In the recent literature on confirmation there are two leading approaches to the provision of a probabilistic measure of the degree to which a hypothesis is confirmed by evidence. The first is to construe the degree to which evidence E confirms hypothesis H as a function that is directly proportional to p and inversely proportional to p . I shall refer to this as the probability approach. The second approach construes the notion as a function that is directly proportional to (...) the true-positive rate – the probability of the evidence if the hypothesis is true, p – and inversely proportional to the false-positive rate – the probability of the evidence if the hypothesis is false, p . These reverse conditional probabilities – of the evidence on the truth or falsehood of the hypothesis – are sometimes known as likelihoods. I shall refer to the approach to confirmation that uses them as the likelihood approach.For each of these approaches, there are two obvious options as to how to define the confirmation function. The first is to define it as the difference between the magnitude that is treated as increasing confirmation or p ) and the magnitude that is treated as decreasing confirmation or p ). The second is to define confirmation as the quotient of these two magnitudes.This yields four different measures of confirmation, represented in the following table: Differences RatiosProbabilities PD = p – p1 PR = Graphic2Likelihoods LD = p – p3 LR = Graphic4All these measures agree on whether or not E provides some support for H. Intuitively, we want to say that E provides some support for H just in case learning that E is true would make us assign a higher probability to H, i.e. when p(H …. (shrink)

The present study investigated the effect of Parkinson’s disease (PD) on prospective memory (PM) tasks by varying the emotional content of the PM actions. Twenty-one older adults with PD and 25 healthy older adults took part in the present study. Participants performed three virtual days in the Virtual Week task. On each virtual day, participants performed actions with positive, negative or neutral content. Immediately following each virtual day, participants completed a recognition task to assess their retrospective memory for the various (...) prospective memory tasks. PD patients were less accurate than the control group at both PM accuracy and recognition task accuracy. The effect of emotional valence was also evident, indicating that all participants were more accurate on positive PM tasks than both negative and neutral. This study confirmed PM impairment in PD patients and extended previous research showing how positive emotional stimuli can influence PM performance. (shrink)

After acquiring knowledge of the neuroscience of learning, memory, stress and emotions, teachers incorporate more cognitive engagement and student-centered practices into their lessons. However, the role understanding neuroscience plays in teachers own affective and motivational competencies has not yet been investigated. The goal of this study was to investigate how learning neuroscience effected teachers’ self-efficacy, beliefs in their ability to teach effectively, self-responsibility and other components of teacher motivation. A pilot training-of-trainers program was designed and delivered in Liberia combining basic (...) neuroscience with information on social, emotional, behavioral and mental health issues faced by students. Tier I of the professional development was a 2 weeks workshop led by a visiting neuroscientist. A subset of the 24 Tier I secondary science teachers formed a Leadership Team who adapted the content to the Liberian context and subsequently led additional workshops and follow-up sessions for the Tier II secondary science teachers. Science teachers in both tiers completed the affective-motivational scales from the internationally vetted, multiscale Innovative Teaching for Effective Learning Teacher Knowledge Survey from the OECD. Tier II teachers completed the survey in a pre-post-delayed post design. Tier I teachers completed the survey after the workshop with their attitudes at that time and separately with retrospective projections of their pre-workshop attitudes. Ten of the 92 Tier II teachers participated in structured interviews at follow-up. Statistical analysis of survey data demonstrated improved teacher self-efficacy, self-responsibility for student outcomes, and motivation to teach. Qualitatively, teachers expressed more confidence in their ability to motivate students, engage them through active learning, and manage the class through positive rather than negative reinforcement. Teachers’ own self-regulation improved as they made efforts to build supporting relationships with students. Together, these results demonstrated that (i) teacher affective-motivational attitudes can be altered with professional development, (ii) basic neuroscience, as knowledge of how students learn, can improve teacher competency, and (iii) a training-of-trainers model can be effective in a low and middle income country for disseminating neuroscience knowledge, increasing teachers’ knowledge of students’ social and emotional needs, and promoting educational improvement. (shrink)

We investigated family members’ lived experience of Parkinson’s disease aiming to investigate opportunities for well-being. A lifeworld-led approach to healthcare was adopted. Interpretative phenomenological analysis was used to explore in-depth interviews with people living with PD and their partners. The analysis generated four themes: It’s more than just an illness revealed the existential challenge of diagnosis; Like a bird with a broken wing emphasizing the need to adapt to increasing immobility through embodied agency; Being together with PD exploring the kinship (...) within couples and belonging experienced through support groups; and Carpe diem! illuminated the significance of time and fractured future orientation created by diagnosis. Findings were interpreted using an existential-phenomenological theory of well-being. We highlighted how partners shared the impact of PD in their own ontological challenges. Further research with different types of families and in different situations is required to identify services required to facilitate the process of learning to live with PD. Care and support for the family unit needs to provide emotional support to manage threats to identity and agency alongside problem-solving for bodily changes. Adopting a lifeworld-led healthcare approach would increase opportunities for well-being within the PD illness journey. (shrink)

