Background: Treating medication-refractory freezing of gait in Parkinson’s disease remains challenging despite several trials reporting improvements in motor symptoms using subthalamic nucleus or globus pallidus internus deep brain stimulation. Pedunculopontine nucleus region DBS has been used for medication-refractory FoG, with mixed findings. FoG, as a paroxysmal phenomenon, provides an ideal framework for the possibility of closed-loop DBS.Methods: In this clinical trial, five subjects with medication-refractory FoG underwent bilateral GPi DBS implantation to address levodopa-responsive PD symptoms with open-loop stimulation. Additionally, PPN (...) DBS leads were implanted for CL-DBS to treat FoG. The primary outcome of the study was a 40% improvement in medication-refractory FoG in 60% of subjects at 6 months when “on” PPN CL-DBS. Secondary outcomes included device feasibility to gauge the recruitment potential of this four-lead DBS approach for a potentially larger clinical trial. Safety was judged based on adverse events and explantation rate.Findings: The feasibility of this approach was demonstrated as we recruited five subjects with both “on” and “off” medication freezing. The safety for this population of patients receiving four DBS leads was suboptimal and associated with a high explantation rate of 40%. The primary clinical outcome in three of the five subjects was achieved at 6 months. However, the group analysis of the primary clinical outcome did not reveal any benefit.Interpretation: This study of a human PPN CL-DBS trial in medication-refractory FoG showed feasibility in recruitment, suboptimal safety, and a heterogeneous clinical effect in FoG outcomes. (shrink)

Gene therapy approaches have great promise in the treatment of neurodegenerative disorders and malignant brain tumors. Neuwelt et al. review available viral-mediated gene therapy methods and their blood-brain-barrier (BBB) disruption delivery technique, briefly mentioning nonviral mediated gene therapy methods. This commentary discussed the BBB disruption delivery technique, viral and nonviral mediated gene therapy approaches to Parkinson's disease, and the potential use of antisense oligo to suppress malignant brain tumors.

In this article I study Kant's doctrine of the power of judgement. I focus on its main function of rendering possible the transition from the lawfulness of nature to the realization of practical ends. In order to do so, I analyze the concept of “spontaneity” and the principle of “purposiveness of nature”, understood as a “principle of contingency”, according to Kant's explanation in the Critique of the Power of Judgement.

This article is an edited transcript of the roundtable entitled “What is Philo-Performance?” that took place in Paris on 28 June 2014, within the framework of the “Theatre, Performance, Philosophy International Conference: Crossings and Transfers in Anglo-American Thought”. The conference was organized by Julien Alliot, Flore Garcin-Marrou, Liza Kharoubi and Anna Street from the LAPS, a French research group on performance philosophy.

The European project European and Latin American Systems of Ethics Regulation of Biomedical Research Project (EULABOR) has carried out the first comparative analysis of ethics regulation systems for biomedical research in seven countries in Europe and Latin America, evaluating their roles in the protection of human subjects. We developed a conceptual and methodological framework defining ‘ethics regulation system for biomedical research’ as a set of actors, institutions, codes and laws involved in overseeing the ethics of biomedical research on humans. This (...) framework allowed us to develop comprehensive national reports by conducting semi-structured interviews to key informants. These reports were summarised and analysed in a comparative analysis. The study showed that the regulatory framework for clinical research in these countries differ in scope. It showed that despite the different political contexts, actors involved and motivations for creating the regulation, in most of the studied countries it was the government who took the lead in setting up the system. The study also showed that Europe and Latin America are similar regarding national bodies and research ethics committees, but the Brazilian system has strong and noteworthy specificities. (shrink)

Information on the risks and benefits related to surgical procedures is essential for patients in order to obtain their informed consent. Some disciplines, such as sociolinguistics, offer insights that are helpful for patient—professional communication in both written and oral consent. Communication difficulties become more acute when patients make decisions through an informed consent document because they may sign this with a lack of understanding and information, and consequently feel deprived of their freedom to make their choice about different treatments or (...) surgery. This article discusses findings from documentary analysis using the sociolinguistic SPEAKING model, which was applied to the general and specific informed consent documents required for laparoscopic surgery of the bile duct at Torrecárdenas Hospital, Almería, Spain. The objective of this procedure was to identify flaws when information was provided, together with its readability, its voluntary basis, and patients’ consent. The results suggest potential linguistic communication difficulties, different languages being used, cultural clashes, asymmetry of communication between professionals and patients, assignment of rights on the part of patients, and overprotection of professionals and institutions. (shrink)

