People judge that an individual who attempts to harm someone but fails should be blamed and punished more when they imagine how things could have turned out worse, compared to when they imagine how things could have turned out the same, or when they think only about what happened. This moral counterfactual amplification effect occurs when people believe the protagonist had no reason for the attempt to harm, and not when the protagonist had a reason, as Experiment 1 shows. It (...) occurs for intentional failed attempts to harm and also for accidental near-misses, as Experiment 2 shows, but not for failed attempts in which the harm occurs anyway by another cause, for both general judgments about the event and specific judgments about the individual's actions, as Experiments 3 and 4 show. The implications for understanding the role of counterfactual thoughts in moral judgement are discussed. (shrink)

The Ontology for Biomedical Investigations (OBI) is an ontology that provides terms with precisely defined meanings to describe all aspects of how investigations in the biological and medical domains are conducted. OBI re-uses ontologies that provide a representation of biomedical knowledge from the Open Biological and Biomedical Ontologies (OBO) project and adds the ability to describe how this knowledge was derived. We here describe the state of OBI and several applications that are using it, such as adding semantic expressivity to (...) existing databases, building data entry forms, and enabling interoperability between knowledge resources. OBI covers all phases of the investigation process, such as planning, execution and reporting. It represents information and material entities that participate in these processes, as well as roles and functions. Prior to OBI, it was not possible to use a single internally consistent resource that could be applied to multiple types of experiments for these applications. OBI has made this possible by creating terms for entities involved in biological and medical investigations and by importing parts of other biomedical ontologies such as GO, Chemical Entities of Biological Interest (ChEBI) and Phenotype Attribute and Trait Ontology (PATO) without altering their meaning. OBI is being used in a wide range of projects covering genomics, multi-omics, immunology, and catalogs of services. OBI has also spawned other ontologies (Information Artifact Ontology) and methods for importing parts of ontologies (Minimum information to reference an external ontology term (MIREOT)). The OBI project is an open cross-disciplinary collaborative effort, encompassing multiple research communities from around the globe. To date, OBI has created 2366 classes and 40 relations along with textual and formal definitions. The OBI Consortium maintains a web resource providing details on the people, policies, and issues being addressed in association with OBI. (shrink)

In a series of related essays, Dr Parkinson argues that both science and religion are at a crossroads, because in both cases their current paradigms are breaking down. In science, Einstein’s General Relativity has left an unbridgeable gap between quantum physics and the new cosmology and, in the West, the gap between the story told by modern scholarship and “gospel truth” has become equally wide. What for two millennia has been considered to be historical fact is now seen often (...) to be not only pious myth but deliberate falsification. The author adds something new and positive – but controversial- to the debate, in arguing that a future science and religion must be symbiotic. That is to say, in being true to their most basic principles of truth-seeking, both will find themselves to be not merely harmonious but mutually supporting and illuminating. When the evidence for this is fully, and honestly, assessed, the “phoney war” between science and religion can be seen for what it is. The question under all the questions is this: if simple honesty is an essential part of both science and religion, can either continue to survive with what J. K. Galbraith called “institutional truth?”. (shrink)

Background: Concern has been expressed about the process of consent to clinical trials, particularly in phase I “first-in-man” trials. Trial participant information sheets are often lengthy and technical. Content-based readability testing of sheets, which is often required to obtain research ethics approval for trials in the USA, is limited and cannot indicate how information will perform. Methods: An independent-groups design was used to study the user-testing performance of the participant information sheet from the phase I TGN1412 trial. Members of the (...) public were asked to read it, then find and demonstrate understanding of 21 key aspects of the trial. The participant information sheet was then rewritten, redesigned and tested on 20 members of the public, using the same 21-item questionnaire. Results: On the original TGN1412 participant information sheet, participants could not find answers and some of the found information was not understood. Six of 21 questions, including those relating to placebo, follow-up visits and the emergency phone number, were found by eight or fewer of 10 participants. The revised information sheet performed better, with the answers to 17 of 21 questions found and understood by all 20 participants. Conclusions: Tests showed that the TGN1412 participant information sheet may not inform participants adequately for consent. Revising its content and design led to significant improvements. Writers of materials for trial participants should take account of good practice in information design. Performance-based user testing may be a useful method to indicate strengths and weaknesses in trial materials. (shrink)

