Combined Subthalamic and Nigral Stimulation Modulates Temporal Gait Coordination and Cortical Gait-Network Activity in Parkinson’s Disease.Jonas R. Wagner,MiriamSchaper,Wolfgang Hamel,Manfred Westphal,Christian Gerloff,Andreas K. Engel,Christian K. E. Moll,Alessandro Gulberti &Monika Pötter-Nerger -2022 -Frontiers in Human Neuroscience 16.detailsBackgroundFreezing 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)
Subthalamic Deep Brain Stimulation Lead Asymmetry Impacts the Parkinsonian Gait Disorder.Frederik P. Schott,Alessandro Gulberti,Hans O. Pinnschmidt,Christian Gerloff,Christian K. E. Moll,MiriamSchaper,Johannes A. Koeppen,Wolfgang Hamel &Monika Pötter-Nerger -2022 -Frontiers in Human Neuroscience 16.detailsBackgroundThe 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)
The Enemy as a Patient: What can be Learned from the Emotional Experience of Physicians and Why does it Matter Ethically?Gil Rubinstein &Miriam Ethel Bentwich -2016 -Developing World Bioethics 17 (2):100-111.detailsThis qualitative research examines the influence of animosity on physicians during clinical encounters and its ethical implications. Semi-structured interviews were conducted with ten Israeli-Jewish physicians: four treated Syrians and six treated Palestinian terrorists/Hezbollah militants or Palestinian civilians. An interpretive phenomenological analysis was used to uncover main themes in these interviews. Whereas the majority of physicians stated they are obligated to treat any patient, physicians who treated Syrians exhibited stronger emotional expression and implicit empathy, while less referring to the presence of (...) the Israeli-Arab conflict. In contrast, physicians who treated enemy combatants or Palestinian civilians showed the exact opposite. Linking these results to the “Implicit Bias” theory, the role of empathy and the beneficence principle in medical ethics, we argue that: the unconscious decreased emotional involvement among the latter group of physicians is a deficiency that needs to be recognized; and this deficiency undermines the principle of beneficence, thereby possibly influencing the fulfillment of the commitment to treat patients. Acknowledging and addressing the potential emotional and ethical deficiencies entailed in encounters with the so-called enemy-patients are of importance to the global medical community, since such encounters are increasingly an integral part of the current political realities faced by both the developed and developing worlds. (shrink)
La acción humana: una propuesta integral para el diálogo interdisciplinar sobre la personalidad.José Víctor Orón Semper &Miriam Martinez Martínez Mares -2021 -Scientia et Fides 9 (2):133-154.detailsHuman Action: a Comprehensive Proposal for Interdisciplinary Dialogue on Personality The need to categorize the personality is recurrent in philosophical, theological and, especially, psychological studies. However, the lack of dialogue between the different disciplines gives rise to analyzes that seem to divide human reality into 'parts', often incompatible with each other. In view of this problem, this article proposes the integral analysis of human action, seeking a psychological parameterization that is more adjusted to the complexity of the personality. Starting from (...) the integral vision of the action, the human behavioral and mental aspects commonly studied are seen as insufficient and the horizon is broadened with the reference to interiority. It is intended to achieve a more accurate vision of the complexity of human action. Interiority, parameterized as personal identity, relational intention, and existential positioning, calls for a renewed and related understanding of psychology, philosophy, and theology. (shrink)
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Prelude to Aesthetics.Schaper Eva -1968 - London,: Routledge.detailsFirst published in 1968. Aesthetics is a living debate of issues concerning the concepts involved in speaking about the arts and the appreciation and creation of art works. But contemporary aesthetics is seriously impoverished if it forgets to take issue or come to terms with its own past. Discovering how problems first arose, and tracing their subsequent careers, can suggest perspectives for contemporary analysis in aesthetics. This book by EvaSchaper examines the views of Plato and Aristotle at the (...) very beginning of philosophical reflection on the nature and purpose of art. Both thinkers, in raising questions and offering solutions, contributed formative ideas which are still an essential part of our common stock of aesthetic notions. This title will be of interest to students of philosophy. (shrink)
Seneca: A Philosopher in Politics.Miriam T. Griffin -1976 - Oxford: Clarendon Press.detailsFor this Clarendon Paperback, Dr Griffin has written a new Postscript to bring the original book fully up to date. She discusses further important and controversial questions of fact or interpretation in the light of the scholarship of the intervening years and provides additional argument where necessary. The connection between Seneca's prose works and his career as a first-century Roman statesman is problematic. Although he writes in the first person, he tells us little of his external life or of the (...) people and events that formed its setting.Miriam Griffin addresses the problem by first reconstructing Seneca's career using only outside sources and his de Clementia and Apocolocyntosis, whose political purposes are undisputed. In the second part of the book she studies Seneca's treatment of subjects of political significance, including his views on slavery, provincial policy, wealth, and suicide. On the whole, the word of the philosopher is found to illuminate the work of the statesman, but notable exceptions emerge, and the links that are revealed vary from theme to theme and rarely accord with traditional autobiographical interpretations of Seneca's works. (shrink)
