dem Schluss, dass ein generelles Verbot der pränatalen Diagnostik spätmanifestierender Erkrankungen im Sinne der Zielsetzung womöglich insuffizient ist sowie in der Begründung Inkonsistenzen zum bereits bestehenden Regelwerk aufweist, und lenken daher den Blick auf unter Umständen bessere Alternativen. (shrink)

Translating Religion advances thinking about translation as a critical category in religious studies, combining theoretical reflection about processes of translation in religion with focused case studies that are international, interdisciplinary, and interreligious. By operating with broad conceptions of both religion and translation, this volume makes clear that processes of translation, broadly construed, are everywhere in both religious life and the study of religion; at the same time, the theory and practice of translation and the advancement of translation studies as a (...) field has developed in the context of concerns about the possibility and propriety of translating religious texts. The nature of religions as living historical traditions depends on the translation of religion from the past into the present. Interreligious dialogue and the comparative study of religion require the translation of religion from one tradition to another. Understanding the historical diffusion of the world's religions requires coming to terms with the success and failure of translating a religion from one cultural context into another. Contributors ask what it means to translate religion, both textually and conceptually, and how the translation of religious content might differ from the translation of other aspects of human culture. This volume proposes that questions on the nature of translation find particularly acute expression in the domains of religion, and argues that theoretical approaches from translation studies can be fruitfully brought to bear on contemporary religious studies. (shrink)

Die Transformation der Kernphysik aus dem akademischen Labor über die Großforschung hin zum gescheiterten großtechnologischen Projekt war eng verknüpft mit der Implementierung transnationaler Wissensströme. Christian Forstner zeigt am Beispiel Österreichs, wie Industrie, Wissenschaft, Politik und Zivilgesellschaft interagieren müssen, um erfolgreiche Innovation möglich zu machen. Zunächst analysiert er die frühe Radioaktivitätsforschung bis zur Kernspaltung und dem NS-Forschungsverbund Uranverein. Anschließend folgt der Weg von den österreichischen Forschungsreaktoren im Rahmen des US-amerikanischen Atoms for Peace-Programms bis hin zum Bau des Kernkraftwerks Zwentendorf, das nach (...) dem „Nein zu Zwentendorf“ als Ergebnis einer Volksabstimmung im November 1978 nie in Betrieb ging. Der Autor: PD Dr. Christian Forstner ist Physiker und Wissenschaftshistoriker und derzeit Privatdozent für Geschichte der Naturwissenschaften an der Goethe-Universität Frankfurt am Main. Er leitet den Fachverband „Geschichte der Physik“ der Deutschen Physikalischen Gesellschaft. (shrink)

Taking regular walks when living with Parkinson’s disease has beneficial effects on movement and quality of life. Yet, patients usually show reduced physical activity compared to healthy older adults. Using auditory stimulation such as music can facilitate walking but patients vary significantly in their response. An individualized approach adapting musical tempo to patients’ gait cadence, and capitalizing on these individual differences, is likely to provide a rewarding experience, increasing motivation for walk-in PD. We aim to evaluate the observance, safety, tolerance, (...) usability, and enjoyment of a new smartphone application. It was coupled with wearable sensors and delivered individualized musical stimulation for gait auto-rehabilitation at home. Forty-five patients with PD underwent a 1-month, outdoor, uncontrolled gait rehabilitation program, using the BeatWalk application. The music tempo was being aligned in real-time to patients’ gait cadence in a way that could foster an increase up to +10% of their spontaneous cadence. Open-label evaluation was based on BeatWalk use measures, questionnaires, and a six-minute walk test. Patients used the application 78.8% of the prescribed duration and enjoyed it throughout the program. The application was considered “easy to use” by 75% of the patients. Pain, fatigue, and falls did not increase. Fear of falling decreased and quality of life improved. After the program, patients improved their gait parameters in the six-minute walk test without musical stimulation. BeatWalk is an easy to use, safe, and enjoyable musical application for individualized gait rehabilitation in PD. It increases “walk for exercise” duration thanks to high observance.Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT02647242. (shrink)