Artificial intelligence (AI) has garnered tremendous attention in health care, and many hope that AI can enhance our health system’s ability to care for people with chronic and degenerative conditions, including Parkinson’s Disease (PD). This paper reports the themes and lessons derived from a qualitative study with people living with PD, family caregivers, and health care providers regarding the ethical dimensions of using AI to monitor, assess, and predict PD symptoms and progression. Thematic analysis identified ethical concerns at four (...) intersecting levels: personal, interpersonal, professional/institutional, and societal levels. Reflecting on potential benefits of predictive algorithms that can continuously collect and process longitudinal data, participants expressed a desire for more timely, ongoing, and accurate information that could enhance management of day-to-day fluctuations and facilitate clinical and personal care as their disease progresses. Nonetheless, they voiced concerns about intersecting ethical questions around evolving illness identities, familial and professional care relationships, privacy, and data ownership/governance. The multi-layer analysis provides a helpful way to understand the ethics of using AI in monitoring and managing PD and other chronic/degenerative conditions. (shrink)

Neurodegenerative Parkinson's Disease (PD) is one of the common incurable diseases among the elderly. Clinical assessments are characterized as standardized means for PD diagnosis. However, relying on medical evaluation of a patient's status can be subjective to physicians' experience, making the assessment process susceptible to human errors. The use of ICT-based tools for capturing the status of patients with PD can provide more objective and quantitative metrics. In this vein, the Personalized Serious Game Suite (PGS) and intelligent Motor Assessment (...) Tests (iMAT), produced within the i-PROGNOSIS European project (www.i-prognosis.eu), are explored in the current study. More specifically, data from 27 patients with PD at Stage 1 (9) and Stage 3 (18) produced from their interaction with PGS/iMAT are analyzed. Five feature vector (FV) scenarios are set, including features from PGS or iMAT scores or their combination, after also taking into consideration the age of patients with PD. These FVs are fed into three machine learning classifiers, i.e., K-Nearest Neighbor (KNN), Support Vector Machines (SVM), and Random Forest (RF), to infer the stage of each patient with PD. A Leave-One-Out Cross-Validation (LOOCV) method is adopted for testing the classification performance. The experimental results show that a high (>90%) classification accuracy is achieved from both data sources (PGS/iMAT), justifying the effectiveness of PGS/iMAT to efficiently reflect the motor skill status of patients with PD and further potentiating PGS/iMAT enhancement with a machine learning a part to infer for the stage of patients with PD. Clearly, this integrated approach provides new opportunities for remote monitoring of the stage of patients with PD, contributing to a more efficient organization and set up of personalized interventions. (shrink)

Postural instability in Parkinson’s disease (PD) is characterized by impaired postural responses to transient perturbations, increased postural sway in stance and difficulty transitioning between tasks. In addition, some studies suggest that loss of dopamine in the basal ganglia due to PD results in difficulty using proprioceptive information for motor control. Here, we quantify the ability of subjects with PD and age-matched control subjects to use and re-weight sensory information for postural control during steady-state conditions of continuous rotations of the (...) stance surface or visual surround. We measure the postural sway of subjects in response to a pseudorandom, surface-tilt stimulus with eyes closed, and in response to a pseudorandom, visual-tilt stimulus. We use a feedback control model of the postural control system to interpret our results, focusing on sensory weighting as a function of stimulus amplitude. We find that subjects with PD can re-weight their dependence upon sensory information in response to changes in surface- or visual-stimulus amplitude. Specifically, subjects with PD behaved like age-matched control subjects by decreasing proprioceptive contribution to stance control with increasing surface-tilt amplitude, and decreasing visual contribution with increasing visual-tilt amplitude. However, subjects with PD do not decrease their reliance on proprioception as much as age-matched controls for small increases in surface-stimulus amplitudes. Levodopa medication did not affect sensory re-weighting behaviors for postural control. The impairment in PD subject’s ability to respond differently to small changes in surface rotation amplitudes is consistent with an increased threshold for perceiving proprioceptive signals, which may result from decreased signal-to-noise in the dopaminergic pathways associated with sensory processing and/or sensory integration. (shrink)