Social work and K-12 schools casebook: phenomenological perspectives.Miriam Jaffe (ed.) -2017 - New York, NY: Routledge.detailsThis volume offers a collection of nine case studies from clinical social workers in K-12 schools, each from a phenomenological perspective, with the objective of educating Master of Social Work students and early career social work clinicians. Each chapter is framed with pre-reading prompts, reading comprehension questions, and writing assignments. This casebook provides a resource for understanding the range of practice in school social work as well as some of the challenges that school social workers face in today's complex world. (...) Using a phenomenological perspective the contributors stay close to the lived experience of students, teachers, parents, and social workers, revealing a deeper and more nuanced understanding of the genesis and treatment of students' problems in school. (shrink)
Believing Against the Evidence: Agency and the Ethics of Belief.Miriam Schleifer McCormick -2014 - New York: Routledge.detailsThe question of whether it is ever permissible to believe on insufficient evidence has once again become a live question. Greater attention is now being paid to practical dimensions of belief, namely issues related to epistemic virtue, doxastic responsibility, and voluntarism. In this book, McCormick argues that the standards used to evaluate beliefs are not isolated from other evaluative domains. The ultimate criteria for assessing beliefs are the same as those for assessing action because beliefs and actions are both products (...) of agency. Two important implications of this thesis, both of which deviate from the dominant view in contemporary philosophy, are 1) it can be permissible to believe for non-evidential reasons, and 2) we have a robust control over many of our beliefs, a control sufficient to ground attributions of responsibility for belief. (shrink)
(1 other version)Permission to Believe: Why Permissivism Is True and What It Tells Us About Irrelevant Influences on Belief.Miriam Schoenfield -2012 -Noûs 48 (2):193-218.detailsIn this paper, I begin by defending permissivism: the claim that, sometimes, there is more than one way to rationally respond to a given body of evidence. Then I argue that, if we accept permissivism, certain worries that arise as a result of learning that our beliefs were caused by the communities we grew up in, the schools we went to, or other irrelevant influences dissipate. The basic strategy is as follows: First, I try to pinpoint what makes irrelevant influences (...) worrying and I come up with two candidate principles. I then argue that one principle should be rejected because it is inconsistent with permissivism. The principle we should accept implies that it is sometimes rational to maintain our beliefs, even upon learning that they were caused by irrelevant influences. (shrink)
Social Empiricism.Miriam Solomon -2001 - Cambridge, MA, USA: MIT Press.detailsFor the last forty years, two claims have been at the core of disputes about scientific change: that scientists reason rationally and that science is progressive. For most of this time discussions were polarized between philosophers, who defended traditional Enlightenment ideas about rationality and progress, and sociologists, who espoused relativism and constructivism. Recently, creative new ideas going beyond the polarized positions have come from the history of science, feminist criticism of science, psychology of science, and anthropology of science. Addressing the (...) traditional arguments as well as building on these new ideas,Miriam Solomon constructs a new epistemology of science. After discussions of the nature of empirical success and its relation to truth, Solomon offers a new, social account of scientific rationality. She shows that the pursuit of empirical success and truth can be consistent with both dissent and consensus, and that the distinction between dissent and consensus is of little epistemic significance. In building this social epistemology of science, she shows that scientific communities are not merely the locus of distributed expert knowledge and a resource for criticism but also the site of distributed decision making. Throughout, she illustrates her ideas with case studies from late-nineteenth- and twentieth-century physical and life sciences. Replacing the traditional focus on methods and heuristics to be applied by individual scientists, Solomon emphasizes science funding, administration, and policy. One of her goals is to have a positive influence on scientific decision making through practical social recommendations. (shrink)
Making Medical Knowledge.Miriam Solomon -2015 - Oxford: Oxford University Press.detailsHow is medical knowledge made? There have been radical changes in recent decades, through new methods such as consensus conferences, evidence-based medicine, translational medicine, and narrative medicine.Miriam Solomon explores their origins, aims, and epistemic strengths and weaknesses; and she offers a pluralistic approach for the future.
