Directional deep brain stimulation contacts provide greater spatial flexibility for therapy than traditional ring-shaped electrodes, but little is known about longitudinal changes of impedance and orientation. We measured monopolar and bipolar impedance of DBS contacts in 31 patients who underwent unilateral subthalamic nucleus deep brain stimulation as part of a randomized study. At different follow-up visits, patients were assigned new stimulation configurations and impedance was measured. Additionally, we measured the orientation of the directional lead during surgery, immediately after surgery, and (...) 1 year later. Here we contrast impedances in directional versus ring contacts with respect to local anatomy, active stimulation contact, and over time. Directional contacts display larger impedances than ring contacts. Impedances generally increase slightly over the first year of therapy, save for a transient decrease immediately post-surgery under general anesthesia during pulse generator placement. Local impedances decrease at active stimulation sites, and contacts in closest proximity to internal capsule display higher impedances than other anatomic sites. DBS leads rotate slightly in the immediate postoperative period but otherwise remain stable over the following year. These data provide useful information for setting clinical stimulation parameters over time. (shrink)

In 2018-2019, at the Keck School of Medicine of the University of Southern California, we developed and piloted a narrative-based health systems science intervention for patients living with HIV and medical students in which medical students co-wrote patients’ life narratives for inclusion in the electronic health record. The pilot study aimed to assess the acceptability of the “life narrative protocol” from multiple stakeholder positions and characterize participants’ experiences of the clinical and pedagogical implications of the LNP. Students were recruited from (...) KSOM. Patients and staff were recruited from the Maternal, Child, and Adolescent/Adult Center for Infectious Disease and Virology at Los Angeles County+USC Medical Center. Ten patients, seventeen students, and ten MCA staff participated in the pilot study. Qualitative methods were used to gather data from students’, patients’, and staff’s perspectives. Three themes emerged from the thematic analysis: patients’ life narratives conveyed their unique life experiences and voices; the protocol could result in wide-ranging effects on HIV care; the LNP enabled students to contribute value to patients’ healthcare. Across groups, participants considered the LNP an acceptable intervention. The LNP, its limitations, and implications for HIV care, narrative medicine, and health information technology are presented. (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)

In their Target Article, “Promoting Ethical Payment in Human Infection Challenge Studies,” Lynch et al. propose a framework for ethical payment to research participants and apply it to the c...

The need for informed analyses of health policy is now greater than ever. The twelve essays in this volume show that public debates routinely bypass complex ethical, sociocultural, historical, and political questions about how we should address ideals of justice and equality in health care. Integrating perspectives from the humanities, social sciences, medicine, and public health, this volume illuminates the relationships between justice and health inequalities to enrich debates. Understanding Health Inequalities and Justice explores three questions: How do scholars approach (...) relations between health inequalities and ideals of justice? When do justice considerations inform solutions to health inequalities, and how do specific health inequalities affect perceptions of injustice? And how can diverse scholarly approaches contribute to better health policy? From addressing patient agency in an inequitable health care environment to examining how scholars of social justice and health care amass evidence, this volume promotes a richer understanding of health and justice and how to achieve both. -/- The contributors are Judith C. Barker, Paula Braveman, Paul Brodwin, Jami Suki Chang, Debra DeBruin, Leslie A. Dubbin, Sarah Horton, Carla C. Keirns, J. Paul Kelleher, Nicholas B. King, Eva Feder Kittay, Joan Liaschenko, Anne Drapkin Lyerly, Mary Faith Marshall, Carolyn Moxley Rouse, Jennifer Prah Ruger, and Janet K. Shim. (shrink)

The framework of Findlay & Walker's target article provides a first attempt to model the saccadic system at all levels. Their scheme is based on two main principles. These are “parallel processing of saccade timing and metrics” and “competitive inhibition through winner-take-all strategies.” In our opinion, however, both concepts are in their strictest sense at odds with the current knowledge of the saccadic system, and need to be refined to make the scheme more relevant.