The American Urological Association (AUA) and American College of Surgeons (ACS) codes of professionalism require surgeons to disclose the specific roles and responsibilities of trainees to patients during the informed consent process. The objective of this study is to analyze how these requirements are met by urology training programs. An anonymous electronic survey was distributed to the program directors (PDs) of the 143 Accreditation Council for Graduate Medical Education urology residency programs in the United States in 2021. Information was collected (...) regarding program demographics, aspects of the program’s consent process, and the disclosure to patients of the role and participation of residents in their surgery. There were 49 responses to the survey (34.3% response rate). Nearly 70 percent of PDs reported that attending physicians lead the consent process. The topics covered during consent discussion include possible complications (25%), expected recovery time (23%), length of the surgery (22%), the people involved (18%), and their specific roles (7%). Many PDs do not explicitly discuss trainee involvement (48.8%) or when a resident is to perform the majority of the case (87.8%). The majority of PDs (78.8%) communicate medical student involvement, but 73.2 percent reported having a patient decline participation of a trainee after describing their role. Despite the AUA and ACS codes of professionalism, many urologists do not disclose resident involvement in surgery to patients. Further discussions are needed to explore how to better balance resident education and patient autonomy. (shrink)

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)

A study of the structural perfection of icosahedral quasicrystalline grains of various alloys and Al-Cu-Fe), grown by different slow solidification techniques was performed using high-resolution diffraction, including recording rocking curves combined with X-ray topography and phase contrast radiography, at a third-generation synchrotron radiation source . For Al-Pd-Mn, additional coherent diffraction and diffuse scattering measurements were also carried out. After evaluating the potentialities of the techniques used, in the light of the criteria defined for crystals, it is shown that the structural (...) perfection of icosahedral quasicrystals is quite comparable with that of metallic crystals but is considerably influenced by either uniform phason strains which can destroy the quasiperiodic long-range order, or by long-wavelength phason fluctuations leading to diffuse scattering. The structural perfection was also found to be extremely variable across the as-grown quasicrystalline grains and to be dependent on the presence and characteristics of inhomogeneities often included in the quasicrystalline matrix. Regarding the grains that we used, it has been impossible to distinguish a clear influence of either the type of alloy or the growth method. It has, however, been noticed that Al-Pd-Mn and Al-Cu-Fe grains appeared less defective than Zn-Mg-RE grains and that the microstructure of these latter grains looks like that of crystals grown by the same technique. Annealing and mechanical polishing effects have also been analysed in the case of Al-Pd-Mn grains. It appeared that annealing improves the quasicrystalline lattice perfection by lowering phason strains insofar as no precipitates are nucleated. Mechanical polishing can introduce defects, located at the external surfaces, having the shape of bands. (shrink)

BACKGROUND: Hallucinations and delusions that complicate Parkinson’s disease could lead to nursing home placement and are linked to increased mortality. Cognitive impairments are typically associated with the presence of hallucinations but there are no data regarding whether such a relationship exists with delusions. OBJECTIVE: We hypothesized that hallucinations would be associated with executive and visuospatial disturbance. An exploratory examination of cognitive correlates of delusions was also completed to address the question of whether they differ from hallucinations. METHODS: 144 PD subjects (...) completed a neuropsychological battery to assess cognition and the SAPS to examine psychosis. Correlational analyses assessed associations between hallucinations and delusions with cognitive domains. RESULTS: 48 subjects reported psychotic symptoms: 25 experienced hallucinations without delusions, 23 had symptoms dominated by delusions. Severity and/or number of hallucination subtypes were significantly correlated with lower scores in language, memory, attention, executive functioning, and visuospatial ability. Correlations with delusions were non-significant. Tests of differences in the size of the correlations between groups revealed a significant relationship between language and visuospatial performance with hallucinations. CONCLUSIONS: Cognitive correlates of hallucinations and delusions appear to be different in PD, suggesting distinct pathogenic mechanisms and possibly anatomical substrates. Hence, delusions may not share the same associations with dementia as hallucinations. Since this is a new finding, further studies will be needed to confirm our results. (shrink)

Deep brain stimulation of the subthalamic nucleus is a clinically effective tool for treating medically refractory Parkinson’s disease, but its neural mechanisms remain debated. Previous work has demonstrated that STN DBS results in evoked potentials in the primary motor cortex, suggesting that modulation of cortical physiology may be involved in its therapeutic effects. Due to technical challenges presented by high-amplitude DBS artifacts, these EPs are often measured in response to low-frequency stimulation, which is generally ineffective at PD symptom management. This (...) study aims to characterize STN-to-cortex EPs seen during clinically relevant high-frequency STN DBS for PD. Intraoperatively, we applied STN DBS to 6 PD patients while recording electrocorticography from an electrode strip over the ipsilateral central sulcus. Using recently published techniques, we removed large stimulation artifacts to enable quantification of STN-to-cortex EPs. Two cortical EPs were observed – one synchronized with DBS onset and persisting during ongoing stimulation, and one immediately following DBS offset, here termed the “start” and the “end” EPs respectively. The start EP is, to our knowledge, the first long-latency cortical EP reported during ongoing high-frequency DBS. The start and end EPs differ in magnitude and latency, and the end, but not the start, EP magnitude has a significant relationship to ongoing high gamma power during the EP. These contrasts may suggest mechanistic or circuit differences in EP production during the two time periods. This represents a potential framework for relating DBS clinical efficacy to the effects of a variety of stimulation parameters on EPs. (shrink)