The rise of mathematical developments in the theories of consciousness has led to new measures to detect consciousness in a system. The Integrated Information Theory is one of the best mathematical rooted attempts to quantify the level of consciousness in a system with Φ as the effective information generated in a system above its parts. Recently, the IIT has inspired the Perturbational Complexity Index to detect conscious states in patients with disorders of consciousness, and it has shown to have almost (...) perfect classification accuracy. In this study, we explore the statistical correspondence between the theoretical Φ and the experimental PCI through a neurocomputational model of coupled oscillators that can be artificially perturbed, which mainly focuses on the dynamics of collective synchronization between subsets of brain areas. Our results reveal that both measures are statistically related but, in principle, this relationship is far to be perfect. These results are discussed in the context of the model of coupled oscillators, which mainly focuses on the dynamics of collective synchronization between subsets of brain areas. (shrink)

Luis de Molina was a leading figure in the remarkable sixteenth-century revival of Scholasticism on the Iberian peninsula. Molina is best known for his innovative theory of middle knowledge. Alfred J. Freddoso's extensive introductory essay clears up common misconceptions about Molina's theory, defends it against both philosophical and theological objections, and makes it accessible to contemporary readers.

Bioethics emerged as a discipline in the 70s of the last century. One of its main objectives has been to analyze clinical cases that pose moral problems. This analysis is generally carried out by a multidisciplinary group, the Health Care Ethics Committee, which is comprised of ethical experts or healthcare providers assisted by a facilitator, depending on the context. Different methodologies are used in these situations. The deliberative method, in its various configurations, is the most widely used in many Committees. (...) Identify whether the deliberative method is included in regulated undergraduate and postgraduate teaching; analyze whether a single model can be identified or whether there is heterogeneity in the proposals. A bibliographic review was carried out, following the scoping review method. With respect to the first objective, there is no evidence on the teaching and use of the deliberative method in the Faculties and Schools of Medicine and Nursing, the emphasis is placed on training oriented to the resolution of clinical cases and a certain deliberative proposal is developed from them, more pragmatic than ethical-philosophical. In relation to the second objective, differences are observed between the two most prevalent schools (D. Gracia and B. Molewijk), with the model proposed by Gracia being used more in the Spanish-speaking world, and Molewijk's model in the English-speaking world. It can be seen that D. Gracia's proposal is more philosophical and Molewijk's more pragmatic. Finally, it is considered pertinent to further disseminate the deliberative method and its advantages, as well as its potential for bioethics education. (shrink)

Requiring family authorization for apnea testing subtracts health professionals control over death determination, a procedure that has traditionally been considered a matter of clinical expertise alone. In this commentary, we first provide evidence showing that health professionals’ (HPs) disposition to act on death determination without family’s prior consent could be much lower than that referred to by Berkowitz and Garrett (2020). We hypothesize that HPs may have reservations about their own expertise as regards death, and may thus hesitate to impose (...) their views on patients’ families. We then address the theoretical question of clinical expertise in death determination by distinguishing judgments about facts (e.g., the presence or absence of spontaneous breathing) from interpretations given of these facts (i.e., their meaning for the vital status of an individual). We argue that, while clinicians may claim some expert authority on the former, they hold no particular authority on the latter. (shrink)

Callosidad cerebral -- Odiseo y Dédalo -- Tántalo, Sísifo e Ixión -- Tiresias, Calígula y Edipo -- El jugador, Sansón y Butes -- Sócrates y Merlín -- La caña Pesante.