Leg rigidity is associated with frequent falls in people with Parkinson’s disease, suggesting a potential role in functional balance and gait impairments. Changes in the neural state due to secondary tasks, e.g., activation maneuvers, can exacerbate rigidity, possibly increasing the risk of falls. However, the subjective interpretation and coarse classification of the standard clinical rigidity scale has prohibited the systematic, objective assessment of resting and activated leg rigidity. The pendulum test is an objective diagnostic method that we hypothesized would (...) be sensitive enough to characterize resting and activated leg rigidity. We recorded kinematic data and electromyographic signals from rectus femoris and biceps femoris during the pendulum test in 15 individuals with PD, spanning a range of leg rigidity severity. From the recorded data of leg swing kinematics, we measured biomechanical outcomes including first swing excursion, first extension peak, number and duration of the oscillations, resting angle, relaxation index, maximum and minimum angular velocity. We examined associations between biomechanical outcomes and clinical leg rigidity score. We evaluated the effect of increasing rigidity through activation maneuvers on biomechanical outcomes. Finally, we assessed whether either biomechanical outcomes or changes in outcomes with activation were associated with a fall history. Our results suggest that the biomechanical assessment of the pendulum test can objectively quantify parkinsonian leg rigidity. We found that the presence of high rigidity during clinical exam significantly impacted biomechanical outcomes, i.e., first extension peak, number of oscillations, relaxation index, and maximum angular velocity. No differences in the effect of activation maneuvers between groups with clinically assessed low rigidity were observed, suggesting that activated rigidity may be independent of resting rigidity and should be scored as independent variables. Moreover, we found that fall history was more common among people whose rigidity was increased with a secondary task, as measured by biomechanical outcomes. We conclude that different mechanisms contributing to resting and activated rigidity may play an important yet unexplored functional role in balance impairments. The pendulum test may contribute to a better understanding of fundamental mechanisms underlying motor symptoms in PD, evaluating the efficacy of treatments, and predicting the risk of falls. (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)

Human-Computer Interaction (HCI) and games set a new domain in understanding people’s motivations in gaming, behavioral implications of game play, game adaptation to player preferences and needs for increased engaging experiences in the context of HCI serious games (HCI-SGs). When the latter relate with people’s health status, they can become a part of their daily life as assistive health status monitoring/enhancement systems. Co-designing HCI-SGs can be seen as a combination of art and science that involves a meticulous collaborative process. The (...) design elements in assistive HCI-SGs for Parkinson’s Disease (PD) patients, in particular, are explored in the present work. Within this context, the Game-Based Learning (GBL) design framework is adopted here and its main game-design parameters are explored for the Exergames, Dietarygames, Emotional games, Handwriting games, and Voice games design, drawn from the PD-related i-PROGNOSIS Personalized Game Suite (PGS) (www.i-prognosis.eu) holistic approach. Two main data sources were involved in the study. In particular, the first one includes qualitative data from semi-structured interviews, involving 10 PD patients and four clinicians in the co-creation process of the game design, whereas the second one relates with data from an online questionnaire addressed by 104 participants spanning the whole related spectrum, i.e., PD patients, physicians, software/game developers. Linear regression analysis was employed to identify an adapted GBL framework with the most significant game-design parameters, which efficiently predict the transferability of the PGS beneficial effect to real-life, addressing functional PD symptoms. The findings of this work can assist HCI-SG designers for designing PD-related HCI-SGs, as the most significant game-design factors were identified, in terms of adding value to the role of HCI-SGs in increasing PD patients’ quality of life, optimizing the interaction with personalized HCI-SGs and, hence, fostering a collaborative human-computer symbiosis. (shrink)

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)

BackgroundAn increasing number of studies utilize intracranial electrophysiology in human subjects to advance basic neuroscience knowledge. However, the use of neurosurgical patients as human research subjects raises important ethical considerations, particularly regarding informed consent and undue influence, as well as subjects’ motivations for participation. Yet a thorough empirical examination of these issues in a participant population has been lacking. The present study therefore aimed to empirically investigate ethical concerns regarding informed consent and voluntariness in Parkinson’s disease patients undergoing deep (...) brain stimulator (DBS) placement who participated in an intraoperative neuroscience study.MethodsTwo semi-structured 30-minute interviews were conducted preoperatively and postoperatively via telephone. Interviews assessed participants’ motivations for participation in the parent intraoperative study, recall of information presented during the informed consent process, and participants’ postoperative reflections on the research study.ResultsTwenty-two participants (mean age = 60.9) completed preoperative interviews at a mean of 7.8 days following informed consent and a mean of 5.2 days prior to DBS surgery. Twenty participants completed postoperative interviews at a mean of 5 weeks following surgery. All participants cited altruism or advancing medical science as “very important” or “important” in their decision to participate in the study. Only 22.7% (n = 5) correctly recalled one of the two risks of the study. Correct recall of other aspects of the informed consent was poor (36.4% for study purpose; 50.0% for study protocol; 36.4% for study benefits). All correctly understood that the study would not confer a direct therapeutic benefit to them.ConclusionEven though research coordinators were properly trained and the informed consent was administered according to protocol, participants demonstrated poor retention of study information. While intraoperative studies that aim to advance neuroscience knowledge represent a unique opportunity to gain fundamental scientific knowledge, improved standards for the informed consent process can help facilitate their ethical implementation. (shrink)