This paper studies long-term norms concerning actions. In Meyer's Propositional Deontic Logic (PDₑL), only immediate duties can be expressed, however, often one has duties of longer durations such as: "Never do that", or "Do this someday". In this paper, we will investigate how to amend (PDₑL) so that such long-term duties can be expressed. This leads to the interesting and suprising consequence that the long-term prohibition and obligation are not interdefinable in our semantics, while there is a duality between these (...) two notions. As a consequence, we have provided a new analysis of the long-term obligation by introducing a new atomic proposition I (indebtedness) to represent the condition that an agent has some unfulfilled obligation. (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)

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)

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)

Mimesis as Make-Believe is important reading for everyone interested in the workings of representational art.

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)

Entre les états (2, 3) et (2, 4), le Principe de Différence (PD) choisit-t-il le premier, le second, ou est-il indifférent? Cette dernière interprétation est confortée par le choix par Rawls des courbes en L pour illustrer le PD (Rawls 1999 [1971], § 13, fig. 5), formellement analogue au Maximin en théorie de la décision, et qui admettrait des courbes d’indifférence ; une fois le plus mal loti maximisé, on est indifférent entre les états des mieux lotis ; le Leximin (...) enjoint lui de choisir le second état, puisqu’il réitère le PD sur le dernier plus mal loti. La plupart des commentateurs choisissent le Leximin ; or ce principe est inégalitaire, car il peut laisser s’enrichir les riches alors que les pauvres stagnent. Le PD sélectionne en fait le premier état. Si l’on peut passer du premier état au second, on doit pouvoir passer du premier à un état (2+n, 3-n). Le PD est univoque, différent du Maximin et du Leximin, qui peut favoriser des sociétés duales, où seuls les riches s’enrichissent. On n’a pu généraliser le résultat à plus de deux classes, même en tenant compte de la « connexion en chaîne », laquelle exprime l’idée fondamentale de Rawls : la solidarité via la coopération.Code JEL : I13. (shrink)

Objective: To investigate the correlation between preoperative response to the L-dopa challenge test and efficacy of deep brain stimulation (DBS) on motor function in Parkinson’s disease (PD).Methods: We retrospectively reviewed the data of 38 patients with idiopathic PD who underwent DBS surgery with a median follow-up duration of 7 months. Twenty underwent bilateral globus pallidus interna (GPi) DBS, and 18 underwent bilateral subthalamic nucleus (STN) DBS. The Movement Disorder Society Unified Parkinson Disease Rating Scale-Motor Part (MDS UPDRS-III) was assessed before (...) surgery and at the last follow-up in different medication and stimulation conditions, respectively.Results: Pearson’s correlation analysis revealed a positive correlation between preoperative L-dopa challenge responsiveness and GPi-DBS responsiveness on the total score (R2 = 0.283, p = 0.016) but not on the non-tremor total score (R2 = 0.158, p = 0.083) of MDS UPDRS-III. Such correlation remained significant (R2′ = 0.332, p = 0.010) after controlling for age at the time of surgery as confounding factor by partial correlation analysis. The preoperative L-dopa challenge responsiveness was significantly correlated with the tremor-controlling outcome of GPi-DBS (R2 = 0.390, p = 0.003). In contrast, we found a positive correlation between preoperative L-dopa challenge responsiveness and STN-DBS responsiveness on the non-tremor total score (R2 = 0.290, p = 0.021), but not on the total score (R2 = 0.130, p = 0.141) of MDS UPDRS-III. The partial correlation analysis further demonstrated that the predictive value of preoperative L-dopa challenge responsiveness on the non-tremor motor outcome of STN-DBS was eliminated (R2′ = 0.120, p = 0.174) after controlling for age at the time of surgery as confounding factor.Interpretation: The short-term predictive value of preoperative response to the L-dopa challenge test for the motor outcome of GPi-DBS in PD was systematically described. Our findings suggest: (1) a solid therapeutic effect of GPi-DBS in treating L-dopa-responsive tremors; (2) a negative effect of age at the time of surgery on motor outcomes of STN-DBS, (3) a possible preference of STN- to GPi-DBS in L-dopa-resistant tremor control, and (4) a possible preference of GPi- to STN-DBS in elderly PD patients who have a satisfactory dopamine response. (shrink)