Este trabajo tiene como objeto poner de manifiesto las claves suarecianas de la teoría de la libertad, de acuerdo con las cuales la libertad es una potencia activa de la voluntad que, si bien se muestra indiferente en el acto de elección, sin embargo, se trata de una indiferencia activa, en la medida en que el ser humano ejerce una específica causalidad por libertad que tiene su fundamento metafísico en la teoría del acto virtual. El hombre es libre porque el (...) concurso divino no determina el acto de la voluntad libre, sino que deja al libre arbitrio humano la decisión de actuar o no actuar, de hacer una cosa o su opuesta. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Narrative Symposium:Conflicting Interests in MedicineLaura Jean Bierut, Sal Cruz-Flores, Laura E. Hodges, Anthony A. Mikulec, Govind K. Nagaldinne, Erine L. Bakanas, John F. Peppin, Joel S. Perlmutter, William H. Seitz Jr., Edward Diao, Andre N. Sofair, and David M. Zientek• To Recruit or Not to Recruit for a Clinical Trial• An Unexpected Lesson• Am I on call for the entire Midwest?• Why is Medicare Wasting Away?• The Downside (...) of the Informed Consent Juggernaut• Expert Testimony at the Food and Drug Administration: Who Wants the Truth?• Crossroads: The Intersection of Personal, Professional Society, and Industry Relationships• A Change of Heart• The Evolution of Conflicts of Interest in a New Subspecialty: A Case Study of the Development of Interventional CardiologyCopyright © 2011 The Johns Hopkins University Press... (shrink)

Este texto propone una defensa de la crítica que Cohen realiza al concepto de propiedad de uno mismo. Para ello, presentaremos la crítica de Cohen a dicho concepto en la obra de Nozick. Luego, se expondrá la defensa elaborada por Mack de la propiedad de uno mismo en la obra de Nozick, por medio de la formulación de lo que denomina “cláusula de propiedad de uno mismo”. Por último, se sostendrá que dicha cláusula no permite superar las críticas de Cohen, (...) debido a que su cumplimiento es compatible con un régimen de propiedad colectiva. (shrink)

Given that the pastoral societies of the Peruvian Andes have seldom participated in scientific and political debates about climate change, this paper aims to explain and account for the languages of beliefs, meanings, and experiences of those principally affected from a philosophical and anthropological approach. In a time of ecological crisis, not only is the world of certainties or the significant experiences of the highland shepherds put into question, but also there is an opportunity forthe critique of the relationships of (...) reciprocity in the totality of what exists, offering answers to various inquiries through different interpretative paradigms or language games. With the same strength with which the accounts of the peasants are able to show that crisis, critic, and creation go essentially hand-in-hand, there rises the need to establish limits to the scientific or dogmatic pretention of reducing the debate about climate change solely to closed decisions of expert groups or autonomous power centers, apart from all political process of discussion and dialogue with those mainly affected. Thence comes the ethical demand to initiate processes of democratization that can give a voice to the marginalized and include them in the procedures of public deliberation about climate change by means of reciprocity, social cooperation, and symbolic exchanges on equal standing. (shrink)

Este trabajo examina los diferentes reparos que el recurso a las ideas procedentes de la cultura pública como base de su concepción de la justicia le ha procurado a Rawls. Ese examen se propone establecer dos conclusiones. Primera, frente a quienes sugieren que, con la apelación a tales fundamentos, la solidez del método de justificación que Rawls articula se resiente gravemente y los que esgrimen que, con esa apelación, Rawls renuncia a las pretensiones de universalidad que son consustanciales a la (...) doctrina liberal, intenta poner de manifiesto que el papel que esas ideas cumplen en la justificación de una concepción política de la justicia como la suya únicamente muestra la congruencia que la obra de Rawls exhibe en la manera de entender la naturaleza de la justificación y la clase de elementos sobre los cuales se articula. Segunda, frente a quienes sostienen que el método de justificación empleado por Rawls entraña alguna forma de relativismo o etnocentrismo, trata de evidenciar que ese método no conduce a ese tipo de posiciones, por más que tome como base nuestros juicios considerados y nociones políticas fundamentales. (shrink)

Resumen El propósito de este trabajo es profundizar en el concepto de actividad de imagen y defender su utilidad como categoría de estudio para comprender diferentes tipos de comportamiento que afectan a la imagen social de los hablantes en la interacción comunicativa: cortesía, descortesía y actividad de autoimagen. Teniendo como base estudios sociopragmáticos del español desde una perspectiva cultural y estudios teóricos en inglés de la última década, se tratará el concepto de actividad de imagen, el cual se caracteriza de (...) acuerdo con dos conceptos claves: el del efecto social que un comportamiento comunicativo tiene sobre las imágenes de los hablantes y el del continuo social, la conexión que se establece entre sus imágenes en la interacción. De esta forma, se propone tratar la actividad de imagen desde dos perspectivas relacionadas: la de la dirección seguida por el efecto social hacia los interactuantes y la de las características de este efecto, siendo su interrelación el factor que permite identificar y caracterizar el tipo de actividad de imagen. (shrink)