Pathological tremor is a common but highly complex movement disorder, affecting ~5% of population older than 65 years. Different methodologies have been proposed for its quantification. Nevertheless, the discrimination between Parkinson’s disease tremor and essential tremor remains a daunting clinical challenge, greatly impacting patient treatment and basic research. Here, we propose and compare several movement-based and electromyography-based tremor quantification metrics. For the latter, we identified individual motor unit discharge patterns from high-density surface electromyograms and characterized the neural drive to (...) a single muscle and how it relates to other affected muscles in 27 Parkinson’s disease and 27 essential tremor patients. We also computed several metrics from the literature. The most discriminative metrics were the symmetry of the neural drive to muscles, motor unit synchronization, and the mean log power of the tremor harmonics in movement recordings. Noteworthily, the first two most discriminative metrics were proposed in this study. We then used decision tree modelling to find the most discriminative combinations of individual metrics, which increased the accuracy of tremor type discrimination to 94%. In summary, the proposed neural drive-based metrics were the most accurate at discriminating and characterizing the two most common pathological tremor types. (shrink)

Humans' voice offers the widest variety of motor phenomena of any human activity. However, its clinical evaluation in people with movement disorders such as Parkinson's disease lags behind current knowledge on advanced analytical automatic speech processing methodology. Here, we use deep learning-based speech processing to differentially analyze voice recordings in 14 people with PD before and after dopaminergic medication using personalized Convolutional Recurrent Neural Networks and Phone Attribute Codebooks. p-CRNN yields an accuracy of 82.35% in the binary classification of (...) ON and OFF motor states at a sensitivity/specificity of 0.86/0.78. The PAC-based approach's accuracy was slightly lower with 73.08% at a sensitivity/specificity of 0.69/0.77, but this method offers easier interpretation and understanding of the computational biomarkers. Both p-CRNN and PAC provide a differentiated view and novel insights into the distinctive components of the speech of persons with PD. Both methods detect voice qualities that are amenable to dopaminergic treatment, including active phonetic and prosodic features. Our findings may pave the way for quantitative measurements of speech in persons with PD. (shrink)

Artificial intelligence (AI) technologies in medicine are gradually changing biomedical research and patient care. High expectations and promises from novel AI applications aiming to positively impact society raise new ethical considerations for patients and caregivers who use these technologies. Based on a qualitative content analysis of semi-structured interviews and focus groups with healthcare professionals (HCPs), patients, and family members of patients with Parkinson’s Disease (PD), the present study investigates participant views on the comparative benefits and problems of using human (...) versus AI predictive computer vision health monitoring, as well as participants’ ethical concerns regarding these technologies. Participants presumed that AI monitoring would enhance information sharing and treatment, but voiced concerns about data ownership, data protection, commercialization of patient data, and privacy at home. They highlighted that privacy issues at home and data security issues are often linked and should be investigated together. Findings may help technologists, HCPs, and policymakers determine how to incorporate stakeholders’ intersecting but divergent concerns into developing and implementing AI PD monitoring tools. (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)

BackgroundCentral to ethically justified clinical trial design is the need for an informed consent process responsive to how potential subjects actually comprehend study participation, especially study goals, risks, and potential benefits. This will be particularly challenging when studying deep brain stimulation and whether it impedes symptom progression in Parkinson’s disease, since potential subjects will be Parkinson’s patients for whom deep brain stimulation will likely have therapeutic value in the future as their disease progresses.MethodAs part of an expanded informed (...) consent process for a pilot Phase I study of deep brain stimulation in early stage Parkinson’s disease, an ethics questionnaire composed of 13 open-ended questions was distributed to potential subjects. The questionnaire was designed to guide potential subjects in thinking about their potential participation.ResultsWhile the purpose of the study (safety and tolerability) was extensively presented during the informed consent process, in returned responses 70 percent focused on effectiveness and 91 percent included personal benefit as potential benefit from enrolling. However, 91 percent also indicated helping other Parkinson’s patients as motivation when considering whether or not to enroll.ConclusionsThis combination of responses highlights two issues to which investigators need to pay close attention in future trial designs: (1) how, and in what ways, informed consent processes reinforce potential subjects’ preconceived understandings of benefit, and (2) that potential subjects see themselves as part of a community of Parkinson’s sufferers with responsibilities extending beyond self-interest. More importantly, it invites speculation that a different paradigm for informed consent may be needed. (shrink)