BackgroundFreezing of gait is a disabling burden for Parkinson’s disease patients with poor response to conventional therapies. Combined deep brain stimulation of the subthalamic nucleus and substantia nigra moved into focus as a potential therapeutic option to treat the parkinsonian gait disorder and refractory FoG. The mechanisms of action of DBS within the cortical-subcortical-basal ganglia network on gait, particularly at the cortical level, remain unclear.MethodsTwelve patients with idiopathic PD and chronically-implanted DBS electrodes were assessed on their regular dopaminergic medication in (...) a standardized stepping in place paradigm. Patients executed the task with DBS switched off, conventional STN DBS and combined STN+SN DBS and were compared to healthy matched controls. Simultaneous high-density EEG and kinematic measurements were recorded during resting-state, effective stepping, and freezing episodes.ResultsClinically, STN+SN DBS was superior to conventional STN DBS in improving temporal stepping variability of the more affected leg. During resting-state and effective stepping, the cortical activity of PD patients in STIM OFF was characterized by excessive over-synchronization in the theta, alpha, and high-beta band compared to healthy controls. Both active DBS settings similarly decreased resting-state alpha power and reduced pathologically enhanced high-beta activity during resting-state and effective stepping compared to STIM OFF. Freezing episodes during STN DBS and STN+SN DBS showed spectrally and spatially distinct cortical activity patterns when compared to effective stepping. During STN DBS, FoG was associated with an increase in cortical alpha and low-beta activity over central cortical areas, while with STN+SN DBS, an increase in high-beta was prominent over more frontal areas.ConclusionsSTN+SN DBS improved temporal aspects of parkinsonian gait impairment compared to conventional STN DBS and differentially affected cortical oscillatory patterns during regular locomotion and freezing suggesting a potential modulatory effect on dysfunctional cortical-subcortical communication in PD. (shrink)

BackgroundThe preferable position of Deep Brain Stimulation electrodes is proposed to be located in the dorsolateral subthalamic nucleus to improve general motor performance. The optimal DBS electrode localization for the post-operative improvement of balance and gait is unknown.MethodsIn this single-center, retrospective analyses, 66 Parkinson’s disease patients were assessed pre- and post-operatively by using MDS-UPDRS, freezing of gait score, Giladi’s gait and falls questionnaire and Berg balance scale. The clinical outcome was related to the DBS electrode coordinates in x, y, z (...) plane as revealed by image-based reconstruction. Binomial generalized linear mixed models with fixed-effect variables electrode asymmetry, parkinsonian subtype, medication, age class and clinical DBS induced changes were analyzed.ResultsSubthalamic nucleus-deep brain stimulation improved all motor, balance and FoG scores in MED OFF condition, however there were heterogeneous results in MED ON condition. DBS electrode reconstructed coordinates impacted the responsiveness of axial symptoms. FoG and balance responders showed slightly more medially located STN electrode coordinates and less medio-lateral asymmetry of the electrode reconstructed coordinates across hemispheres compared to non-responders.ConclusionDeep brain stimulation electrode reconstructed coordinates, particularly electrode asymmetry on the medio-lateral axis affected the post-operative responsiveness of balance and FoG symptoms in PD patients. (shrink)

IntroductionThe assessments of the motor symptoms in Parkinson’s disease are usually limited to clinical rating scales, and it depends on the clinician’s experience. This study aims to propose a machine learning technique algorithm using the variables from upper and lower limbs, to classify people with PD from healthy people, using data from a portable low-cost device. And can be used to support the diagnosis and follow-up of patients in developing countries and remote areas.MethodsWe used Kinect®eMotion system to capture the spatiotemporal (...) gait data from 30 patients with PD and 30 healthy age-matched controls in three walking trials. First, a correlation matrix was made using the variables of upper and lower limbs. After this, we applied a backward feature selection model using R and Python to determine the most relevant variables. Three further analyses were done using variables selected from backward feature selection model, movement disorders specialist, and all the variables from the dataset. We ran seven machine learning models for each model. Dataset was divided 80% for algorithm training and 20% for evaluation. Finally, a causal inference model using the DoWhy library was performed on Dataset B due to its accuracy and simplicity.ResultsThe Random Forest model is the most accurate for all three variable Datasets followed by the support vector machine. The CIM shows a relation between leg variables and the arms swing asymmetry and a proportional relationship between ASA and the diagnosis of PD with a robust estimator.ConclusionsMachine learning techniques based on objective measures using portable low-cost devices are useful and accurate to classify patients with Parkinson’s disease. This method can be used to evaluate patients remotely and help clinicians make decisions regarding follow-up and treatment. (shrink)