Working Virtue is the first substantial collective study of virtue theory and contemporary moral problems. Leading figures in ethical theory and applied ethics discuss topics in bioethics, professional ethics, ethics of the family, law, interpersonal ethics, and the emotions.Virtue ethics is centrally concerned with character traits or virtues and vices such as courage, kindness, and generosity. These character traits must be looked to in any attempt to understand which particular actions are right or wrong and how we ought to live (...) our lives. As a theoretical approach, virtue ethics has made an impressive comeback in relatively recent history, both posing an alternative to, and, in some ways, complementing well-known theoretical stances such as utilitarianism and deontology. Yet there is still very little material available that presents virtue-ethical approaches to practical contemporary moral problems, such as what we owe distant strangers, our parents, or even non-human animals. This book fills the gap by dealing with these and other pressing moral problems in a clear and theoretically nuanced manner. The contributors offer a variety of perspectives, including pluralistic, eudaimonistic, care-theoretical, Chinese, comparative, and stoic. This variety allows the reader to appreciate not only the wide range of topics for which a virtue-ethical approach may be fitting, but also the distinctive ways in which such an approach may be manifested. (shrink)

Working Virtue is the first substantial collective study of virtue theory and contemporary moral problems. Leading figures in ethical theory and applied ethics discuss topics in bioethics, professional ethics, ethics of the family, law, interpersonal ethics, and the emotions.

This expanded edition of C L Hardin's ground-breaking work on colour features a new chapter, 'Further Thoughts: 1993', in which the author revisits the dispute ...

The story of the end of the Philosophical Society of Edinburgh in 1783, is linked with that of the founding of the Society of Antiquaries of Scotland and the Royal Society of Edinburgh , both of which were given Royal Charters sealed on 6 May 1783. It is a story which has been admirably told by Steven Shapin. He persuasively argued that the P.S.E. was a casualty of bitter quarrels rooted in local Edinburgh politics, in personal animosities and in disputes (...) about the control of cultural property and intellectual leadership. In all this he was surely correct just as he was in finding the principal actors in this controversy to be: David Erskine, 11th Earl of Buchan; the Reverend Dr John Walker, Professor of Natural History in Edinburgh University; Dr William Cullen, Professor of the Theory and Practice of Medicine and Vice-President of the P.S.E.; Mr William Smellie, Printer to the Society of Antiquaries; Henry Home, Lord Kames, S.C.J. and President of the P.S.E.; Sir George Clerk-Maxwell, Vice-President of the P.S.E.; John Robison, Professor of Natural Philosophy and Secretary to the P.S.E.; Edinburgh University's Principal, William Robertson; the Curators of the Advocates Library: Ilay Campbell, Robert Blair, Alexander Abercromby, Alexander Fraser Tytler, Professor of Public Law; Henry Dundas, Lord Advocate and M.P. for Midlothian. In a peripheral way, the Royal Colleges of Physicians and Surgeons were probably also involved; so too were Lord Buchan's brothers, Henry and Thomas Erskine, Foxite Whigs who opposed Dundas politically. Henry Erskine displaced Dundas as Lord Advocate in August 1783. After the change of ministry on 18 December 1783 he was ousted, but became Dean of the Faculty of Advocates in 1785. National as well as burgh politics touched these disputes and gave the parties of the Erskines and Dundas and his friends some leverage in London. (shrink)

C W Evers, J C Walker; Knowledge, Partitioned Sets and Extensionality: a refutation of the forms of knowledge thesis, Journal of Philosophy of Education, Volume.

This detailed and sympathetic, but not uncritical, study of On Liberty' argues for the general consistency and coherence of Mill's defence of individual liberty, but maintains that there are significant non-utilitarian elements in his arguments.

What ecological advantages do animals gain by being able to detect, extract and exploit wavelength information? What are the advantages of representing that information as hue qualities? The benefits of adding chromatic to achromatic vision, marginal in object detection, become apparent in object recognition and receiving biological signals. It is argued that this improved performance is a direct consequence of the fact that many animals' visual systems reduce wavelength information to combinations of four basic hues. This engenders a simple categorical (...) scheme that permits a rich amount of sensory information to be rapidly and efficiently employed by cognitive machinery of limited capacity. (shrink)