As individuals enter their 80s, they are inevitably confronted with the problem of neuronal loss in the brain. The incidence of the common movement disorder ‘mild parkinsonian signs’ (MPS) is approximately 50% over the age of 85 years. It has long been known that the loss of dopaminergic neurons in the substantia nigra pars compacta is a neuropathological hallmark of Parkinson's disease (PD). Recently, two papers1,2 present clear evidence for a high burden of mitochondrial DNA deletions within substantia nigra (...) neurons in aged individuals and individuals with PD, pointing towards a common pathway inevitably leading to neuronal dysfunction and death. BioEssays 28: 963–967, 2006. © 2006 Wiley Periodicals, Inc. (shrink)

IntroductionCognitive impairment is a highly prevalent non-motor feature of Parkinson’s disease. A better understanding of the underlying pathophysiology may help in identifying therapeutic targets to prevent or treat dementia. This study sought to identify metabolic alterations in the prefrontal cortex, a key region for cognitive functioning that has been implicated in cognitive dysfunction in PD.MethodsProton Magnetic Resonance Spectroscopy was used to investigate metabolic changes in the PFC of a cohort of cognitively normal individuals without PD, as well as PD (...) participants with either normal cognition, mild cognitive impairment, or dementia. Ratios to Creatine resonance were obtained for glutamate, glutamine and glutamate combined, N-acetylaspartate, myoinositol, and total choline, and correlated with cognitive scores across multiple domains administered to the PD participants only.ResultsWhen individuals retain cognitive capabilities, the presence of Parkinson’s disease does not create metabolic disturbances in the PFC. However, when cognitive symptoms are present, PFC Glu/Cre ratios decrease with significant differences between the PD-NC and PPD groups. In addition, Glu/Cre ratios and memory scores were marginally associated, but not after Bonferroni correction.ConclusionThese preliminary findings indicate that fluctuations in prefrontal glutamate may constitute a biomarker for the progression of cognitive impairments in PD. We caution for larger MRS investigations of carefully defined PD groups. (shrink)

Stein & Glasier suggest embryonic neural tissue grafts as a potential treatment strategy for Alzheimer's and Parkinson's disease. As an alternative, we suggest that the family of nerve growth factor-related neurotrophins and their trk (tyrosine kinase) receptors underlie cholinergic basal forebrain (CBF) and dopaminergic substantia nigra neuron degeneration in these diseases, respectively. Therefore, treatment approaches for these disorders could utilize neurotrophins.

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)