Background: The Parkinsonian [i.e., Parkinson's disease ] gait disorder represents a therapeutical challenge with residual symptoms despite the use of deep brain stimulation of the subthalamic nucleus and medical and rehabilitative strategies. The aim of this study was to assess the effect of different DBS modes as combined stimulation of the STN and substantia nigra and environmental rehabilitative factors as footwear on gait kinematics.Methods: This single-center, randomized, double-blind, crossover clinical trial assessed shod and unshod gait in patients with PD with (...) medication in different DBS conditions during different gait tasks and compared gait characteristics to healthy controls. Notably, 15 patients participated in the study, and 11 patients were analyzed after a dropout of four patients due to DBS-induced side effects.Results: Gait was modulated by both factors, namely, footwear and DBS mode, in patients with PD. Footwear impacted gait characteristics in patients with PD similarly to controls with longer step length, lower cadence, and shorter single-support time. Interestingly, DBS exerted specific effects depending on gait tasks with increased cognitive load. STN+SN DBS was the most efficient DBS mode compared to STIM OFF and STN DBS with intense effects as step length increment during dual task.Conclusion: The PD gait disorder is a multifactorial symptom, impacted by environmental factors as footwear and modulated by DBS. DBS effects on gait were specific depending on the gait task, with the most obvious effects with STN+SN DBS during gait with increased cognitive load. (shrink)

Ist es moralisch verantwortbar, Menschen mit technischen Eingriffen zu verbessern? Der Aufsatz versucht diese Frage zu beantworten, indem zwei Gefahren für Verbesserungswillige beleuchtet werden: der Verlust der Menschlichkeit und der unerwünschte Wandel der individuellen Persönlichkeit. Sodann wird ein „Liberalismus mit Auffangnetz“ als Lösung des Problems vorgestellt, die eine unterschiedliche Bewertung von reversiblen und irreversiblen Eingriffen vornimmt. Im letzten Schritt wird überprüft, wie weit diese Konzeption auch anwendbar ist, wenn Eltern ihre Kinder verbessern lassen wollen, also ein „informed consent“ nicht vorausgesetzt (...) werden kann. Dabei werden Argumente zurückgewiesen, die Habermas gegen eine Verbesserung von Kindern vorgebracht hat. (shrink)

Für die Argumentation von Moralphilosophen, die die Legalisierung der aktiven Sterbehilfe befürworten, spielt das Autonomieprinzip eine wichtige Rolle. Ihrer Auffassung nach verlangt der Respekt vor der Autonomie, die Entscheidung eines schwer kranken Menschen gegen die Fortsetzung des Lebens vorbehaltlos anzuerkennen. Dagegen haben verschiedene Theoretiker auf Gefahren hingewiesen, die die rechtliche Zulassung der Tötung auf Verlangen für die individuelle Autonomie mit sich bringt. Sobald der Kranke über die Möglichkeit der aktiven Sterbehilfe verfüge, falle ihm die Verantwortung für die Inanspruchnahme von Pflegeleistungen (...) zu. In der Folge könne u. a. von Seiten der Familie die Forderung an ihn gestellt werden, den vom Gesetzgeber eröffneten Ausweg zu nutzen und sie von der Last seiner Pflege zu befreien. Die Bedenken erscheinen insofern berechtigt, als Formen sozialen Zwangs vorstellbar sind, die eine freie Entscheidung des Patienten verhindern. Allerdings vermag weder das Verbot noch die Zulassung der aktiven Sterbehilfe eine autonome Entscheidung aller Individuen zu gewährleisten. Die Abwägung der Risiken, mit denen beide Optionen behaftet sind, spricht im Ergebnis für die Legalisierung der Tötung auf Verlangen. (shrink)