Reclaiming liberty: from crisis to empowerment.Miriam Bentwich -2012 - New York, NY: Palgrave-Macmillan.detailsBased on a reconstruction of earlier liberal conceptions of liberty (the political theories of John Locke & J.S. Mill), this book stresses the empowering nature of liberal freedom and explains why such a concept of liberty better addresses two key contemporary challenges in liberal theory and praxis: wealth redistribution and multiculturalism."--Publisher's website.
Seneca on Society: A Guide to de Beneficiis.Miriam T. Griffin -2013 - Oxford University Press.detailsA volume which explores in detail Seneca's De Beneficiis. Divided into three sections, it looks at the historical and philosophical context of the work, its relation to Seneca's other texts, and concludes with a detailed synopsis of each book, accompanied by notes in commentary form.
Dangers of neglecting non-financial conflicts of interest in health and medicine.Miriam Wiersma,Ian Kerridge &Wendy Lipworth -2018 -Journal of Medical Ethics 44 (5):319-322.detailsNon-financial interests, and the conflicts of interest that may result from them, are frequently overlooked in biomedicine. This is partly due to the complex and varied nature of these interests, and the limited evidence available regarding their prevalence and impact on biomedical research and clinical practice. We suggest that there are no meaningful conceptual distinctions, and few practical differences, between financial and non-financial conflicts of interest, and accordingly, that both require careful consideration. Further, a better understanding of the complexities of (...) non-financial conflicts of interest, and their entanglement with financial conflicts of interest, may assist in the development of a more sophisticated approach to all forms of conflicts of interest. (shrink)
Kant's Schematism Reconsidered.EvaSchaper -1964 -Review of Metaphysics 18 (2):267 - 292.detailsThe easiest and most tempting solution of these problems is to dissolve them by pointing out the artificiality of the issues leading to these "third things." Though tempted, I am not convinced that Kant's philosophy can be treated thus as an exercise in a complicated solution of pseudo-problems. Also, I would thereby deprive myself of the uncomfortable and nagging sense of obscure importance which assails me—and many Kant students share this feeling—whenever I consider these points. I am prepared to admit (...) that the problems may be represented as artificial. But I want to maintain, with special emphasis on the Kantian schema, that a serious reconsideration repays the effort, even if it should force us to reconsider critically also some of Kant's systematic assumptions. (shrink)
Responding to Skepticism About Doxastic Agency.Miriam Schleifer McCormick -2018 -Erkenntnis 83 (4):627-645.detailsMy main aim is to argue that most conceptions of doxastic agency do not respond to the skeptic’s challenge. I begin by considering some reasons for thinking that we are not doxastic agents. I then turn to a discussion of those who try to make sense of doxastic agency by appeal to belief’s reasons-responsive nature. What they end up calling agency is not robust enough to satisfy the challenge posed by the skeptics. To satisfy the skeptic, one needs to make (...) sense of the possibility of believing for nonevidential reasons. While this has been seen as an untenable view for both skeptics and anti-skeptics, I conclude by suggesting it is a position that has been too hastily dismissed. (shrink)
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