Buku ini berawal dari sebuah disertasi yang ditulis Sr. Gerardette Philips, RSCJ, pengarangnya, untuk meraih gelar doktor di bidang Ilmu Filsafat di Sekolah Tinggi Filsafat Driyarkara, Jakarta. Penerbitannya menjadi sebuah buku oleh Interfidei—sebuah Penerbit di Indonesia yang menaruh perhatian khusus pada persoalan dialog antaragama— sungguh layak disambut baik. Penerbitan buku ini dalam bahasa Inggris memiliki segi negatif maupun positifnya tersendiri. Segi negatifnya, hal itu membuat jumlah publik pembacanya di Indonesia lebih terbatas pada mereka yang dapat memahami bahasa Inggris. Jumlahnya jelas (...) jauh lebih sedikit dibandingkan dengan jumlah pembaca buku ini kalau ditulis dalam bahasa Indonesia. Walaupun demikian, segi positifnya, dengan diterbitkannya dalam bahasa Inggris, publik pembaca yang dapat mengaksesnya secara internasional menjadi lebih banyak. Apalagi buku ini juga memuat Kata Pengantar dalam bahasa Inggris dari Prof. Seyyed Hossein Nasr, seorang tokoh Muslim yang hendak ditampilkan pengarang buku ini sebagai pemikir sekaligus pelaku dialog Muslim-Kristen yang melampaui pendekatan pluralisme. Tokoh dari pihak agama Kristen yang ditampilkan oleh pengarang adalah Hans Küng. Selama ini banyak orang beranggapan bahwa pluralisme merupakan paham hubungan antaragama, yang memiliki bentuk pendekatan yang paling tepat dalam melakukan dialog antaragama, termasuk di dalamnya dialog antara umat Muslim dan Kristen. Memang, dibandingkan dengan pendekatan eksklusivisme maupun inklusivisme, seperti ditegaskan oleh pengarang buku ini (hlm. 1; 60–63; 67), pluralisme memiliki kelebihan tersendiri. Namun, pluralisme mengandung beberapa kelemahan yang layak dikritik. Paling tidak ada tiga kelemahan pokok dari pendekatan pluralisme yang dicoba ditunjukkan dalam buku ini. Pertama, pluralisme mengandung bahaya tidak mengambil serius identitas keagamaan yang khas dan berbeda untuk setiap agama karena ingin menekankan keselarasan antara semua agama, agar tidak terjadi konflik antara pemeluk agama yang berbeda. Guna menguatkan pendapatnya, pengarang mengutip pernyataan Paul Knitter (hlm. 64) yang berbunyi: “Karena begitu terpesona oleh keindahan sebuah simfoni, kaum pluralis melupakan perbedaan dan kekhasan dari masing-masing alat musik yang dipakai.” Pendekatan pluralisme juga mengandung bahaya jatuh ke dalam relativisme, karena— terdorong oleh kehendak untuk mau bersikap terbuka terhadap penganut agama yang lain dan mau menghormati perbedaan keyakinan mereka— para pluralis lalu cenderung merelatifkan klaim kebenaran agamanya sendiri. Tanpa harus menjadi seorang eksklusivis—yang memutlakkan klaim kebenaran keyakinan agamanya sendiri seraya menganggap sesat keyakinan agama yang lain—keseriusan untuk sungguh meyakini kebenaran iman agama yang dipeluknya, sangat diperlukan dalam berdialog agar tidak menjadi kompromistis dan jatuh ke dalam relativisme. Sikap terbuka terhadap para pemeluk agama yang lain—yang berbeda dengan agamanya sendiri—memang diperlukan dalam sebuah dialog antaragama yang sejati. Namun, hal itu perlu dilakukan tanpa kehilangan jatidirinya sendiri sebagai pemeluk agama tertentu yang diyakini kebenarannya. Kelemahan ketiga dari pluralisme adalah bahaya menjadi imperialis tanpa disengaja. Kembali mengutip pernyataan Knitter (hlm.68), pengarang menyebut adanya dua kemungkinan seorang pluralis yang berniat baik tanpa disengaja menjadi seorang imperialis. Pertama, dengan terlalu cepat seorang pluralis menarik kesimpulan tentang adanya suatu dasar pijak atau platform yang sama dari macam-macam agama yang ada yang dapat mempersatukan semuanya. Kedua, ia dengan terlalu mudah merumuskan panduan umum bersama untuk melakukan dialog antaragama-agama yang berbeda................ Salah satu kelemahan buku ini—sebagai sebuah buku yang dimaksud- kan untuk dibaca oleh publik pembaca umum—adalah bahwa formatnya masih mempertahankan format aslinya sebagai sebuah disertasi dan belum cukup diolah untuk dijadikan buku yang lebih dapat diakses dan lebih enak dibaca oleh publik pembaca umum. Bahkan di dalamnya masih dapat ditemukan kata “disertasi” dan belum diganti dengan kata “buku” (lihat hlm. 11). Semboyan dalam bahasa Latin “Extra Ecclesiam Nulla Salus,” artinya “Di luar Gereja tidak ada keselamatan,” yang dalam teks asli disertasi salah ditulis “Extra Ecclesiam Nulla Sales!” masih terulang kesalahannya dalam buku ini (lihat hlm. 90). Lepas dari kelemahan kecil di atas, penerbitan buku ini sekali lagi sungguh layak dihargai dan jelas menambah khasanah intelektual yang dapat memperkaya wawasan maupun memberi inspirasi yang berguna bagi siapa saja yang bermaksud mengembangkan dialog antaragama pada umumnya dan khususnya dialog Muslim-Kristen yang menjadi fokus perhatian dalam buku ini. Sr. Gerardette Philips, RSCJ, Ph.D., penulis buku ini, bukan hanya menjadi seorang akademikus yang telah meneliti pemikiran Hans Küng dan Seyyed Hosein Nasr, tetapi