Die prospektive Analyse der ethischen Implikationen medizinisch-technischer Innovationen läuft immer auch Gefahr, sich in den Wunschbildern von Marketingexperten zu verfangen. Vor diesem Hintergrund könnte es durchaus nützlich sein, die Erkenntnisse der Wissenschafts- und Technikforschung zur Genese und Entwicklung neuer Techniken auszuschöpfen. Dies erscheint gerade auch für die ins Phantastische weisende Zukunft der Individualisierung medikamentöser Therapie, wie man ihr häufig in der Beschreibung pharmakogenetischer Behandlungskonzepte begegnet, angebracht. Techniken, die sich noch im Entwicklungsstadium befinden und deren breite Anwendung noch einige Jahre auf (...) sich warten lassen wird, sollten sehr sorgfältig auf ihren Realitätsgehalt und das zu erwartende Leistungspotenzial hin analysiert werden. Dazu gehört v. a. auch eine kritische Auseinandersetzung mit den Leitbildern, Visionen und Nutzenversprechen, mit denen technische Innovationen oft sehr absichtsvoll ausgestattet werden. Wird dabei die Distanz zur Rhetorik der Protagonisten der neuen Techniken nicht gewahrt, gerät die ethische Reflexion unvermittelt in die Rolle, profane Marketingstrategien wortgewandt und ideenreich zu veredeln. (shrink)

Decision-making under normative uncertainty requires an agent to aggregate the assessments of options given by rival normative theories into a single assessment that tells her what to do in light of her uncertainty. But what if the assessments of rival theories differ not just in their content but in their structure -- e.g., some are merely ordinal while others are cardinal? This paper describes and evaluates three general approaches to this "problem of structural diversity": structural enrichment, structural depletion, and multi-stage (...) aggregation. All three approaches have notable drawbacks, but I tentatively defend multi-stage aggregation as least bad of the three. (shrink)

Kants Musikästhetik wird weithin unterschätzt. Dabei bietet sie die entscheidenden Ansätze zur Befreiung der Musik aus den Fängen der Nachahmungsästhetik, wie sie vor allem E.T.A.Hoffman kongenial umgesetzt hat.

Les disciplines historiques, littéraires et philosophiques font un emploi abondant des catégories historiographiques. Parmi celles-ci, les termes en ismes sont très fréquents pour référer à une doctrine, un courant artistique, une idéologie ou des événements spécifiques. On fait cependant remarquer que ces désignations posent de nombreux problèmes d’interprétation. En particulier, que l’origine exacte d’une catégorie est souvent méconnue et que sa signification est plus équivoque qu’on ne le croit habituellement. La formation d’un terme en isme s’explique souvent dans un contexte (...) polémique et sert à condamner ou critiquer plutôt qu’à comprendre une pensée, un mouvement ou des faits historiques. Les catégories d’athéisme, de classicisme ou de féminisme en sont de bons exemples. Le présent volume vise à contribuer à l’étude critique des catégories historiographiques et des notions en isme en s’attardant à l’époque moderne (XVI e XVIII e siècles). Il s’agit d’un moment clef de l’histoire européenne pendant laquelle nombre de ces notions apparaissent ou pour laquelle l’historiographie en a fait un emploi abondant. Les chapitres en examinent la valeur théorique par rapport à une origine ou des usages, et déterminent de quelles manières elles contribuent à l’interprétation de l’histoire, de la littérature ou de la philosophie, de la Renaissance jusqu’à la Révolution française. (shrink)

The principle that rational agents should maximize expected utility or choiceworthiness is intuitively plausible in many ordinary cases of decision-making under uncertainty. But it is less plausible in cases of extreme, low-probability risk (like Pascal's Mugging), and intolerably paradoxical in cases like the St. Petersburg and Pasadena games. In this paper I show that, under certain conditions, stochastic dominance reasoning can capture most of the plausible implications of expectational reasoning while avoiding most of its pitfalls. Specifically, given sufficient background uncertainty (...) about the choiceworthiness of one's options, many expectation-maximizing gambles that do not stochastically dominate their alternatives "in a vacuum" become stochastically dominant in virtue of that background uncertainty. But, even under these conditions, stochastic dominance will not require agents to accept options whose expectational superiority depends on sufficiently small probabilities of extreme payoffs. The sort of background uncertainty on which these results depend looks unavoidable for any agent who measures the choiceworthiness of her options in part by the total amount of value in the resulting world. At least for such agents, then, stochastic dominance offers a plausible general principle of choice under uncertainty that can explain more of the apparent rational constraints on such choices than has previously been recognized. (shrink)