ia sendiri sudah cukup lama terlibat dalam upaya mengembangkan dialog Muslim- Kristen. Beliau bahkan sempat menjadi anggota tim penasihat Paus Benedictus XVI dalam Komisi Kepausan dalam Bidang Hubungan dengan Islam. Pengalamannya yang cukup banyak dalam mewujudkan dialog hidup antara umat Islam dan umat Katolik jelas ikut memperkaya wawasan dalam buku ini. (J. Sudarminta, Program Pascasarjana, Sekolah Tinggi Filsafat Driyarkara, Jakarta). (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Not Only Sub Specie Aeternitatis, but Equally Sub Specie DurationisA Defense of Hegel's Criticisms of Spinoza's PhilosophyJ. M. Fritzman and Brianne RileyIn what seem like halcyon days, when William Jefferson Clinton was America's President, James Carville wrote We're Right, They're Wrong: A Handbook for Spirited Progressives, arguing against the Republican Party's "Contract with America" (derided by the Left as a "Contract on America") and for progressivism. In the present (...) philosophical conjuncture, what is required is a precisely analogous intervention—"Hegel's Right, Spinoza's Wrong: An Article for Spirited Hegelians." Hegel criticizes Spinoza's philosophy at various places in his writings.1 Spinozists have made several major challenges to Hegel's criticisms.2 Although there have been explications of Hegel's criticisms, there has been no effective response to the Spinozists' challenges.3 Until now. This article defends Hegel's criticisms of Spinoza's philosophy and shows that the challenges to his criticisms fail.This article presents a précis of Spinoza's system and shows the senses in which Hegel is not wholly enamored with it. It defends Hegel's criticism of Spinoza's system as an acosmism from Parkinson's challenges to it. It considers both Myers's view that Hegel's system begins where Spinoza's system ends and McMinn's charge that the systems of Spinoza and Hegel are fundamentally identical. Myers and McMinn misunderstand Hegel's dialectical method, and so they incorrectly believe that the methods of Spinoza and Hegel are complementary. Hegel's dialectics can sublate the systematic pluralism that Myers and Armour propose as its alternative. The penultimate section discusses the modifications that must be made to Spinoza's system to advance from his substance to Hegel's subject.Clinton successfully appropriated what was worthwhile in the "Contract with America," but he also effectively argued that the "Contract" would be a disaster for America. Similarly, Hegel assimilates the truth in his predecessors' philosophies while demonstrating how those philosophies remain [End Page 76] one-sided and partial. This article concludes by showing how this happens to Spinoza's philosophy.Everybody Loves SpinozaSpinoza's philosophy is a metaphysical monism. That is, he thinks that there is only one basic substance. Although there is only one substance, it necessarily expresses itself through an infinite number of attributes, and an attribute is the essence of substance as experienced by the intellect.4 Humans are capable of knowing only two of these attributes: thought and extension. Objects, ideas, and relations—Spinoza refers to all of these as "modes"—are presented through some attribute or other. Spinoza denies that a thing presented through one attribute can cause or be affected by anything presented through another attribute. Rather, each thing which is presented through an attribute has an infinite number of counterparts presented through the infinite number of attributes. Indeed, those infinite counterparts are that thing, presented through the other attributes. Substance necessarily expresses itself through the attributes and modes, according to Spinoza, and everything that is possible is also actual.5Spinoza's substance expresses itself through its attributes and modes, but what occurs at the level of the attributes and modes has no reciprocal effect on substance. Like unrequited love, expression is a one-way street. Not e pluribus unum (out of many, one), but e unibus plurum (out of one, many). Unlike the relation of the states to the federal government, the attributes and modes do not possess a relative or circumscribed autonomy vis-à-vis substance.6 Substance expressing itself through its attributes and modes is nature, according to Spinoza, and nature in turn is God. Hence, Spinoza's God is wholly immanent within the world—for him, God is the world—and so he rejects that traditional God of theism, who transcends and is wholly independent from the world. Spinoza rejects as illusory all notions of purpose and intention.7 Although individuals generally believe that their actions are performed in order to fulfill some goal, Spinoza instead maintains that human actions are entirely determined and necessary and that the belief that actions are done to accomplish something is entirely mistaken. He believes that all happenings—physical... (shrink)

In 1989, in the wake of the first operations to transplant fetal tissue into the brains of sufferers from Parkinson's Disease, the UK Code of Practice governing the use of the fetus for research was overhauled by an eminent committee under the chairmanship of the Reverend Dr John Polkinghorne. The Polkinghorne Report has, however, attracted remarkably little comment or analysis. This paper is believed to be the first to subject it to sustained ethical and legal scrutiny. The author concludes (...) that, although the committee's recommendations meet the major objections to the Code of Practice, the report is nevertheless vulnerable to criticism in its treatment of at least three issues: the moral status of the fetus; paternal consent to fetal use, and the ethical inter-relation of fetal use and abortion. (shrink)

PURPOSE: To evaluate the effects of social support on comprehension and recall of consent form information in a study of Parkinson disease patients and their caregivers.DESIGN and METHODS: Comparison of comprehension and recall outcomes among participants who read and signed the consent form accompanied by a family member/friend versus those of participants who read and signed the consent form unaccompanied. Comprehension and recall of consent form information were measured at one week and one month respectively, using Part A of (...) the Quality of Informed Consent Questionnaire .RESULTS: The mean age of the sample of 143 participants was 71 years . Analysis of covariance was used to compare QuIC scores between the intervention group and control group . In the 1-week model, no statistically significant intervention effect was found . However, the intervention status by patient status interaction was statistically significant . In the 1-month model, no statistically significant intervention effect was found . Again, however, the intervention status by patient status interaction was statistically significant . At both time periods, intervention group patients scored higher on the QuIC than did intervention group caregivers, and control group patients scored lower on the QuIC than did control group caregivers.IMPLICATIONS: Social support played a significant role in enhancing comprehension and recall of consent form information among patients. (shrink)

While slowness of movement is an obligatory characteristic of Parkinson’s disease (PD), there are conditions in which patients move uncharacteristically fast, attributed to deficient motor inhibition. Here we investigate deficient inhibition in an optimal sensory-motor integration framework, using a game in which subjects used a paddle to catch a virtual ball. Display of the ball was extinguished as soon as the catching movement started, segregating the task into a sensing and acting phase. We analyzed the behavior of 9 PD (...) patients (ON medication) and 10 age-matched controls (HC). The switching times (between sensing and acting phase) were compared to the predicted optimal switching time, based on the individual estimates of sensory and motor uncertainties. The comparison showed that deviation from predicted optimal switching times were similar between groups. However, PD patients showed a weaker correlation between variability in switching time and sensory-motor uncertainty, indicating a reduced propensity to generate exploratory behavior for optimizing goal-directed movements. Analysis of the movement kinematics revealed that PD patients, compared to controls, used a lower peak velocity of the paddle and intercepted the ball with greater velocity. Adjusting the trial duration to the time for the paddle to stop moving, we found that PD patients spent a smaller proportion of the trial duration for observing the ball. Altogether, the results do not show the premature movement initiation and truncated sensory processing that we predicted to ensue from deficient inhibition in PD. (shrink)

The 30th anniversary of the first DBS surgery of the subthalamic nucleus (STN) for Parkinson’s disease was celebrated in Grenoble this June. Since this initial surgery, the application of DBS has e...

Gilbert et al. argue that the neuroethics literature discussing the putative effects of Deep Brain Stimulation on personality largely ignores the scientific evidence and presents distorted claims that personality change is induced by the DBS stimulation. This study contributes to the first-hand primary research on the topic exploring DBS clinicians’ views on post-DBS personality change among their patients and its underlying cause. Semi-structured interviews were conducted with sixteen clinicians from various disciplines working in Australian DBS practice for movement disorders and/or (...) psychiatric conditions. Thematic analysis of the interviews revealed five primary themes: 1) types, frequency and duration of personality change, 2) causes of personality change, 3) impact on patient and family, 4) communication, comprehension and awareness, and 5) management. Clinicians described a variety of personality changes in Parkinson’s disease following DBS including irritability, impulsivity and impaired decision-making. The frequency of personality change seen in patients varied amongst clinicians, but changes were overwhelmingly transient. Clinicians considered both DBS stimulation and additional factors as inducing personality change. For DBS patients with major depressive disorder, a restoration of pre-morbid personality was associated with alleviation of illness. Considerations for future research of personality change following DBS include selecting suitable tools for quantitative examination and developing a common language between the scientific and ethics communities. Clinical implications including recommendations for the informed consent process for patients and families and clinicians’ management of personality change are discussed. (shrink)